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Researchers: Woman's Severely Damaged Brain Responds To Directions

by Dave Reynolds (subscribe)

CAMBRIDGE, ENGLAND--Researchers using new brain imaging technology are opening a window into the awareness levels of people with the most severe of brain injuries, and providing hope that they will someday be able to communicate with others. Their research is also casting doubt on the accuracy of the 'vegetative state' diagnosis.

For a report published this month by the journal Science, neuroscientist Dr. Andrew Owen, head of Cambridge University's Medical Research Council Cognition and Brain Sciences Unit, used functional magnetic resonance imaging (fMRI) to scan the brain of a 23-year-old woman who has been diagnosed in a "vegetative state" since she was injured in a July 2005 car accident.

For months, doctors said the woman was unresponsive, that she could not follow instructions, nor could she focus her eyes or track a person or object around the room with her eyes.

Dr. Owen scanned the woman's brain with fMRI technology while asking her to imagine herself playing tennis and walking around her house. The parts of the woman's brain that before her injury would have controlled body movements lit up as if she were actually performing the tasks. Owens then scanned the brains of a dozen people whose brains were not injured, and found that the same areas of their brains were activated when they were asked to imagine the same tasks.

Owen said the woman had fit all of the clinical criteria for being in a vegetative state.

"What we have developed is a method for detecting when someone is aware in the absence of other clinical evidence," he said.

Owen and other scientists were quick to point out that fMRI imaging would not have helped Terri Schiavo, who died of dehydration last year after her feeding tube was removed at her husband's request. Many doctors and Schiavo's husband insisted that Terri's brain was heavily damaged when she stopped breathing for several minutes in February 1990. Terri's parents fought to keep her alive, arguing that she responded to them by laughing, following balloons with her eyes, and trying to speak to them. They unsuccessfully battled through the courts for tests that they believed would show that she was aware of her surroundings, and for therapies that they said might have helped her to regain some of her abilities, such as speaking or swallowing.

In February of 2005, about a month before Schiavo died, disability rights advocates in the U.S. called for a national moratorium to stop doctors from removing feeding tubes from all people considered to be in a "persistent vegetative state" and who did not have an advance directive or durable power of attorney.

Not Dead Yet called for the action in response to research done at Cornell University, which suggested that people in a "minimally conscious state" may be aware of their surroundings and can hear what is going on around them -- even though they may not be able to respond. Researchers compared fMRI scans on subjects that had significant brain injuries with those done on volunteers with no brain injuries. The researchers found that while the resting brain activity for those with brain damage was almost nonexistent, their brain activity jumped up to the same level as the volunteers when researchers played audio tapes of loved ones telling familiar stories and talking about shared life experiences.

Thoughts of woman in 'waking coma' revealed (Nature)
'I felt trapped inside my body' (BBC News)
Disability Group Calls For Suspension Of Feeding Tube Removals February 23, 2005 (Inclusion Daily Express)
Terri Schiavo's Right To Live (Inclusion Daily Express Archives)

Copyright 2006 Inonit Publishing
Article reproduced here under special arrangement with Inclusion Daily Express international disability rights news service. Please do not reprint, republish or forward without permission.


"Owen and other scientists were quick to point out that fMRI imaging would not have helped Terri Schiavo," why not?

Hi Bruce,

In the articles I read, many scientists emphasized that Schiavo's brain was damaged much longer and much more severely than this woman's. How they determined how long or how damaged a person's brain would need to be before being nonresponsive, I don't know. I'm not sure they do either, considering that this fMRI research casts doubt on the popular assumption that people in 'persistent vegetative states' do not feel, think, or interact.

The researcher in this story said the woman showed no outward signs of awareness or responsiveness. Only the imaging technology revealed the true extent of her condition.

From what I saw of Michael Schiavo's attitude and actions, my sense is that he would not have permitted fMRI scans in the first place (other tests were done only at the court's direction and despite Mr. Schiavo's protests). Even if fMRIs were done and revealed that Terri was alert and aware, my guess is he would not have backed down from her death sentence.

Remember, disability advocates pushed for a halt to feeding tube removals for people in Terri's situation after fMRIs showed activity in the brains of others who were in "minimally conscious states". If Mr. Schiavo were worried at all that he was ordering the death of a woman who might not already be "brain dead" (her tombstone has February 25, 1990 as the date she "departed this earth"), he could have stopped the dehydration process and allowed her brain to at least be tested.

No, for whatever reason, he apparently wanted to get her life over as quickly as possible.

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