An astonishing medical recovery puzzles science and provides optimism to traumatic brain injury patients.
Had Simon Lewis returned to his bungalow to get a different coat, or had they never taken the detour to look at a house, the accident never would have happened. This would be something he would think about the rest of his life. As it is, on an early Los Angles evening, Simon and his wife Marcy are heading west on Beverly Boulevard in a brand-new Infiniti Simon had just purchased. The immaculate street is lined with maple trees and the sun is beginning to set, flickering light between the trees. Marcy suggests they look at her boss’s newly renovated house since they are near, so they begin a detour. Suddenly a white van traveling at seventy-five miles an hour rips through the stop sign on Beverly. It blindsides Lewis’s car, slamming it into the curb, where it becomes airborne and is stopped by a maple tree at the corner of Beverly and McCadden Place.
Simon sustained a broken skull, jaw, arms, clavicle, and pelvis, with compound fractures in nine ribs. Yet the injury that would change his life was the catastrophic brain injury because of the crash.
Lewis went into a coma the night of the accident, on the Glasgow Coma Scale (GCS) of three to 15, GCS3 means no motor response, no verbal response, and no visual response. It was as close to death as one can get. Studies suggest that patients with GCS3-5 have less than a 10 per cent chance of a living a normal life, particularly if they fail to respond within fourteen days of the injury. Lewis remained in a coma for 31 days.
As horrific as Lewis’s accident was (it killed his wife, Marcy), his incredible recovery and tireless work for Traumatic Brain Injury (TBI) research has helped broaden TBI awareness. With TED talks and his book, Rise and Shine, he helps give hope to victims of traumatic brain injury, and his story demonstrates the brain's incredible ability to regenerate itself. Yet it also highlights a growing trend in brain science: cognitive training. "What my experience demonstrates is how much we can train the brain measurably and repeatedly," Lewis told the Sydney Morning Herald. "And that applies to everyone. We need to start screening children at school who are falling behind, and treat their difficulties, rather than writing them off. There are techniques that rebuild the processes of your mind."
The odds of surviving a coma are notoriously hard to predict, with brain injury being the most complex affliction for the most complicated organ in the body, yet cognitive training helped Lewis become a functional TBI survivor.
Cognitive training is not new concept, but one that emerged in the 1940’s to treat the brain-injured soldiers as they prepared to return home. The cognitive assessment and training market is predicted to be worth $18.01 billion globally by 2027, and much of that growth comes from brain training for every demographic. Its functionality is proven with the older population as well as children, and the market has exploded with phone apps, online platforms, and brain train groups. While these companies often make generous assertions on what their products do for the brain, scientists are ambivalent about the some of the claims the companies make. Only some of the research demonstrates brain training works in non- TBI people.
A study published in 2010 monitored eleven-hundred adults that performed exercises designed to improve attention, reasoning, memory, and visual-spatial skills, and it concluded that they improved accomplishing the tasks themselves but those skills sometimes did not transfer to life improvements. Some scientists believe intensive brain exercises can exhaust people and be counterproductive instead of beneficial.
Part of Lewis’s injury was a “catastrophic brain insult," where a stroke obliterated a third of his right hemisphere and induced a brainstem contusion with severe internal bleeding. Neuroscientists used to assume each part of the brain had a set, inflexible role, and if certain areas were injured there was nothing to be done, other than live your life with the deficits. With the science of neuroplasticity, or changing the way the brain functions, they have realized that the brain is more pliable than previously thought. With the right cognitive training, it is possible to alter other areas of the brain, so they are assigned the tasks of the damaged areas.
Cognitive training like the kind Lewis received and continues to do has proven results in TBI patients that emerged from comas. The challenge remains that the longer patients remain in a coma, the less chance they have of regaining full brain function. For Lewis's case, it took many medical professionals to rebuild his mind, and he attributes much of his recovery not to a world class brain expert, but to Dr Lois Provda, an educational therapist in West Hollywood.
When he was referred to her, in October 1995, his IQ was 89, just a point below normal (between 90-110) on the Revised Wechsler Adult Intelligence Scale. Provda treated him three times a week, and by February 1997, Lewis had an IQ of more than 151, a score that is considered genius.
“She had me working with Kapla building blocks, and memorizing numbers backwards and forwards,” says Lewis. “I had to put cartoon images in sequence, to help me with cause and effect, the idea that one event leads to another. Another exercise was called Interactive Metronome, where I’d have to write things with a metronome clicking out a beat. It was exhausting!”
Today, most of Lewis’s medical staff consider his brain to be, if anything, overactive. Alert and infectiously cheerful, he's morphed into a curious academic, sling shotting from task to task by pure enthusiasm. A Cambridge law graduate historically, he was always known for this intelligence, yet the way his brain seemed to remodel after his accident is unprecedented.
Recovery Isn't Just Neuronal
For recoveries in TBI like Lewis’s, it’s a patient's attitude and support system that really distinguish how well that recovery goes, says Jeffrey Kreutzer, the editor of Brain Injury magazine, and professor of physical medicine and rehabilitation at Virginia Commonwealth University. "Patients who stay at home and say, 'I don't need advice, I'll figure it out myself, leave me alone' - they do poorly. But someone who seeks out social relationships, volunteer work, does much better. Recovery isn't just neuronal – it's a process that involves family support, as well as a positive attitude.”
Simon Lewis is an inspiring example of this attitude, although he is still receiving treatment more than two decades after the accident. His brain does not work in many ways, and he has significant disabilities. He wears special prism glasses to drive. He can think about lifting his left foot, yet it does not move. To walk, he uses a revolutionary device that stimulates the foot muscles. Without it, he cannot walk. There is still residual pain from his reconstructed pelvis, and vision issues in both eyes. "My memories used to be like a photo album," he says. "You could flick the pages and go back in time. But now, the album's gone, all I've got are the photos, and I can't tell what order they came in," he says.
Yet his memory – and his brain - are vivid and intact. He recalls the accident and the emotions that come with it as though it were yesterday, and that inspires him to spread TBI awareness, and it reminds us that cognitive training might just change brain science.