An Xtreme recovery

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NickManningBikeWhen 14-year-old Nick Manning of Chesapeake fell in love with motocross, the extreme sport of riding motorcycles over bumpy dirt trails, his parents set very firm ground rules for his participation. Nick must never ride alone. A parent must always accompany him to the tracks. And full safety gear would be required for every ride, including a helmet, goggles, neck protector, chest guard, kidney belt, special boots and clothes with extra padding.

Nick was wearing all of his equipment on the morning of August 26, 2006. As his stepfather, Chad Ackerman, watched from a tower, Nick started a series of three jumps, a trick he’d completed successfully dozens of times before. He cleared the first jump but made an awkward landing after the second. Instead of attempting the third jump with a wobbly approach, he steered his bike off the track.

Nick disappeared from view for a second. When Chad saw him again, Nick was 20 feet above the ground, pushing his motorcycle away from himself in the air.

Marcie Ackerman was in the racetrack’s office when a man rode up on a motorcycle and asked if she was the mother of rider number 24. When she nodded, he said, “You’d better come with me.”

When Marcie reached the accident scene, Chad was already there. Nick was on the ground, unconscious. “I kept trying to wake him up,” Marcie remembers. “I called his name again and again. Finally, he opened his eyes for a second and moaned.”

Nick was transported via the Nightingale helicopter to the regional trauma center at Sentara Norfolk General Hospital. Later that day, he was admitted to CHKD’s Pediatric Intensive Care Unit where pediatric neurosurgeon Joseph Dilustro examined him.

“Nick had a severe traumatic brain injury – TBI,” Dr. Dilustro said. “He had swelling throughout his brain, which is a very dangerous situation. When the brain swells, the skull can’t expand to accommodate it. This causes tremendous pressure inside the cranium, interrupting the normal flow of blood and oxygen to the brain. If the swelling is not controlled, the brain can actually herniate, or push through the base of the skull, causing death.”

Dr. Dilustro could see the damage on Nick’s CT scans. But his clinical exam of Nick was even more alarming. “Nick was having some reflexive limb movements that are usually indicative of a severe TBI.

NickManning“I felt that we were dealing with a situation that was far more serious than we could even see on the CT scan at that point. I knew we had to treat him very aggressively.”

That night, Dr. Dilustro inserted a monitor into Nick’s brain to measure the pressure there and started him on a combination of medications that would reduce the brain swelling and increase his blood pressure so his brain could get as healthy an infusion of needed blood and oxygen as possible.

“After that, we basically monitored the pressure in his brain, adjusting the medications accordingly,” Dr. Dilustro said. “That monitoring wasn’t hour by hour. It was minute by minute. Traumatic brain injuries are the leading cause of accidental death in kids and one of the most complex conditions we treat,” he added. “Taking out a brain tumor can seem simple in comparison.”

For the next 11 days, Nick’s family and loved ones watched over him in the PICU and prayed for his survival. Marcie and Chad were at the hospital constantly, as were Nick’s father and stepmother, Scott and Julia Manning. “I remember praying, ‘please, just let me see his eyes again,’ ” Marcie said.

On day three, Nick’s parents learned that the increased pressure in his brain had caused a small stroke in his occipital lobe, the part of the brain that controls vision. But worry over that was insignificant compared to the fear that Nick would not survive his injuries.

On day 12, Marcie’s prayer was answered. During his daily neurological exam with Dr. Dilustro, in response to prodding from nurse Jillian Perry, Nick opened his eyes.

That was the beginning of Nick’s slow resurfacing. “Every day, we had a little more hope,” Marcie said. “One day, he would squeeze the therapist’s hand. Then the next day, he would squeeze it a little harder.”

After 23 days, Nick was stable and alert enough to move to CHKD’s inpatient rehabilitation unit and the care of pediatric physical medicine specialist Katrina Lesher.

“We help patients maximize their quality of life, so they can be as independent as possible,” Dr. Lesher says. “And we also make sure that families are trained to compensate for whatever deficits a patient has.

“When Nick arrived on the unit, he wasn’t walking, talking or eating yet. So we had to start with the basics,” she added.

NickManningTherapy“When they get you on that rehab floor, they are focused,” Marcie said. “It was an amazing experience. I have to admit, I was scared to leave the PICU. They took such good care of Nick and all of us, really. But the nurses and therapists on the rehab unit were phenomenal too. They became our family.”

Several memories of Nick’s time on the rehab unit bring tears to Marcie’s eyes. Because of the stroke in his occipital lobe, no one knew how well he could see. “One day, his occupational therapist, Kathy Yopp, was encouraging him to reach for a ball. She held it out and said, ‘Where is the ball?’ Nick looked at her and said, ‘It’s right in front of me. And it’s purple.’ These were the first words he spoke after the accident. So not only could he see, he could talk! Everyone was clapping and crying. We were so happy,” Marcie said.

On another day, Nick’s physical therapist, Nicole Wallace, helped him to stand for the first time. “He’s bigger than she is, and he kind of bent down and looked her right in the eye and gave her this huge hug. And she got all teary,” Marcie said. “It was his way of saying thank you. It really touched her.”

From that point on, Nick just took off. “He progressed a lot more quickly than we anticipated,” Dr. Lesher said. “He was unusual in that respect, but he did have several things going for him. He had no other injuries other than his brain trauma to stand in his way. He had tremendous personal motivation and an incredibly supportive family who worked with him constantly.”

Marcie gives all the credit to her son. “Nick has always been a super determined person,” she said. “If they asked him to do something once, he’d do it three times.”

The original plan was to try to get Nick home by Thanksgiving. But he made such rapid progress that Nick was strong enough to go home on October 5, after only 18 days in rehab.

After his discharge, Nick’s rehabilitation continued at the CHKD Health Center at Greenbrier, near his Chesapeake home. “He had outpatient speech, occupational and physical therapy every day at first. In November, we tapered down to fewer days per week. But it’s such a blessing to have everything he needs in one place, all under one roof so close to home,” Marcie says.

Today, Nick is walking, talking and very grateful to be alive.

He still has slight vision problems in one eye from the stroke, so he is wearing a patch over the strong eye to make the weaker eye work harder. His speech sounds great, but he still has some trouble finding the right word. Nick is a little more outgoing than he used to be, but personality changes are not unusual after TBIs.

“The critical time for recovery after a traumatic brain injury is the first six months,” Dr. Lesher said. “And most patients will achieve their maximum recovery in the first 12 months.”

Nick still has a few months to go, but he’s already “far beyond what we could have hoped,” Dr. Dilustro said.

“Nick has been so strong,” his mother said. “Since his recovery started, his worst day was when we had to tell him that he could no longer ride motorcycles. He was very down about that. I told him it was okay to be upset, and he said, ‘You know what, Mom? It’s a miracle I’m even alive.’ ”

Dr. Dilustro practices with CHKD Health System’s neurosurgery practice. Dr. Lesher practices at CHKD with Eastern Virginia Medical School’s Pediatric Faculty Associates.

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