Reading minds

I recently had the opportunity to volunteer in the traumatic brain injury unit of a Chicago hospital.   Some of these patients have been left in a vegetative state following their injuries.  When assisting with their care, I found myself constantly wondering to what extent, if at all, the patients are conscious.  Can they understand what is being said around them?  Are there things they want to communicate but are simply unable to?  Is there something more in their eyes than a blank screen?  It is possible that a patient who is labeled as being in a "vegetative state" might have some level of awareness but lacks the ability to express this.  In therapy sessions, a patient might smile, nod, or grunt, leaving us to wonder if there was any intent behind those gestures or whether it was only random byproduct of physiology. It was a curious and bewildering experience for me and, of course, even more so for the patients themselves (assuming consciousness) and their friends and families.  Daniel Bor discusses this subject in his book, The Ravenous Brain, saying, "Doctors, too ... can often struggle to disentangle the subtle, inconsistent signs of real awareness from random sounds and movements."  Currently, scientists are working to try to communicate with those "vegetative" patients who might actually have awareness.  The most promising method so far is via fMRI and/or EEG, as was famously demonstrated by Dr. Adrian Owen and his team in their 2006 "tennis study".  In this groundbreaking study, fMRI was used to establish a reliable measure of consciousness based on areas of brain activation in response to imagination tasks, playing tennis specifically.  Bor details this study and those that have built on it, which have been able to show strong evidence of awareness in patients previously classified as vegetative.  

And now, a new study published by researchers at the University of Cambridge and the MRC Cognition and Brain Sciences Unit, Cambridge, has used EEG to establish certain brain networks to be associated with consciousness in patients who are unresponsive (in either vegetative or minimally conscious states).  They found that these networks are activated equivalently in both healthy patients and some patients who are unable to give physical responses.  This is compelling evidence that it is possible to identify physically unresponsive patients who are conscious and to actually communicate with them.  Using EEG is much more practical and less expensive than using fMRI so these new findings could provide a very useful diagnostic tool for doctors in the future.

There is more work to be done in order to refine these methods and also, as is characteristic and necessary in science, new questions arise.  One of these which weighs on my mind is, if we are now able to communicate with patients trapped in unresponsive bodies, how will they answer when asked if they want to continue on life support?

References:

Bor, D. (2012). The ravenous brain: How the new science of consciousness explains our insatiable search for meaning. New York: Basic Books.

University of Cambridge. (2014, October 16). Scientists find 'hidden brain signatures' of consciousness in vegetative state patients. ScienceDaily. Retrieved October 17, 2014 from www.sciencedaily.com/releases/2014/10/14

Dallas Star to Dementia Patient

Two hundred pounds of pure muscle colliding head to head, players accelerating to over 15 mph come to a complete halt upon impact.  Professional football players are prone to all types of injuries, not just physical, but mental as well.  Some on field injuries could send a player straight to the hospital, others may require a quick trip to the locker room to get their head straight.  Because football is a such high-impact sport, concussions are inevitable.  Though they may not seem like a big deal to the strong, manly brutes on the field, multiple concussions can be extremely harmful to your brain in the long run. 

In the New York Times article "For A Cowboys Star With Dementia, Time Is Running Out" by Juliet Macur, Dallas Cowboys Star and Hall Of Famer, Rayfield Wright, discusses his struggle with dementia due to the series of concussions he had suffered while in the NFL.  Macur states, "Studies have repeatedly shown that N.F.L. players encounter dementia, Alzheimer's and other neurological diseases with greater frequency than the general population" (Macur).  Like many retired NFL players, Wright's series of concussions have taken their toll on his brain.  He speaks of his daily struggles and dangerous experiences, “Sometimes, I walk into the kitchen and forget why I went there,” he said. “I’ve gotten into several car accidents because of seizures. Totaled two cars. My memory is not good. There’s a big fight within myself”(Macur).  Wright’s brain damage has altered the way he goes about his daily functions. Everything has become a struggle for him, whether it is the constant headaches, forgetting his plans, or venturing into an unstable plot of his imagination.  Jeannette DeVader, Wright’s former girlfriend and now caretaker, argues that Mr. Wright cannot be left alone.  In addition to his inability to function normally, he has tens of thousands of dollars worth of medical bills.  Having his tough,football mentality, Wright hid his struggles from everyone, dealing with them on his own.  But when Wright finally acknowledged his mental complications, he wanted to know why.  Why was he not able to function like he used to? Why does he have headaches all the time?  Why has living become a struggle for him? Recently, psychologists have diagnosed him with depression; he refused to believe it. His irritability and unstableness can be attributed to his brain damage.

In Daniel Bor's The Ravenous Brain, Bor explains how candidates are selected for basic neurological imaging experiments.  The fMRI scanner is a very powerful magnetic imaging device so all precautions are taken in account for when determining the best brains to test.  In order to have the most "normal" brains to test with, eligible candidates must have no history of brain implants, strokes, tumors, or any other neurological conditions, including knockouts or concussions.  Bor explains how even the slightest brain injury like a sports concussion may hinder results.  Concussions, though minor, cause low-level brain damage.  Ten to fifteen percent of concussion victims, including those of have suffered multiple concussions; will experience more severe brain damage, including long-term memory loss and compromised concentration.

As mentioned in the article, Wright’s daily routines have been compromised by the struggle to focus and retain information.  How do repeated concussions impair the brain with such magnitude?  In the midst of a concussion, or any heavy impact to the head, the brain bounces back and fourth in the skull.  As it brushes against the sides of the skull, it may shear or tear at the jagged edges, damaging connective tissue and neurons.  fMRI scanners allow doctors to see a decrease in brain activity in patients suffering a concussion.  Monitoring these changes as a player progresses is an important part of allowing the player to continue playing the sport safely.

Bor, Daniel. The Ravenous Brain: How the New Science of Consciousness Explains Our Insatiable Search for Meaning. New York: Basic, 2012. Print.

Macur, Juliet. "For a Cowboys Star With Dementia, Time Is Running Out." The New York Times. The New York Times, 26 Jan. 2014. Web.