A small study offers hope for people with traumatic brain injuries
ARI SHAPIRO, HOST:
A severe traumatic brain injury often causes lasting damage.
GINA ARATA: I couldn't get a job because if I was, like, say, a waitress and you put in an order, I would forget. I couldn't remember to get you, like, a Diet Pepsi.
SHAPIRO: Now a small study offers hope. NPR's Jon Hamilton reports on how precisely targeted deep brain stimulation appears to help injured brains work better.
JON HAMILTON, BYLINE: Gina Arata's brain was injured when she was 22 and driving to a wedding shower.
ARATA: I was, like, maybe a minute from my house. And I just had hydroplaned over a water puddle, and I swerved towards trees.
HAMILTON: Arata spent 14 days in a coma. Then came the hard part.
ARATA: I had to learn everything again - how to button my pants, how to shave my legs, how to feed myself - because right after the accident, I couldn't use my left side of my body.
HAMILTON: Arata's physical abilities improved, but her focus and memory remained unreliable. And she had no filter, which was awkward when she went on dates. Fifteen years passed with little change. During that time, Dr. Nicholas Schiff at Weill Cornell Medicine in New York was studying people with moderate to severe traumatic brain injuries. He noticed a problem with connections to parts of the frontal cortex.
NICHOLAS SCHIFF: Although the people were able to wake up, have a day, live on their own, they couldn't go back to school and work because some of the resources in those same parts of the frontal cortex were unavailable to them.
HAMILTON: Which meant they had limited use of brain areas involved in planning, focus and self-control. In 2007, Schiff had been part of a team that used deep brain stimulation to help a patient in a minimally conscious state become more aware and responsive. Nearly a decade later, Schiff wanted to see if a similar approach could help people like Gina Arata.
SCHIFF: What we didn't know, of course, was, would this work in people who had moderate to severe brain injury? And if it did basically work the way we expected it to work physiologically, would it make a difference?
HAMILTON: To find out, Schiff collaborated with Dr. Jaimie Henderson, a neurosurgeon at Stanford. Henderson's job was to implant tiny electrodes deep in the brain.
JAIMIE HENDERSON: There is this very small, very difficult-to-target region right in the middle of a relay station in the brain called the thalamus.
HAMILTON: The region plays a critical role in determining our level of consciousness. The team hoped that stimulating it would help people whose brains hadn't fully recovered from a traumatic injury. So starting in 2018, Henderson operated on five patients, including Arata.
HENDERSON: Once we put the wires in, we then took those wires up to a pacemaker like device that's implanted in the chest, and then that device can be programmed externally.
HAMILTON: Henderson says overall, patients were able to complete a cognitive task more than 30% faster.
HENDERSON: Everybody got better, and some people got dramatically better, better than we would really ever expect with any other kind of intervention.
HAMILTON: Gina Arata realized how much difference her implanted stimulator made during a testing session with Dr. Schiff.
ARATA: He asked me to name things in the produce aisle, and I could just rattle them off like, ooh, lettuce, eggplant, apples, bananas. I was just flying through.
HAMILTON: Then Schiff changed the setting and asked her about another grocery store aisle. She couldn't name a single item. The results, which appear in the journal Nature Medicine, are promising, says Deborah Little, a psychologist at UTHealth in Houston.
DEBORAH LITTLE: What this study shows is that they potentially can make a difference years out from injury.
HAMILTON: Little, the research director at the Trauma and Resilience Center at UTHealth, says it's still not clear whether the approach is feasible for large numbers of patients. But she says if it is, stimulation might help some of the people who have run out of rehabilitation options.
LITTLE: We don't have a lot of tools to offer them. I get calls from patients from previous studies, even, who will call me and ask if there's anything new they can try.
HAMILTON: Little says some patients' lives could be changed if they experience the sort of improvement found in the study.
LITTLE: Even a 10% change in function can make the difference between being able to return to your job or not.
HAMILTON: Gina Arata, who is 45 now, hasn't landed a job yet, but she says her implanted stimulator is allowing her to do other things like read books and maintain relationships.
ARATA: It's on right now. I've had my battery changed and upgraded. I have a telephone to turn it on and off or check the battery lifespan. It's awesome.
HAMILTON: The researchers are already planning a larger trial of the approach. Jon Hamilton, NPR News.
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