Making Every Word Count for Nonresponsive Patients

Despite the apparent absence of external signs of consciousness, a significant small proportion of patients with disorders of consciousness can respond to commands by willfully modulating their brain activity, even respond to yes or no questions, by performing mental imagery tasks. 



However, little is known about the mental life of such responsive patients, for example, with regard to whether they can have coherent thoughts or selectively maintain attention to specific events in their environment. The ability to selectively pay attention would provide evidence of a patient’s preserved cognition and a method for brain-based communication, thus far untested with functional magnetic resonance imaging in this patient group.



In a just-posted article in JAMA Neurology, Canadian researchers Lorina Naci and Adrian Owen show for the first time with functional magnetic resonance imaging that behaviorally non-responsive patients can use selective auditory attention to convey their ability to follow commands and communicate. 



One patient in a minimally conscious state was able to use attention to establish functional communication in the scanner, despite his inability to produce any communication responses in repeated bedside examinations. More important, 1 patient, who had been in a vegetative state for 12 years before the scanning and subsequent to it, was able to use attention to correctly communicate answers to several binary questions. The technique may be useful in establishing basic communication with patients who appear unresponsive to bedside examinations and cannot respond with existing neuroimaging methods.