If that patient is actually aware of his surroundings, then he has been trapped in a body with almost no sensory input for almost 6 years. Personally, that sounds like the worst hell imaginable.
I've told everyone close to me that if I am injured badly they are to ask for 'no extreme measures' for this exact reason...
It's just the opposite actually, and worse. If he's aware of his surroundings, he's been trapped for 6 years without any output instead. Able to observe and think, but unable to move, unable to speak, unable to interact with or affect his environment except as a comatose patient.
Being Locked-in is one of the worst things I can imagine and yet is very real.
Yes, you are absolutely correct. I was kind of thinking in terms of interaction but got it backward.
What I was trying to convey was that no matter how dedicated your loved ones are they're not going to be with you every minute of every day if you're apparently comatose. That means this poor guy has probably spent most of the last six years lying in a bed by himself with nothing going on around him...
I think within a few months you would descend into a self-hallucinatory dreamworld -- you'd be insane, but I don't think it would be the worst hell imaginable. Not even close.
Hallucinations are caused by sensory-deprivation rather than motor parylization. For example, float tanks, also there are specially designed rooms that have as close to no background noise as possible, and people report hearing all kind of audio hallucinations such as bees, etc.
This test demonstrates he can at least hear sound. I'd imagine the effects would resemble senility from lack of engagement more.
Over stimulation by excitatory neurotransmitters is the primary cause of neuron death during stroke, the idea is that many neurons thought to be dead might have just shutdown to prevent from being overstimulated. And if baseline stimulation is reduced enough through what is normally sleeping medication, they might actually start to activate again.
I'm not sure that I meant hallucination in the clinical sense. I meant that if I was trapped inside my own mind for months on end, I would have nothing else to do besides create elaborate fantasy worlds in my mind and I suspect many others would do something similar.
Good point on the living will... Up until now I have just made every person close to me promise to pull the plug if it ever came to a situation like this. I'll look into that some more...
Great news, comminucation is the most important thing.
Here is the story boy that was unable to speak or contact with world and was considered "vegetable" by doctors, till he picked up a language BLISS from a teacher that was teaching some other child in his hospital room.
That sank without a trace - no comments, no upvotes - perhaps this report will get a better response. I think it's interesting, so I hope it does.
It's a fascinating idea, getting yes/no answers from brain scans. The potential is there for using text output devices similar to those that Hawking uses, except driven by the patient imagining playing tennis.
Well, I would hope the first application is to determine if the patient is in physical pain and where that pain is. Reducing suffering should be priority one. The next part I would hope would be to see if the patients can recognize voices of loved ones. I would imagine these two milestones could help patients learn to "write" to such a device, which could be automated to flag down a nurse or turn on a radio for a while or something.
The real question from this though is about the patient's rights to choose. IANAL but if I understand it correctly this could cause difficult questions in consent, especially where minors are concerned.
There was a book written by a man with locked-in syndrome after a stroke. It made me want to write a living will.
"The entire book was written by Bauby blinking his left eyelid, which took ten months (four hours a day). A transcriber repeatedly recited a French language frequency-ordered alphabet (E, S, A, R, I, N, T, U, L, etc.), until Bauby blinked to choose the next letter. The book took about 200,000 blinks to write and an average word took approximately two minutes. The book also chronicles everyday events for a person with locked-in syndrome."
I wonder which would actually faster - binary search on the standard ordered alphabet or going linearly in order of letter frequency.
Even better - some hybrid algorithm that goes through the most common letters then goes into binary search for the remaining letters (many of which appear at approximately equal frequency)
You could probably also have a tree of the ~32 most common words. At the very beginning you could have a branch to choose whether you want to pick the 'word' tree or the 'letter' tree.
This whole story is really very fascinating, although a few details seem a bit odd.
For example, the patient didn't answer the last question because.. he fell asleep? I would imagine if I was trapped inside my body and suddenly given a mechanism to communicate, I would be too excited to fall asleep.
Did they observe any signs of excitement that I would expect a person to feel in this situation? Increased heart rate or other brain activity? Did the man try to convey his own message using the new-found communication mechanism?
It almost sounds like they are communicating with some small ghost of the man's subconscious, something that can respond to basic queries and recall memories, but lacks what we would really consider a consciousness.
Actually, detecting brain activity in an MRI requires long aquisition times. Around 30 seconds per answer at least (which is the duration used in this study AFAIK). That means that a single "yes" (imagining you're playing tennis) or "no" (imagining you're walking in your house) requires 30 seconds of sustained attention.
This patient is obviously severely brain damaged.
If you've ever seen a person recovering from brain trauma, you'll know that their ability to focus is usually minimal. Answering questions for this patient may very well have been exhausting. This means that out of the other 22 patients in the study, some may be conscious but unable to cooperate long enough for the mnesic trace to be recorded.
Regarding other signs of activity, you can't detect random activity using fMRI. I haven't read this paper so I don't know the details (I'm only familiar with previous studies done by this team), but regarding heart rate, blod presure, etc, the brain damage may prevent it from occurring too.
Since he was only able to produce yes and no ansers using a contrieved process, he was of course unable to produce any other message.
The idea that the patient was exhausted came to my mind as well.
Imagine being locked-in for so many years, and then suddenly being asked to imagine things. It's not as easy as it sounds: Imagining something in such a strict order over such a long period of time is actually quite exhausting.
For example, the patient didn't answer the last question because.. he fell asleep? I would imagine if I was trapped inside my body and suddenly given a mechanism to communicate, I would be too excited to fall asleep.
They probably made that assumption because people fall asleep inside MRI's all of the time, especially during extremely long fMRI tests, when they try to isolate the senses (i.e. it's very dark, you wear earplugs and ear phones). Also, the brain damage might predispose someone to have a short attention span/wakeful periods.
Did the man try to convey his own message using the new-found communication mechanism?
If I understand correctly, he was given the means to convey "yes" by imagining himself playing tennis. The concept of "no" was encoded by the absence of "yes".
If he had wanted to send some message, like "tell my children I love them", or "I feel pain in my abdomen", how would he encode it?
He certainly can't send messages as complicated as that, but if I only had one bit to flip, I would be flipping it as much as possible to get someone's attention.
That said, he probably did the correct thing by simply answering their questions. That shows that "someone is home" better than flipping his bit randomly.
However, I think their publishing the idea that these patients were "conscious" is morally questionable. The reasons for this are expressed far more elegantly that I could manage by Parashkev Nachev in the following response:
I've told everyone close to me that if I am injured badly they are to ask for 'no extreme measures' for this exact reason...