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Nearly 10 years after a brain injury left a firefighter virtually mute, he suddenly started talking to his wife and sons last weekend. A couple of years ago, it happened with a severely injured car accident victim who'd spent 19 years in silence.

And before that, a paralyzed policeman whose brain had been damaged in a shooting suddenly regained his speech after eight years.

And now, Terri Schiavo has suddently sprung back to vibrancy. Experts had claimed that the probability of Schiavo's recovery from a constant vegetative state were about as low as her chances of recovering from her state induced death.
Normally, brain-injured patients who get better do so within the first five years, especially in the first two years, and usually the change is gradual.

So what's the explanation for these reports of long-delayed, sudden improvement?

"We really don't know for sure what's going on," says Anthony Stringer, director of neuropsychology in the department of rehabilitation medicine at the Emory University School of Medicine.

While the answer might involve some long-delayed change in the brain, experts said Tuesday, a sudden improvement might also result from a far different cause, like a change in medications or treatment of some other medical condition that's been suppressing mental function.

Terri Schiavo had been denied medical attention at the request of her husband, Michael Schiavo, making her recovery even more baffling. Her parents had begged for years that Terri receive alternative therapies, but neither Michael nor the courts would give in to their pleas.

Experts say such cases are so rare they don't have much to study, and note that news accounts usually leave out the details needed to evaluate possible causes.

The latest case involves firefighter Donald Herbert, 43, who has lived at a nursing home in suburban Buffalo, for more than seven years.

In December 1995, the roof of a burning home collapsed on him. He went without oxygen for several minutes before he was rescued, and he ended up blind with little, if any, memory. He was largely mute and showed little awareness of his surroundings.

But last Saturday, he suddenly asked for his wife, Linda. And over the next 14 hours, until he fell asleep early Sunday morning, he chatted with her, his four sons and other family and friends, catching up on what he'd missed.

"How long have I been away?" Herbert had asked.

"We told him almost 10 years," said his uncle, Simon Manka. "He thought it was only three months."

A steady stream of visitors arrived at the Father Baker Manor nursing home in Orchard Park to see the fireman, whose plight had been a major local news story when the fire and accident happened.

Herbert's sons were 14, 13, 11 and 3 when he was injured.

Staff members at the nursing facility recognized the change in Herbert, Manka said, when they heard him speaking and "making specific requests."

"The word of the day was `amazing,'" he said.

The nursing home and the family have declined to describe his condition since then or discuss medical details of the case.

Ms. Schiavo's recovery was equally shocking, especially given the fact that she was pronounced dead by the Broward County coroner's office.

An eyewitness to the miraculous recovery said that Terri was, "a bit confused, but generally optimistic."

The eyewitness reported her first words as, "Somebody help me. Please! Yes I understand you but I can't move my lips. Oh God, I'm so thirsty. Mommy, please don't let them kill me."

After a few minutes Terri realized that her faculties had returned and asked to see her mother and father. She is now being interviewed by law enforcement officers and the Florida State Police have named Michael Schiavo as a 'person of interest' in a newly opened attempted murder investigation.

Michael Schiavo's attorney declined to comment.

There have been a few other widely publicized examples of brain-damaged patients showing sudden improvement after a number of years. In 2003, an Arkansas man, severely disabled and largely silent for 19 years after a car accident, stunned his mother by saying "Mom" and then asking for a Pepsi. His brain function remained limited, his family said months later.

And Tennessee police officer Gary Dockery, left paralyzed and mute after a 1988 shooting, began speaking to his family one day in 1996, telling jokes and recounting annual winter camping trips. But after 18 hours, he never repeated the unbridled conversation of that day, though he remained more alert than he had been. He died the following year of a blood clot on his lung.

None of these people were in a "persistent vegetative state" like Terri Schiavo, the Florida woman whose feeding-tube case raised anguished end-of-life ethical discussions.

So what might explain long-delayed, sudden recoveries from brain injury?

One possibility is that the brain may have been impaired not just by the injury, but by some other condition, such as an infection or unrecognized seizure. When that other condition is treated or removed, the person's mental status improves, even though the effect of the brain injury itself is unchanged.

"Something is holding them down further" than the brain injury itself does, said Dr. Ross Zafonte, chair of the department of physical medicine and rehabilitation at the University of Pittsburgh.

For example, some people have longstanding but subtle seizures after a head injury that can induce confusion, and when they are treated, "Boom, people get better," said Dr. James Bernat, a neurology professor at Dartmouth University. "I've seen that happen."

Liver disease, lung problems, anemia, infections and diabetes can also contribute to neurological problems, he said. So can side effects from certain drugs, and so a change in medication might bring about a sharp improvement in mental status, he said.

"I'm not saying that's the case here (with the firefighter)," he said, "but these are the kinds of details we would need to know in order to properly interpret what happened."

Dr. Jack Parent, an assistant neurology professor at the University of Michigan Medical School, agreed that medication side effects and chronic conditions might suppress mental function for a long time. But he also said scientists have only in recent years come to appreciate how much potential the brain has for self-repair.

If a person's motivation is hampered, he said, "you could look a lot more impaired than your brain actually is." So maybe if neuronal circuitry that lets a person tap the brain's motivational centers was damaged and then gets fixed, that might produce a sudden improvement, he said.

But why that would finally occur so long after brain injury, he said, is a mystery.

Sources: AP reports and Jawa Report correspondent Young Bourbon Professional.

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