TORONTO – His father takes him to the movies even though doctors assume the patient has been unresponsive and in a vegetative state for the past 16 years. But when Canadian scientists tested his brain functioning while watching a short film, they realized the patient understood the plot of the movie – and, in turn, probably understands what’s happening in his daily life.
Using what they’re calling a “game-changing” brain scanning technique, Canadian researchers say they can detect consciousness in patients thought to be in a vegetative state.
The breakthrough research out of the University of Western Ontario is another piece in a series of findings on communicating with patients thought to be completely unresponsive.
Last year, the researchers worked with three brain injury victims – one who had been in a vegetative state for 12 years following a car accident, knew his name, his identity and that he was in hospital.
This time around, a father reached out to the scientists led by Dr. Adrian Owen in hopes of learning how aware his 34-year-old son is. Turns out, he’s much more cognizant than his “unresponsive” state suggests.
The researchers handpicked an Alfred Hitchcock short movie – about eight minutes long – for their study. In it, a little boy finds a loaded gun and waves it around, even pointing it at people, thinking it isn’t real.
A group of healthy participants watched the film as the scientists documented their brain activity during suspenseful, scary moments. Then Owen and his team showed the film to the patient in a vegetative state.
“[This] patient responded to the particular events exactly the same way as healthy participants did when it came to particularly gripping parts,” Owen, the study’s co-author, told Global News. He’s a neuroscientist who’s spent the last 25 years working in brain imaging. He’s also the Canada Excellence Research Chair in Cognitive Neuroscience and Imaging.
“On this basis, we were able to conclude the patient was actually following the plot of the movie, he wasn’t just in a vegetative state. He understood when the plot changed directions, and he was responding to particular events that were scary or offered relief. This is very important…we can deduce that this happens to him during real life events too.”
Owen suggests the findings take his team’s previous research to the next level in many ways.
In their previous study, the researchers had patients listen to music to determine if they could hear sounds compared to silence. Then the patients were asked to follow commands to see if they could focus on the music, then relax and ignore the noise.
In that case, the patients’ brain activity lessened each time they were asked to relax. They could even answer simple questions – are you in a supermarket? Are you in a hospital? Is your name Mike? – by focusing on a specific response.
“Everything we’ve tried in these patients in the past has involved them making some kind of response by either changing their brain activity or having them concentrate on particular stimuli. All of those things are very effortful and demanding,” Owen said.
This new testing is also easier to carry out and may not require patients to head to the lab. It’s not as rigorous as past techniques, so the researchers hope it can be rolled out in hospitals and remote areas.
“This will be something that will allow us to more accurately determine how many of these patients have internal life we don’t know about,” Owen said.
Misdiagnosing patients who aren’t in a vegetative state happens more frequently than Canadians realize. Owen’s previous work has suggested that up to 20 per cent of patients can communicate via some sort of command following.
Vegetative patients aren’t the same as people in a comatose state. They open their eyes, look around, and they can even have sleep cycles. They’re incapable of moving but, in some cases, they’re conscious of their situation.
“Being trapped inside their bodies is rather frightening but it’s an accurate description of the situation,” Owen said.
It’s uncharted territory in communicating with unresponsive patients – and with this breakthrough comes many questions, experts say.
“If in fact you can reach in and have some kind of communication then I would argue we have an ethical obligation to be really, honestly checking in with those patients and allowing those patients to weigh in on their own end-of-life decisions,” Dr. Kerry Bowman told Global News in 2013.
He’s a bioethicist and professor at the University of Toronto, specializing in end-of-life decision-making.
Owen said that with the new technology, the researchers have already reached out to about a dozen patients. Over the past years, he’s looked at hundreds more. The team is also open and willing to work with families who get in touch with them.
“We’re always interested in seeing more people. This is a very poorly understood population of patients and…each patient tells us something different, we learn different things from different patients,” he said.
Ultimately, it could help shape decision-making with patients’ needs and concerns in mind.
Owen’s full findings were published Monday in the Proceedings of the National Academy of Sciences.
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