Is anybody there?

British and Belgian scientists have developed a fascinating way to communicate with patients with severe brain injury as reported in this week’s New England Journal of Medicine.

Martin Monti and colleagues used functional magnetic resonance imaging (fMRI) to visualize real-time brain activity in response to questions in a group of patients in either vegetative or minimally conscious states.

The ingenious feature in this work is that the patients were asked to respond to questions by thinking about either a motor activity (playing tennis) or a spatial activity (driving around a familiar location).  Since these mental activities “light up” different parts of the brain they can be used to signal a “yes” or “no” in response to questions.

The study involved 54 patients – 23 were in a vegetative state (unresponsive, eyes open) and 31 in a minimally conscious state (inconsistent, erratic responsiveness, eyes open).   The third category (not assessed in this study) is coma in which patients are non-responsive and have their eyes closed.

They found that five of the 54 patients could alter their brain activity by focussing on types of activities.  One of those patients was able to use this approach to communicate with physicians even though standard means of communication were impossible.

The authors concluded that some patients with severe brain injury can demonstrate brain activity consistent with awareness and cognition and that this approach can be used to communicate with these patients in a rudimentary way.

Quite amazing — with lots of potential applications in life sciences.