1 in 5 vegetative patients is conscious. This neuroscientist finds them. | Big Think x Freethink

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What if vegetative patients are conscious? Neuroscientist Adrian Owen, author of Into The Gray Zone and a professor at Western University in Canada, is using fMRI technology to try to reach the people who may still be aware of their surroundings.

Consciousness has traditionally been assessed by asking patients to respond to verbal commands. Through brain imaging, Dr Owen and his team were able to prove that these tests are inadequate, and it's estimated that 20 percent of vegetative patients are conscious but are physically incapable of communicating it.

"Communication is the thing that really makes us human," says Dr. Owen. "If we can give these patients back the ability to make decisions, I think we can give them back a little piece of their humanity."
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DR ADRIAN OWEN:

Dr Adrian Owen is a Professor at The Brain and Mind Institute, Western University, Canada and the former Canada Excellence Research Chair in Cognitive Neuroscience and Imaging. His research combines neuroimaging (MRI and EEG), with cognitive studies in brain-injured patients and healthy participants. He has spent the last twenty years pioneering breakthroughs in cognitive neuroscience. Find out more at OwenLab.uwo.ca.

Check his latest book Into the Gray Zone: A Neuroscientist Explores the Mysteries of the Brain and the Border Between Life and Death at https://amzn.to/3le2QPX
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TRANSCRIPT:

DR. ADRIAN OWEN: Imagine this scenario. You've unfortunately had a terrible accident. You're lying in a hospital bed and you're aware—you're aware but you're unable to respond, but the doctors and your relatives don't know that. You have to lie there, listening to them deciding whether to let you live or die. I can think of nothing more terrifying.

I'm Dr. Adrian Owen. I'm the author of ‘Into the Gray Zone’, a neuroscientist explores the border between life and death.

Communication is at the very heart of what makes us human. It's the basis of everything. What we're doing is we're returning the ability to communicate to some patients who seem to have lost that forever. The vegetative state is often referred to as a state of wakefulness without awareness. Patients open their eyes, they'll just gaze around the room. They'll have sleeping and waking cycles, but they never show any evidence of having any awareness.

So, typically, the way that we assess consciousness is through command following. We ask somebody to do something, say, squeeze our hand, and if they do it, you know that they’re conscious. The problem in the vegetative state is that these patients by definition can produce no movements. And the question I asked is, well, could somebody command follow with their brain? It was that idea that pushed us into a new realm of understanding this patient population. When a part of your brain is involved in generating a thought or performing an action, it burns energy in the form of glucose, and it's replenished through blood flow. As blood flows to that part of the brain, we're able to see that with the fMRI scanner.

I think one of the key insights was the realization that we could simply get somebody to lie in the scanner and imagine something and, based on the pattern of brain activity, we will be able to work out what it is they were thinking. We had to find something that produces really a quite distinct pattern of activity that was more or less the same for everybody. So, we came up with two tasks. One task, imagine playing tennis, produces activity in the premotor cortex in almost every healthy person we tried this in. A different task, thinking about moving from room to room in your house, produces an entirely different pattern of brain activity; particularly, it involves a part of the brain known as the parahippocampal gyrus. And again, it's very consistent across different people.

So, we realized that we could use this as a simple mechanism for asking yes or no questions. We could say, well, I'm going to ask you a question. If the answer is yes, imagine playing tennis. If the answer is no, imagine thinking about moving through the rooms of your home. I can still remember exactly what it felt like the first time we saw a patient that we thought was in a vegetative state activate their brain...

Read the full transcript at https://bigthink.com/videos/neuroscience-vegetative-consciousness