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St. Michael's goes to the Oscars® – Part 3

In the last of a three-part series, we connect St. Michael's researchers and clinicians to the Best Picture nominees

Toronto, February 25, 2011

On Sunday, February 27, the Academy of Motion Picture Arts and Sciences® will be handing out the Oscars® for the best of the best in cinema from Hollywood and around the world.

The 83rd Academy Awards® will feature 10 nominees for Best Picture.

What's the connection between St. Michael's and the Oscars®? Other than the fact that all our researchers, educators and clinicians are stars? Many of this year Best Picture nominations touch on physical or mental health issues that are treated or studied here at St. Michael's. We'd like to highlight some of that leading research and patient care in the days leading up to the 83rd Annual Academy Awards® on Sunday.

127 Hours

127 Hours tells the real-life story of mountain climber Aron Ralston's (James Franco) remarkable adventure to save himself after a fallen boulder crashes on his arm and pins him inside an isolated canyon in Utah. Over the next five days, with only limited food and resources, Ralston examines his life and discovers he has the courage to free himself by any means necessary.

St. Michael's Hospital, one of the top three centres for orthopedic surgery and care in Canada, treats patients with orthopedic trauma every day. Dr. Michael Mckee, an orthopedic surgeon, is one of the only surgeons in Ontario who performs an innovative bone reconstruction procedure on patients who have suffered significant bone loss. He is also able to repair fractures that have not healed. Dr. Mckee worked with the Canadian Armed Forces in Kandahar, Afghanistan, where he encountered unusual challenges treating mass casualties with limited resources.

The movie's plot resonates all-too-well with former St. Michael's patient, Mike Scholte, whose story is eerily similar. Mr. Scholte was hiking in Collingwood, Ont., with three other people when he looked up to see that a boulder "about the size of a small van" had come loose and was falling toward him. The rock landed on him almost exactly the same way it happened to Ralston in the movie – pinning his arm between the boulder and the cliff.

"My first thought was 'wow, that was close.' It didn't register that I was stuck," he said. "I pulled my arm and I remember hearing a tearing sound. I thought it was my sweater but when I looked, my whole arm had come off."

Scholte's foot was also been crushed by the boulder. He began losing a lot of blood quickly and was unable to move.

When a helicopter appeared to take him to St. Michael's, Scholte described the sight as "angelic." He said he "still can't believe the absolutely amazing work the orthopedic and plastic surgery departments were able to do."

The team at St. Mike's reconstructed the remaining part of his arm so that today he has complete functionality with his prosthetic arm. He said his foot was "completely smashed" when he arrived at the hospital, but that "somehow they were able to reconstruct it." He maintains an active lifestyle, running marathons and participating in dragon boat races.

Scholte said it was difficult for him and his wife to see the movie, but he was satisfied with the way the accident was portrayed as well as the mental state of the character while going through the trauma.

"The types of things that go through your head in these situations are not what you would think," he said. "I remember being upset my favourite sweater had ripped. It's been 16 years and I'm still amazed by the team who worked on me at St. Mike's. I wouldn't be here today if it weren't for them. It's that simple."

The Fighter

The Fighter is a drama about boxer "Irish" Micky Ward (Mark Wahlberg) and his unlikely path to become world lightweight champion. Dicky Eklund (Christian Bale), Micky's half-brother, is a talented boxer who once went the distance with Sugar Ray Leonard in a title fight but then turned to crime and landed in prison. After his release he turned his life around and helped his underperforming brother find the spark for a remarkable run that led to the world title.

Boxers, especially those who don't wear protective headgear, risk repeated concussions and other head injuries. A knockout in boxing involves rendering someone unconscious or at least neurologically incapacitated for a brief time. The phrase "punch drunk" originally meant acting like a person who had suffered repeated blows to the head, such as a professional boxer. The American Association of Neurology has asked that boxing be banned due to the risk of permanent brain damage. Dr. Michael Cusimano, a neurosurgeon at St. Michael's Hospital, is a leading researcher in the field of traumatic brain injuries, especially in sports. He has a five-year STAIR (Strategic Teams in Applied Injury Research) grant from the Canadian Institutes for Health Research to look at TBI in sports such as hockey, in vulnerable groups such as the homeless, and in motor vehicle collisions and falls. His team will also probe the link between violence and aggression.

Inception

A professional thief and his team use specialized technology to enter a business mogul's dream state. They venture through several subconscious levels of sleep depths and eventually arrive at the third state; here they will be able to change his way of thinking in the real world.

Fantasy or reality? It couldn't happen if you suffer from insomnia or certain other conditions treated at St. Michael's. We asked respirologist Dr. Christopher Li, who diagnoses many breathing and other problems that interrupt healthy sleep patterns in the hospital's sleep lab, about them.

Sleep apnea is one of the more serious conditions he sees, affecting many overweight and obese patients. This is a condition where the patient's airway becomes obstructed during sleep, leading to repetitive stops in breathing. This causes frequent arousals or "brainwave awakenings," which can result in disrupted sleep and often a reduction in the amount of REM sleep. Patients may experience unrefreshing sleep, daytime sleepiness, and even cognitive difficulties.

The most severe cases are treated effectively with a Continuous Positive Airway Pressure (CPAP) machine. Milder cases are often treated with lifestyle changes such as weight loss, changing sleep positions and abstaining from alcohol. In some cases, patients can also be fitted with a dental appliance to prevent airway obstruction.

Other conditions that can interrupt sleep include chronic medical problems, psychiatric disease, and restless legs syndrome.

The Kids Are All Right

Two teenagers, conceived through artificial insemination, look for their biological father. After the kids start developing a relationship with him, one of their mothers discovers inherit behavioral traits and facial expressions from their fraternal father that she sees in her children everyday.

We asked St. Michael's pediatrician Dr. Doug Campbell if there is any validity to this observation. Campbell told us about a recent study in the Proceedings of the National Academy of Sciences by Gili Peleg et al. where people who were blind at birth were found to have had the same facial expressions in certain scenarios such as anger as their family members. He explained that it made some sense in an evolutionary sense.

In the study, the scientists videotaped 51 subjects – 21 who were blind, and 30 of their relatives. When participants were provoked to show six emotional states: concentration, sadness, anger, disgust, joy and surprise, the researchers used a classification tool to assign values (e.g. for types of movements, frequencies) to each of the subject's expressions. After defining the values, another classification tool determined which subjects were family members.

Quite convincingly, 80 per cent of the classifications correctly identified family members when taking into account all six emotional expressions. The single emotion that received correct classification of family members when tested alone was anger at 75 per cent. In a test comparing the family members with each other, the scientists also found that related subjects showed similar frequencies of facial expressions for the emotions of concentration, sadness and anger, but not the others.