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Tue Nov 13, 2012, 11:49 PM

Vegetative man tells doctors ĎIím not in painí via MRI communication

Yikes!

More than 12 years after a car accident left him in a vegetative state, a Canadian man has begun communicating with doctors who are monitoring his brain activity through Functional Magnetic Resonance Imaging (fMRI) scans.

The BBC reports that 39-year-old Scott Routley has been able to communicate to doctors that he is not in any pain, marking the first time an uncommunicative, severely brain-damaged patient has been able to give direct answers regarding their care and treatment.

"Scott has been able to show he has a conscious, thinking mind," British neuroscientist Adrian Owen told the BBC. "We have scanned him several times and his pattern of brain activity shows he is clearly choosing to answer our questions. We believe he knows who and where he is."

Owen leads a team at the Brain and Mind Institute, University of Western Ontario, which used MRI scans to measure responses from Routley.

Traditional tests have continued to indicate that Routley is in a vegetative state, with no relevant brain activity. Owen and other doctors say this means medical text books will literally need to be re-written when it comes to evaluating patients suffering from severe brain injuries.

http://news.yahoo.com/blogs/sideshow/vegetative-man-tells-doctors-m-not-pain-via-020801923.html

40 replies, 4056 views

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Reply Vegetative man tells doctors ĎIím not in painí via MRI communication (Original post)
flamingdem Nov 2012 OP
limpyhobbler Nov 2012 #1
ThoughtCriminal Nov 2012 #2
slackmaster Nov 2012 #36
BlueStreak Nov 2012 #3
UnrepentantLiberal Nov 2012 #5
The Magistrate Nov 2012 #4
UnrepentantLiberal Nov 2012 #6
markpkessinger Nov 2012 #7
JimDandy Nov 2012 #20
cthulu2016 Nov 2012 #8
Care Acutely Nov 2012 #15
BlueMan Votes Nov 2012 #9
flamingdem Nov 2012 #11
BouzoukiKing Nov 2012 #10
flamingdem Nov 2012 #12
BouzoukiKing Nov 2012 #14
babydollhead Nov 2012 #32
davidn3600 Nov 2012 #21
Dash87 Nov 2012 #39
TexasBushwhacker Nov 2012 #13
cthulu2016 Nov 2012 #16
Care Acutely Nov 2012 #22
Whovian Nov 2012 #17
flamingdem Nov 2012 #19
yonder Nov 2012 #23
renate Nov 2012 #25
hollysmom Nov 2012 #30
Skittles Nov 2012 #31
JI7 Nov 2012 #18
Care Acutely Nov 2012 #24
LeftishBrit Nov 2012 #26
longship Nov 2012 #27
cthulu2016 Nov 2012 #28
BlueStreak Nov 2012 #34
longship Nov 2012 #37
DonCoquixote Nov 2012 #29
Shankapotomus Nov 2012 #33
Still Sensible Nov 2012 #35
MiniMe Nov 2012 #38
librechik Nov 2012 #40

Response to flamingdem (Original post)

Tue Nov 13, 2012, 11:50 PM

1. wow.

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 12:03 AM

2. Captain Pike?

beep!

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Response to ThoughtCriminal (Reply #2)

Wed Nov 14, 2012, 10:42 AM

36. BEEP... ...BEEP

 

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 12:04 AM

3. This is not what I expected of a "persistent vegetative state"

When the doctor was talking with him, his eye movement seemed to me to indicate he was paying attention. I would have thought there would be no eye movement at all, or at least least random movements. If I had seen only the video (no audio) and not known the background, I would not have guessed this patient was what they classify as "persistent vegetative state."

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Response to BlueStreak (Reply #3)

Wed Nov 14, 2012, 12:50 AM

5. Sounds like cold fussion.

 

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 12:05 AM

4. This Is Going To Need a Lot Of Checking And Confirmation, Ma'am

The article contains very little information, and none establishing the basis for the claimed results.

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Response to The Magistrate (Reply #4)

Wed Nov 14, 2012, 12:51 AM

6. Yes it will.

 

Is he "frozen" or brain dead?

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Response to UnrepentantLiberal (Reply #6)

Wed Nov 14, 2012, 01:22 AM

7. "Persistent vegetative state" is a grey area -- brain death is not n/t

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Response to The Magistrate (Reply #4)

Wed Nov 14, 2012, 02:04 AM

20. Here are the original sources:

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Response to flamingdem (Original post)


Response to cthulu2016 (Reply #8)

Wed Nov 14, 2012, 01:48 AM

15. Imagining tennis his visual and motor cortices lit up

His ventricles were F'n huge but then again . . .

http://www.reuters.com/article/2007/07/20/us-brain-tiny-idUSN1930510020070720

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 01:29 AM

9. what a horrible thought...

 

having a conscious mind, trapped in a comatose body for 12+ years.

it's the ultimate solitary confinement.

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Response to BlueMan Votes (Reply #9)

Wed Nov 14, 2012, 01:35 AM

11. This story freaks me out

but I was happy to hear it is a Canadian man. They seem kind of accepting of the things life throws in their way.

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 01:35 AM

10. Can one even begin to imagine...

...the iron will and sanity that could survive 12 years locked inside the prison of a solitary skull without any external, or even bodily communication?

Is there sleep? What would you do to pass the time... build crossword puzzles and solve them? Re-create the calculus? Would you scream inside your own head until it got boring?

The mind boggles.

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Response to BouzoukiKing (Reply #10)

Wed Nov 14, 2012, 01:36 AM

12. Exactly. Perhaps this person lives in a kind of haze

but if they can communicate with yes and no they'll be able to answer those concerns. It would be tragic to learn he wants to die. In that sense I hope this story is not real.

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Response to flamingdem (Reply #12)

Wed Nov 14, 2012, 01:46 AM

14. The most terrible not-real story...

... I ever read, was "Johnny Got His Gun", by Dalton Trumbo. It examined pretty much the same thing; but from an anti-war perspective, in the sixties.

If you haven't read it...

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Response to BouzoukiKing (Reply #14)

Wed Nov 14, 2012, 07:37 AM

32. "Johnny Got his Gun" haunts me

it was written in 1938. haunting. I can't even look at the cover of the book.
it was about WW1. but it could be about any war.

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Response to BouzoukiKing (Reply #10)

Wed Nov 14, 2012, 02:10 AM

21. Maybe more in line with a never-ending dream than anything else

Technically the brain isnt supposed to dream during a coma as it is not a normal state of the brain. And cognitive functions are supposedly shut down.

However many people have woken up from long comas and can recall dreams, that family had visited them, and overheard what doctors were saying at times. Others even have weird out of body experiences and "seeing the light" kind of stories.

Obviously a lot more going on in the mind than what we understand or can register on tests. The brain is still not very well understood.

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Response to BouzoukiKing (Reply #10)

Wed Nov 14, 2012, 01:08 PM

39. Since he's comatose, it's probably

Kind of like just being asleep the whole time. I'm guessing just bc the brain reacts, doesn't mean he's locked in some state of consciousness where he knows he's in a coma. Probably depends on what parts of the brain are damaged too.

So basically, sleep would kind of be a moot concept to imagine because it would be like trying to fall asleep while you're already asleep.

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 01:40 AM

13. If he said "I'm in pain" would they tell us? n/t

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Response to TexasBushwhacker (Reply #13)

Wed Nov 14, 2012, 01:50 AM

16. Few seances find the loved one to have ended up in Hell

Funny how that works.

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Response to TexasBushwhacker (Reply #13)

Wed Nov 14, 2012, 02:50 AM

22. did you watch the BBC piece?

let's start there. Did you watch it?

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 01:50 AM

17. Now caring for my mother who has suffered a stroke

 

and cannot communicate with anything other than hand gestures I certainly see this as a very real thing. She's still all there intellectually and cognitively but the signals for communication have been scrambled.

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Response to Whovian (Reply #17)

Wed Nov 14, 2012, 01:56 AM

19. I think there is an "us" that lives beyond the physical

and that is the uncanny aspect of this article, if it's true.

Best of luck to you with your mom, I wish her well in her recovery.

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Response to flamingdem (Reply #19)

Wed Nov 14, 2012, 02:52 AM

23. I came across this the other day, I think on DU:

"You don't have a soul. You have a body. You ARE a soul." or something like that. It seems fitting

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Response to Whovian (Reply #17)

Wed Nov 14, 2012, 03:04 AM

25. oh gosh... that must be so tough on both of you

My very best wishes for her recovery. Thank goodness she can at least communicate via hand gestures, but what a painful thing to have happened, for both of you.

I'm glad she has someone like you to care for her and to ask her what she wants so she still has some control over her environment. From everything I've read about psychology, having some control is absolutely crucial to well-being... while her world has suddenly grown much smaller, being able to choose her music, or TV channels, or food, etc, is really important and I'm so glad she can communicate her wishes. for you both.

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Response to Whovian (Reply #17)

Wed Nov 14, 2012, 05:06 AM

30. Bless you

been there - My mom had a stroke and was lucky enough to have just aphasia as a side effect. before she learned how to speak again, there were moments of pure anger that we could not understand - the anger came from frustration. I had to remind myself she was not mad at me, but the situation.

I hope your mom improves and gets communication back, there have been great strides in recovery.

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Response to Whovian (Reply #17)

Wed Nov 14, 2012, 06:08 AM

31. Whovian

write down those scrambled signals (the stimulus, the response) - until she starts to recover it can help you communicate

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 01:54 AM

18. i would rather be dead if this was true

which i don't believe it is.

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Response to JI7 (Reply #18)

Wed Nov 14, 2012, 03:03 AM

24. Many would, and I believe that choice should be available

with careful safeguards in place, of course.

This man may feel differently.

One should always have autonomy over the integrity of their person and destiny insomuch as it is possible for any of us.

Isn't that a good reason to view these findings with an open mind? If valid, they will be repeatable. That would be a good thing.

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 03:15 AM

26. I saw a Panorama programme about that on British TV last night

It was interesting to see the ways that fMRI techniques are able to show what was not observable in the past.

About 20 per cent of people with apparent vegetative states have shown signs of awareness on such brain scans.

This can indicate who are possibly going to be the few people who (usually only partially) recover from such states, and may benefit from intensive therapy. One patient shown on the programme had progressed to a point where, though still unable to speak, he could communicate by pointing to letters on an alphabet board to spell out words.

But many people, even those who show some awareness on brain scans, will never really be able to move or to communicate under ordinary circumstances.

Frankly I'd rather be in a real vegetative state, or dead, than locked in my body and be aware of it.

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 03:25 AM

27. A neurologist's view.

Dr. Steven Novella is an academic clinical neurologist at Yale. He is also the host of the wildly popular Skeptics Guide to the Universe, which for many years has put out an hour+ podcast every week without any gaps.

Here's his take on this case.

http://theness.com/neurologicablog/index.php/communicating-with-the-vegetative/

(Won't quote. If you are interested, you can click through. Very interesting read by a very interested author.)

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Response to longship (Reply #27)

Wed Nov 14, 2012, 03:48 AM

28. I read the study, then read your link

His take seems a good one.

The study itself seemed to overstate the results in a way that missed the chief significance of what was being doneóas a diagnostic toll, rather than a reliable communication tool.

Of the 5 positive response patients in the study, three of them were not in a persistent vegetative state, despite having been given that diagnosis previously.

The study's conclusion should, it seems to me, have not been "Hey, we can communicate with people in a persistent vegetative state." The study does not make that case strongly enough to warrant such a top-line conclusion.

It should have been, "Hey, not everyone's diagnosis of being in a PVS is correct, and this MRI technique can improve the quality of diagnosis." The study does suggest that quite strongly.

There are only two actual PVS communicators in the study and the noise and subjectivity factors are significant. Skepticism is indicated. (Were the interpretations of MRI activity blind? They said the interpreters didn't know the answers, but if they knew when the questions were being asked that is plenty of room for error. I would hope that someone (or ones) reviewed the MRI data record over an hour or half hour truly blind, after the fact, to find all significant activity levels, and then check for correlation with the questions.

Did the detected reactions only happen in response to questions?

I am surprised there wasn't more about the relative likelihood that someone in a PVS would understand spoken language.

Anyway, the cases of MRI activity leading to re-examination and discovery that the patient was not PVS at that time are quite striking.

One wishes they had conducted the same level of re-examination of all the patients. Perhaps there were non-communicators who were also over-diagnosed, but lacked the language ability, or other necessary function, to deal with the specific test.

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Response to longship (Reply #27)

Wed Nov 14, 2012, 09:50 AM

34. Are we supposed to believe ...

That they could not sense any brain activity at all -- hence the PVS diagnosis, yet the guy certainly blinked his eyes and seemed to have facial expressions?

Are we to believe that they couldn't measure any mental activity at the point that he was being given instructions -- instructions that would require significant mental processing. Yet then minutes later they could detect mental activity that they interpreted as "I'm thinking about playing tennis"?

It seems to me it would take more mental activity to process the instructions than it would take to imagine a game of tennis.

And how do they know he wasn't trying NOT to imagine tennis at that point? The instructions were "If you feel no pain, then imagine you are playing tennis." Well, if I understood that and I was in severe pain, I would be trying really hard not to imagine a game of tennis.

Try that right now. Don't think about playing a game of tennis. Don't think about a great backstroke. Don't think about the smell of the fresh air. Don't think about the sound of the racquet hitting the ball. Don't think about planting your feet on the baseline. Don't think about serving an ace.

How did that go for you?

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Response to BlueStreak (Reply #34)

Wed Nov 14, 2012, 12:28 PM

37. I don't think that's what they're saying.

Your post seems to set up some what of a straw man.

Sorry.

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 04:39 AM

29. My sister was in a coma

And doctors were prepping us for the worse. She looked worse than a dead body, and I say this as someone that worked for a funeral home at one point.

However, not only did she recover, but all those conversations that were said to her,

she remembered them!

The doctors were shocked, namely because they said she should not have, thankfully the conversation was a rant based on a quentin tarnetino flick I loved, and my sister HATED, Kill Bill. I said to her "what am I supposed to do, say "wiggle your big toe?"



Of course, that is how I know my sister was cognizant, because, even an inch fromthe valley of death, she got pissed at my love of Tarentino flicks. Quentin, not that you read this, but if you do, thank you, because maybe my sister beign subjected to your films, which she hated, might have stimulated her brain

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 07:39 AM

33. Can we use this to detect brain activity

in Republicans???

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Response to Shankapotomus (Reply #33)

Wed Nov 14, 2012, 10:41 AM

35. It would be a long shot! n/t

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Response to flamingdem (Original post)

Wed Nov 14, 2012, 12:58 PM

38. Waiting for the Terry Schiavo fans to chime in next

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Response to MiniMe (Reply #38)

Wed Nov 14, 2012, 01:24 PM

40. me too. This is a troublesome miracle for some purposes.

but it gives me new respect for my hubby who has begged me not to unplug him if he's vegetative. Conscious thought goes on, even after death (is his belief)

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