Slashdot Mirror
"Vegetative State" Patients Can Communicate
Kittenman writes "The BBC is carrying a story about researchers in the UK and Belgium who can detect the thinking processes within a patient previously thought to be in a vegetative state. The researchers ask the patient verbally to think in certain ways to indicate a 'yes', in other ways to indicate a 'no' — and have successfully communicated with 4 out of 23 patients previously thought to be in a coma."
As a life-long vegetarian, I'm horrified with the idea of being able to communicate with my... oh wait.
Us vegetative types have been doing that for years on World of Warcraft.
I always talk to them :)
Dear
From TFA:
"Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage. "
It's official. Most of you are morons.
so if i go into coma to get some peace and quiet while i finish planning my world domination your saying that i wont be able to get that piece and quiet.... im guessing the underground bunker is still the way to go then....
epic sig..... ya i got nothing
Wasn't there a Law & Order episode about this?
A vegetative state is by definition where there is no detectable awareness. You could legitimately say that they were "previously thought to be in a vegetative state," but if you detect awareness then they are in a coma.
This is one of those terrible fears. It's great that they have found a way to communicate with someone in this state, but at the same time this type of story makes me ponder how horrific that must be for the person.
I will shred my adversaries. Pull their eyes out just enough to turn them towards their mewing, mutilated faces. Illyria
So all they have to do is live in an MRI machine for the rest of their lives and they can communicate. Problem solved!
I judt got a nre Kinesis keybiartf so please excusr ant egregiou typos.
have successfully communicated with 4 out of 23 patients previously thought to be in a coma.
That's actually a better return than I get on security surveys sent to faculty...
that is all.
I'm not a neuroscientist, but it seems to me that 4 out of 23 is a pretty low success rate, especially given the kind of indirection the researchers were resorting to in order to elicit the signals they were looking for. How do we know, for example, that a patient doesn't have some kind of spurious activity in the brain area they're using to signal "A"? For that matter, how can we distinguish between "no answer" and a deliberate "B" in the absence of such activity? How can we assume that the patient, who by definition has brain damage, is capable of understanding the question correctly and answering correctly? I agree, this is better than absolutely no communication, but I'm curious how they intend to control for factors like these.
I'm disabling ads until because I choose not to reward redesigns that are less usable than "view source".
This is not really surprising if you are aware what a real coma is. There is a lot of states between fully consciousness and complete unconsciousness. In movies, and in soaps you switch between those states in a surprise wake-up. In reality this is much more complex.
Anyway, better diagnosis is needed to prevent accidents like Brain scan finds man was not in a coma--23 years later and other possible improvements in brain damage treatment.
01101110011000010110000101100001
epic sig..... ya i got nothing
This has been plastered all over the news. The problem is, its similar to the Headline "Gas pedals can suddenly accelerate the car". Surely, some are misdiagnosed, while others have no brain to think with. Its ridiculous.
> It does raise many ethical issues - for example - it is lawful to allow patients in a permanent vegetative state to die by withdrawing all treatment, but if a patient showed they could respond it would not be, even if they made it clear that was what they wanted.
It seems kinda silly that you're only allowed to die when you're unable to make that decision. To me it seems cruel to keep someone alive in a vegetative state just because they have enough of their conciousness left to want to end it. Yay for legalized euthanasia in the Netherlands.
"Eat me, I'm nutritious."
Isn't this like that House episode with the completely paralysed patient? At first he could only blink, but then that ability disappeared. He kept having visions where House and himself would appear on the beach and stuff. He was a black man as I recall. Anyway, they hooked him up to a brain-reading device which moved a cursor on a screen to indicate Yes or No (top and bottom halves of the screen).
In case anybody missed this the first time: http://prefrontal.org/blog/2009/09/the-story-behind-the-atlantic-salmon/
On one hand, this would be very scary, if one were locked in like that, unable to speak, move, and thought to be in a vegetative state. TFA does a great job drumming up that fear in the readers.
On the other hand, fMRI studies also find dead salmon do a lot of thinking. The whole fMRI field suffers from what we'll generously call "Statistical Issues," and until we get better handle on it, I'm going to remain somewhat dubious about fMRI studies that claim to be able to detect this or that. 4/27 is not a stellar rate, and it isn't implausible that these 4 are really vegetative people who have various parts of their brains active as a matter of course.
5 of 54 patients who underwent this procedure. Showed a possible response.
3 of those 5 it turned out showed awareness to normal stimuli and were either mislabeled by doctors, or their condition changed.
So basically that leaves 2 patients out of 51 seeming to "be able to modulate their brain activity". And only ONE of those was able to "correctly answer 5 of 6 yes/no questions"
This could be legit, but there is also PLENTY of room for statistical chance to have created this "result".
The bottom line is that too much of a big deal is being made out of a tiny kernel of good data in a mountain of null results.
My first thought on reading the slashdot summary was "Not this again..." because there was a recent Belgian case of a man who was supposedly in a coma for 20+ years and was now communicating with the help of a woman. And it was total bull.
This does appear to be something different, though I imagine it may get confused with the known pseudoscience of facilitated communication.
Facilitated communication can't be taken for real communication, in peer reviews it's usually discredited because the person that is really communicating is the "facilitator".
Fry: "BEEP!"
Zap: "'Yes.' Ok. And, are you guilty!?"
Fry: "BEEP! BEEP!"
Zap: "Double 'Yes'!"
Sorry -- too lazy to dig for the exact quote.
If you haven't check out this study publicized in Wired, where they detected human emotion activity in the brain of a salmon. A dead salmon.
Just because the fMRI shows some colors, that doesn't necessarily mean that there's really cognition going on. It could just be false detections from imperfect scanning, or it could be scientists seeing patterns in data that don't really exist, or it could be the result of our imperfect understanding of how the brain works, or a whole slew of other things.
This is made worse by things like the Houben case, which used Facilitated Communication to "prove" that Houben had an intact consciousness. FC hasn't passed any rigorous scientific study (i.e. blind tests to prevent the facilitator's motivations/desires from modifying the results), but stories like Houben cause those with loved ones with sever brain damage in PVS to start clamoring that there may still be hope. James Randi has written about FC, and the Houben case in particular.
It was a CAT scan, not MRI, and certainly not active MRI.
- But I'm afraid that even 'just' a CAT scan can show whether brain tissue is present, and it wasnt.
"Oops, I always forget the purpose of competition is to divide people into winners and losers." - Hobbes
The book was about a WWI soldier who lost all four limbs, blind, deaf, and mute, yet still awake. The medical people thought his twitching was just instinct. Then someone realizes his head banging is Morse code. The story is from the patient's perspective. It resurfaces as an ant-war book periodically.
Anyone else is having nightmares with this news?
Imagine being 20 years locked down inside your body... I guess I would be begging for someone to pull the plug.
FTA: The team told him to use "motor" imagery like a tennis match to indicate "yes" and "spatial" imagery like thinking about roaming the streets for a "no".
I've done a little bit of research in the area of spatial vs motor visualization. I think they could have chosen a better discriminator for the "spatial" task - it could be that the physical act of "wandering the streets" could be confounded with "playing tennis". There are many more tasks that I believe would have tapped into a more pure measure of the spatial component (e.g., imagine rotating an object).
"Before God we are all equally wise - and equally foolish"
Albert Einstein
I wonder if they expanded the fMRI to review what happens when other questions are posed. My brother-in-law has been in a "vegetative state" for 20+ years, since he smashed his car into a tree. I'd be curious to know what he thinks about things.
OTOH, is a vegetative state someone with consciousness or simply brain injured enough not to be able to respond?
The Kai's Semi-Updated Website Thingy
NOT 10010001100111101001111010011110
prot's been telling us that for years.
Smegma.
Try:
http://www.sciencebasedmedicine.org/?p=3122
for a critical point of view.
(founded 95,000,000 yrs ago, very space opera)
You mean the cereal rapist will spend time in Vegetative State Penitentiary.
One day I thought, "What if one day Steven Hawking had the most blinding insightful revelation anyone has ever had, but it was just after all his muscle control was lost?"
So I wrote this. (Disclaimer: No physicists were actually harmed in the writing of this play.)
http://www.scribd.com/doc/19550880/GUT-The-Grand-Unified-Theory-A-oneact-play-with-seven-blackouts
If Slashdot were chemistry it would look like this:Cadaverine
The ultimate use for a brain-computer interface:
http://slashdot.org/story/10/02/03/1722200/Next-X-Prize-mdash-10M-For-a-Brain-Computer-Interface
So it isn't pointless to keep your loved-one around, with the real hope of future technical developments letting them interact with society again.
___________________ I want to be free()!
Two beeps for stop bothering me, I'm sleeping!
Some patients, appearing to be in a vegetative state, are in fact capable of a form of communication.
stuff |
"We receive as friendly that which agrees with, we resist with dislike that which opposes us" - Faraday
it might be a useful technique during a zombie apocalypse, to broker some sort of peaceful agreement rather than BRAIIIIIIIINSSSSSSSS
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Read the article more closely, the answers given that were "right" were judged BY THE FAMILY. In other words, they only knew they were the right answers because the family said they were. So this is pretty much identical to the "facilitated communication" scam. I bet if you were to do a properly controlled study asking the family the same questions BLINDLY, that you would find no correlation between the activity in the brain and the answers given, just like with "facilitated communication".
Starbuck's Staff have been doing this for years in the mornings with customers.
I think our understanding of the brain is primitive, and we still can't say anything for certain. But now you see how bad "euthanasia" is, or at least how evil it is to promote it based on statistics or (even educated) opinions without certainty.
What are the bigger picture implications of this?
Will this result in family members/religious zealots demanding that patients in these kinds of states keep receiving ongoing medical care and not have the plug pulled, despite the infinitesimally small chances that they will wake up under the justification that they are "still alive"?
Does this mean we'll spend more money on essentially lost causes and/or keep pushing healthcare costs higher and thus deny meaningful services to people who aren't vegetative?
I'm in a vegetative state right now.
Yeah, I know... "tell us something we don't know"
...have successfully communicated with 4 out of 23 patients previously thought to be in a coma.
So let me get this straight. They're asking the patient to "think" a certain way for yes and a different way for no. They have achieved success with 4/23 patients, for a rate of 17.3%. In other words, their "system" is not only worse than a coin toss (50% success rate), it is less than half as successful as a coin toss.
Am I missing something here?
I have a bad feeling about this...
The patient responded accurately to five out of six autobiographical questions posed by the scientists.
That's not very convincing. I find it easier to believe that random chance could get 5 out of 6 true/false question right, than that someone could get 1 out of 6 questions about their own life wrong.
"You cannot simultaneously prevent and prepare for war." -- Albert Einstein
Another Star Trek fantasy tech will become reality. Think Christopher Pike's wheelchair.
We recently had an article on just this subject, using MEG. Comparing the time frame of an fMRI scan and the duration of the response it's supposed to be looking at, it is quite likely the fMRI is catching many more neural processes even within the same region than the response related to the stimulus.
In fact, I'm thinking it's likely BBC made an error (or worse). TFA starts out with the same phrase as the MEG article, "a new brain scan technique". Then it specifies fMRI and says it was used because it "shows brain activity in real time", which it most certainly does not.
"I may be synthetic, but I'm not stupid." -- Bishop 341-B
... *all* members of the US House and Senate have been scheduled for fMRI scans ... (sigh).
It must have been something you assimilated. . . .
Here in US we took it to the next level and got people in vegetative state running the freaking country
I will not be pushed, filed, stamped, indexed, briefed, debriefed or numbered. My life is my own.
Of the 54 patients examined in the study most had suffered either from traumatic brain injury or anoxic brain injury. Anoxic brain injury for the most part means your heart had stopped for a prolonged period of time (although other things such as severe prolonged hypoglycemia or carbon monoxide can do the same thing). Anoxic brain injury is a diffuse process and its course is highly predictable. Depending on the severity of the initial event with anoxia patients will either improve after a relatively short period of time or they never will. Of all of the 'miracle' re-awaking cases that have occurred (extremely rare cases of people waking up to a severely disabled state) none of them have been by someone who has suffered anoxia.
Traumatic brain injury has a less predictable course as some of the parts of the brain are destroyed while other parts can be relatively undamaged. Of the five patients in the study who were found with some brain activity all of them were traumatic brain injury cases.
Schiavo suffered anoxic brain injury due to cardiac arrest. These patients never need fancy brains scan as their external findings accurately reflect what has happened to their entire brain. The current New England Journal of Medicine article actually serves to support that anoxia patients have no cognition.
Yes, living wills, and informing your loved ones to remove you from life support in such cases are very important. But as the Schivo case proved, it doesn't really matter when religious politics become involved. Your living will is only as valid as the willingness of your relatives to honor it.
Schiavo did NOT have a living will, which was the cause of the interminable legal wrangling. Had she clearly designated someone to exercise medical power of attorney, there would have been no controversy. Instead, the Florida default rules it fell to her husband who claimed that she had orally represented to him that she did not want to be kept alive in such a case. Her parents claimed that she would not have, given her religious faith. "Religious politics" had nothing to do with it. Quoting Wikipedia (my emphasis)
Given the lack of a living will, a trial was held during the week of January 24, 2000, to determine what Schiavo's wishes would have been regarding life-prolonging procedures. Testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes was heard. Michael claimed that Schiavo would not want to be kept on a machine where her chance for recovery was minuscule, her parents claimed that Schiavo was a devout Roman Catholic who would not wish to violate the Church's teachings on euthanasia by refusing nutrition and hydration.
Honestly, the case really boils down to that -- who do we believe is best qualified to take an essentially random guess about what a person would want. Ideologues on both sides tried to make it into more than that but it just wasn't. If she was genuinely religious and would have wanted to be kept alive, we should have kept her alive. If she would have wanted to die, we should have let her die. The resolution of this essentially factual question (in the absence of any reliable evidence) neatly solves the entire affair.
To summarize, if we can learn anything from the whole shitfest, please leave notarized documentation of your desires. Not even for yourself (although that should be motivation enough) but so your loved ones can feel confident in your wishes instead of being forced to guess. That is not a burden I would wish on the people that care about me, nor do I think it's fair to give them that responsibility. The document does not have to be complicated or expensive -- it can be as simple as designating a person to chose for you.
So you remember everything about your life, especially after having brain trauma? That's pretty fucking impressive.
"Growing old is inevitable; growing up is optional."
Did they also ask if his father's name was Bob, John, Edvard and Vader? Getting a series of yes/no questions right is much easier then getting a series of related yes/no questions right.
Alexander: yes. Bob: no. John: no. Edvard: yes. Vader: no. Hmm...
Analogies don't equal equalities, they are merely somewhat analogous.
House already did this
"Get me away from these charlatans!"
Would you like us to euthanize you?
This issue is a bit more complicated than you think.
Am I missing something here?
Maybe you are missing the part where the expected rate is 0%.
This issue is a bit more complicated than you think.
On some of my more sluggish co-workers
Please do not read this sig. Thank you.
The people running the country have put us in a vegetative state with their insidious "American Idol," "Biggest Loser" and the evil "Jay Leno"
Please do not read this sig. Thank you.
and have successfully communicated with 4 out of 23 patients previously thought to be in a coma.
17%. Well, let's look at it another way. Being a physician and remembering my rounds on the neurology/neurosurgery wards, I remember very well how antagonistic family members feel towards medical staff - as if the persistent condition of these patients was somehow our fault. I do remember many family members being in denial - refusing to accept that when we told them a patient was unlikely to recover due to the nature of the injury, and continuing to clutch at the invisible straw that grandma or grandpa would suddenly "wake up" (hey it happens in the movies and on TV) and walk out of the hospital.
Doctors have to feel compassion. It's an important hallmark of our profession. I was very upset myself when this happened to my (late) grandfather. However there are some injuries that can never be recovered from. The fact that a "yes" or "no" pattern MRI can be detected (again, in only 17% of cases) still will not change the prognosis for the patient. Perhaps the greatest use for this technique would be to obtain consent from the patient for disconnecting life support.
However I can see the mentioned article being used by family members to beg for (or take legal action to obtain) continued life support. That's all very well when you're paying for it. However in my country with a state-run health care system, there comes the time when we need the limited number of beds and the machines for someone else.
Seven puppies were harmed during the making of this post.
The article was either written poorly, or the writer was attempting to insert his/her own opinions into the discussion. The full quote from the article is as follows:
The study in the New England Journal of Medicine shows that scans can detect signs of awareness in patients thought to be closed off from the world.
Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage.
The article goes on to describe how the researchers showed that there was awareness in the patients, due to their ability to "answer" questions by thinking about different types of activities -- involving motor skills vs spatial analysis, for example.
By quoting just the second sentence I've included here, the OP gives the impression that there's nothing to see.
mmm... yeah... You see, we're putting the cover sheets on all TPS reports now before they go out...
Also, they are tasty.
You put 2 and 2 together.
No brain, no pain.
I can see lots of support of this for keeping the person alive at all costs but what happens if you ask them if they want to be allowed to die and they respond "yes". How many of those same supporters would now support allowing the person to die because that's what they wanted?
So you remember everything about your life, especially after having brain trauma? That's pretty fucking impressive.
I'm not saying that it definitely is one way or the other. I'm just looking at probabilities.
They would have had to choose very simple, easy to answer questions, partly because they were questioning a brain-damaged individual, but also partly because they had to choose questions that they also knew the answers to. So, the questions would likely be things like "Is your name Bob?", and "Are you male?" and "Were you born in London?". While it is entirely possible that brain trauma could cause a person to forget what city they were born in, it is also possible for a coin toss to result in 5 out of 6 correctly answered true/false questions. Therefore, the evidence, at least as it's presented in the article, is not exactly convincing.
"You cannot simultaneously prevent and prepare for war." -- Albert Einstein
While they may be able to get binary type responses from these patients we have no idea whether the answers are made in sound judgment.
For example, if we were to ask one of these patients, "Should we pull the plug?" We have no idea if their reasoning capabilities are impaired by whatever caused them to enter this state. Would they be suicidal if they understood their current state, or would they be 'drunk" by their cocktail of drugs and have a lack of inhibition? Or would they be emotionally terrified of death and want to cling to life regardless of the possibility of recovery? Or would their answers be child like in simply want to please the person asking the questions? I don't think we will ever know...
it says:
"DO NOT turn me off under any condition...ever"
The Kruger Dunning explains most post on
So when a patient now knows in his incoherent state that he is actually in a coma,
and can communicate with others, then does that mean he can still be held at his word....
Salesman>I thought you said we had a deal
Vegetable>.....yes
Salesman>So we did have a deal, or you admit to not keeping the deal
Vegetable>.....no
Salesman>Stop playing with me, I might have to hurt you....
Vegetable>.....
speaking from personal experience. when my grandfather was in this state. being a vegetable means theirs no to very little brain activity a brain dead state. at that point you are dead. they can keep your body alive with machine but even that wont last very long but if you not religious the siance is if the brains dead your very dead theirs no coming back. cases of people waking up are simply misdignosed. there not brain dead but in coma in that state something has shut down your ability to be consuous but your brain is still working.and in most cases whatever damage that has happen heals and you wake up. the brains one tough orgen.
Am I the only one who sees the parallel to The Menagerie?
The worst day of my life was the one when I told the doctor to shut off life support on my wife and watching the heart monitor with skipping heartbeats until it was flatlined. It would have been good to know if she knew that we were there talking to her.
"She said the hospital did a study of 60 patients admitted with a diagnosis of vegetative state and 43% could communicate. "
How can you have 43% communication rate out of 60 patients? That would mean 0.43 * 60 = 25.8 patients?
So one could not communicate fully? How do you judge that?
Seems like someone is throwing percent around for the fun of spewing statistics
Why not? It's not like all trauma is the same and affects all parts of the brain the same way, is it?
...Ouija boards really do work.
You say "Kenny", but I say "tomato". If they're in a vegetative state, they're not answering questions, they're just responding to surrounding stimuli, like plants bending towards a sunny window.
Furries make the internet go.
Depends, if they can clearly distinguish between "Yes", "No" and "Patient didn't respond", their rate of success might be ok. On the other side if they just did go with "Yes" and "No" it indeed looks like random chance. After all we got the thinking dead salmon, so there is quite a bit of wiggle room in fMRI.
In the end the only real proof would be if they could actually get real communication going, not just six questions, which really seems a little low. So lets wait and see for further studies before jumping to conclusions.
It all boils down to the personnality of the "almost-PVS" victim.
Some, like you, would see it as a wonderful opportunity to meditate in what is a wonderful state of detachment from anything else.
Some, like a few other poster, would see it as an awful form of hell, their mind trapped in a dead body with nothing else to interact.
It's like: would you like to spend the rest of your life stranded on a desert island ?
Some would appreciate getting rid of other people and civilisation. (Lots of asocial geeks could)
Some would get completely insane from loneliness. (I probably would) The "almost-PVS" state is even worst because those couldn't keep their mind busy trying to survive.
Now, this is something for which a choice should be left. Enforcing idealogical view on this subject is bordering on torments (keeping unwilling victims alive) or murder (unwilling euthanasia).
"Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
If you accused her of being a terrorist, the Neo-Cons would line up in a firing squad to pull the trigger.
Remember, a terrorist doesn't have to actually do anything terrorist-y to be a terrorist - that's what the whole "pre-emptive defense" doctrine means.
"Vegetative State" Plants Can Communicate"
640YB ought to be enough for anybody.