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Biotech Medicine

"Vegetative State" Patients Can Communicate 347

Posted by samzenpus
from the hello-in-there dept.
Kittenman writes "The BBC is carrying a story about researchers in the UK and Belgium who can detect the thinking processes within a patient previously thought to be in a vegetative state. The researchers ask the patient verbally to think in certain ways to indicate a 'yes', in other ways to indicate a 'no' — and have successfully communicated with 4 out of 23 patients previously thought to be in a coma."
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"Vegetative State" Patients Can Communicate

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  • by Anonymous Coward on Thursday February 04, 2010 @12:02PM (#31023116)
    As a life-long vegetarian, I'm horrified with the idea of being able to communicate with my... oh wait.
  • by Anonymous Coward on Thursday February 04, 2010 @12:03PM (#31023118)

    Us vegetative types have been doing that for years on World of Warcraft.

    • Re: (Score:3, Funny)

      by cayenne8 (626475)
      "Us vegetative types have been doing that for years on World of Warcraft."

      Hell, I was thinking more along terms of my current management.

  • by Tim C (15259) on Thursday February 04, 2010 @12:03PM (#31023130)

    From TFA:

    "Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage. "

    • Re: (Score:3, Informative)

      by b0bby (201198)

      The WSJ gave more details:
      "Researchers at two centers, in England and Belgium, used functional magnetic resonance imaging (MRI) tests on 54 patients with severe brain injury. Of these patients, 31 were diagnosed as being in a minimally conscious state, meaning they showed intermittent signs of awareness such as laughing or crying. The other 23 were diagnosed as being in a vegetative state, meaning they were considered unresponsive and unaware of their surroundings."

      http://online.wsj.com/article/SB1000142405 [wsj.com]

  • Confusion of terms (Score:5, Insightful)

    by Compholio (770966) on Thursday February 04, 2010 @12:05PM (#31023150)

    ... and have successfully communicated with 4 out of 23 patients previously thought to be in a coma.

    A vegetative state is by definition where there is no detectable awareness. You could legitimately say that they were "previously thought to be in a vegetative state," but if you detect awareness then they are in a coma.

  • Terrible fear (Score:3, Insightful)

    by Thyamine (531612) <.thyamine. .at. .ofdragons.com.> on Thursday February 04, 2010 @12:06PM (#31023170) Homepage Journal
    This is one of those terrible fears. It's great that they have found a way to communicate with someone in this state, but at the same time this type of story makes me ponder how horrific that must be for the person.
    • by delinear (991444)
      Well it could help with the recovery process, if having their friends and family support them aids the recovery process then it would be a big morale boost to those people to know their messages are getting through. It must be easy for the family of patients in such a state to get disheartened and give up hope. It's only a small crumb of comfort but it's better than we've been able to offer so far.
    • This is one of those terrible fears. It's great that they have found a way to communicate with someone in this state, but at the same time this type of story makes me ponder how horrific that must be for the person.

      Practice those lucid dreams.

    • by machine321 (458769) on Thursday February 04, 2010 @12:45PM (#31023686)

      Especially if a land mine has taken your sight, taken your speech, taken your hearing, taken your arms, taken your legs, taken your soul, and left you with life in hell.

    • Yeah, straight out of World War 1, and Johnny Got His Gun [wikipedia.org]

  • Great! (Score:5, Insightful)

    by Itninja (937614) on Thursday February 04, 2010 @12:06PM (#31023172) Homepage
    So all they have to do is live in an MRI machine for the rest of their lives and they can communicate. Problem solved!
  • have successfully communicated with 4 out of 23 patients previously thought to be in a coma.

    That's actually a better return than I get on security surveys sent to faculty...

    • Re: (Score:2, Insightful)

      by stubob (204064)

      Not to mention replies to résumés.

    • by mcgrew (92797) *

      If you're only sending out 23 surveys you need to take a remedial statistics course. And actually an almost 25% return rate is very good for any survey. Most folks are lucky to get a 10% return.

      • by IndustrialComplex (975015) on Thursday February 04, 2010 @12:32PM (#31023520)

        If you're only sending out 23 surveys you need to take a remedial statistics course. And actually an almost 25% return rate is very good for any survey. Most folks are lucky to get a 10% return.

        What if you only have 23 faculty members?

        Damn, you know last night I asked my wife how her day was. What a fool I was. How could I ever get valid results with such a small sample pool.

        • by mcgrew (92797) *

          Asking your wife how her day was was hardly a sample. If there are onlt 23 faculty members, why do you even need a survey?

      • by daenris (892027)
        OP never said there were only 23 surveys sent out, he just said that 4 out of 23 was a better return rate. Maybe there were 230 surveys sent out and less than 40 were returned, just as an example. Also, just over 17% isn't really "almost 25%."
    • by delinear (991444)
      I wonder though if they chose patients who had a higher chance of responding to the measurement. I haven't RTFA (hey, this is /.) so I don't know if this is even possible, if statistically they can say patients who entered their current state due to a particular type of accident or illness have shown the best chance of eventually responding to stimuli so we'll try patients in this group first, or if it was just totally random. If it was the former, that might conceivably skew the results more favourably - I
    • IIRC, 30 is considered the threshold amount of data samples to be comsidered statistically valid for a normal population. Lower than that allows results to quickly skewed by only 1 or 2 data points. One other point that was drummed home in Graduate Stats class was that many doctors don't know statistics and those that do many times cherry pick patients and/or filter the data so its skwed to the desirable result. In other words they are not impartial and let the data say what the results are for many reason
  • False Positive (Score:3, Insightful)

    by BrotherBeal (1100283) on Thursday February 04, 2010 @12:08PM (#31023214)
    I'm not a neuroscientist, but it seems to me that 4 out of 23 is a pretty low success rate, especially given the kind of indirection the researchers were resorting to in order to elicit the signals they were looking for. How do we know, for example, that a patient doesn't have some kind of spurious activity in the brain area they're using to signal "A"? For that matter, how can we distinguish between "no answer" and a deliberate "B" in the absence of such activity? How can we assume that the patient, who by definition has brain damage, is capable of understanding the question correctly and answering correctly? I agree, this is better than absolutely no communication, but I'm curious how they intend to control for factors like these.
    • Re:False Positive (Score:5, Informative)

      by MaXintosh (159753) on Thursday February 04, 2010 @12:17PM (#31023330)
      The problem of improper controls and false positives is really serious with these fMRI studies. It can be summed up in three words, really: Thinking dead salmon. [wired.com]
    • Re: (Score:3, Insightful)

      by Thiez (1281866)

      > How can we assume that the patient, who by definition has brain damage, is capable of understanding the question correctly and answering correctly?

      That one seems rather easy, you ask them many questions and see how many of the answers make any sense. If a large part of them make sense, it is a reasonable to conclude the patient understood and was able to answer. Of course this would disqualify patients who are able to understand the question but unable to answer, and those who would be able to answer b

    • Re:False Positive (Score:5, Informative)

      by Fnkmaster (89084) on Thursday February 04, 2010 @12:31PM (#31023496)

      I don't think they addressed the "no answer" vs. "B", however, they did assess the patients' ability to answer a series of factual questions about the patient's life prior to whatever put them where they were - I think that pretty much shows that there is something non-spurious being measured here and it's not just the dead salmon fMRI effect as another reply suggested - the probability of random readings matching up with the correct answers to a series of such questions seems very minute.

      And 4 out of 23 is not a success rate - it's a misdiagnosis rate! Nobody in their right mind is claiming that *all* patients in persistent vegetative states have meaningful cognition occurring (except the EXTREMELY inaccurate and misleading Slashdot article title). Rather, some patients who failed the standard tests to assess consciousness levels are perhaps more conscious than was previously detectable.

      • That's a good point about this being a misdiagnosis rate - I hadn't thought of it from that angle. Even though I read the article, that point still wasn't terribly clear, so thanks for bringing it up. It's still not clear to me, though, how the spurious brain activity can be ruled out based on what the article described. Yes, you're right - asking a series of ?'s can be much less subject to random bias than asking a ? in isolation. However, is it possible for said spurious brain activity to occur for a lon
        • Re: (Score:3, Informative)

          Just ask a long enough series of questions, randomize them so that you aren't asking them in a way to expect any sort of pattern in the responses.

          Is your name John Smith? Expect yes
          Did you attend wrong school name? Expect no
          Did you get married?
          Did you have any children?
          Did you have 1 child
          Did you have 2 children.
          Was your mother's name...

          And so on.

          You can look into the rate at which your 'yes' or 'no' indicators happen. If it is him moving his thumb, when not being asked questions, or when being stimulate

        • Re:False Positive (Score:4, Informative)

          by daenris (892027) on Thursday February 04, 2010 @01:17PM (#31024060)
          Yes responses were indicated by one type of mental imagery, no responses by another, so yes and no were both distinguishable from "no answer."

          The scanning was done in a fashion that is typical of fMRI studies in that an active condition was alternated with a rest condition. In fMRI it's essentially impossible to get a meaningful activation without contrasting two different conditions, in this case Answer with Relax, so the "activation" that is measured is a comparison between the answer and relax conditions. If a subject just had continuous spurious activation in the target brain region: 1) it wouldn't have been identified in the localizer task (described briefly below) and 2) it wouldn't show up as a differential activation between the Answer and Relax periods.

          The subjects first underwent a "localizer" task to determine what particular region of the motor cortex to use for their responses. They alternated periods of mental imagery (imagining playing tennis, and imagining navigating through a familiar city) with relax. This identified the regions that would later be used to indicate Yes or No responses (one type of imagery for yes, the other for no).
    • With one patient - a Belgian man injured in a traffic accident seven years ago - they asked a series of questions.

      He was able to communicate "yes" and "no" using just his thoughts.

      The team told him to use "motor" imagery like a tennis match to indicate "yes" and "spatial" imagery like thinking about roaming the streets for a "no".

      The patient responded accurately to five out of six autobiographical questions posed by the scientists.

      For example, he confirmed that his father's name was Alexander.

  • by leuk_he (194174) on Thursday February 04, 2010 @12:09PM (#31023222) Homepage Journal

    This is not really surprising if you are aware what a real coma is. There is a lot of states between fully consciousness and complete unconsciousness. In movies, and in soaps you switch between those states in a surprise wake-up. In reality this is much more complex.

    Anyway, better diagnosis is needed to prevent accidents like Brain scan finds man was not in a coma--23 years later [cnet.com] and other possible improvements in brain damage treatment.

  • Euthanasia (Score:5, Insightful)

    by Thiez (1281866) on Thursday February 04, 2010 @12:11PM (#31023252)

    > It does raise many ethical issues - for example - it is lawful to allow patients in a permanent vegetative state to die by withdrawing all treatment, but if a patient showed they could respond it would not be, even if they made it clear that was what they wanted.

    It seems kinda silly that you're only allowed to die when you're unable to make that decision. To me it seems cruel to keep someone alive in a vegetative state just because they have enough of their conciousness left to want to end it. Yay for legalized euthanasia in the Netherlands.

    • Re:Euthanasia (Score:5, Insightful)

      by Xelios (822510) on Thursday February 04, 2010 @12:21PM (#31023376)
      Relative: "Oh, I just don't know what he would want! I can't make this decision for him..."
      Doctor: "Well, thanks to recent breakthroughs we may be able to ask him directly. Lets just get him into this MRI..."
      Doctor: "The results are clear, we were able to communicate with him and he was very adamant about stopping all treatment. He clearly does not want to live out his remaining days in this state, and I don't think anyone could blame him for that."
      Relative: "If that's his wish then yes, lets stop all treatment."
      Doctor: "I'm sorry m'aam, but that's no longer an option..."

      It may have been funny if it weren't so sad...
    • Re: (Score:3, Insightful)

      by MrNemesis (587188)

      Hopefully this'll be available outside of the UK but this is Terry Pratchett giving a lecture on his Alzheimers and legalised euthanasia from a few days ago: http://www.bbc.co.uk/programmes/b00qmfgn [bbc.co.uk]. Guardian article covering the same subject here http://www.guardian.co.uk/society/2010/feb/02/terry-pratchett-assisted-suicide-tribunal [guardian.co.uk]

      Pratchett has done alot to provoke intelligent debate on assisted suicide and related matters, thankfully without much in the way of people shouting him down - I'm a firm believ

      • Re: (Score:3, Funny)

        by bareman (60518)

        I think we've come full circle

        "for the last five years of my life, forgotten by and an embarrassment to my friends and family is my idea of hell."

        back to the World of Warcraft player.

    • Re: (Score:3, Insightful)

      I've actually never understood this attitude about wanting to end everything. Yeah, granted, life would suck compared to what it could have been, but on the other hand, if you die, you are GONE FOREVER. There is nothing on the other side. You simply cease to exist, and it's as if you had never existed. All your consciousness is gone.

      I can see wanting to check out if you're in constant pain and will never recover, but if you have your thoughts, you can at least think and have some hope of someday recovering.

  • by codewarren (927270) on Thursday February 04, 2010 @12:12PM (#31023262)

    "Eat me, I'm nutritious."

    • by Chris Burke (6130)

      I thought they'd say "Aaah! Aaah! Put me back in the grooooound!"

    • You know, your joke got me to thinking... what if they hooked this up to some vegetables on someone's plate and the vegetables responded "don't eat us!". Would this cause the creation of PETV [thebigjewel.com]? On the bright side, its members probably wouldn't last long without food...
    • Soylent Green is PEOPLE!!

  • On one hand, this would be very scary, if one were locked in like that, unable to speak, move, and thought to be in a vegetative state. TFA does a great job drumming up that fear in the readers.

    On the other hand, fMRI studies also find dead salmon do a lot of thinking [wired.com]. The whole fMRI field suffers from what we'll generously call "Statistical Issues," and until we get better handle on it, I'm going to remain somewhat dubious about fMRI studies that claim to be able to detect this or that. 4/27 is not a stel
  • Take a closer look (Score:5, Insightful)

    by ZuchinniOne (1617763) on Thursday February 04, 2010 @12:15PM (#31023310)

    5 of 54 patients who underwent this procedure. Showed a possible response.

    3 of those 5 it turned out showed awareness to normal stimuli and were either mislabeled by doctors, or their condition changed.

    So basically that leaves 2 patients out of 51 seeming to "be able to modulate their brain activity". And only ONE of those was able to "correctly answer 5 of 6 yes/no questions"

    This could be legit, but there is also PLENTY of room for statistical chance to have created this "result".

    The bottom line is that too much of a big deal is being made out of a tiny kernel of good data in a mountain of null results.

    • 3 of those 5 it turned out showed awareness to normal stimuli and were either mislabeled by doctors, or their condition changed.

      That's scary. I'm glad they underwent this procedure which in turn showed they actually were aware to normal stimuli.

  • My first thought on reading the slashdot summary was "Not this again..." because there was a recent Belgian case of a man who was supposedly in a coma for 20+ years and was now communicating with the help of a woman. And it was total bull.

    This does appear to be something different, though I imagine it may get confused with the known pseudoscience of facilitated communication.

  • by kungfugleek (1314949) on Thursday February 04, 2010 @12:32PM (#31023508)
    Zap: "Is your name 'Fry'?"
    Fry: "BEEP!"
    Zap: "'Yes.' Ok. And, are you guilty!?"
    Fry: "BEEP! BEEP!"
    Zap: "Double 'Yes'!"

    Sorry -- too lazy to dig for the exact quote.

    • Re: (Score:3, Informative)

      by lorg (578246)

      Not to ruin the funny but I was horribly bored so here goes ...

      ZAP: Philip J. Fry, you stand accused of travelling to the forbidden planet Omega 3. A crime punishable by 12 concurrent death sentences. Do you understand the charges?
      KIF; One beep for yes, two beeps for no.
      FRY: *BEEP*
      ZAP: Yes. So noted. You pleed guilty?
      FRY: *BEEP* *BEEP*
      ZAP: Double Yes. Guilty. I will now carry out the sentence ...

      It's the first minute and a half or so from the episode "Where no fan has gone before" if someone is wondering.

  • fMRI is not perfect (Score:5, Interesting)

    by bitslinger_42 (598584) on Thursday February 04, 2010 @12:32PM (#31023516)

    If you haven't check out this study [wired.com] publicized in Wired, where they detected human emotion activity in the brain of a salmon. A dead salmon.

    Just because the fMRI shows some colors, that doesn't necessarily mean that there's really cognition going on. It could just be false detections from imperfect scanning, or it could be scientists seeing patterns in data that don't really exist, or it could be the result of our imperfect understanding of how the brain works, or a whole slew of other things.

    This is made worse by things like the Houben case [sciencebasedmedicine.org], which used Facilitated Communication to "prove" that Houben had an intact consciousness. FC hasn't passed any rigorous scientific study (i.e. blind tests to prevent the facilitator's motivations/desires from modifying the results), but stories like Houben cause those with loved ones with sever brain damage in PVS to start clamoring that there may still be hope. James Randi has written about FC [randi.org], and the Houben case in particular.

    • "It could just be false detections from imperfect scanning," fMRI is attuned to blood oxygen levels. The study doesn't really say any anything except "hey guys, remember that fMRI doesn't actually image neuron firings but increased oxygenated blood flow."
  • by peter303 (12292) on Thursday February 04, 2010 @12:35PM (#31023552)
    The book was about a WWI soldier who lost all four limbs, blind, deaf, and mute, yet still awake. The medical people thought his twitching was just instinct. Then someone realizes his head banging is Morse code. The story is from the patient's perspective. It resurfaces as an ant-war book periodically.
  • FTA: The team told him to use "motor" imagery like a tennis match to indicate "yes" and "spatial" imagery like thinking about roaming the streets for a "no".

    I've done a little bit of research in the area of spatial vs motor visualization. I think they could have chosen a better discriminator for the "spatial" task - it could be that the physical act of "wandering the streets" could be confounded with "playing tennis". There are many more tasks that I believe would have tapped into a more pure mea

  • I wonder if they expanded the fMRI to review what happens when other questions are posed. My brother-in-law has been in a "vegetative state" for 20+ years, since he smashed his car into a tree. I'd be curious to know what he thinks about things.

    OTOH, is a vegetative state someone with consciousness or simply brain injured enough not to be able to respond?
  • prot's been telling us that for years.

  • Try:

    http://www.sciencebasedmedicine.org/?p=3122 [sciencebasedmedicine.org]

    for a critical point of view.

  • One day I thought, "What if one day Steven Hawking had the most blinding insightful revelation anyone has ever had, but it was just after all his muscle control was lost?"

    So I wrote this. (Disclaimer: No physicists were actually harmed in the writing of this play.)

    http://www.scribd.com/doc/19550880/GUT-The-Grand-Unified-Theory-A-oneact-play-with-seven-blackouts [scribd.com]

  • Some patients, appearing to be in a vegetative state, are in fact capable of a form of communication.

A CONS is an object which cares. -- Bernie Greenberg.

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