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