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BBC World News 'Panorama' reveals brain injured patients can communicate

Broadcasting on November 17 and 18, the findings could have profound implications for the patients and their families, as well as for scientists

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BBC World News 'Panorama' reveals brain injured patients can communicate

BBC World News 'Panorama' reveals brain injured patients can communicate

Broadcasting on November 17 and 18, the findings could have profound implications for the patients and their families, as well as for scientists and medical staff

BestMediaInfo Bureau | Delhi | November 16, 2012

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A 'Panorama' special from BBC World News reveals that a Canadian man who was believed to be in a vegetative state for more than a decade has been able to tell scientists that he is not in any pain. British neuroscientist, Prof Adrian Owen, led the research at the Brain and Mind Institute of Western Ontario.

In The Mind Reader: Unlocking My Voice, which airs this weekend (Saturday, November 17 at 2.40 PM and Sunday, November 18 at 7.40 AM and 8.40 PM) on BBC World News, BBC's Medical Correspondent Fergus Walsh explores the remarkable method that is allowing some of these patients to find their voice. The findings could have profound implications for the patients and their families, as well as for scientists and medical staff.

Prof Owen told Panorama that this was the first time a severely brain injured patient had been able to give answers that were clinically relevant to their care. He said, “Asking a patient something important to them has been our aim for many years.  In future we could ask what we could do to improve their quality of life.  It could be simple things like the entertainment we provide or the times of day they are washed and fed.”

For over a year, Panorama has filmed several vegetative and minimally conscious patients undergoing pioneering medical research at the Brain and Mind Institute of Western Ontario and the Wolfson Brain Imaging Centre, Addenbrooke's Hospital, Cambridge.

Prof Owen's team uses brain scanning to detect hidden awareness in patients and to enable them to communicate. His technique is based on functional Magnetic Resonance Imaging (fMRI), which measures the real time activity of the brain by tracking the flow of oxygen rich blood.

He repeatedly asked patients to imagine playing tennis or walking around their home. It requires concentration to repeatedly start and stop imagining playing tennis so if the patients can do this, it demonstrates that they must be conscious.

In healthy volunteers, imagining these scenarios produces a distinct pattern of activity in the premotor cortex for the first task and the parahippocampal gyrus for the second. This activity is detected by the fMRI scanner and allows the researchers to put a series of yes or no questions to severely brain injured patients.  A minority of those tested were able to answer by using the power of thought.

Scott Routley from London in Ontario, Canada, was believed to have been in a vegetative state for over 12 years, having suffered traumatic head injuries after his car was hit at a crossroads by a police car. All of Scott's observational tests both before and since his brain scans have suggested he is vegetative, but Prof Owen told Panorama that evidence from the fMRI show that is not the case: “Scott has been able to show he has a conscious, thinking mind.  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.”

Routley's parents say they always thought he was conscious and could communicate by lifting a thumb or moving his eyes, although this was never accepted by medical staff.

Prof Bryan Young of University Hospital in London, Ontario, who has been Scott's neurologist for a decade, said the scan results overturned all the behavioral assessments that had been made over the years. “He had the clinical picture of a typical vegetative patient – no emotional response, no fixation or following with his eyes. He didn't have any spontaneous movements that looked meaningful and I was quite impressed and amazed that he was able to show these cognitive responses with fMRI.”

Prof Owen has previously shown that nearly one in five vegetative patients is in fact conscious.  Another of his patients, Steven Graham, was also able to answer a series of questions whilst in the brain scanner and demonstrated that he was capable of reasoning and that he had laid down new memories since his brain injury.

Five years ago, Steven was driving to work when his car slid on ice and he collided with a telegraph pole. He was in a coma for three and a half months and, since then had been in a minimally conscious state.  His parents were unsure whether he had any perception of himself or the outside world.

During his scans, Steven demonstrated significant brain activity and was able to answer 'yes' when asked whether he knew about his two-year-old niece, 'Ceili'. Steven's niece was born after his car accident and his response therefore demonstrated that he is continuing to create and store memories and suggests he is aware not just of himself but of those around him.

However, only a minority – approximately 20 per cent – of patients who have undergone fMRI brain scans have been able to demonstrate that they are conscious.

Panorama also spent time with patients at the Royal Hospital for Neuro-disability in Putney, which specialises in the rehabilitation of brain injured patients. It collaborates with the team of Cambridge University neuroscientists at the Wolfson Brain Imaging Centre at Addenbrooke's Hospital, Cambridge.

Two patients at the RHN are seen undergoing SMART, an assessment programme developed by the hospital which explores all the senses, looking for signs of awareness and the ability to communicate.

Alex de Martelly Seaman, who is 20, suffered severe brain injuries last year when he jumped off a moving bus.  He had to have a large section of his skull removed due to internal bruising. Alex was too ill to have a full assessment at the RHN but appears unresponsive and vegetative.  His brain scans show that he is minimally conscious with some periods of awareness, and may be able to recognise the faces of his family and friends.

Michael Taylor, who is 25, also suffered severe brain injuries in a car accident.  His assessments in Putney and Cambridge confirm his diagnosis as being in a vegetative state.

“Most patients we don't draw conclusions like this for.  We see many, many patients who are diagnosed as vegetative and for the most part, we have to conclude that we weren't able to show that they were conscious,” said Prof Owen. “So, when it happens – and we are very extremely careful because it is clinically very important – but when we see it, we are prepared to put our money where our mouths are and say, yes, these patients are conscious and they are communicating.”

Info@BestMediaInfo.com

Info@BestMediaInfo.com

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