When you all go to sleep tonight, please say a prayer of thanks and let your guardian angels know they can rest their wings for another week! Insurance approved Corey until February 2nd.
Dr. Long turned on the shunt last Friday, adjusted it on Monday and will adjust again this Friday. He plans on sending Corey to Paoli on Monday for another CT for a comparison and monitor the ventricles. The plan is to progress to a setting of 120.
I met with our case manager today and she explained the Comma Recovery Scale that the team is using to assess Corey’s progress. Bryn Mawr has been using this scale since Corey was admitted. Normally, Insurance doesn’t consider this tool in their functional improvement criteria. Insurance wants concrete data showing improvement in physical mobility. Corey’s injury is so severe; Dr. Long has pushed the insurance company to use the CRS exam as their concrete data since she hasn’t been capable or consistent with her mobility, but appears to be showing potential signs of cognitive improvement that could lead to physical mobility.
The exam gives points for auditory, visual, motor, oral motor, arousal and communication functions.
The following are examples of each based on response to commands;
Auditory-noxious noise, response to voice – they look to see if she turns her head and/or reacts to the stimuli;
Visual-tracking with eyes – can she follow an object or person;
Motor-physical movement from any limb;
Oral motor-moaning, groaning, vocalization;
Arousal-alertness and response time;
Communication-her ability to express the response.
Last week, before the shunt was turned on, she scored a 7 for the above criteria. As of today she scored a 12! This is a significant increase in less than a week. The team reported her visually tracking them in her room and the gym. During transitions she moved her arm behind her hip in a protective response as if she was trying to feel for what was behind her. This has been a consistent motion with each transition. Oral motor examples; Corey has been making moaning noises throughout her day. Her moans are beginning to have different inflections in their tone.
Tonight was the first sign of her trying to communicate with us. We were sitting together and she began chomping her teeth making a clicking noise, her face was strained. We told Corey we were going to ask her questions and a long blink would mean Yes. We asked if she was in pain; no blink. We asked if her leg was cramping and needed to reposition her legs or body; no blink. We asked if she wanted to be “changed”; Long Blink. Sure enough, she was correct! This is the first time she was able to communicate her discomfort and alert us!
Earlier, Nick reported that he tested her by asking her to move her right leg in response to a question. She looked as if she might be overheated. He asked her to straighten her right leg if she was hot; she straightened her leg. To test her, he asked her to bend her right leg if she was cold. She didn’t budge. He listened to her because we all know that right leg never stops moving!
Corey it’s starting to happen, sweetie. We’re watching and listening to everything you’re trying to say. We will learn “Corey Talk” and make sure that everyone has the decoder ring! Be patient with us Corey, but have confidence that you have a team ready to help you anyway we can so you can continue to get stronger!
We love you. Happy dreams, xoxo