After many years of struggling with bulimia, Terri Schiavo's heart had finally had enough. Doctors were able to revive her but she was left with significant brain damage that would leave her in a vegetative state. Facing the decision of removing her feeding tube or leaving it in, Terri's husband and her parents began a seven year long battle. This situation ignited a political, religious, and moral debate across the country, making people question what truly determines a permanent vegetative state.
A vegetative state is when one has "some form of sleep wake cycle, and sometimes opens his eyes, but shows no signs of awareness..." (Bor, 2012). This state is related to damage to the individual's thalamus and connects to the pre-frontal cortex. Bor states that to the grieving family, twitches, smiling, or grinding of one's teeth may seem to be hopeful glimpses of improvement, but are often only reflexes. Therefore, it is extremely difficult to tell the difference between the true consciousness of a person and the reflexes of the individual's body. Several different experiments have been performed in hopes of providing a better way to diagnose a permanent vegetative state, like Terri's, and maybe even predict recovery.
Adrian Owen developed the idea of using an fMRI machine to scan the brain of a vegetative patient (Bor, 2012). The patient listens to four different noises, each testing a different level of consciousness. He then compares the vegetative patient's brain scan to than of a fully conscious person. The extent to which a patient passed also became a reliable predictor of how well they would recover, if at all. This is one of the most simple and reliable ways of gauging an individual's consciousness and awareness without the aid of surgery or other major medical procedures.
This exact experiment was written about by Ellen Zolfagharifard a little over 3 months ago on Mail Online- Science & Tech website. After spending 12 years in a permanent vegetative state, a patient was able to communicate via fMRI scans. When asked yes and no questions, the patient responded mentally and doctors were able to understand his answer by reading his scans (Zolfagharifard, 2013). This shows that he is aware of the world around him and even has a deep mental capacity that may or may not have been present earlier in his condition. Later, by using this technique with many other patients, Owen has also found misdiagnosed vegetative patients.
As Owen continues to improve upon this process, there is greater hope that vegetative patients will be able to communicate with the outside world, giving loved ones and doctors alike hope for recovery. While this is something that many families have dreamed and prayed for, this makes things much more difficult for those who are seriously deliberating the removal of a feeding tube, or those who have already done so. Knowing now that there is new research that can show whether a patient is conscious when all other factors indicate otherwise is sure to make them wonder what might have been.
References:
Bor, D. (2012). The Ravenous Brain: How the New Science of Consciousness Explains Our Insatiable Search for Meaning. (p. 223-231). New York: Basin Books, 2012. Print.
Zolfagharifard, E. (2013). "Locked In His Body for 12 Years but Finally Given a Voice: Man in a Vegetative State Can Speak Thanks to Mind-Reading Computer." Mail Online- Science & Tech, 13 Aug. 2013. Web. Retrieved from: <http://dailymail.co.uk/sciencetech/article-2391214/Locked-body-12-years-finally-given-voice-Man-vegetative-state-speak-thanks-mind-reading-computer.html>.
It is truly a remarkable thing on how far science as well as technology has come with the ability to communicate with patients in a vegetative state. I think it might be hard for one of us to imagine ourselves awake but have no awareness of what is going on in the world. Even though the patients are in a vegetative state, there is hope for communication between them and the outside world. You mentioned an example of a patient being able to communicate through fMRI scans. These communications are in my mind incredible. I would never think to imagine that a person could show awareness through brain imaging. I also read an article on the same patient stuck in a vegetative state for twelve years. This article was in the NBC news cite and was entitled Brain scanners reveal which ‘vegetative’ patients are alert, trapped in bodies. In this article, Lorina Naci states, “they want to reach out to the patients who are trapped in their bodies”. This research does give hope to patients who are in a vegetative state.
ReplyDeleteResources:
Fox, Maggie. "Nbc News Health." NBC News. N.p., 15 Aug. 2013. Web.
Retrieved from: http://www.nbcnews.com/health/brain-scans-reveal-which-vegetative-patients-are-alert-trapped-bodies-6C10902050
This is powerful research, the stress that families go through when deciding to let their vegetative loved ones continue life confined to their bodies or to let nature take its course and bid farewell is immense. I wonder if these fMRI responses to yes/no questions are also seen in coma patients or is this a state that develops when the mind realizes that it no longer has any control over the body and after a period of time finds anyway to communicate with the outside world. Maybe these responses are a variant of "out of body experiences" that we hear so much about and some of us have had, or maybe could these responses be dreams? Is there evidence that vegetative patients dream? that would be cool too, to see if these coma or vegetative patients show active visual cortex areas when they are read to or when music is played. Definitely something to follow up on.
ReplyDeleteI find this progress very promising. While it helps to redefine what communication constitutes, it also makes the definition of vegetation difficult. I wonder at what rate medical advancements will affect political, religious and political beliefs. For the average person, I believe it is hard to correlate these findings with what one actually "sees". In my opinion, the pace of this research will outpace that of social development. I think this research is very uplifting, and I hope to see it further progress in all realms.
ReplyDeleteI find it interesting that Owen, in his fMRI experiments, solely tested for consciousness using auditory stimuli considering even we from class, have come to understand, all the different modalities our brains possess for intercepting so many different senses. I really hope he further improves his theory to test for consciousness in other ways. I find it terrific though that Zolfagharifard was able to discover that his patient could respond via fMRI imaging by simply thinking of what he’s being asked. The patient’s family must have been thrilled. I agreed, that that situation does bring to light that these patients are indeed not “vegetables.” Even when we reach that point where this is standard practice, I believe we should never ask the patient if they themselves would like to continue living or pass away because it wouldn’t be moral to ask a person who is at an incompetent state. I do agree that patients should be screened using methodologies such as the ones you have written on, so that the patients who show hope can be kept on life support until medical technology can revive them. Stem cell research is finally being done, after years of controversy, and shows great promise for regenerating tissue, including brain tissue.
ReplyDeleteI think this is a very important topic to bring up, especially because we don't often think about just how active the mind is in these vegetative patients. it would be such a huge and exciting technological advance to be able to communicate with them, especially because this would mean that they have more of a say in their treatment and what they want. Life could be a lot more fulfilling to them and perhaps they wouldn't feel so trapped. I think that we would need to know a great deal more about brain activity and cognition to be able to fully or even partially communicate with them, however. But this brings to light how positive technological advances can be.
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