Thursday, August 10, 2006

Brain Stuff

I've not read more than a couple pages of Oliver Sacks, the neurologist who has written several books on the oddities of the human brain. The one I had a little familiarity with was The Man Who Mistook His Wife for a Hat, wherein, in the title story, a man's neurological malady caused him to grab his wife's head--still very much in use, thanks--and attempt to place it on his head. Alas, having done the setup, I'm now unable to deliver the punch line, as I don't remember the details of his malady.

But I'm reminded of the whole business by the brain injury with which my family is now occupied. My mother, a creative and strong-willed, right-handed person, suffered a massive blockage of blood to the entire left hemisphere of her brain, and that hemisphere is now pretty much permanently MIA. Thus she is now deprived of far more things than would have been the case had the blockage been to the other side of her brain (the neurologist says that strokes are not more likely to happen to a person's dominant side). And yet, with all the obvious deficits, there is still so much of the old her that remains. I'm not quite sure how to process this. The neurologist looks at the CT scan, where the damage is clearly visible, and gives a prognosis of all that is lost. Her language is probably entirely gone, though the right hemisphere has the capability of relearning language, albeit pretty much from scratch; control over movement of the right side is extremely doubtful, the arm especially since the area of control is located in a heavily damaged area; the right leg's control locus is undamaged, but the signals from it must travel through the damaged area, making much controlled movement highly unlikely. Her ability to recognize familiar faces is even somewhat in doubt, and evidence is at least a little mixed.

To my question of what things remain he is considerably less sure. Rather than the retention of specific skills, the otherwise-intact right brain appears to be suffering mostly from the loss of leadership and directive will. The left hemisphere of a normal right-handed person will direct everything, and the right hemisphere will be submissive and fundamentally supportive in nature; without the strong leadership and direction of the dominant left brain, the right brain will be rudderless and confused. And it is not thought that the right brain can simply learn to be dominant in the absence of the now-disabled left hemisphere. That's just not how things go in practice.

Language especially intrigues me, both in normal circumstances and now, a bit morbidly, I suppose, when injury brings this specialized human capacity to the fore. The neurologist seems pretty sure that her existing linguistic capabilities have been lost entirely. But this is difficult to know with certainty, and it's hard to measure or evaluate. Many stroke victims have what is called aphasia, a condition where language remains intact in the brain, but the ability to control and express it is hampered. (This is the condition assumed by the entire staff, and everyone addresses her clearly but normally, and they assume that messages are getting through.) Presumably there is a scale where on the one hand a stroke victim is aphasiac and has a quite complete grasp of language while on the other hand the whole language center(s) of the left brain is damaged and gone. And in between is an infinite scale of comprehension and expression. Alas, there is no way--certainly not for a layman like myself--to know with any certainty where on this scale a person might reside, and even the speech therapists and the neurological staff cannot be made to commit to anything. It's trial and error.

When I think of this, I realize that I'm not even very clear on what it means to "lose one's language." What we include under the umbrella term of "language" is not any single entity. She clearly recognizes things--she knows what to do with a comb and with chap stick--so what is it about letters and numbers that makes them now incomprehensible? Just a different type or degree of utility? That's language via the eyes. What of language via the ears? She clearly recognizes and responds to music; she taps her foot or hand or nods her head in good time to whatever I play. But what does she recognize? Probably not the words. But there is something familiar and maybe soothing about the sounds. Is this a part of language comprehension? (The questions come fast and furious: is this all just a question of anatomy? Can the centers of language or of the emotional component of communication be located with enough precision to predict these things with any certainty? Or are these complex skills handled piecemeal by different sectors of the brain such that deficits may be similarly piecemeal? Are the differences between the hemispheres purely physical? Not physical at all? Or is it a question of experience and learning? Does a child's "choice" of which side is dominant then cause her brain to GROW differently? Language is most easily learned by children ages, roughly, 12 months to 7 years. Why is this? And is this something which is in play now as we try to teach mom words anew?)

And these are the language questions. No language decidedly does not mean no communication, which brings us to another whole wing in our house of questions. I remember reading in some communications course from my college years that something like 85% of our normal communication is non-verbal, and much of that may remain intact in a stroke victim. In some cases mom's ability to grasp the emotional content of a conversation is obvious. Someone tells a joke and we laugh, and she joins in the laughter, picking up on the vibe of levity. But at other times things are far less clear and the clues are so intriguing. In the early days after her stroke, my brother and I sat at her bedside and played cribbage (a family tradition), engaging in our usual quiet, jovial down-putting banter of each other's playing skills. And on several occasions she reacted appropriately to this banter when, it seemed to me, our delivery was very dry and there was nothing on our faces to react to. Hmm. So far, over nearly three weeks, I've not seen a single question or pointed request or command from a doctor or therapist directed at her get any kind of a response or glimpse of understanding. But you can demonstrate things and get the behavior through imitation. It's a step.

It remains early days, and we'll hope for continued progress on any front.


Mandy said...

It's amazing how complex the human brain is, and it's also amazing how strong the human will can be. This must be a confusing and frustrating time for all concerned - but I'll continue to send good thoughts your way!

Esbee said...

:) Thinking of you.

Don't forget to take care of YOU. It does your mother no good if you eat only crap, don't sleep, and give yourself an ulcer.

Jeffy said...

Isn't it endlessly fascinating how the human brain seems to work? The language skills are particularly amazing. It seems so odd that there is a huge difference between hearing a word being spoken and reading it visually.

It is unfortunate that we learn the most about the brain when we observe it malfunctioning in some way.

I hope your Mom continues to do as well as can be expected, and I'll continue thinking of you and your family.

wunelle said...

Thanks for the thoughts, all.

I've been there for a few days before my schedule takes me away for longer stretches. She's made little steps each day, and our fingers are still crossed that there's more to come.

One intriguing thing lately is that she loves to take the crossword or sudoku I'm working on and look at it. I'm quite sure she doesn't comprehend it exactly, but I think it's interesting that if I give it to her upside-down she immediately inverts it! The letters & numbers may not make sense, but she sure knows what they're supposed to look like.

woolf said...

It is interesting how one never quite thinks about a body function until something goes awry. When I had my brain surgery on the left hemisphere, I woke up with a temporary aphaisa and partial paralysis on my right side. I knew what i wanted to say, but I just couldn't say it. Something I'd always taken for granted was suddenly gone. Temporarily for me. Within a few weeks things cleared up. My nerves made new connections or something. I still mix words and letters up at times and my handwriting is more atrocious than it was beforehand, since I'm a right hander. :)

I will certainly be sending healing vibes your way. Although I've never met your mother, I imagine she's a tough lady--since she had to raise you!

wunelle said...

Yeah, I spend my time alternating between sorrow for what's happened to my mom (and hope for as much recovery as possible) and fascination about what it all means, how everything works. I think because she has such an unusually effervescent personality, it's intriguing how much of that remains after such an injury as this. Even without any language or (presumably) understanding, it's still identifiably HER.

(And the jury's still out as to whether her raising of me toughened or weakened her! ;-)

Anonymous said...

Dude, she raised four of us for gods sake - she is definitely a tough women! Although I'm pretty sure she worked harder on you than me! :-) Once again, thanks for being there for me and keeping me in the loop. BTW Interesting posting.

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