One-third of vegetative patients may be conscious: study

Kate Lunau
Credit Zeynep M. Saygin, McGovern Institute, MIT
 
Image number B0009489
 
Collection Contemporary images
 
Short Desc. Nerve fibres in a healthy adult human brain, MRI
 
Description of image content Bird's eye (axial) view of nerve fibres in a normal, healthy adult human brain. Brain cells communicate with each other through these nerve fibres, which have been visualised using diffusion weighted magnetic resonance imaging (DWI MRI). Diffusion weighted imaging is a specialised type of MRI scan which measures water diffusion in many directions in order to reconstruct the orientation of the nerve fibres. Since these images are in 3D, colours have been used to represent the direction of the fibres: blue is for fibres travelling up/down, green for front/back, and red for left/right. These patterns of connectivity in the brain are being used to study brain development and developmental disorders such as dyslexia.
 
Technique Magnetic resonance imaging
 
Creation date 2013
 
Supplementary Keywords Mind
Red
Blue
Green
 
Medium of master Digital
 

Imagine being confined to a bed, diagnosed as “vegetative“—the doctors think you’re completely unresponsive and unaware, but they’re wrong. As many as one-third of vegetative patients are misdiagnosed, according to a new study in The Lancet. Using brain imaging techniques, researchers found signs of minimal consciousness in 13 of 42 patients who were considered vegetative. “The consequences are huge,” lead author Dr. Steven Laureys, of the Coma Science Group at the Université de Liège, tells Maclean’s. “These patients have emotions; they may feel pain; studies have shown they have a better outcome [than vegetative patients]. Distinguishing between unconscious, and a little bit conscious, is very important.”

Detecting human consciousness following brain injury remains exceedingly difficult. Vegetative patients are typically diagnosed by a bedside clinical exam, and remain “neglected” in the health care system, Laureys says. Once diagnosed, “they might not be [re-examined] for years. Nobody questions whether or not there could be something more going on.” That’s about to change.

Laureys has collaborated previously with British neuroscientist Adrian Owen, based at Western University in London, Ont., who holds the Canada Excellence Research Chair in Cognitive Neuroscience and Imaging. (Owen’s work was featured in Maclean’s in October 2013.) Together they co-authored a now-famous paper in the journal Science, in 2006, in which a 23-year-old vegetative patient was instructed to either imagine playing tennis, or moving around her house. Using functional magnetic resonance imaging, or fMRI, they saw that the patient was activating two different parts of her brain, just like healthy volunteers did. Laureys and Owen also worked together on a 2010 follow-up study, in the New England Journal of Medicine, where the same technique was used to ask a patient to answer “yes” or “no” to various questions, presenting the stunning possibility that some vegetative patients might be able to communicate.

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In the new Lancet paper, Laureys used two functional brain imaging techniques, fMRI and positron emission tomography (PET), to examine 126 patients with severe brain injury: 41 of them vegetative, four locked-in (a rare condition in which patients are fully conscious and aware, yet completely paralyzed from head-to-toe), and another 81 who were minimally conscious. After finding that 13 of 42 vegetative patients showed brain activity indicating minimal consciousness, they re-examined them a year later. By then, nine of the 13 had improved, and progressed into a minimally conscious state or higher.

The mounting evidence that some vegetative patients are conscious, even minimally so, carries ethical and legal implications. Just last year, Canada’s Supreme Court ruled that doctors couldn’t unilaterally pull the plug on Hassan Rasouli, a man in a vegetative state. This work raises the possibility that one day, some patients may be able to communicate through some kind of brain-machine interface, and maybe even weigh in on their own medical treatment. For now, doctors could make better use of functional brain imaging tests to diagnose these patients, Laureys believes. Kate Bainbridge, who was one of the first vegetative patients examined by Owen, was given a scan that showed her brain lighting up in response to images of her family. Her health later improved. “I can’t say how lucky I was to have the scan,” she said in an email to Maclean’s last year. “[It] really scares me to think what would have happened if I hadn’t had it.”

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If I was to talk about grief, people would nod and understand and sympathize, but loneliness is just this horrible word still. \- Marci O'Connor When she was finally ready to reach out, O'Connor says many of her friendships had disappeared, That's when she started working hard to find ways to fight her feelings of loneliness. She joined a gym and signed up for group fitness classes rather than hiking by herself as she used to. She started taking her dog to an off-leash dog park where she could mingle with other dog owners, rather than going for long walks alone. She also turned to therapy. She says talking with someone about how she was feeling changed how she thought about loneliness. "We're not used to talking about it," O'Connor says. "We're not used to using that word and if you do there is a stigma … if I was to talk about grief people would nod and understand and sympathize, but loneliness is just this horrible word still." O'Connor has now learned to allow her loneliness to guide her to new possibilities. Last year, she even applied to the navy in an attempt to find a community she could call her own. Though she ultimately didn't make the cut, she says the experience pushed her out of her comfort zone and showed her that she can use her emotions as a motivator to improve her life. "I can't change the loneliness, but the choice I have is just to sort of breathe and accept it and say 'OK, what can I do now — it's there, what can I do now?" Melvina Alderson Loneliness does not discriminate by age. Researchers have shown it affects people in all demographics. However, recent census data shows 25 per cent of seniors live alone, and loneliness does hit this demographic particularly hard. In seniors, loneliness has been linked to dementia, social isolation and a shortened lifespan. Melvina Alderson, 73, lives alone in Brampton, Ont. She has family nearby, but often spends her days alone and finds the silence so difficult that she works hard to mask it. "I'll turn music on. I usually have music on all the time," she says. "It's like you're not alone, because you've got voices and singing and it's one of the best ways to get rid of depression." In addition to having music blaring in her one-bedroom apartment practically around the clock, Alderson also goes to great lengths to ensure that she's rarely alone. She volunteers for her local legion branch several times a week and helps with things like staffing the branch's poppy stand at the mall near her home, putting in eight hour days in the weeks leading up to Remembrance Day. "Oh, the busier I am the better I am, and the happier I am, because I'm not sitting around doing nothing," she explains. Sometimes it feels like no one cares, but when I feel that way it's time to pull up my socks and go and do something where someone appreciates what I'm doing. \- Melvina Alderson On the days Alderson isn't volunteering for the legion, she runs the food bank program at her building, sorting through dozens of pounds of food donated through The Knight's Table and doling it out to residents who need it. Alderson also signed up for a program called Keeping Connected that pairs volunteers with seniors for weekly check-in phone calls. Alderson gets her calls on Thursday mornings and says they go a long way to helping her cope with being alone. "Every Thursday I look forward to that phone call," she says. "It's a connection, and when you find a connection like that it's great because you're not lonely." Even with all her coping strategies, though, Alderson admits the loneliness doesn't always abate. "It comes in different waves, it's not always all the time," she says. "Sometimes it feels like no one cares, but when I feel that way it's time to pull up my socks and go and do something where someone appreciates what I'm doing. But, yeah, it can be devastating, especially if it's a long period of time or at special times of the year." Angelo Cariati Homestead Public School in Brampton, Ont., prides itself on going further than most schools in making sure its students feel welcome and supported. It's a big school, with more than 800 students and a large immigrant population. It has a newcomers club and a recess buddy program. And it recently made an addition educators hope will help new kids feel less lonely when they arrive. "One of our ideas to help kids was pursuing a friendship bench," says Angelo Cariati, the school's vice-principal. "It's tangible, it's proactive and the children can go there if they need a friend or somebody to talk to." The bench sits in the school's atrium. The idea is that kids who are feeling lonely or upset sit on it, and that act alone is an invitation for someone else to sit down beside them and strike up a conversation. Already, Cariati has heard of several instances where exactly that has happened. One day last month, right before recess, Fifth Grader Sukhkaran Pandher says he sat on the bench — and what happened next was amazing. Within minutes a girl sat down beside him and asked him what was wrong and why he was alone. Pandher was lonely and was also being bullied by an older student. "I didn't tell anyone," he says. "I just kept it to myself." But the bench changed that. "Now there was this girl sitting here and she was nice … I told her everything." It's a good thing that I can have somewhere to share my problems with someone. \- Sukhkaran Pandher Cariati says this incident is exactly why his school pushed so hard to get the bench, a process that included a fundraising initiative. "You couldn't have planned that," he says. "It's a child who instantly felt a connection with what came out of the bench, so now I know as an educator 'wow that's great, we do have a tool there.'" Cariati adds that now he can follow up to make sure Pandher is "going home feeling safe and coming back to school feeling safe." Cariati is well aware of the impact of children feeling lonely at school, including how it leads to low self esteem and children taking fewer risks. He says his school is committed to making sure issues like these get dealt with head-on. For his part, Pandher says he now feels he has somewhere to turn to that he didn't before. "It's really nice, and it's a good thing that I can have somewhere to share my problems with someone," he says. More from CBC Watch The National's story on the health effects of loneliness and how people are learning to manage it:

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    New military helicopters join HMCS Toronto as it departs on six-month tour

    CH-148 Cyclone Helicopters embark on their second operational deployment ever as part of HMCS Toronto's six-month mission. Jeremy Keefe reports.

  • 'Our loss can't mean nothing': Mother of Humboldt Broncos therapist pleads for mandatory semi driver training
    News
    CBC

    'Our loss can't mean nothing': Mother of Humboldt Broncos therapist pleads for mandatory semi driver training

    Carol and Lyle Brons say nothing can bring back their daughter, Dayna, who was killed in the Humboldt Broncos bus crash, but that there is something politicians can do for others. Federal and provincial transport ministers are meeting Monday in Montreal. The Brons family is pleading with them to make training mandatory for semi truck drivers. "Our loss can't mean nothing. I mean, it'd be very heartbreaking — as much pain as we're going through now — to think that pain doesn't count for anything," Carol Brons said in an interview with CBC News from her home in Lake Lenore, Sask. Sixteen people were killed and 13 others injured when the Humboldt Broncos bus crashed into a semi trailer in rural Saskatchewan last April. Jaskirat Singh Sidhu, the driver of the semi, has pleaded guilty to 16 counts of dangerous driving causing death and 13 of dangerous driving causing bodily harm. Sidhu was not drinking, texting or speeding, but admits he ran through a stop sign at up to 96 km/h according to documents. At the moment, only Ontario requires semi drivers to take a training course. Alberta and Saskatchewan are bringing in similar rules in the spring. Farmers will be exempt in Saskatchewan as long as they don't leave the province. Critics say progress is being made, but that the changes are also creating an inconsistent "patchwork" of rules across the country. They say it makes no sense because semi drivers regularly cross provincial borders. Lyle Brons has worked as a semi driver. He said he took a training course and was mentored by older drivers in his company. He said that's not always the case and he can't believe there are still no requirements for training. "You can read a book, write a couple of multiple-choice tests and take a road test and get your licence and be on the road driving a 144,000-pound truck in a matter of days," he said. The Brons family supports a petition demanding national mandatory training. It was started by an Alberta woman, Patti Babij, whose husband was killed in a crash with a semi. Carol Brons said the petition has more than 1,200 names and has been endorsed by Kelly Block, MP for Humboldt, Sask. She said she knows some people oppose government regulation or worry about the cost of a semi driver-training program. She said those should not be the main concerns. "Of course it's going to cost money, but they can trade places with me any day. I don't think they'd give up a child," she said. "Nobody would trade places with any of us. To put a price tag on that is very disheartening." Federal Transport Minister Marc Garneau's office has said mandatory training is a good idea, but wouldn't say whether the federal government will take over. Academics have noted provinces currently set the rules, but said the federal government has the power to intervene and set national standards. Joe Hargrave, Minister of Saskatchewan Government Insurance, said he's optimistic semi driver training will soon be mandatory in every province. He expects everyone to reach a consensus in Montreal. "I know all the provinces are looking at it," Hargrave said. "I expect to see it across the country in a very short time anyway, without the federal government mandating it."

  • Busting myths and embracing newcomers: New project aims to make N.L. more welcoming
    News
    CBC

    Busting myths and embracing newcomers: New project aims to make N.L. more welcoming

    People from Newfoundland and Labrador are known as a friendly bunch, but a new pilot project wants communities to take their welcoming skills to a whole other level. In some cases, the first step is correcting locals' misconceptions on immigration, says the project's co-ordinator in Corner Brook. "One of my favourite myths to bust is that newcomers are stealing jobs from Canadians, and that's just not the case.

  • A life of firsts: Ernest Tucker, trailblazing Montreal journalist, dead at 87
    News
    CBC

    A life of firsts: Ernest Tucker, trailblazing Montreal journalist, dead at 87

    When Ernest Tucker graduated from Toronto's Ryerson Institute of Technology in 1954, he took the long bus ride north to Sudbury, Ont., to be interviewed for a job as a reporter. It was the Bermudian native's first experience with racism in Canada. "He had been bouncing back and forth between Canada and Bermuda in the 50s because he wasn't able to get hired in Canada, at first, as a journalist," Brian Daly, a CBC News TV producer in Halifax and a former student of Tucker's, recalls his mentor telling him.