Communicating with the “Unreachable”–the severely cognitively injured

By Dave Andrusko

Adrian Owen

National Right to Life President and Pro-Life Perspective Host Carol Tobias today offers insight into the late bioethicist Ronald Cranford who argued that people with severe cognitive disabilities ought to be “allowed” to die. (See “The Minimally Conscious State.”)

At the other end of the spectrum Nature magazine’s David Cyranoski offered an intriguing, in-depth profile of Adrian Owen who (as the story is headlined) “has found a way to use brain scans to communicate with people previously written off as unreachable. Now, he is fighting to take his methods to the clinic.”

We’ve written several times about Owen’s remarkable work, most recently at www.nationalrighttolifenews.org/news/2011/11/new-consciousness-test-won%E2%80%99t-stop-dehydrations-without-a-change-in-values. What the Nature profile does is walk the reader through Owen’s determined campaign to reach patients in so-called persistent vegetative state (PVS) and in a minimally conscious state. And while he has his critics, Owen’s work (done in conjunction with a number of other fine researchers) is positively breathtaking in its reach and creativity.

If people in a PVS cannot gesture or speak aloud, how do we know they are “conscious” (a VERY tricky term, by the way) or can “comprehend” (equally tricky)? Back in 1997, Kate Bainbridge, a 26-year old patient had been left in a coma after suffering a viral infection. According to David Cyranoski

“Months after her infection cleared, Bainbridge was diagnosed as being in a vegetative state. Owen had been using positron-emission tomography in healthy people to show that a part of the brain called the fusiform face area (FFA) is activated when people see a familiar face. When the team showed Bainbridge familiar faces and scanned her brain, ‘it lit up like a Christmas tree, especially the FFA’, says Owen. ‘That was the beginning of everything.’ Bainbridge was found to have significant brain function and responded well to rehabilitation. In 2010, still in a wheelchair but otherwise active, she wrote to thank Owen for the brain scan. ‘It scares me to think of what might have happened to me if I had not had mine,’ she wrote. ‘It was like magic, it found me.’”

Critics brushed this off, and “Owen realized that he needed a different experiment to persuade the skeptics.”  Cyranoski explains

“It was June 2006. Wimbledon was on, and in a headline-stealing study, Owen took fMRI [functional magnetic resonance imaging] scans of a 23-year-old woman in a vegetative state while he asked her to imagine playing tennis and walking through the rooms of her house. When healthy, conscious adults imagine playing tennis, they consistently show activation in a region of the motor cortex called the supplementary motor area, and when they think about navigating through a house, they generate activity in the parahippocampal gyrus, right in the centre of the brain. The woman, who had been unresponsive for five months after a traffic accident, had strikingly similar brain activation patterns to healthy volunteers who were imagining these activities, proving, in Owen’s mind, that she was conscious. The result, published in a one-page article in Science5, evoked wonder and disbelief. ‘I got two types of e-mail. People either said ‘this is great’ or ‘how could you possibly say this woman is conscious?’,” Owen says.”

Owen and his colleagues are on a mission to take these tests out of the lab and “put his technique into the hands of clinicians and family members.” Part of that is using an EEG, rather than functional magnetic resonance imaging. An EEG, while less precise, is cheaper, faster, and relatively portable. Another component of the strategy is using a “new ‘EEGeep’, a jeep equipped with experimental equipment that will allow the researchers to travel around to test patients who cannot be transported to Western Ontario.”

Cyranoski writes that each year Owen and his team will be studying 25 people in a “vegetative state,” looking to see if there are additional brain systems (such as smell or taste) “that might be intact and usable for communication.” [“Vegetative” and being in a “persistence vegetative state” are often used interchangeably.]

The numbers are general but there are likely “tens of thousands of people in a vegetative state in the United States alone,” according to Cyranoski.

“Owen reckons that up to 20% of them are capable of communicating; they just don’t have a way to do so. ‘What we’re seeing here is a population of totally locked-in patients,’ Owen says.”

You can read the full story at www.nature.com/news/neuroscience-the-mind-reader-1.10816.

Editor’s note. There is still time to register for the National Right to Life convention June 28-30 and to reserve a hotel room at the Hyatt Regency Crystal City in  Arlington, Virginia. Just go to www.nrlconvention.org.