Posted on 02/08/2005 2:23:11 AM PST by LibWhacker
Thousands of brain-damaged people who are treated as if they are almost completely unaware may in fact hear and register what is going on around them but be unable to respond, a new brain-imaging study suggests.
The findings, if repeated in follow-up experiments, could have sweeping implications for how to care best for these patients. Some experts said the study, which appeared yesterday in the journal Neurology, could also have consequences for legal cases in which parties dispute the mental state of an unresponsive patient.
The research showed that the brain-imaging technology, magnetic resonance imaging, can be a powerful tool to help doctors and family members determine whether a person has lost all awareness or is still somewhat mentally engaged, experts said.
"This study gave me goose bumps, because it shows this possibility of this profound isolation, that these people are there, that they've been there all along, even though we've been treating them as if they're not," said Dr. Joseph Fins, chief of the medical ethics division of New York Presbyterian Hospital-Weill Cornell Medical Center. Dr. Fins was not involved in the study but collaborates with its authors on other projects.
Other experts warned that the new research was more suggestive than conclusive, and that it did not mean that unresponsive people with brain damage were more likely to recover or that treatment was yet possible.
But they said the study did open a window on a world that has been neglected by medical inquiry. "This is an extremely important work, for that reason alone," said Dr. James Bernat, a professor of neurology at Dartmouth.
Dr. Bernat said findings from studies like these would be relevant to cases like that of Terri Schiavo, a Florida woman with brain damage who has been kept alive for years against her husband's wishes. In that case, which drew the attention of Gov. Jeb Bush and the Legislature, relatives of Ms. Schiavo disagreed about her condition, and a brain-imaging test - once it has been standardized - could help determine whether brain damage has extinguished awareness.
The patients in question have significant brain damage. Three million to six million Americans live with the consequences of serious brain injuries, neurologists said. An estimated 100,000 to 300,000 of them are in what is called a minimally conscious state: they are bedridden, cannot communicate and are unable to feed or care for themselves, but they typically breathe on their own.
They may occasionally react to instructions to blink their eyes or even reach for a glass, although such responses are unpredictable. By observing behavior in a bedside examination, neurologists can determine whether a person is minimally conscious or in a "persistent vegetative state" - without awareness, and almost certain not to recover.
In the study, a team of neuroscientists in New York, New Jersey and Washington, D.C., used imaging technology to compare brain activity in two young men determined to be minimally conscious with that of seven healthy men and women. In a measure of overall brain activity, the two groups were vastly different: the two minimally conscious men showed less than half the activity of the others.
But the researchers also recorded an audiotape for each of the nine subjects in which a relative or loved one reminisced, telling familiar stories and recalling shared experiences. In each of the brain-damaged patients, the sound of the voice prompted a pattern of brain activity similar to that of the healthy participants.
"We assumed we would get some minimal response in these patients, but nothing like this," said Dr. Nicholas Schiff, an assistant professor of neurology and neuroscience at Weill Cornell Medical College in Manhattan and the study's lead author. The two men showed near-normal patterns in the language-processing areas of their brains, Dr. Schiff said, suggesting that some neural networks "could be perfectly preserved under some conditions."
Although the number of patients studied was very small, the specificity and intricacy of the patterns made it all but impossible that the results were a fluke, said Dr. Joy Hirsch, director of the Functional MRI Research Center at Columbia University Medical Center and the study's senior author.
One of the two minimally conscious men lay still in a brain-imaging machine while his sister recounted his toast at her wedding and recalled times playing together as children. Although his eyes were closed, the researchers found that visual areas of his brain were active, suggesting that he might have been producing images, Dr. Hirsch said.
"We do not know for sure what is happening in this man's head, but if he were imagining things at the sound of his sister's voice, that would suggest some connection to emotion," Dr. Hirsch said.
Since the study was completed, Dr. Hirsch said, the team has run the same kinds of tests on seven similar brain-injury patients, with similar results: the language processing networks in their brains display seemingly normal patterns upon their hearing the voice of a loved one. The government has provided financing for the team to conduct a larger study of mental activity in minimally conscious people.
A better understanding of brain patterns in minimally conscious patients should also help cut down on misdiagnosis by doctors, Dr. Fins said. He said one study had found that as many as 30 percent of patients identified as being unaware, in a persistently vegetative state, were not. They were minimally conscious.
Moreover, mental states can change over time, and some patients have almost completely recovered function after being thought vegetative. Brain imaging would be one way to track these changes, and even link them to efforts at treatment. Doctors have no cure for either a minimally conscious or persistently vegetative state.
"The most consequential thing about this is that we have opened a door, we have found an objective voice for these patients, which tells us they have some cognitive ability in a way they cannot tell us themselves," Dr. Hirsch said. The patients are, she added, "more human than we imagined in the past, and it is unconscionable not to aggressively pursue research efforts to evaluate them and develop therapeutic techniques."
Glad to have the opportunity to meet you here, muddypaws.
Interesting. Guess an apology just doesn't wash on these threads. Sheesh, I am only human you know.
Not to worry. From here out, I will stick to the science threads and you can keep these threads pristine for only the folks who agree with you. (I should have known better)
You have my deepest apologies for intruding on your private little part of FR. I wont be back.
Well said.
Apology accepted.
The Terri threads are not a private little part of FR. You are welcome here anytime, although it may not always appear that way.
My sincerest apologies to those of you who don't feel welcome. I'd much rather that we not bicker back and forth. I find it unproductive. If we are all for Terri then we shouldn't be arguing about little miscommunications.
Please reconsider your decision to not participate in the discussion of ideas.
That's what they're calling ethics these days. It's a little on the arrogant side of things.
You're a good person, Ohio, and I thank you for speaking up.
If more of the reasonable ones would, it would be helpful. I sure could have used it a few days ago. lol
When others sit quietly by, or worse, jump on our cases for defending ourselves... Yeah, it's hard to feel welcome.
Sure thing!!
No need to apologize and I'm sorry for anything I said that was wrong.
I also want to apologize for not speaking up on other threads you've been on. Most people who support Terri at one time or another had felt that what they were told by the MSM was accurate, but when you dig into the documents, you realize that there's so much going on here that is unscrupulous. I admit that sometimes I get busy just trying to keep the ping list notified, and that I don't always participate in the discussion going on.
Thank you. I am sorry my post was taken wrong. :-(
Telling me I would not be missed kinda hurt. I try to do the right thing but sometimes I fall short.
You all have a wonderful day and it is nice (and I truly mean this) to meet you all.
sincerely,
RA
Thanks/Bump
We all do.
You do a great job! I appreciate your work on our behalf (and Terri's behalf).
Brain-Damaged People Show Signs of Awareness: Study
http://www.healthscout.com/news/1/1505724/main.html
Consciousness and the Culture Wars, Part Three
http://www.corante.com/loom/archives/consciousness_and_the_culture_wars_part_three.php
Thanks for the ping to these!
FOR LOCAL AND NON-LOCAL (GLOBAL) DISTRIBUTION:
Here is the Terri Schindler-Schiavo Life Ribbon Desktop Logo with instructions on how to get it on your screen. Also contains an exhortation to the Florida House Representatives and Senators of the FL Senate as well as contact numbers of officials to call, including links to The Empire Journal, terrisfight.org and Free Republic, etc.:
http://www.enlightenment-engine.net/eeng/ribbon/terriliferibbondesktoplogo.zip
Here is a flyer for Terri that can be printed out and distributed:
http://www.enlightenment-engine.net/eeng/ribbon/terriflyer.pdf
Here is html code if you have a webpage and would like to participate in the Terri Schindler-Schiavo Life Ribbon Campaign besides the above of having a Terri Life Ribbon on your own computer:
Copy and paste the following text into your HTML web page code where you want the Terri Schindler Life Ribbon banner to appear:
Terri Schindler-Schiavo Life Ribbon Campaign:
Google -> Life Ribbon
or:
http://bellsouthpwp.net/p/c/pc93/terri_schindler_life_ribbon_campaign.htm
Juan V Schoch - Lake Mary, FL
Concerned Florida Resident / United States Citizen who believes Terri should be provided protection, removed from out of the hands of those trying to kill her via substituted (hearsay) wishes, and who believes she should be placed back on the road to her recovery via rehabilitation and therapy, etc. as well as into the hands of her loved ones, etc.
http://www.freerepublic.com/focus/f-news/1333205/posts
Florida House Could Impeach Schiavo Judge
http://www.freerepublic.com/focus/f-news/1342344/posts?page=1#1
I copied that and sent it out to over 300 personal email contacts that I have...thank you for posting it!
Bump and ping!
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