Vegetative patient says 'I'm not in pain'

http://www.bbc.com/news/health-20268044

by kposehn • 12 years ago

101 66 12 years ago

ballard2• 12 years ago

This suggests future work on assistive devices that may be able to "speak for" a patient by ML and manual algorithmic adjustment... Huge quality-of-life improvement potential for people with limited/impaired vocal-ability.

Beyond that, there is far wider potential for translating brain scans directly and skipping vocal-aural pathway by communicating with others digitally.

ChuckMcM• 12 years ago

I was thinking this as well. It reminded me of the "Commander Pike" character in the original Star Trek that could only respond yes or no through a light.

return02• 12 years ago

Unfortunately fMRI is not suitable for the kind of precision needed for such stuff. Usually implanted electrode arrays are used instead http://en.wikipedia.org/wiki/Multielectrode_array#Applicatio...

Houshalter• 12 years ago

There is evidence that it is. They have been able to record images people are seeing from fMRI data. The information is there, it's just a matter of processing it.

ZeroGravitas• 12 years ago

The quote seems deceptive as presumably the patient had a brain scan reading that they interpreted as "no" shortly after asking "Are you in pain?".

Just from the article I'm dubious. They presented no evidence that this isn't wishful thinking, which I'd be keen to establish it wasn't if I was in their place. Could just be journalists fudging the message though.

bcgraham• 12 years ago

This article leaves out some of the detail from older articles (specifically [1]) about this patient where they describe the painstaking process by which they determined these patients were answering yes-or-no questions knowledgeably. See also [2] for an older article with more detail around the process.

[1] http://www.nbcnews.com/health/health-news/brain-scans-reveal...

[2] http://www.nytimes.com/2010/02/04/health/04brain.html?em

pygy_• 12 years ago

They rely on mental imagery [0] to communicate.

They ask the patients to imagine themselves playing tennis or wandering in their house for tens of seconds at a time. These tasks activate different neural networks, and it is possible to tell them apart using fMRI.

Sustaining the activation of higher level cortices requires not only consciousness but attention and concentration.

From there they can encode yes/no answers (tennis vs house).

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0. Detecting Awareness in the Vegetative State—http://www.sciencemag.org/content/313/5792/1402.short

Full text: http://perso.univ-rennes1.fr/pascal.benquet/index_fichiers/s...

This is the first publication with this protocol, which has been cross-validated and widely applied ever since: http://scholar.google.com/scholar?cites=16360852850070909865...

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Crito• 12 years ago

I can't imagine that this is the first time somebody has put a vegetative patient into an MRI. Does anybody know what makes this time different? Are they using a new imaging technique, or is the patient perhaps in a different (previously undiscovered?) state from other "vegetative" patients?

Edit:

Hitting up wikipedia to refresh on the terminology and delimitation of different states, I found this:

"In 1983, Rom Houben survived a near-fatal car crash and was diagnosed as being in a vegetative state. Twenty-three years later, using "modern brain imaging techniques and equipment", doctors revised his diagnosis to locked-in syndrome.[26] [... interesting stuff about facilitated communication, and how it is bullshit ...] Houben's case had been thought to call into question the current methods of diagnosing vegetative state and arguments against withholding care from such patients.[26][32][33]"

http://en.wikipedia.org/wiki/Locked-in_syndrome#Rom_Houben

Seems potentially similar, but from three decades ago.

pcrh• 12 years ago

I guess it depends on what kind of pain is being referred to. I can't imagine myself being both conscious and in a vegetative state without experiencing a lot of psychological distress.

pyre• 12 years ago

It's been 12 years, though. I think that in all of that time, you would have found some sort of acceptance of your situation.

breadbox• 12 years ago

You're imagining who you are now being in that state, not who you would be after enough brain damage to leave you in a vegetative state. Imagine that you're not (for example) laying down long-term memories, or that your ability to sense the passage of time is compromised.

wetmore• 12 years ago

The article says he was able to lay down long-term memories - he knew that his sister had a daughter, who was born after his accident.

shadowcats• 12 years ago

Can this technology be refined?

Someone should do a startup to build devices that allow higher bandwidth communication.

valarauca1• 12 years ago

I realize this forum is for technological entrepreneurial pursuits but are you kidding me?

A single MRI costs ~2 million used (Angel Investors are always the hard ones to grab). GE Medical Holding invests more then 1 billion dollars a year in R&D with almost 18 billion a year in revenue. This is like reading up on a Intel Processors and wondering if their is a way for you to personally refine and profit from refining the technology.

Yes there is a chance, but good luck.

Sources: http://en.wikipedia.org/wiki/GE_Healthcare

huxley• 12 years ago

While I agree about your main point, your costs are a bit out of date. Most brand-new MRI machines cost between $1-3 million with an additional $300-500,000 for the room and ancillary equipment.

adrianN• 12 years ago

But you wouldn't have to use a MRI. In fact a MRI is not practical at all because the patient needs to be inside it to communicate. Much better would be an implantable electrode array. I'm sure they're much cheaper than a MRI too.

dokem• 12 years ago

12 years? Put the poor bastard out of his misery already.

smoyer• 12 years ago

I'm guessing you're being down-voted for the way you expressed your sympathy, but if it were me, I'd want some brave family member to consider ending my misery. I certainly wouldn't want to be "trapped" in a non-functioning body unless there was a good chance I'd recover at some point.

It's good to hear he's not in pain, but what would they do if he expressed a desire to be "put out of his misery" via the fMRI?

aaronem• 12 years ago

There's enough bandwidth for yes-or-no questions, right? I wonder if anyone will ever come up with the courage to ask such a patient "Do you want to die?"

coldtea• 12 years ago

For one, some people might prefer "this misery" to nothingness. Have you asked that particular guy?

Second, there have been cases of people in states like this for years, who then made a surprising recovery. Like this:

http://www.foxnews.com/story/2005/05/06/firefighter-miracle-...

Or this:

http://www.dailymail.co.uk/news/article-1230092/Rom-Houben-P...

But what I don't particularly like about that line of thinking, is this: medicine thrived and grew on a quest to fight disease and death. The talk about "pulling the plug" and euthanasia opens a huge "Overton Window" that can go from not treating terminally ill patients to eugenics.

contingencies• 12 years ago

So a whole bunch of people have been imprisoned while conscious ... stuck with no capacity to communicate but a constant hospital white noise as their sensory input for decades. Scary.

venomsnake• 12 years ago

Just think of the ones that have been unplugged ... and the @#$%storm that will come out of it.

Terry Shiavo may be just a storm in a teacup compared to that.

return02• 12 years ago

They are known as locked-in patients. http://en.wikipedia.org/wiki/Locked-in_syndrome

mherdeg• 12 years ago

The patient in this article, Scott Routley, died in September 2013: http://www.macleans.ca/society/technology/beyond-words/

Zigurd2• 12 years ago

So, to all you brain upload enthusiasts: What if the Mark I upload experience feels like acquiring an intellectual deficit and living in a dark can? Still better than death?

mjburgess2• 12 years ago

"upload consciousness" is just a meaningless juxtaposition of words, the modern pseudo-intellectual crank lexicon.

One might as well say, in other ears: "capture personality with cathode rays" or "compress the fluid of the soul" or or "render oneself in brass automata" or "bottle the element of the mind".

It is essentially an argument from ignorance combined with an argument from authority: "look what we've discovered! we dont know it's implications! here's some implications (sprinkled with academa-bable)".

m0th87• 12 years ago

This is an ongoing debate in science and philosophy, so it's certainly not a meaningless juxtaposition of words. The counter-arguments against Searle's Chinese room argument alone should be enough to put the handwaving to bed.

hackinthebochs10• 12 years ago

I find it disheartening that this "hyper-skeptical" brand of pseudo-intellectualism has taken hold in certain circles. Suppressing imagination and foresight in favor of a cold reverence to facts is misguided. Creativity and vision (along with need) is the driver of scientific progress; you cannot have one without the other. So dismissing thought experiments and speculation as "meaningless juxtaposition of words" is utterly missing the point of everything that has been accomplished by scientific progress thus far.

It doesn't take much of a leap at all in fact to realize that uploading one's consciousness to a virtual world is very plausible. If the meaningful stuff of consciousness is information rather than matter, it is in fact a certainty. Of course, questions of whether you're uploading your consciousness rather than a copy abound, but I think there are solutions to even that issue (which I've discussed here: http://www.reddit.com/r/philosophy/comments/237qqj/kurzweils...)

graeham3• 12 years ago

The impossibility of an "uploaded mind" relies on the assumption that there is something special about the mechanisms behind the human brain's function that cannot be replicated in a machine (including an artificial, organic computer). The brain's function would have to the the result of something other than the structure and organisation of its biology.

(Probably the people who believe in the possibility of minds in machines would argue 'souls' and 'personality' are also purely functions of the underlying biology and learning, and thus could also be made artificially).

"Consciousness" itself is tricky to define, as it is essentially defined only by the experience of the evaluator. We are little further in our understanding then Descarte's, "I think, therefore I am". Our evaluation of the consciousness of other entities is limited to traits in them that we see in ourselves. "It thinks like me, therefore it is, too." Hence the appeal of the Turing's Imitation Game to evaluate artificial intelligence.

baddox• 12 years ago

Probably better than death, given that you might stick around long enough for better versions. Definitely better than death if you can choose to end it whenever you please.

graeham3• 12 years ago

Probably an uploaded brain would require simulation to prevent this 'dark can syndrome'.

I'm sure if we have the ability to upload a mind, we would be able to find ways to stimulate it from boredom. Perhaps this would be as simple and infinite browsing of Wikipedia. Perhaps stimulation of the dopamine or similar pathway would do the trick, but being immortal just to live high as a kite sounds like a bit of a waste.

Perhaps this need for stimulation could be removed from the mind on upload. Or similarly, perhaps the 'survival instinct' that drives the desire for infinite life through brain upload is vestigial now that modern humans aren't as effected by natural selection.

kimonos• 12 years ago

Couldn't imagine if this happens to one of my family members..

PhasmaFelis• 12 years ago

Jesus, this is terrifying.

I need to go remind my family to unplug me if I'm ever in a state like this. Death is infinitely preferable to being trapped in my body for endless years.

StavrosK• 12 years ago

Can we use one of those $60 brainwave-detecting toys for this? I would imagine training would consist of the patient trying to modulate a tone's frequency with thought, and then testing would have the person answer yes/no with high or low tones.

aaron695• 12 years ago

I'd be pretty sure this is just 'facilitated communication'.

If it is even close to 1 in 5 like they claim there should be a lot more teams out there on this sort of thing.

Vegetative patient says 'I'm not in pain'

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