Functional MRI enables communication for patients in a vegetative state

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A man who had been thought to be in a vegetative state for more than a decade was able to answer questions through the use of functional resonance imaging (fMRI), according to investigators at the Brain and Mind Institute at the University of Western Ontario.

According to a Wired.co.uk article, Scott Routley, a 39-year-old Canadian, suffered a severe brain injury 12 years ago. Although his parents had insisted he was able to communicate by lifting his eyebrows or moving his thumb, neurologists who evaluated him said he had a complete lack of awareness.

However, according to Adrian Owen of the Brain and Mind Institute, Routley "has been able to show he has a conscious, thinking mind." Owen said that he and his colleagues have scanned Routley several times, and that his pattern of brain activity shows that he is able to answer simple yes or no questions.

Owen's technique involves asking a patient questions while actively scanning using fMRI. By watching blood flow patterns in the brain in real time, his team tracked changes and developed codes for asking questions and receiving responses.

For example, healthy subjects might be asked to imagine different scenarios that would allow them to exhibit activity in certain areas of the brain, and consequently represent yes or no responses to questions. Owen and his colleagues used these scenarios with patients in vegetative states to see whether their brain activity would respond in the same manner. A study showed that one in five patients in a vegetative state could use brain function to communicate.

In Routley's case, he was able to tell doctors that he was free of pain. And he is not the only patient involved in the research. One other patient thought to be in a vegetative state was able to communicate that he knew his sister had given birth to a daughter, even though that event occurred five years after his injury.

"We can use this type of technology to ask [the patients in a vegetative state] what sort of entertainment they want to be exposed to," Owen told the Calgary Herald. "Do they want to watch TV or do they want to listen to music? What type of music? What time would they like to be fed ... activities of daily living which are entirely under the control of these people around them, the people caring for them. We can now ask the patients about these things and give them a role in the decision making that governs their life."

The research also could change the way end-of-life decisions are made, according to Kerry Bowman, a bioethicist at the University of Toronto's Joint Center for Bioethics, who spoke with the Toronto Star.

For more information:
- read the article in Wired.co.uk
- see the article in the Calgary Herald
- read the article in the Toronto Star

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