Dr. Thomas D. Kaplan

Trauma becomes Triumph for Lehigh Teen

BY JENNIFER BOOTH REED • JREED@NEWS-PRESS.COM • SEPTEMBER 16, 2008
(Reprinted)

Goosebumps.

Alexandra Brooks-Trimble glanced at her left arm. The hairs were standing on end. This was a big deal. Any sensory response was a big deal.

Five months ago, the 19-year-old lay unconscious on an operating table in Indiana where surgeon Dr. Thomas Kaplan and his team hurriedly worked to reconnect bone and muscles and blood vessels. Brooks-Trimble had severed the arm in a car crash. The broken driver's side window sliced it off at the shoulder as she flew through it and onto the road. Or at least that's the best explanation anyone can figure.

After she left the hospital, Brooks-Trimble postponed a planned return to college in Indiana and moved to her parents' new home in Lehigh Acres so they could help in her rehabilitation.

Meanwhile, Kaplan and the therapists at the hand center combed the Lee County area for a therapist who was qualified and willing to take on the patient. They connected with Constance Kurash, a certified hand therapist at Lee Memorial Health System's Wellness Center.

Now, twice a week, Brooks-Trimble visits Kurash, and the therapist helps her coax an otherwise lifeless limb back to life.

"Goosebumps! For the first time, today!" Kurash said. "That's good." Brooks-Trimble grinned and continued with her exercise. On the table next to her were her medical records and diagrams depicting her arm. Kurash color coded them to track her patient's progress - red for no feeling, green for normal. In June, there was but a blip of green by the shoulder. The color is spreading.

The accident

The sun was setting April 3 when Brooks-Trimble and her boyfriend climbed into her Ford pick-up and sped down the Indiana country road. She was late getting him home. The speedometer hit 85, but she felt as if she were going even faster. Wham!

The truck hit a rut in the road. It swerved right, Brooks-Trimble cranked the steering wheel left, and the truck flipped and rolled - five times, Brooks-Trimble was later told. Her boyfriend survived with lesser injuries.
Then came a series of impossibilities that saved her life.

The expulsion, though it severed her arm, may have saved her life. Had she stayed in the truck, she might have drowned in the mucky field where it landed, upside down. Then, a neighbor on the sparsely populated strip heard the crash and rushed to the scene. The woman packed Brooks-Trimble's gushing shoulder in mud to keep her from bleeding to death. A quick-thinking police officer found the severed arm and packed it on ice, prolonging the time doctors had to consider reattachment before the muscle started to die.

The first doctors to see Brooks-Trimble at a local hospital considered the limb unsalvageable. Pushy nurses persuaded them to transfer her.

The next hospital to receive her couldn't help, either, but the staff there contacted with Kaplan, who told them to get her to his operating room at the Indiana Hand Center.

She arrived about three hours later. The surgeon went to work. For a week, Brooks-Trimble existed in a haze of sleep and semi-consciousness. Every time she woke up, she said parents, Suzy and Dave, had to remind her that she'd lost her arm.

"I was scared that I would have this thing just connected to me for the rest of my life," she remembered.
And she began to realize what she'd done.

"Then I started thinking about how I had hurt everybody. That I had messed up pretty bad," she said.

A lot harder

"Whoa!"

Kurash wrapped a weight around Brooks-Trimble's outstretched bicep, and the runaway limb almost whacked her in the face. "This is a lot harder than people would think," Brooks-Trimble said, regaining control and lifting her arm up and down.

A typical session includes a number of steps. Kurash moves muscles to keep them limber. She runs an ultrasound machine to encourage nerves to heal and then massages the limb to desensitize them. She attaches a device called a neuromuscular electrical stimulator that gently zaps muscles and forces them to move. She kneads scar tissue to keep it from tightening. And as Brooks-Trimble's movement returns, she designs exercises to build her patient's strength and range of motion.

Brooks-Trimble will repeat what she learns at home; Kurash even managed to get her a stimulator machine to use there. That intervention is critical; if the muscles don't get some kind of stimulation, Brooks-Trimble could lose use of them.

The key to Brooks-Trimble's healing lies in rebuilding a road map of nerves. They're what control sensation and muscle movement.

Kaplan, her surgeon, was able to reconnect the four main nerve branches that run down the arm. But the nerve fibers that run down those tubes died at the site of the amputation and need to regenrate. They do so at an estimated rate of an inch a month, creeping downward and branching out to reconnect with the muscles they control.

When Brooks-Trimble flexed her biceps, Kurash knew the musculocutaneous nerve was healing. A tricep extension - the radial nerve was returning.

"I've tried saying, 'Move, finger, move.' But it just sits there," Brooks-Trimble quipped. But she's improving faster than Kurash could have hoped. "She's growing like a weed," the therapist said.

The latest accomplishment: Brooks-Trimble can take her arm, stretch it out to the side and bend her elbow to touch her nose in a sort-of misplaced salute. She has a 145-degree range of motion, Kurash said. That's considered normal.

Kaplan monitors her progress from afar - he even joined MySpace so he can view Brooks-Trimble's online entries.

He's hopeful the nerves will regrow at similar rates - there is a risk of some muscles regaining movement and others staying paralyzed if the regeneration isn't uniform. But even if that happens, there may be surgical interventions to connect parts of functioning muscle and tendon groups with those that aren't working.
"It's a kind of fine-tuning almost," Kaplan said.

He doesn't expect she'll ever have full movement, and it will be months still before the regenerated nerves travel the length of her arm - if they even do so.

"I'm really hoping she gets regeneration at least to the forearm so she gets motion back in her fingers," Kaplan said.

Brooks-Trimble, meanwhile, is settling into her new life in Southwest Florida. Her daily routine includes a careful round of self-directed therapy.

"You know what? In a year I'm going to be moving my hand - you watch," she said.

Video Originally aired on news-press.com (The News-Press)