Neurosurgeon answers questions relating to brain injuries
PARIS (AP) More than four years after a ski accident caused him a near-fatal brain injury, little is known about Michael Schumacher's current condition. Updates on his health have been extremely scarce ever since he left hospital in September 2014 to be cared for privately at his Swiss home on the shores of Lake Geneva. Details of his specific condition and the treatment he received have been kept strictly private. The last public statement 16 months ago clarified nothing further would be said.
Colin Shieff is a retired neurosurgeon from Britain's National Health Service and a trustee of Headway, the national brain injury charity. Although he has never treated Schumacher, or spoken with doctors who've treated Schumacher over the years, he has dealt with similar cases both at immediate critical-care level and further down the line in terms of long-term treatment.
Shieff spent many years working with people with brain injuries and trauma, including at NATO field hospitals in Afghanistan an Iraq. He answered questions for The Associated Press related to the nature of Schumacher's brain injury, pertaining to how his condition may have evolved in the time since his accident.
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Q. In your opinion, what's the likely prognosis at this stage?
A. ''The nature of his injury and those bits of information that are available, and have been available, suggest that he has sustained permanent and very major damage to his brain. As a consequence his brain does not function in a fashion similar to yours or mine. The longer one goes on after an injury the more remote it is that any improvement becomes. He is almost certainly not going to change from the situation he is now.''
Q. What ongoing treatments would he be having?
A. ''He will have the kind of treatment, which is care: giving him nourishment, giving him fluid. The probability is that this is given in the main - or at least as supplements - through some tube passed into his intestinal system, either through his nose or mouth, or more likely a tube in the front wall of the tummy. He will have therapy to sit him, because he won't be able to get himself out of a bed and into a chair. He will be treated in a way that will ensure his limbs move and don't remain rigid.''
Q. Would someone in his position receive around-the-clock treatment?
A. ''He will be allowed a period of rest and sleep and relaxation, and he will be given an environment. I'm positive as I can be without knowing the facts (that) he will be living in an environment that - although it's got artificial bits of medical kit and care and people - will mimic a caring, warm, pleasant, socially stimulating environment.''
Q. Would he be able to sense he's in such an environment?
A. ''I don't know. There is always a technical, medical and neurological issue with defining a coma. Almost certainly he cannot express himself (in a conversation). He may well be able to indicate, or it may be apparent to those around him, that he is uncomfortable or unhappy. Or (he) is perhaps getting pleasure from seeing his children or hearing music he's always liked, or having his hand stroked.''
Q. Are patients in his situation aware of touch and voice from family members?
A. ''Absolutely. Even in the early stages, even in a critical care unit, when medicines are being given, for one individual at one time there may be an ability to discern and show response to someone they are familiar with. Respond to familiar, respond to family you're triggered to. You hear them all your life so that's the very, very familiar (aspect) the person is going to respond to.''
Q. Is there a chance he can make A) a full recovery? B) A partial recovery?
A. ''First one, absolutely, totally no. Number one statistically, number two neurologically, and number three he's been ill for so long. He's lost muscle bulk, even if he opened his eyes and started talking there will have been loss of memory, there will be impact on behavior, on cognitive functions. He would not be the same person. (As for a) partial recovery, even the smallest thing that gets better is some kind of recovery. But (it depends) whether that recovery contributes to a functional improvement for him to be able to express himself - other than an evidence of saying `Yes' or an evidence of saying `No.' (Therefore) if he could use words of two syllables, if he could turn on the remote control for the tele. One can do, professionally, all sorts of wonderful things with electronic devices and couple them up to eye and mouth movements. Sometimes with a person in a situation called `Locked In' or `Profoundly neurologically comprised' - which is essentially paralysis but with continuing intellectual function - ways can be found to communicate with those people. If that had been so with Michael Schumacher I am positive we would have known that is the case, so I don't believe it's so for him.''
Q. This is a deeply personal decision for the family. But how long can treatment last for?
A. ''In, for example, our health system we don't have the luxury to keep maximal intervention going in a high-tech hospital environment. For Michael Schumacher's family, I suspect they have the financial support to be able to provide those things. Therefore, for him, the future is longer but it doesn't imply any change in the quality of it.''
Q. Some reports have estimated the cost of treatment at anything up to 200,000 euros ($245,000) per week. Is that realistic?
A. ''I would personally think that's over the top, in terms of what I reckon that might buy him. He'll have a nurse, a therapist, a visiting doctor. There'll be an extra pair of hands when something physical is being done, when he's being moved to somewhere. That doesn't add up to 150,000 euros or 200,000 euros. He needs essentially, somebody with nursing or therapeutic qualifications with him at all times. So that's however many people you need to run a 24/7 roster. You're talking probably eight people to provide that level of care constantly over a year's period. That's the number of nurses required for instance, to nurse or to staff, one critical care bed in an intensive care unit.''
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Jerome Pugmire on Twitter: http://twitter.com/jeromepugmire
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For further details on Headway: https://www.headway.org.uk
