Sunday, May 07, 2006

Day of Rest

There is a noticeable change of pace in the children's hospital on Sunday, at least in the rehab unit. No therapy (PT, OT, Speech, etc.) is scheduled and the children are encouraged to rest and unwind. The rest of the hospital has slowed down, too. The surgery waiting room near the rehab unit is almost empty.

Our daughter continues to do well and make incremental progress. Today she demonstrated to us that she can extend and spread the fingers of her weak left hand. She can make the numbers 1 and 2 with her fingers. Her grip seems to be getting a bit stronger. After breakfast, she told my wife and I: "Guys, I need to exercise today." We brought her an oversized, lightweight soccer ball that she eagerly kicked up and down the hallway lined with the empty offices of the rehab staff. We tried to keep her from overdoing it, reminding her to walk rather than run, not jump, etc. to reduce the likelihood that she would injure herself. She's walking very well now, her left leg seems to be getting stronger by the hour.

After I left my wife and daughter at the hospital around 11:00 AM, picking up my son from my parents' house, playing with him, and putting him down for his nap, I sat down to review the CDs full of images from my daughter's initial CT and MRI scans. I'm not a radiologist, but finding a couple of images that show what's going on in her brain was not terribly difficult.

Here is a series of five axial MRI images that show an infarction of the internal capsule in the right brain. The images are 5 mm slices, meaning the overall lesion measures 20-25mm in this dimension (click to enlarge):

Here is a different axial MRI view of the lesion:

Here is a coronal MRI view of the lesion:

Here is an image from Gray's Anatomy that illustrates the function of the internal capsule:

This area of the brain is full of neurons that transmit signals from the motor area of the cortex (where movement originates) to the brain stem that ultimately carries the signals to the spine and the extremities. The infarction that occurred following our daughter's stroke disrupted existing communication paths, thus the hemiplegia she presented initially. As is shown above, the nerve pathways through the right inner capsule serve the left side of the body and vice-versa.

The process of rehabilitation following this type of injury to the brain entails the brain "re-wiring" itself to work around these disrupted communication paths so that the cortex can again communicate with the parts of the left side of her body that were initially paralyzed by her stroke.

Tonight we are having a birthday party for my sister at the hospital, which we hope will be a positive experience for our daughter. Tomorrow is going to be a tough day, we will rely on everyone's faith and prayers to carry her and the rest of us through. In the coming days we hope to know more about our daughter's condition, her long-term prognosis, and how we might be able to manage her condition in the future.


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