Flara had to meet with her developmental specialist whose focus is the brain and its development. Let me say... wow, that was a lot of information in a short period of time! But, I LOVED it! I like it when people explain everything... in very full details... to me. I want to learn. Plus, when I do very occasionally work, =) it will give me more knowledge to pass on to parents.
In all my years of NICU nursing, I have never heard of the effects of extreme prematurity on the 'corpus callosum.' The what? I'm sure that's what you're thinking. I labeled many of my posts NICU 101. I think this could be a 300 level course on the brain.
The 'corpus callosum' is defined as "a broad band of nerve fibers joining the two hemispheres of the brain." Key word: BROAD. As with many body systems, when babies are born as extremely early as little FlaraBean, the development of the corpus callosum seems to come to a screeching halt at the point in which baby is born. Thus, at barely third trimester ages, the CC (as I'll now call it) is very THIN. Had Flara stayed in her 5-star hotel, this band of nerve fibers would have continued to thicken to the point that full communication between the hemispheres would be occurring before she entered the world.
Yes, full communication. The CC band has to be thick and broad to fully communicate between the two hemispheres. When it is thin, the nerves are sending messages to the two hemispheres, but not all of those messages are making it to the other side. Sad, huh? It makes me think of the former treatment for epilepsy and mental illness... severing the two hemispheres so communication could no longer take place. It's not that bad in Flara, though. I'm just trying to paint a picture of what is going on in her brain.
It would make more sense to explain it in terms of what Flara is or is not doing to illustrate this defect. She has trouble bringing her arms together at the center of her body. She keeps her thumbs tightly drawn into her fists. She's all-over very stiff. She doesn't roll over. When we sit her up, she doesn't automatically reach her hands out to stop her from falling forward. As our pediatrician noted, and now this specialist, she is lacking in upper body strength.
I'll use the thumbs to explain how this miscommunication is affecting Flara. Because the two hemispheres are not communicating properly, Flara's brain does not recognize that some of her body parts exist. That's partly why little early birds lay splayed out rather than tucking into that nice little 'fetal position.' With her thumbs, her brain simply does not know they are there. Crazy. Thumbs are at the end of the bundle of nerves running from the fingers and hands up through the body to her brain. If we don't actively push and stimulate these body parts, her brain won't get the message. It's through pushing her and stimulating her that we can cause the CC to 'awaken' and begin recognizing that it needs to continue to grow and thicken. If we don't push her, the CC will stay thin.
At this point, she doesn't seem so bad off. She is, after all, still a baby. But, left undeveloped, as she grows we would begin to notice things. She wouldn't be able to coordinate tying her shoe laces, she wouldn't develop balance to ever learn to ride a bike, she would have difficulty balancing and coordinating walking, learning her ABC's would be difficult, colors would be trouble... I could go on and on...
So, when Flara is awake, we are doing lots of activities to send messages to her little growing brain to tell it to thicken up the CC. We are firmly taking her thumbs and circling them in both directions, we are pushing little 'buttons' that trigger her to quickly flex her legs and draw her arms midline (towards the center of her body), we are using those and other buttons also to teach her to tuck in and roll over, we are doing funny little John Travolta maneuvers (that's what this doc calls them) that involve pointing her arms above her head and bringing it down across her body and touching her opposite side... yes, I sing 'Staying Alive' to her when I do this and she smiles. =) We are patting her hands on her opposite cheek, rubbing her upper arm with the opposite hand, working on 'elbows in' when she is on her tummy. (This is beginning to sound like a full-time job in itself!). There is lots more, but I'm getting exhausted typing it all out!
Anyways, every little thing that we are doing is awakening the nerve sensations that are occurring in her body to awaken her brain to realize that it needs to finish what it had set forth to do while still in the womb: thicken up that corpus callosum to its normal 'broad' self.
In two days of work, Mike and I can already see improvements. When she wakes up, I have found her up on her elbows twice now as she attempts to peek out and above the confines of her port-a-crib. When I lay her on her back to change her diaper or start her exercises, she is holding her little hands together and gnawing on her fingers (usually, her arms would be laying out to her sides and rarely come together). It's really been quite exciting! The doctor had said that when everything begins 'clicking,' the progress would move very rapidly. I am so thankful that this information came when it did!
On the flip side, I did see the very ugly reality of not working with the babies. The office waiting room was full of Noël-sized kiddos sitting limply in their strollers. Heads rolled to one side, eyes empty and gazing off in the distance, limp little legs, arms hanging loosely at their sides.
One thought that kept overplaying in my mind was that this is the side of NICU babies I never see. Once they leave the nursery, I really don't know what happens to them. Flara is allowing me to experience the NICU world in a whole new light.
The other thought I've repeatedly had is... how amazing is our God that He created such intricacies within our brains. It really just dazzles my mind to think how complex we are, and that God set forth every single perfect little detail. Who ever would have thought that tucked thumbs in a preemie would indicate brain dysfunction? The other amazing side is that not only are we so complex, but God's design is so perfect that we can manipulate the body to trigger an organ as amazing as the brain to fix itself.
Wow. That's all I can say.
God is just amazing.
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