British neuroscientist Adrian Owen made it his mission to reach these forgotten patients, as he reveals here. ‘When I first met Carol, she had lain in a hospital bed for months without responding or showing any sign of awareness. A scan had revealed substantial damage to frontal lobes of her brain, which control our important cognitive abilities, such as problem solving, memory, language and judgment.’ In July 2005, the married 23 years old had been hit by 2 cars while crossing a busy road. A moment’s distraction had redefined rest of her life. She had repeatedly been tested by neurologists and diagnosed as vegetative. ‘Since 97’, I had been using hospital brain scanners to test patients in vegetative states to see if they were in fact still conscious, though trapped in their bodies. I was working as a research fellow at University of Cambridge’s Addenbrooke’s Hospital when I scanned my first ‘vegetative’ patient, Kate, while showing her pics of her family as she lay inside a brain scanning machine. To my amazement, she had shown a response in a part of her brain called fusiform gyrus. This is associated with facial recognition. Some months later, Kate began to rouse from her vegetative state, though no one can say for sure how this happened. Kate wrote to me a few years afterwards and urged ‘Please use my case to show people how important the scans are. I was unresponsive and looked hopeless, but the scan showed people I was in there. It was like magic, it found me.’ Since Kate’s case, we have been scanning increasing numbers of vegetative patients to find signs of life. Our evidence suggests that 15 to 20 % of people in this state who are assumed to have no more awareness than a head of broccoli are fully conscious, though they never respond to external stimulation’ he continued.
‘They may open their eyes, grunt and groan, occasionally utter isolated words. Like zombies, they appear to live entirely in their own world, devoid of thoughts or feelings. Many really are as incapable of thought as their doctors believe, but some patients are experiencing something quite different: intact minds adrift deep within damaged bodies and brains. They are trapped in grey zone between life and death. My colleagues and I were trying to help them emerge. So back to Carol In 2005, we attempted something entirely new. Rather than simply trying to stimulate patients’ brains and see some response, we were going to ask Carol to communicate back to us while she lay in our scanner a functional magnetic resonance imaging scanner. This machine shows which parts of the brain are active by detecting those that are using most oxygen. We asked Carol to imagine playing tennis to think about swinging her arm back and forth, a volley here, a drop shot there. We wanted her to imagine she was playing tennis as if her life depended on it. In one way, it felt like total madness, but we had found that when healthy volunteers imagined playing tennis while in the brain scanner, they all activated an area on top of brain known as the premotor cortex. This is involved in preparing to make limb movements. Now, with Carol inside scanner, something amazing was happening. Whenever we asked Carol to imagine playing tennis, she would activate her premotor cortex just like healthy volunteers. We then asked Carol to do something else to imagine walking around her home. Our research had shown that when people imagine moving through a familiar environment, it stimulates activity in part of brain called the parahippocampal gyrus.’