About the brainstem/ABIs


The brainstem


"The brain stem--the small region of the central nervous system between the spinal cord and the diencephalon--has a clinical significance that is far out of proportion to its size. Damage to the brain stem can profoundly affect motor and sensory processes as well as consciousness."

[Principles of Neural Science, by Eric R. Kandel (Editor), James H. Schwartz (Editor), Thomas M. Jessell; Copyright 2000, The McGraw-Hill Companies, Inc.]

The brain stem is just a small area of the brain, but it has the major collection of cells which control awareness and behavior. All the cranial nerves (auditory, facial, etc.) rise from groups of cells in the back of the brain stem. These nerves control all functions in the face and the neck and the head itself (including the rest of the brain). This area of the brain is very tiny, and very old. It is the basis for the evolutionary brain in humans coming from apes and back. All animals have a brainstem...even if they do not have much else. A child can be born with just a brain stem. These children are called anaencephalic. They have awareness of a type, they usually do not live long, but I have a niece who is anaencephalic. We love her very much...she is almost nine years old. She cannot see, but we think she hears some because of her reaction to music. Her body controls her breathing and all other necessary functions for life...even if she is not capable of 'thinking' as we know thinking.

All the tracts of nerves for the body run through this area of the brain. They know that lesions (damage, holes, strokes) to this area of the brain can have multiple consequences on both the motor and sensation functions of the brain. They are starting to understand this more as they research it. Unfortunately, understanding this part of the brain means they have to usually cause lesions in animals (usually rats) to find out which part of the body is affected.

--- Karen Sadler

What is an ABI?

QUESTION:
Would someone tell me what an ABI is? I have not a clue.

ANSWER:
You understand what a cochlear implant is? An electronic device implanted under the skin behind and above the ear with electrodes inserted into the cochlea of a person with nerve deafness. Using an external electronic device known as a speech processor, the hearing nerve in the cochlea is electrically stimulated, carrying impulses to the brain that are interpreted as sound, giving persons with nerve deafness the ability to perceive and understand speech and other sounds.

Because surgery to save the lives of patients with NF2 involves the removal of the hearing and balance nerves along with the tumors of both ears (since NF2 produces bilateral tumors), the nerve connections between the cochleas and the brain are severed, resulting in profound deafness. The Auditory Brain stem Implant (ABI) is similar in design and function to cochlear implants and was developed to provide direct electrical stimulation to that part of the brain stem that the hearing and balance nerves once connected to.

Electrical stimulation of that part of the brain stem results in somewhat less successful perception of sound than cochlear implants. I don't personally know of any ABI recipients who are able to understand speech without lipreading or on a telephone, but the hope is that with the newer generation of multi channel ABIs and the electrodes that are inserted directly into the brain stem rather than being placed onto the brain stem, speech recognition among ABI recipients might be improved.

--- Mark Dessert