August 14th, 2024

International Study Detects Consciousness in Unresponsive Patients

Recent research indicates that about 25% of unresponsive brain injury patients may show signs of consciousness through advanced techniques, highlighting the need for better assessment methods and communication strategies.

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International Study Detects Consciousness in Unresponsive Patients

Recent research co-led by Mass General Brigham has revealed that approximately 25% of patients with severe brain injuries, who appear unresponsive, may actually exhibit signs of consciousness when assessed using advanced techniques like functional MRI (fMRI) and electroencephalography (EEG). The study involved 241 participants who were instructed to imagine specific actions while their brain activity was monitored. Results indicated that 60 participants demonstrated cognitive motor dissociation, meaning they could understand and follow instructions covertly despite not showing outward responses. This finding raises important ethical and clinical considerations regarding patient care, as recognizing cognitive awareness can significantly influence treatment decisions and interactions with healthcare teams. The study, which spanned multiple sites across the U.S., U.K., and Europe over 15 years, highlights the need for standardized testing methods to accurately assess cognitive motor dissociation. The researchers emphasize the importance of developing better clinical infrastructure and resources to facilitate the detection of this condition, which could lead to improved communication strategies, including the use of brain-computer interfaces. The findings underscore the necessity of engaging with patients who may have retained cognitive abilities, as failing to recognize their awareness could result in premature withdrawal of life support and missed rehabilitation opportunities.

- Approximately 25% of unresponsive brain injury patients may show signs of consciousness.

- Advanced techniques like fMRI and EEG are crucial for detecting cognitive motor dissociation.

- Recognizing cognitive awareness can significantly alter clinical care and treatment decisions.

- There is a need for standardized testing methods and better clinical infrastructure.

- Research into brain-computer interfaces may enhance communication for patients with severe impairments.

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Link Icon 9 comments
By @mbil - 6 months
Only tangentially related, but reminded me of this anecdote…

I know someone who was a nurse for many years. She told me that once she had a patient, a young man who had been comatose for months. Her and another nurse were changing the bedsheets when they accidentally dropped him, and his head smacked into the bed frame, quite hard. He immediately woke up from the coma.

By @Hnrobert42 - 6 months
There is a fascinating memoir called Ghost Boy. In it, a young man describes how he fell into a coma as a boy and awoke around 14 years old. However, upon awakening, he did not have control of his body. It was many more years before an aide suspected he was conscious.

His story is quite inspiring and well worth the read.

By @amatecha - 6 months
In the past I had heard of "locked-in syndrome"[0] which seemed quite nightmarish to me, but I hadn't thought of the possibility of being "completely unresponsive" and still remaining conscious, perhaps living for years and years like this. Scary stuff :-|

[0] https://en.wikipedia.org/wiki/Locked-in_syndrome

By @noobermin - 6 months
My only qualm with this is mri studies of brain patterns are notoriously suspect. For example, the Bennett dead salmon fmri "experiment."

Moreover, the article does say there are some flaws in the study, as the data is across different institutes that did the measurements differently and often families of comatose victims reached out to be tested, potentially introducing selection bias.

By @m3kw9 - 6 months
I wonder when a one of these patients are in that state, they could be in a dream like state that seem real.
By @PlunderBunny - 6 months
Imagine being in an 'unresponsive' state and on life support for a long period of time - with what consciousness and sanity remain, you might wish to die, so if you were given covert instructions like the examples in the article, would you follow them, knowing that it might help with research, or would you ignore them in the hope that it would increase the possibility you would be declared brain-dead and taken off life support?
By @m3kw9 - 6 months
Consciousness in unconscious patients is a more accurate description
By @m3kw9 - 6 months
Could the instruction following is like the muscle reflex, but on for brain where you are not responding to complex questions accurate it very simple ones