Researchers have used brain scans to communicate with individuals in total vegetative states. Scientists at the University of Cambridge asked "yes" or "no" questions of the patients which they answered by imaging one of two different activities: playing tennis, or just moving around their house. Depending on what they were thinking, different regions of their brains lit up. From New Scientist:
"Giving the 'unconscious' a voice"
"I think we can be pretty confident that he is entirely conscious," says Owen. "He has to understand instructions, comprehend speech, remember what tennis is and how you do it. So many of his cognitive faculties have to have been intact."That someone can be capable of all this while appearing completely unaware confounds existing medical definitions of consciousness, Laureys says. "We don't know what to call this; he just doesn't fit a definition."
Doctors traditionally base these diagnoses on how someone behaves: if for example, whether or not they can glance in different directions in response to questions. The new results show that you don't need behavioural indications to identify awareness and even a degree of cognitive proficiency. All you need to do is tap into brain activity directly.
The work "changes everything", says Nicholas Schiff, a neurologist at Weill Cornell Medical College in New York, who is carrying out similar work on patients with consciousness disorders. "Knowing that someone could persist in a state like this and not show evidence of the fact that they can answer yes/no questions should be extremely disturbing to our clinical practice."
One of the most difficult questions you might want to ask someone is whether they want to carry on living. But as Owen and Laureys point out, the scientific, legal and ethical challenges for doctors asking such questions are formidable. "In purely practical terms, yes, it is possible," says Owen. "But it is a bigger step than one might immediately think."
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Actually the technique is so sensitive that it can even read the thoughts of a dead salmon.
I have to learn to read slower, I thought the headline was "...communication with vegetable people".
I do think this is cool, and it gives me high hopes for those trapped by disease or illness.
At first glance, I read the headline as referring to "vegetarian people."
[Great post, Pesco.]
so, approximately 20% of the vegetative are slightly less vegetative than previously thought?
I bet I can get better results with a ouija board.
Is it not simply the image that "lights up"?
The actual portions of the brain do not light.
Regardless of what "lights up" how is there any helpful human-to-human
communication going on here?
though interesting, this seems like a case of jumping the gun
This is super fascinating and they're getting a lot of press from this, and that should make us all _more_ suspicious of the results.
Pantograph beat me to it. I'm very interested in whether the people assessing the scans were doing so blind, whether the people operating the machine were doing so without knowing what questions were being asked, etc. RThere's an awful lot of voodoo involved in fMRI.
It's not immediately apparent in the full text of the NEJM article how the machine was being operated and who was reading the output.
And 5% are fully conscious and driven so insane by their horrible situation that they can't respond to questions rationally, or respond to trivial questions about tennis with raw fury.
This is interesting research and it'll be fascinating to see where it goes. These guys can hear, right? So if you wrote a program that could recognize the "yes/no" responses and vocalize them, they'd be aware of their ability to contact the outside world.
I'd love to see the brain scan as that dawned upon them.
Okay, if this is the earth-shattering news it seems to be, I would think someone would have already taken this steps further. Come up with a good 20 different mental images that are easily identifiable, brain-scan-wise, and assign a letter to each one. Teach the patient the system, and let them "talk" to you by spelling out each word.
I mean, there's plenty of things you could do to circumvent the vegetative state if this turns out to be as simply true as it seems.
The size of those ventricles is very scary to me.
I have heard of the dead salmon paper - it really highlights the problems of captalising on chance in terms of detecting brain activation.
fMRI is expensive, I know it is less expensive in the US, but in New Zealand it costs $1000 an hour. This type of response isn't useful other than for diagnosis, i.e., can you understand me? If this is all these people can do, they are not likely to see many changes in life, other than family members coming to talk to them more often, and medical staff being a bit kinder.
If they can be taught to blink, move their eyes, raise their blood pressure etc they would have a chance to have some input in their lives.
First question: "If we can't fix you, would you rather be dead?"
Yeah, I know It's morbid, but there's a reason I have a living will. Being stuck in a vegitative state is about the most hellish thing I can imagine. To me, being limited to yes/no responses just isn't enough to make life worth living.
Maybe the brain still has enough functionality to process simple yes/no questions (questions about facts) regardless of whether there's anyone home. It is a machine of sorts after all.
What happens if it is asked opinion questions, like whether it likes a particular relative that the family knows they had mixed feelings about? In a living mind, we'd fluctuate between yes and no as we decide whether to be charitable and say yes, or nasty and say no. If the brains can do this, then maybe it means there's still a person using that brain, weighing the factors and reaching an opinion.
But asking factual yes no questions -- questions that require nothing more than a check of data -- doesn't mean there's anyone using that brain.
Does this mean that we can finally get through to politicians?
"Brain scans enable communication with vegetative people."
ABSOLUTELY NOT.
"Brain scans enable communication with vegetative person."
Correct.
If this is ever the only way I can "communicate," someone please smother me with a pillow.
If there was ever a case for RTFA this one is it.
@ Patrick - Yes a blind test was conducted.
@ Mike the Bard - That question is covered in the article.
Don't just read the synopsis, read the actual article its linking too.
Unfortunately, some of the most important questions can't be answered by the data in the paper. For example the authors say, "Among the 54 patients, we identified 5 who could willfully modulate their brain activity". They back this statement up with sample images showing what look like positive results, and quantitative data showing only the region they say is responding, from one patient. Distinguishing statistical outliers from real responses is impossible with the data they give. How sad. It would be GREAT to know if they're right. NEJM reviewers never should have let them publish without documenting results better. Worst of all, I think, is what they document from their favorite patient, who got 5 of 6 yes/no questions about him/herself right. Is this much better than a coin flip? 5 out of 6 is better than 50-50, but not by much. Is this patient the statistical outlier among multiple patients given the 6 questions? This is just too important a result to leave us wondering.
The first thing I thought of was the Terry Shivo case.
"Regardless of what "lights up" how is there any helpful human-to-human
communication going on here?"
Yes. Example? "Think about playing tennis for 'yes' , think about apple pie for 'no'.... "
We have a responsibility to see if this goes anywhere.
Blessed Clemens vonGalen, pray for us.
All those of you who are saying "If this is what I'm limited to communicating, please smother me with a pillow" should remember that Stephen Hawking has written many books and major scientific papers using almost as little bandwidth.
I always imagined that a vegetative state meant something between absolute unconsciousness and some sort of semi-conscious dreamlike state - in any case something short of self-awareness. I would never want to be kept alive under those circumstances. If this study is correct - that is, if there is even a chance I could be trapped, wide awake in all but appearance, while in a vegetative state - then I absolutely don't want to live that way.
I've been putting off my living will for too long. I'm doing it this week, along with a durable power of attorney for health care, which will appoint my brother as decision maker. I love my parents, but it is precisely because I know they have the best of intentions that I don't trust them to let me go even though they already know exactly what I want.
@valdis #21: You're exactly right, although Hawking's situation is a bit different in that he had a relatively slow descent into his current state. He has been able to adjust mentally and emotionally as best he can. And he obviously has a tremendous reservoir of strength that he draws from to continue his accomplishments. The biggest difference is that Hawking can still communicate, make his wishes known and even move around - all by machine, but he can still do it.
I am one of those people who says "just smother me" but that comes from my fear of getting hit by a car (or something like that) and "waking up" only to find I am trapped in my own body with no ability to communicate, much less move.
Wouldn't this reduce, at least slightly, the certainty with which the pull-the-plug advocates viewed Terri Schiavo?
Terri Schiavo wasn't in a vegetative state. Read the book
Fighting for Dear Life
By Attorney David Gibbs III
http://www.amazon.com/Fighting-Dear-Life-Untold-Schiavo/dp/076420243X
the bottom right photo looks a tad better than the schiavo scan that everyone was touting as proof positive of her complete lack of consciousness.
oops...
"Wouldn't this reduce, at least slightly, the certainty with which the pull-the-plug advocates viewed Terri Schiavo?"
it was never about her particular case. it was about any case they could have imagined that might be similar. she was as much a tool to their ends as she was for the conservatives, who acted, foolishly.
Folks who read of this marvelous progress and immediately respond “just smother me” if they can't be instantaneously “fixed” seem to be stuck in a time warp of the nonce. We've only just made this advance, and what's possible right now is almost certainly far different than what will be feasible in a year, or five years, when equipment that can render a patient's thoughts into human speech and even movement a la Stephen Hawking will eventually be available. Moreover, costs will come down; compare with the human genome decipherment project first achieved a decade ago, at a cost of billions — yet that expense has been declining for a number of years now at a rate of an order of magnitude per year, and soon will be a mere thousand dollars for individuals to obtain their own personal genome. Have patience, oh ye vegetative people!
Am I one of the few people who would like to be kept alive if I am in a VS and showing *any* sign of consciousness? Maybe it's because I don't believe in any sort of afterlife. Even if there is a minute and seemingly unlikely chance of being revived even partially (new drugs, for example), I would take it because the alternative is ceasing to exist.
Almost all of your criticisms have been addressed either in the article itself or supplementary information.
Yeah, it's been sensationalised, but even allowing for that it's still pretty cool.