Sigman is still cautious about declaring the test foolproof, but he asserts that their results could mean only two things: Either the patients "have consciousness or maybe the test is wrong." Determining whether anything—outside of ourselves—truly has consciousness quickly spirals into a philosophical debate. "It's an extremely difficult question in the end," Sigman says. But he hopes that their simple test will help pave the way for more definitive and accurate assessments of consciousness in the severely brain damaged.
Testing treatments
The revelation that some vegetative or minimally conscious patients can learn does not come as a surprise to all. That fMRI findings of cognitive processes in vegetative patients have been trickling in recently leads John Whyte, the principal investigator at the Neuro-Cognitive Rehabilitation Research Network, who wasn't involved in the research, to question the designation system itself. It may be that "there is a firm line" between vegetative and minimally conscious patients, "but our tools are too crude to tell us who is on which side of the line," he says. Or it may be that categories of consciousness are not so easy to define. "It seems quite plausible that people can have neurocircuits that are capable of doing something and [others] that are not."
Such a fuzzy future for assessing patients based on different abilities—rather than the current criteria, which are based on no demonstrable abilities—introduces more ethical dimness. If doctors can no longer give a black-and-white answer to whether a patient is conscious or not, but rather must proceed with a complex, gray-area assessment of cognitive capabilities, it will leave tenuous standards "to hang our ethical decisions on," Whyte says.
The current findings—and research that Whyte and his team have done—underscore the great individuality of each VS or MCS patient. Whyte's recent work has shown pharmaceuticals such as Ambien (zolpidem) help vegetative patients regain consciousness, but it hasn't proved to be a silver bullet. Even treatments that are found to be effective in some patients, Whyte notes, won’t work for everyone.
To Sigman and Bekinschtein, however, their discovery of even a little learning provides a glimmer of hope. "To show that someone can form a memory over half an hour is a way to start," Bekinschtein says. "If we could use this basic association paradigm and build from that, then it could be a form of rehabilitation," he adds. "That's where we're aiming to go."
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Add CommentAmazing, and I think its about time our scientists started paying attention to this issue, as I know if I was in a vegetative state with some consciousness and had some chance of recovery, I would want that chance. It is important to note that a vegetative state should not be confused with Brain Death, where there is no brain activity due to necrosis, as being in a vegetative state does not allow for organ donation.
Reply | Report Abuse | Link to thisThis research is meaningful.
Reply | Report Abuse | Link to thisThis research is meaningful.
Reply | Report Abuse | Link to thisI would be curious if the patients who were under anesthesia and given the test (who showed no signs of learning) had any rememberance or subconscious reaction to the tone after coming out of anesthesia...
Reply | Report Abuse | Link to thisMy dad was declared a veg. I listened to the docs and signed a DNR but declined to remove the tube and instead moved him to a nursing home. A number of months later, he woke up. He eventually came home. He lived around 7 more years until the VA bureaucracy decided he could take the cheaper "blue pill" instead of allowing his doctor to do the immediate surgery she wanted to do (to get at an infection in his jaw and then surgery on his heart). She got three appeals, he got a bottle of pills and 10 days later a massive heart attack. I wonder if they called that panel she appealed to a "death panel"? I do.
Reply | Report Abuse | Link to thisAnd to think this came out right after the exciting results of "Scanning Dead Salmon in fMRI "
Reply | Report Abuse | Link to thishttp://prefrontal.org/files/posters/Bennett-Salmon-2009.pdf
http://www.wired.com/wiredscience/2009/09/fmrisalmon/
How long had the salmon been dead?
Reply | Report Abuse | Link to thisCould the results be due to remining neural activity in a newly deceased organism?
How long had the fish been dead?
Reply | Report Abuse | Link to thisI wonder if the activity noted could be due to the residual neural firing of a newly deceased organism.
This is an interesting study that basically extends the bedside neurologic exam to include testing for conditioned responses. A good idea. Drawbacks to the current methodology include: 1- Performing a decent (thoughtful and time consuming) physical examination in the era of imaging is a lost art. And 2- A substantial number of putatively vegetative patients may be locked in, that is unable to respond even with cranial nerves. It is clear that a more proximal CNS output should be sought as the conditioned response.
Reply | Report Abuse | Link to thisBy the way, learning during anesthesia is not only possible it is fairly well studied. It clearly occurs, but this is a different phenomenon from explicit recall of events. For those of you awaiting surgery, you may also wish to contemplate that certain anesthesia techniques are intended not to prevent suffering but instead to block the transfer of the suffering cognitive trace from the short term to the long term memory registers. If a tree falls in the forest...
Cognitive processes are independent of consciousness. The problem is with the ability to communicate cognition within the neural system or between neural functions and self-consciousness or consciousness and the external environment.
Reply | Report Abuse | Link to thisAnimals and plants are dumb because we are unable to communicate with them. Humans are dumb because we fail to communicate with certain levels of cognition.
"How long had the fish been dead?"
Reply | Report Abuse | Link to thisWell they bought it at the grocery store, so it probably got caught, killed, put on ice until the fishing boat got to port, sent to market and so on. I think it was a "fresh fish" in the sense that it was not yet a spoiled fish, so probably not much residual neural firing of a newly deceased organism.
The fish fMRI study is about statistical analysis and how it can be used to generate misleading derivative data. The authors advise on how to prevent future fMRI studies from accidentally reporting the kind of garbage data that they reported on purpose.
Reply | Report Abuse | Link to thisAre we reinventing the wheel again? My father died twice, the first time intensive care was able to revive him. My grandmother died and her spirit refused to leave the house for over 14 years. My wife talks about 5 prior lives.
Reply | Report Abuse | Link to thisThere are medical cases recorded where a person died and when revived later, told of seing and hearing what happened to him while brain dead. Thus mind as separate from the brain, sees and hears and as a physical life enity evolves the physical parts of the body as they have in the spirit form.
Having been in a two week coma after a cerebral hemorrhage suffered in late January of 1986, I cannot say wha my capacity for learning was while comatose, but suffice ity to say that I went on to succeed in college after some degree of recovery upon release from the hospital and graduated in 1999 with a GPA of 3.54, not bad for what some ableistic folks misnamed "a mental veggie who would never even walk again" - got out of the wheelchair in 6 months after waking up, too. I tend to agree with former Surgeon General C. Everett Koop who suggested we should always err on the side of protcting life - where there's life, there's hope!
Reply | Report Abuse | Link to thisUpon my cerebral hemorrhage in January of 1986, the prognosis was that I would die within 3 days, then that I was soomed to bcoming a mental vegetable who would never walk again. By the grace of God, I woke up from that coma in 2 weeks, rose from the wheelchair within 6 months and went on to graduate from college in 1999 for a B.A. attained magna cum laude, GPA 3.54. While I could nnot tell you how much I was capable of learning during the comatose phase, it's clear that the potential existed nonetheless. I agree with former Surgeon General C. Everett Koop who believed we should always err on the side of protecting life . Terri was cruelly deprived of her chance to recover by a man who was in a hurry to marry someone else - the state should never have indulged that crime gainst humanity - Terri deserved to be protected and hder right to life respected.
Reply | Report Abuse | Link to thisI believe with all of my heart that Michael Schiavo got away with legal murder, and the State of Florida is be held accountable, along with the useless media.
Reply | Report Abuse | Link to thisI will always believe that Michael Schiavo got away with legal murder, and the State of Florida and the useless media are to be held accountable, along with the blind judges that presided over this case at numerous hearings and with blatant evidence to err on the side of life. Shame on them.
Reply | Report Abuse | Link to thisthis research is very meaningful due to brain damage. you might get in a wreck and hit your head really hard, hard enough to make you a vegtable and you have a chance to recover due to some consiousness and they are declaring you brain dead when you may still have the chance to recover.
Reply | Report Abuse | Link to thisYes, Michael wanted to deprive Terri of medical help (antibiotics for an infection) years before he was finally allowed to mandate her death. In fact, it was shortly after his financial award was funded. You would have thought that this would have precluded him being Terri's representative immediately. In any case, for a long time I displayed a bumper sticker that said, BETTER FED THAN DEAD. Those are still my sentiments. I don't even think we have to prove how much brain activity was going on in her head. She had been living without unusual medical procedures for 15 years. (A feeding tube is not an unusual piece of equipment.) She had a RIGHT TO LIFE--period. Sarita
Reply | Report Abuse | Link to thisThis is encouraging. My older brother has been in what they term PVS for 4 weeks now. I will say the medical professionals prognosis is not positive, but we, his family, have faith and believe that he will wake up. Faith in glory and power of our Father will make this happen.
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