Posted on 11/14/2012 6:20:31 AM PST by NYer
More than 12 years after a car accident left him in a vegetative state, a Canadian man has begun communicating with doctors who are monitoring his brain activity through Functional Magnetic Resonance Imaging (fMRI) scans.
The BBC reports that 39-year-old Scott Routley has been able to communicate to doctors that he is not in any pain, marking the first time an uncommunicative, severely brain-damaged patient has been able to give direct answers regarding their care and treatment.
"Scott has been able to show he has a conscious, thinking mind," British neuroscientist Adrian Owen told the BBC. "We have scanned him several times and his pattern of brain activity shows he is clearly choosing to answer our questions. We believe he knows who and where he is."
Owen leads a team at the Brain and Mind Institute, University of Western Ontario, which used MRI scans to measure responses from Routley.
Traditional tests have continued to indicate that Routley is in a vegetative state, with no relevant brain activity. Owen and other doctors say this means medical text books will literally need to be re-written when it comes to evaluating patients suffering from severe brain injuries.
Routley's previous neurologist said that for a decade all test results taken from scans of Routley's brain indicated he was not experiencing any mental activity.
"I was impressed and amazed that he was able to show these cognitive responses, said University Hospital's Bryan Young. "He had the clinical picture of a typical vegetative patient and showed no spontaneous movements that looked meaningful."
Owen says the results could lead to improved patient care for those living with severe brain injuries, making a major improvement in the daily of patients, including routine tasks such as when they prefer to be fed or bathed.
(Excerpt) Read more at news.yahoo.com ...
Indeed. Remember Terri Schiavo.
I was wondering the same thing, but based on some clues from a sidebar in the article, it looks like there is real communication:
"The patients were repeatedly asked to imagine playing tennis or walking around their home
"In healthy volunteers each produces a distinct pattern of activity, in the premotor cortex for the first task and the parahippocampal gyrus for the second
"It allowed the researchers to put a series of yes or no questions to severely brain-injured patients. A minority were able to answer by using the power of thought"
I am unfamiliar with all of these medical devices.
In this woman’s case, she collapsed suddenly, and CPR was administered to her for 40 minutes, before she regained a pulse.
Then she was taken to the ICU. I have no idea what machines were hooked up to her; but, she did not exhibit brain activity for 5 days. I don’t know if she needed a ventilator; but, I think she probably did, if there was no brain function.
And the brain function was what the discussion was about. Once they took her off whatever machine she was on, she died within minutes...so this wasn’t a case of a body able to breath without medical help, but only in need of somebody kind enough to ‘feed’ them.
I understand that doctors have to be blunt with patients and their families...and from the minute I heard about this 5 days ago, I was very worried that 40 minutes of cpr would be very bad for her brain...so I don’t doubt the doctors’ assessment that she was ‘brain dead’.
I am still astonished that 5 days seems to be the threshold they use. And I was amazed that it all happened in one day yesterday. In the early afternoon they had the discussion with the doctor about pulling the machines off...and at 6:30 pm, they did the deed. I would have pleaded for ‘just one more day’ after having the initial discussion.
Anyway, I hope my old classmate steers clear of this article, or he’ll have second thoughts for the rest of his life (or even more than he’ll already have).
Look, I don't give a damn' what you think about Obama-Care - but try having a modicum of respect for those of us who've had to deal with this issue in real life. There's no call for "Vega Table folks." That's disgusting and disrespectful.
Yep. ‘fraid so. Unresponsive but registered to vote for Obama.
Since we haven't seen the real data from the experiment, we can't really say. Maybe the difference between the two patterns is as persuasive as having a traffic light rigged up to the patient's brain. If the doctors publish their exact protocol in a peer-reviewed journal, other scientists and doctors will have an opportunity to propose alternate explanations for the data, if any are possible.
You could say that one weak hand squeeze is meaningful and another is just an involuntary reflex. Same for blinking.
It's an awful, awful decision one has to make and will likely have second doubts about it for the rest of your life. The only thing you can gain comfort from is knowing that another critically ill child or adult and their respective families will be given a second chance at life thru the harvested organs.......
My younger brother, then 38, was critically injured in a car accident back in 1998 while on business in California. He laid in a coma for a week before the decision was made. We were told that approximately 35 people would be the beneficiaries of his death....I just wish they could have know what a wonderful kid he was.
Quick, kill him before he communicates again!
Yikes!
And there are legal means to prevent that from happening. I filled out an exhaustive questionnaire provided by my attorney which asked for those medical conditions under which I refuse to continue to live and demand that all life-support (including food and water) be withheld.
My wife, who holds my medical power of attorney can, if necessary, go to a court and demand that my wishes be honored, i.e. if the doctors refuse to comply.
As I said, there are means.
It has to do with observed laws of averages... a patient such as the one you described probably had a period of prolonged brain anoxia and if, after taking sedation off, this patient has not exibited any signs of spontaneous improvement in level of consciousness or even improvements in being able to breathe on her own, all within about 5 days or so, the odds are she never would! An EEG would be done to rule out any higher brain wave functions and finding none, discussions would be initiated to end life support. Sometimes though, even after ending ventilator support, a patient’s brainstem and medulla are still quite functional and the patient may remain breathing with a healthy heart beat for a time...it depends on the damage to the brain. Thus you have a potential Terri Schiavo situation, especially if over time (longer than 5 days) the patient does begin to exhibit increased responsiveness though not in ways that give any hope of return to independent life!
It sounds like you have a medical background. One word you used piqued my interest: sedation.
The woman I have written about was deliberately cooled to 91 degrees, I think as an attempt to prevent brain damage. This is apparently very painful, so she was also sedated.
After a day in the hospital, she was warmed up, and they tried to take her off the sedatives. But, each time they did this, her body would tremor so badly, they couldn’t accurately monitor vital signs.
I don’t think they ever took her off the sedatives. Could the presence of sedatives affect the ability to monitor brain function?
It's not "the doctors"--it is the hospital. The doctors do not set the policy. The hospital administrators do. The state boards that supervise hospitals do. The doctors are the agents.
“Could the presence of sedatives affect the ability to monitor brain function”
Somewhat, if one is trying to assess for spontanoues return to neuro functioning/ increased level of consciousness. But the brain, damaged by severe anoxia due to a prolonged time without oxygen can go into status epilepticus when sedation is taken off which is also a sign of very poor prognosis. The brain, being severely injured is severely irritable, (think of damaged wiring with arcing and shorting between the various exposed strands), and by reducing the sedation, the dampening effects of the drugs disapates and the entire nervous system goes haywire...not conducive to life. A forty minute code, especially occuring suddenly without the knowledge of what caused the collapse is not conducive to liefe generally.
Now I’ve seen codes as long as 40 minutes where the patient survives, but usually, in a hospital situation when it happens, we know the patient’s issues and correct for them during the code, we pump 100 per cent oxygen and get them intubated right away and good CPR is important. The out of the blue collapses are problematic, so during the code we try to account for all possible causes while trying to maintain an open air way and give good CPR...hoping that we can blow the dying embers into flame again.
Early icing is important to preserve brain function and we are seeing excellent results, not just folks surviving a code, but increased numbers of these folks walking out of the hospital with almost if not all neuro functions intact! The key is chilling the brain early enough and keeping it flooded with good circulated oxygenated blood immediatly once a spontaneous pulse and circulation have been restored.
If too much time had passed and much brain death had occured before ROSC(return of spontaneous circulation)...say with a major stoke or brain bleed or just too much time without oxygen, as what might have happened with this lady you spoke of...then there is not much left that could ever be done medically.
They could have let the lady continuously tremor and tried some anti-convulsant drugs(which they may have probably tried but they probably didn’t work; if they did everything they were supposed to have done) but a continous status epilepticus just fries more brain cell, causes even more cerebral edema, raises the fever to dangerous levels and well just about everything you don’t want to see in loved ones just prior to their deaths.
Sometimes in anoxic brain injuries, you don’t get seizures but the hypothalmus is damaged and you get enormous fevers/sweats, blood pressure and rhythm changes. You get brain swelling and herniation of the brain into the spinal canal. It all depends on where the damage is, patient factors....etcetera.
FL could have re-written it in '05 if they listened to others and not be so hell bent on starving Terry Schiavo to death to suit the courts and her evil husband. YES, she was in pain when they starved her to death, the maggots, and denied her the care she needed - along with the love of her parents/family.
Ok,
Thanks for the information. From the very beginning, I worried that 40 minutes of CPR would be very damaging.
And, since it was done by the husband, with direction from a 911 operator, for the first 5-10 minutes, I certainly would not characterize it as ‘good’ cpr.
It sounds like she had really poor odds, right from the beginning.
Okay now that I am not confined to using a cell phone with itty bitty buttons I will reword my post - hopefully to your satisfaction...
Here in Amerika, under Obamacare - Citizens who have fallen into a vegetative state will likely be quickly removed from life support by the Health Care Financial Sustainability Committee (death panels), for the good of the Collective et al.
This is kinda all a moot point now.
The fact that the patient is conscious, or even walking, talking, and playing chess, is irrelevant, if the care of the patient is for other reasons costing the state too much in money and health care resources, and not capable of voting for the Democrat Party.
Keep your eyes on Jesus Christ. The Babylonians have laid siege to Jerusalem and are streaming through the gates.
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