Scott Routley – a man who has appeared to be in a persistent vegetative state for 10 years – has answered questions using a functional MRI scan. Canadian researchers asked him to think of playing tennis to answer ‘yes’ and to think of walking around his house to answer ‘no’. These thoughts stimulate different parts of the motor cortex which can then be detected by fMRI. The researchers have been evaluating these techniques in various patients but this is the first time it has been used for complex communication in a person in apparent persistent vegetative state. It was the subject of a recent BBC Panorama programme “The mind reader: unlocking my voice“.
The ongoing research in this area demonstrates different types of techniques [1,2] for communication and is also confirming that there are different sub-types (or misclassifications) of vegetative state . Some patients do have awareness of their surroundings, can understand speech but are unable to make any form of communication themselves. Functional MRI as a communication tool can be used in these patients to better understand their perspective, their symptoms, and their wishes.
1. Bardin JC, Schiff ND, Voss HU. Pattern classification of volitional functional magnetic resonance imaging responses in patients with severe brain injury. Arch. Neurol. 2012 Feb;69(2):176–181.
2. Cruse D, Chennu S, Chatelle C, Bekinschtein TA, Fernández-Espejo D, Pickard JD, Laureys S, Owen AM. Bedside detection of awareness in the vegetative state: a cohort study. Lancet 2011 Dec;378(9809):2088–2094.