A Canadian man presumed to be in a permanent vegetative state for more than a decade is “talking” to researchers and answering their questions.
Severely brain injured in a traffic crash 12 years ago, Scott Routley’s condition had been officially classified “vegetative state,” unable to communicate with the outside world.
His family has always believed differently. Now, high-tech brain imaging appears to have proven them right. With the help of functional MRI, Routley has been able to answer “No” to the question, “Are you in pain?”
The finding, first reported Tuesday by the BBC, could have profound implications for helping those locked in a vegetative state.
“Brain imaging techniques are helping us to understand more about what some of these patients can and can’t do, particularly things they can do that might not be apparent from standard clinical examination,” said Adrian Owen of the University of Western Ontario’s Centre for Brain and Mind. The British neuroscientist moved to Canada last year from the University of Cambridge.
“His official clinical condition has been that he was in a vegetative state. But his family have always maintained that there is more going on with Scott — that he is aware of many things going on around him, and even that he was able to communicate,” Owen said in an interview with Postmedia News.
“That’s one reason why our results are very interesting — in many ways they confirm what the family has known for many years.”
A vegetative state is often referred to as being in a state of wakefulness without awareness, Owen said. But, “there is an enormously high misdiagnosis rate in this population, it’s more than 40 per cent.” That’s because it’s often difficult to spot subtle signs of consciousness.
“These patients do move, they’ll often spontaneously move,” Owen said. They often grunt; they will open their eyes or move their hand. The problem is knowing, “Is that a conscious response, or was it just chance?” Owen said. “They do look around the room but they don’t seem to focus on anything in particular. But what if they do for a few fleeting seconds? Does that mean something, or does it mean nothing?’
“We’re not saying anybody has made any mistakes here,” Owen stressed. “It’s enormously difficult to know what is going on inside the minds of these patients,” he said, “because behaviour is very complicated in these patients.” With brain imaging, Owen’s team has taken behaviour out of the equation.
“Instead of trying to work out what’s going on in their brains from what they can do, we just measure their brain activity directly and try to conclude how conscious they are, and whether they can answer questions, by directly measuring brain activity.” Patients are put inside the brain scanner and asked to imagine two scenarios: playing a game of tennis, or walking around their homes. Experiments in healthy people have shown different areas of the brain light up when they imagine doing these tasks, said Damian Cruse, a post-doctoral fellow at Western working in Owen’s lab.
Patients are asked a series of “yes” or “no” questions, and instructed to imagine playing tennis if they want to respond “yes”, or walking around their house for “no.” In past experiments, vegetative patients have been asked simple questions, Cruse said. “Do you have brothers or sisters? Is your father’s name Alex?”
