Vegetative State Patient Plays Tennis in Her Head

Many medical-treatment decisions are made based on the patient's likelihood of recovery and anticipated quality of life. A diagnosis of a persistent vegetative state brings with it the documented low likelihood of recovery and, for those who do recover, the documented high likelihood of moderate or severe disability. In many cases, a diagnosis of a permanent vegetative state is a key factor in deciding to withdraw life-sustaining treatment. Accurate diagnosis of vegetative states is extremely important.

New research (discussed below) holds great promise for improving the accuracy in diagnosing vegetative states. First, some background.

Many learned of the medical term "vegetative state" in the coverage of the tragedy that befell Terri Schiavo and her family. Terri died on March 31, 2005, 13 days after the removal of her feeding tube, after a 15-year struggle that captured hearts and minds across the country.

In a vegetative state, the person shows no sign of awareness or ability to interact with others. It is accompanied by sleep-wake cycles and at least partial retention of brain-stem autonomic functions (breathing and blood circulation, for example).

A vegetative state that has lasted for one month or longer is called a persistent vegetative state. It is typically called a permanent vegetative state after 12 months (in the case of a traumatic injury, as from an auto accident) or six months (after a non-traumatic injury, as from a heart attack or near-drowning). As confirmed by the autopsy performed after her death, Terri Schiavo had been in a permanent vegetative state.

People in vegetative states are unable to respond or communicate. If they can't respond or communicate, it has been impossible to know whether they have any awareness of their surroundings or circumstances.

Recently, however, researchers in Cambridge, England, created a breakthrough. They worked with a 23-year-old woman who had sustained a severe brain injury in a traffic accident. She was unresponsive and met all the criteria for a diagnosis of persistent vegetative state.

Using functional magnetic resonance imaging (fMRI), they mapped the woman's brain activity while they asked her to imagine playing tennis or moving around her home. They produced a startling result: The woman responded by activating different areas of her brain in the same way as healthy volunteers did. Her brain activity showed she was able to recognize spoken commands and respond to them. She was aware and able to interact! Accordingly, she was not truly in a vegetative state.

"These are very exciting findings," said Dr. Adrian Owen, who led the research. "This technique may allow us to identify which patients have some level of awareness," he said, adding "Future work will investigate whether this discovery could lead to a way of communicating with some patients who may be aware, but unable to move or speak."

For information on how to help you family avoid a tragedy like the tragedy that befell Terri Schiavo and her family, see our www.better-endings.org site.