Vegetative patient shows he is aware of his identity, whereabouts

For 12 years, Scott Routley was entirely unresponsive, living in a vegetative state since a car accident badly damaged his brain. But researchers at the University of Western Ontario have proven he is aware of his identity and whereabouts after mapping his brain’s response to yes-or-no questions.

The 38-year-old is one of three vegetative patients to correctly answer questions such as, “Are you in a hospital?” and “Is your name Mike?” posed using a new, more effective technique of magnetic resonance imaging (MRI). His responses are a leap forward in communications with unresponsive patients, building on a breakthrough contact that researchers achieved with him in 2012 using a more primitive technique.

These latest findings contradict some clinicians’ long-held views that vegetative patients are unaware of their surroundings, and confirm what many families of unresponsive patients have long believed – that their loved ones can hear them. But the paper, published Monday in the Journal of the American Medical Association for neurology, also revives a host of ethical questions about patients’ ability and right to decide day-to-day matters in their lives, and perhaps even whether they want to live on at all.

“I think this definitely puts us on that road,” said Adrian Owen, a leading researcher at Western’s Brain and Mind Institute. “… I think it’s inevitable that down the line this is going to be used for more serious decision-making.”

In 2012, Mr. Routley was able to let Dr. Owen and postdoctoral fellow Lorina Naci know that he wasn’t in pain by imagining himself performing an activity – like playing tennis – to signify a yes or no, spurring brain activity captured in an MRI.

But in their latest study, Dr. Naci and Dr. Owen have devised a simpler, more accurate technique that lets the patient answer with less effort, simply by focusing on the word yes or no while in the MRI machine. With this new method, Mr. Routley showed he knew his own name as separate from another, and that he was in a hospital rather than elsewhere – a higher level of self-awareness.

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