4 August 1997

The Knoxville News-Sentinel

KXVL

Final

A7

English

(Copyright 1997)

STOCKHOLM, Sweden

Complete with lights and horn and engine sounds, a toy tractor-trailer rig utterly fascinates Peter Lillelid.

If the toy is out of reach, however, Peter can't run to get it. Five months after his second birthday and four months after being shot in the head and torso, Peter has recovered from the bullet wounds to find himself with legs that are scarcely able to crawl.

But, his doctors predict, Peter will walk again soon.

``I'm quite sure he will be a walker before the end of the year, in fact," said Stockholm pediatric neurologist Bo Ericsson.

Ericsson, also a specialist in pediatric rehabilitation, has been Peter's physician since the child left his hometown of Knoxville to live with relatives in Sweden.

Peter and his parents, Vidar and Delfina Lillelid, and his 6-year-old sister, Tabitha, were returning from a religious conference in Johnson City to their home in Powell when they were carjacked, robbed and shot April 6 after stopping at an Interstate 81 rest area in Greene County.

Vidar, 34, Delfina, 28, and Tabitha did not survive the shooting.

Peter spent three months in Knoxville hospitals before his paternal aunt, Randi Heier, and her husband, Odd, won a courtroom custody battle with Peter's maternal relatives.

For the past three weeks, Peter has been a patient of Ericsson's at the children's clinic of Stockholm's St. Goran's Hospital. Consulting on Peter's treatment is Ericsson's supervisor, Dr. Hans Forssberg, a pediatric neurology professor and researcher at Stockholm's Karolinska Institute, home-base of the Nobel Prize.

During a Friday meeting at St. Goran's, both doctors said it's too soon to know whether Peter's current disabilities will be permanent.

One bullet entered Peter's skull behind his right ear and exited through his right eye, for which he now wears an artificial replacement. Another bullet struck Peter in the back and passed through his torso without striking bone.

``The bullet through his head never had any penetration of the brain but just made some pressure against the temporal lobe, the undersurface of the brain, before it blew out the eye,'' Ericsson said.

``From an MRI scan done on April 26, you can see just some small bleeding there.

``We're planning to do another MRI next week to see what's changed in that time. We expect we may see some sort of scarring, perhaps some calcification in that area.

Forssberg described the potential for ``micro-changes'' in the brain, further from the bullet's path, because of a shock wave experienced in the skull.

``That's quite common in a blow to the brain, seeing results of the force in areas not near the impact,'' Forssberg said.

``That's why I also think one has to be a bit careful to say that there are no effects on the brain, because you can't see everything on the MRI.''

Currently, the doctors said, Peter appears developmentally sound and not to be suffering any brain function loss. Only time can bring the complete picture, however.

``You have always to be careful as a physician, especially with children in which there are many different processes active at the same time, to make conclusions about brain injuries,'' Forssberg said.

``When there is damage to the brain, you effectively kill some cells that will never be alive again. Shock might damage some that may survive, and after some months could recover. There might be a plasticity so that some other neurons might take over.

``It's a very long process, and in a kid even more special because you have development of new functions along the way.''

As an example, Forssberg cited potential learning disabilities that may not be detected until a child is old enough to attempt reading or similar tasks. Possible atrophy in the affected area may become evident years later when X-rays could show Peter's undamaged spinal cord growing normally in contrast with the injured portion.

``Peter is behaving so that his brain function is quite normal for a kid his age,'' Ericsson said.

``What is not normal is his legs. There he has problems from spinal cord damage. He has no damage to the bone, but there is the pressure waves from the bullet.''

The doctors are awaiting delivery of a chest X-ray Peter underwent earlier in Knoxville and they also plan to run their own next week.

``We haven't seen the spine, but we know from his symptoms that the spinal cord is damaged,'' Ericsson said.

Peter's symptoms include near-permanent hyper-extension in the right knee and ankle. The problem, Forssberg said, is from disruption in spinal cord motor neurons that allow voluntary muscle control, resulting in weakness of the muscle.

That's combined with ongoing bombardment of the nerves by reflexes and other centers in the brain, resulting in ``spasticity,'' or small, rapid shaking in the right leg.

Peter is being fitted with special braces to maintain flexion in the knees and ankles, keep the muscles pliable and enable him to re-learn to walk by strengthening the left leg muscles and compensating for the problems in the right leg.

Any of a number of possible methods to correct the problem through medication, surgery or otherwise shouldn't be tried unless they are still necessary when Peter is more physically mature, Ericsson said.

``He still has the capacity to control the proximal muscles which give stability, and that will probably help him a lot,'' Ericsson said.

``In an interval of a week, I saw him two times and I saw that he used his left leg better than before, so what we're what hoping is to strengthen it so that he can use it to rise up.

``He's conscious of his abilities and of the right leg. He reaches to hold it to stop its convulsing.''

Ericsson predicted that as Peter grows more secure in his new family, he may be willing to work harder in his therapy sessions. He's only recently been willing to leave his aunt's arms at the hospital.

``He already knows how, even with the leg weak, to come up to a standing position,'' Ericsson said.

``When he will be happy in his family, he will venture to try more. He's also a very clever boy. He knows how to handle this.''

PETER'S PROGRESS (Series)