Mom looks forward to hearing son speak with aid of implant device

By LaKisha Ladson           

Rosemary Miramontes doesn’t mind being the target of friendly jokes with her adult son, Franco. She tries to make their days light and cheerful so she can see him laugh. With the help of a device implanted by UT Southwestern surgeons, Mrs. Miramontes hopes for the day when she can not only see her son’s face light up, but also hear his laughter, along with his voice.

“Franco is very opinionated,” she lovingly said. “Before the accident, we would talk every day, and I loved hearing him tell me how much he knew.”

The 2007 accident – when Mr. Miramontes was knocked from his motorcycle during morning rush hour on Interstate 35 – left him with a horrific spinal cord injury.

Doctors said he would never walk or move his arms again. Both his lungs collapsed, and he was put on a ventilator to help him breathe. Because of the tubes put down his throat, he could no longer speak. Then just 23 years old, he was expected to spend the rest of his life confined to a bed. 

“I was devastated,” Mrs. Miramontes said. “You don’t expect something like this to happen, especially not to one of your kids. But he was alive, with his brain fully functional and memories intact.”

He was then transferred to University Hospital - St. Paul, where he battled several upper respiratory infections – common for quadriplegic patients who are placed on ventilators. Being at the forefront of patient care, UT Southwestern was one of only two sites in Texas and 25 in the country equipped to offer implantable breathing devices for quadriplegic patients.

“Patients who have high-level spinal-cord injuries are unable to breathe efficiently because the nerve signals no longer function,” said Dr. Michael DiMaio, Associate Professor of Cardiovascular and Thoracic Surgery.

The new implantable device, called the NeuRX system, allows surgeons to implant four electrodes directly into the diaphragm. Electrical signals from an external control device induce impulses from the phrenic nerve, which runs from the spine to the diaphragm, the muscle that enables normal breathing. Once those signals reach the electrodes in the diaphragm, the muscle is stimulated to expand and contract. This action simulates normal breathing more closely than external ventilators.

“It’s a laparoscopic procedure, and patients are typically sent home the same day or the next day,” Dr. DiMaio said. “They can achieve a greater level of freedom because they’re not physically attached to a large, external ventilator.”

That’s exactly what happened in Mr. Miramontes’ case. He uses the ventilator at night and the NeuRX during the day. Free from the ventilator attachments, he experiences less pain when he is moved, and he can sit up in a wheelchair. Instead of breathing oxygen from a machine, he can breathe the same air as those around him. The device also reduces the likelihood of lung infections, a frequent problem for quadriplegic patients.

 “Franco was listless and depressed,” his mother said. “Now with the implant, he has become more independent. Franco’s eyes look brighter, and I believe he seems more hopeful every day. His life is far from over.”

Mr. Miramontes recently started speech therapy. Family members read his lips when he speaks. When they’re having a hard time, he spells out the word he is trying to communicate as a family member writes the letters on a board.

Physicians believe that his muscles are healthy and that with the help of the NeuRX and speech therapists, he’ll be able to speak sentences eventually. He constantly adds to the number of words he can say.

For Mrs. Miramontes, her son’s breath and smile are deeply satisfying. The NeuRX system allows them hope of more mobility and more fluent speech.

“Then I may hear him tell me more often that he is right, but the truth is mothers definitely know best,” Mrs. Miramontes said.

Dr. DiMaio holds the Laurence and Susan Hirsch/Centex Distinguished Chair in Heart Disease.