They Hear More than You Think

Coma patients may have more awareness than previously thought, according to new research related to therapies for those in a vegetative state.

A minimally conscious state, contrary to a vegetative state, is characterized by some evidence of awareness of self or the environment, and patients tend to improve. The new research gives hope to the more bleak of the two conditions.

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“A number of patients who appear to be in a vegetative state are actually aware of themselves and their surroundings, able to comprehend the world around them, create memories and imagine events as with any other person,” Davinia Fernandez-Espejo, a professor in the School of Psychology at the University of Birmingham, told ScienceDaily.

Some patients in an apparent vegetative state are actually aware of their surroundings.

The study looked to identify the reason for the dissociation between coma patients’ “retained awareness,” and their “inability to respond with intentional movement,” according to research published in JAMA Neurology.

The findings identified structural damage in the brain between the thalamus, a symmetrical structure of two halves that relays sensory and motor signals and regulates consciousness, and the primary motor cortex, located in the dorsal portion of the frontal lobe. The primary motor cortex works with other motor areas to plan and execute movements.

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“In highlighting damage to the pathways that physically connect the thalamus, one of the hubs of consciousness if you will, and the motor cortex, which drives our voluntary muscular activity, as the reason behind the dissociation, we have provided an important explanation,” Fernandez-Espejo said.

One patient in a vegetative state — a status of “wakeful unconsciousness” —  for more than 12 years who had produced repeated evidence of covert awareness was studied, as well as another patient who had similar clinical variables but was additionally capable of intentional movement. Fifteen healthy “control” volunteers were also monitored for the study.

Using functional magnetic resonance imaging and fiber tractography — a 3-D reconstruction technique to access neural tracts — participants were asked to respond to various commands, such as imagining moving their hands in response to the word “move,” while their brain activity was measured and recorded. The researchers also evaluated the integrity of the patients’ structural pathways, revealed to be essential for motor execution (those connecting the thalamus and the primary motor cortex).

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“The ultimate aim is to use this information in targeted therapies that can drastically improve the quality of life of patients,” Fernandez-Espejo said. “For example, with advances being made in assistive technology, if we can help patients regain even limited movement in one finger it opens up so many possibilities for communication and control of their environment.”

Research continues into the mysteries of the brain in regard to coma. A recent study by researchers from Northwestern University Feinberg School of Medicine and the Edward Hines, Jr., VA Hospital has found that hearing a voice known to the coma patient tell a story can help the patient recover consciousness faster, as well as begin to respond to both conversation and directions.

“Families feel helpless and out of control when a loved one is in a coma,” lead researcher Theresa Pape said in a statement about the research. “It’s a terrible feeling for them. This (storytelling) gives them a sense of control over the patient’s recovery and the chance to be part of the treatment.”

“The family and friends of a person with a brain injury are important members of the team,” according to the “Coma Guide for Caregivers” offered by the Delaware Health and Social Services Office. The guide was developed for the Delaware Department of Health and Social Services by the family of a coma patient. “Friends of those with brain injuries may find it uncomfortable to visit when the patient is confused or agitated. Honest explanations from family members may help them continue to offer the attention and support that is so helpful to patients.”