It’s not clear how much Jeff Tremblay knows about the role he’s playing in a revolution in the treatment of the catastrophically brain injured
“The ominous events in the early morning hours of August 12, 1997 led to a tragedy in Lloydminster, Saskatchewan….” – from a Saskatchewan Court of Queen’s Bench ruling issued in 1998.
Jeff remained comatose for three weeks, until one day Paul, camped out around the clock in Jeff’s hospital room, looked up from his crossword puzzle and saw his son’s wide-open eyes and that great big smile, and thought, ‘Geez, he’s going to be fine.’” Now, tests that can detect covert consciousness, not just expensive, bulky fMRI, but bedside EEG machines that use small discs on the scalp to measure brain activity, are moving a step closer to routine use.
If someone can modulate their neural activity — communicate via signals from his or her brain — is that a sufficient, or even reliable proxy for speech? And if we find a way to communicate, what, then, do we ask them? Is there anything we can do to make you more comfortable? Is there anything you’d prefer to watch on TV? Do you wish to continue living?
But this is where things get dicey, says Dr. Judy Illes, Canada Research Chair in neuroethics at the University of British Columbia. Individuals who we thought were in a persistent vegetative state may not be and, in some cases, certainly are not However, people diagnosed as being in a vegetative state, or the much larger group known as the minimally conscious, simply can’t marshal the resources to, say, blink an eye, or move a foot on command. It’s not a muscular problem. They aren’t paralyzed. Rather, there’s a central nervous system problem, a disconnection that’s preventing them from executing any movement at all, Owen says. But their thoughts, their mental process could be intact.
Since then, Owen and his team have used imaging to ask patients if they prefer the temperature lower or higher, whether they still like watching hockey. “One of the sad truths is that they get exposed to an awful lot of whatever it is they used to like before they had a brain injury,” Owen says. “If you were a great lover of Celine Dion 20 years ago when you had your brain injury, maybe you don’t want to listen to that anymore. We can return a little autonomy to patients.
“Well, maybe, but we didn’t know where to start. You need the basic imaging and you need to understand what’s causing the problem before you can solve the problem of how to fix people. And I think we’re getting there. We’re just at the tipping point right now,” Owen says. “We’ve got patients who we know are on the edge of being able to establish communication, but we don’t really know what to do for them yet,” says Schiff, adding that it’s a population of patients that has been horribly neglected for years.
“My gut tells me that families might not know what to do with this information. What they will want to know is whether their loved one can hear their voices, feel their touch, or if he or she is experiencing pain.” However, the tests aren’t pitch perfect. Accuracy rates range from 60 to 80 per cent.
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