HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Sunday, February 13, 2005

Minimally Conscious Patient Starts Talking 20 Years Post-Injury

The Associated Press reports (courtesy of MSNBC) that a 38-year-old Kansas woman has started talking 20 years after an accident left her unable to respond to questions no one knew she understood other than through blinks of her eye. 

A week ago, [Sarah Scantlin's] parents got a call from Jennifer Trammell, a licensed nurse at the Golden Plains Health Care Center. She asked Betsy Scantlin if she was sitting down, told her someone wanted to talk to her and switched the phone to speaker mode:

“Hi, Mom.”

“Sarah, is that you?” her mother asked.

“Yes,” came the throaty reply.

“How are you doing?”

“Fine.”

“Do you need anything,” her mother asked her later.

“More makeup.”

“Did she just say more makeup?” the mother asked the nurse

After 20 years in a nursing home, "Scantlin still suffers constantly from the effects of the accident. She habitually crosses her arms across her chest, her fists clenched under her chin. Her legs constantly spasm and thrash. Her right foot is so twisted it is almost reversed. Her neck muscles are so constricted she cannot swallow to eat."

It's a heart-warming story, but of interest to bioethicists and health lawyers for other reasons as well. 

First, it is a reminder that we are a long way from understanding the rehabilitative potential of the human brain, or even the plasticity of the human brain.  As a discipline, brain study is still in its infancy, and we have a lot to learn. 

Second, this is the sort of story that gives the families of brain-damaged patients enormous -- and in some cases unrealistic -- hope.  According to Sarah's doctors, the restoration of her ability to speak may have occurred through the spontaneous regeneration of neural pathways that had been destroyed at the time of her accident.  Last week's article in Neurology suggests that the language center in the the brains of some minimally conscious patients is a lot more intact than we've ever before suspected, but restoration of the speech center in such a patient is the rarest of rarities.  In patients diagnosed to be in a persistent vegetative state (or even to be brain dead), however, there is no evidence of any such restorative capacity.  That will not stop families from citing the case of Sarah Scantlin in support of their belief that PVS or brain-dead patients retain the potential to speak.  [tm]

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