Sara Green Mele, a top Speech Pathologist and Cognitive Rehab
Specialist states in her affidavit that Terri is vocalizing, not
PVS, responds and reacts, swallows her saliva, and would benefit
from many forms of therapy.


Saturday, August 2, 2003

Pathologist's statement in Terri Schiavo case

Posted: August 2, 2003
1:00 a.m. Eastern

© 2003 WorldNetDaily.com
AFFIDAVIT

STATE OF ILLINOIS
COUNTY OF COOK

BEFORE ME the undersigned authority personally appeared Sara Green
Mele, MS, CCC-SLP, who being first duly sworn, deposes and says:

1. My name is Sara Green Mele, and I have been engaged in the
continuous private practice of speech-language pathology since 1996,
and have served on the staff of the Rehabilitation Institute of
Chicago from 1996 to 1999 and from 2001 to the present. Prior to that
I practiced cognitive therapy at Baylor Institute for Rehabilitation
in Dallas Texas. In both settings I worked with the broad range of
brain injured populations. The Rehabilitation Institute of Chicago is
affiliated with Northwestern University Feinberg School of Medicine,
and is recognized in the United States rehabilitation community as
the top facility in the United States. The Baylor Institute for
Rehabilitation is affiliated with Baylor University Medical Center,
and is recognized in the United States rehabilitation community as
one of the top ten facilities in the United States. I am a clinical
lecturer at Northwestern University Feinberg School of Medicine, and
lecture for continuing medical education credits (CME) through the
Rehabilitation Institute's continuing education program as well as at
national conferences. In April of this year I participated in the
presention of a two-day head injury course entitled Interdisciplinary
Rehabilitation Management in Traumatic Brain Injury to over two
hundred health professionals in Tampa, Florida. My full curriculum
vitae is attached.

2. In my practice, I treat many patients who have had diffuse brain
injury, both anoxic and hypoxic, and I am familiar with states of
impairment known as coma, coma-like, minimally conscious and
persistent vegetative state. I regularly participate in the
evaluation and cognitive/linguistic diagnosis of patients whose
differential diagnosis include such conditions. In connection with my
practice of speech-language pathology, I also evaluate patients, and
train others in the evaluation of patients for swallowing function.
During my career as a speech-language pathologist, I have personally
treated approximately thirty patients similar to Terri Schiavo.

3. In evaluating patients for rehabilitation, the Rehabilitation
Institute of Chicago does not track the diagnosis of patients by
their referring caregivers, but rather evaluates them for itself
because the misdiagnosis rate is so high.

4. While I have not physically examined Terri Schiavo, I have looked
at her medical records at MediPlex covering the period from January
to July of 1991, including physical therapy, speech and language
therapy, and occupational therapy. Also, I have studied the video
clips presented at the October 2002 Medical Evidentiary Hearing,
along with audio recordings of Terri Schiavo interacting with her
father in November of 2002. The observations that follow are all
within the parameters of speech-language pathology, and are similar
to the observations that I am called upon to make regularly in the
course of treating patients as a speech-language pathologist. All
conclusions are based on standards used in the speech-pathology
profession in the treatment of patients such as Theresa Schiavo.

5. Based on my experience and my observations, Mrs. Schiavo is
clearly aware of her environment and interacts with it, albeit
inconsistently. She is able to comprehend spoken language, and can,
at least inconsistently, follow simple one-step commands. This is
documented both in the MediPlex records and in the following
behaviors noted in the following video segments:

C 01 (Examination of Dr. Cranford on July 9, 2002) – Terri
appears to
respond to her mother's voice, although there is not much to
differentiate between a generalized and localized response in this
clip.

C 02 (same exam as above) – Terri appears to track a balloon.
This is
difficult to verify with complete certainty for two reasons. First,
many of the camera shots are too "tight" on Terri's face to be
certain of the location of the balloon. Second, Dr. Cranford presents
a great deal of information to Mrs. Schiavo very quickly. Even
moderately brain-damaged patients have severe difficulty responding
that quickly to commands. Such patients display a significant delay
in processing, which Dr. Cranford does not seem to allow for. In the
same clip, Terri appears to move her head toward Dr. Cranford's
voice, despite limited motor ability. Clearly, once her head is
positioned, she appears to move her gaze toward a voice.

M 01 (Examination of Dr. Maxfield 9/4/02) – Although it is
difficult
to hear on the video, Terri appears to respond to the sound of her
mother's voice on a cell phone held to her ear. Additionally, Terri
appears to move her head as well as her eyes in tracking a balloon.

M 03 (same exam as above) – Terri appears to have a purposeful
laugh
in response to the story from her childhood as related by her father
in the video. This would appear to be an appropriate emotional
reaction to latent memory.

H 01 (Examination of Dr. Hammesfahr 9/3/02) – Although Terri
seems to
fixate on the source of the music, there is little response until she
hears her mother's voice, at which time she smiles and moans
purposefully.

H 04 (Same exam as above) – A loosening of Terri's muscular tone
appears to be a result of a soothing effect on Terri of her father's
voice. This could indicate recognition of the voice as her father's,
and an appropriate emotional response. Later in this clip, Terri's
behavior of looking first at Dr. Hammesfahr and then at her mother
appears to be responsive to the request that she do so. When she
opens and closes her eyes, she clearly appears to be following the
commands of Dr. Hammesfahr to do so, although she cannot engage in
this behavior consistently .

H 09 (Same Exam as above) – Terri appears to keep her eyes closed
on
command, but it would be helpful to assess in other venues, such as
relative to her neck position and visual stimulii.

H 11 (Same exam as above) – Terri appears to track a balloon but
appears to be challenged by motor deficiency to move past midline.
This could be secondary to an oculomotor dysfunction.

6. Terri is clearly vocalizing. She does not appear to vocalize at
random during these examinations. Her vocalizations are generally
purposeful and usually in response to specific environmental stimuli,
most particularly family members.

7. Over the years since her injury, Terri has infrequently spoken
audible words. The records of MediPlex reflect the fact that she has
said "stop" in apparent response to a medical procedure being done to
her. The family reports that they have heard Terri say "ugh-hugh,"
ugh-ugh," and "No" on a few occasions.

8. Since the time of the medical evidentiary hearing in October of
2002, family members have made a concerted effort to encourage Terri
to vocalize, and have attempted, as laypersons, to coach her in basic
speech.

Most prominently, they have coached Terri in trying to say "yea", as
a way in which she may answer "yes" to questions. The family has an
audiotape recorded in November of 2002 in which Terri vocalizes in
apparent response to her father. Her vocalizations include repeated
sounds which approximate the word "yeah," in the same manner in which
she was coached. Prior to that time, no member of her family recalls
Terri being able to approximate the "yeah" sound. I cannot conclude
that Terri can accurately answer a yes/no question without the
therapy suggested below.

9. The apparent addition of an approximation of the word "yeah" to
Terri's repertoire of responses is clearly a learned behavior. Her
use of this sound on the audiotape is apparently in response to her
father. It is reasonable to conclude that Terri is trying, despite
her motor deficits, to speak as best she can. Terri is clearly a
suitable candidate for speech-language therapy.

10. It is not my opinion that Mrs. Schiavo is in a coma or in a
persistent vegetative state. In my opinion, she exhibits purposeful
though inconsistent reactions to her environment, particularly her
family. Her eye movements, easily observed on the videotape, are
particularly suggestive that she recognized family members and
responded. She also appeared to have sufficient sustained attention
to track a balloon. It is not my opinion that these behaviors are
merely reflexive. The entire range of behaviors listed above, and
each and every one of them, are inconsistent with a diagnosis of
persistent vegetative state.

11. Even without the benefit of any medical treatment which
successfully improves this patient's organic medical condition or
cognitive abilities, in my opinion Terri would benefit from speech-
language therapy, physical therapy and occupational/recreational
therapy. Her ability to interact with her environment and her ability
to communicate can be enhanced. Her quality of life can be
significantly enhanced.

12. I would specifically recommend that Terri be given access to a
system known as an environmental control system. We use such systems
at the Rehabilitation Institute of Chicago to permit patients such as
Terri to exercise control over their environment, such as to turn
their television or radio on or off, change channels, and to control
volume. Such environmental controls may also permit Terri to control
room lighting. In my opinion, Terri could make use of such a system
if it were made available and she received training in its use. I
would further recommend that a yes/no system be implemented, and that
Terri be trained in its use from the beginning of her rehabilitation
regimen. Such a system could permit Terri to more effectively
communicate.

13. It is apparent that Terri has sufficient swallowing ability to
handle her own secretions, therefore it would be my recommendation
that she receive a modified barium swallow study to assess swallow
function for intake trials of thin and thick liquids and pureed
consistencies. It has been my experience that patients similar to
Terri have been able to accomplish food intake. This would permit
Terri greater interaction with her family and in social situations
through the enjoyment of mealtimes. I have worked with numerous
disabled patients who have expressed to me that being able to eat
would make the difference between their desiring to live or die.

14. It is my judgement based on my training and clinical experience
working with patients similar to Terri that she would, within a
reasonable degree of clinical probability, be able to improve her
ability to interact with her environment, communicate with others,
and control her environment if she were given appropriate therapy and
training as outlined above. These recommendations, in my opinion,
would greatly improve Terri's quality of life.

FURTHER AFFIANT SAYETH NAUGHT.

Sara Green Mele, MS, CCC-SLP

http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=33875


acknowledgements: Saveterrislife Yahoo Group
http://health.groups.yahoo.com/group/saveterrislife/message/3