Communicating through MRI? How do they know what he is saying?

Vegetative man tells doctors ‘I’m not in pain’ via MRI communication.

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 his 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.”

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 textbooks will literally need to be re-written when it comes to evaluating patients suffering from severe brain injuries.

I’m REALLY unclear about this. How do they know he is answering and just not processing the information? More over, how can they interpret what he is saying from a brain scan? How can they tell he is not in pain or that he knows what is going on? The article doesn’t say. This needs to be documented as a study so other doctors can use this information, test it and see if it can actually be used as they claim it can. Meanwhile, I just don’t know what to believe about this. Sounds too good to be true.

Tip: David Gluck

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  10 comments for “Communicating through MRI? How do they know what he is saying?

  1. November 14, 2012 at 8:06 PM

    Yeah, haven’t there already been a lot of “first times” when it comes to facilitated communication? This would be wonderful, but I absolutely remain skeptical until there’s good science on it. These stories are not necessarily a boon for the disabled.

  2. Andrew
    November 14, 2012 at 10:30 PM

    I read this article yesterday, and was every bit as confused as DN seems to be. How do they “know” any of this? It sounds to me like it is wild speculation on their part.

  3. November 14, 2012 at 11:26 PM

    This sounds like high-tech pareidolia.

  4. November 15, 2012 at 3:30 AM

    I haven’t watched the Panorama program yet,but there was a small piece on Radio 4 about this the other morning. One of the questions they asked patient was to imagine playing tennis and the FMRI showed activity in the Motor Cortex (IIRC) which is apparently what would happen when one imagines a physical activity.

    Based on this it would appear that they are trying their best to rule out as much as possible and this is not just your average facilitated communication. My biggest issue here is that this is a news story, even the television program is part of the BBC’s news output, and to date I haven’t seen anyone refer to and critique a paper.

  5. Hannah
    November 15, 2012 at 1:08 PM

    I’m glad I wasn’t the only one who thought these claims were reaching beyond their evidence.

  6. Rand
    November 15, 2012 at 1:12 PM

    I could see them starting off with “such and such lit up, patient, can you make it light up 3 times? now try 4? now doing the ‘shave and a haircut’ rhythm…. ” that could establish if the patient can understand them, and actually control whatever it is they are looking at in the mri. After that, they could do once for no, 2 for yes, 3 for can’t answer with yes/no”, and go 20 questions with it. Heck, if they guy knows (or can learn) morse code, it could get real interesting….

  7. Phil
    November 15, 2012 at 7:45 PM

    Wouldn’t there be certain simple tests to see if there’s any brain response? Shining a light in the eye? Loud noise? How on earth did the patient communicate?

  8. November 16, 2012 at 5:07 AM

    OK so I watched the Panorama show last night (although I did fall asleep in the last 5 minutes or so)

    The technique used in the FMRI was to ask the patient to think really hard of playing tennis when the word tennis was said, and to relax when instructed to relax. On different occasions patients were asked to think of walking around the rooms of their houses. Both of these “imagination actions” are alleged to consistently activate certain areas of the brain, the motor cortex in the tennis action and I forget where for the house/rooms action, for almost everyone. The FMRI showed blood flow to these particular areas of the brain which was counted as a success.

    The documentary did show one person who did not respond to the tennis question in the manner expected and who was deemed to be in a vegetative state. Other patients were shown who were previously diagnosed as vegetative through physical diagnosis but who responded as expected to the tennis actions.

    Finally, after at least 2 sessions of recording tennis/house actions the Doctor believed that the patients were consciously aware and devised a method to ask the patients some Yes/No questions. The question would be asked and the patient asked to imagine playing tennis when the word imagine was said if their answer to the question was yes.

    In all this seems like a very interesting proposition, and as I said before not your average facilitated communication. However I have the following concerns that were not displayed on the program.

    1) No evidence of baseline/control. It is stated that almost everyone responds to the tennis action in the same way but not demonstrated so we have to take this on faith. The experiments should really display a fully conscious subject perform the same tests as a control.

    2) No apparent randomisation. The subjects were asked to imagine the actions on a voice command but there was no signs that the voice command was in any way randomised.

    3) No blinding. Interpretation of the FMRI results was performed by the operators of the FMRI who also issued the commands. Perhaps a third party should be interpreting the results without knowing when the voice commands were issued.

    • November 16, 2012 at 5:16 AM

      Thanks for looking into this. That is helpful information and pretty much what I expected.

  9. November 16, 2012 at 2:14 PM

    These findings have been published in Nature and the Lancet, which are pretty much two of the top places you can publish. A Google search can provide ample additional background, as this is not a new story (apart from the fact a documentary crew tracked it the whole way through for the first time). Hope this helps.

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