Monday, July 11, 2011

Rediscovering consciousness in PVS patients

The recent edition of Discover Magazine is reporting on new research that is showing that the human brain can regenerate after traumatic injury and it is proving that certain types of stimuli has had some success at restoring consciousness for people who are thought to be in a Permanent Vegetative State (PVS).

Before explaining some of the findings in the article I question why this news is being reported as new or revolutionary. In 2004, I attended a conference in Europe on Persistent Vegetative State. At that conference there were two presentations on the success of "Awakening Centers" in Europe.

Awakening Centers didn't use electrical impulses, such as those being used by the team at Cornell Medical Center, but rather they focused on physical stimuli. The Awakening Centers would physically stimulate all the parts of the human body by simulating crawling or simulating walking as well as they would have physiotherapists stimulate all the main muscles of the body. These Awakening Centers had significant success with people who were abandoned as PVS patients.

I also question why there are no Awakening Centers in North America and there has been no information reported about the success of the Awakening Centers in Europe.

The article in Discover Magazine explains the success that Dr Giacino is having by using electrical stimulation on people who are diagnosed as PVS. The success of this work is turning our understanding of PVS up-side-down.

The article states:
The old verdict was harsh but clear-cut: Mourn your loved one, because he or she is gone.

“These are human beings who seem to have lost their humanity,” Giacino says. “The question is, is that really the case?”

The article describes the case of a man who was beat up and had been beat-up and was believed to be in a PVS state. After stimulation was applied to the brain the article stated:
As soon as the researchers switched the stimulator on, the man’s eyes opened. The doctors were not yet sure that it worked; they waited two months for the patient to completely heal from surgery before beginning their cognitive tests. The real moment of drama came during one of those first sessions, when the patient had the electrodes fully switched on for several hours. Schiff and Giacino showed him a picture of a red Radio Flyer, and before Schiff even remembered what the toy was called, the patient said, “Wagon.”

As months passed his repertoire increased; with the stimulator switched on, he could swallow, hold a cup, name objects, speak short sentences, and smile. The real impact of the stimulation is best described by his mother, who had been told the night of his beating that he would never be more than a vegetable. “My son can now eat, speak, and watch a movie without falling asleep,” she said through tears at a press conference announcing the results of the study. “He can express pain. He can cry and he can laugh. The most important part is, he can say ‘Mommy’ and ‘Pa.’ He can say, ‘I love you, Mommy.’ ”

Research concerning the rediscovering of consciousness is important because today we warehouse people in care homes who are determined to be in PVS or we abandon them to death by dehydration. They are treated as non-humans or the living dead.

The case of Terri Schiavo was even refered to in the article which stated:
In 2005, just as the deep brain stimulation patient was making his first forays into awareness, the fate of Terri Schiavo, a Florida woman who had been in a vegetative state since 1990, sparked an ideological war. Her husband wanted her feeding tube removed, ... her parents disagreed. Eventually, everyone from the governor of Florida to the U.S. Congress took sides. The arguments hinged on different impressions of how much awareness Schiavo still retained. A clip of Schiavo smiling was shown over and over again on TV. Senate majority leader Bill Frist (a heart surgeon) insisted that the video meant she was still conscious. ... Eventually her feeding tube was removed and she died


The future holds much hope for people who are declared to be PVS. The article refers to one successful case that appeared from the outset to be impossible. The article stated:
One of the Schiff group’s recent subjects was 23 years old when he sustained a severe head injury in a car crash. CT scans showed that his brain was ravaged, with a huge shadow of fluid where neural flesh should be. He spent three months in a vegetative state. A year after the accident, a physical therapist realized the patient could voluntarily move his head. The therapist trained him to use a letter board, in which a helper points to letters until the patient reacts, spelling out a message one letter at a time. His IQ turned out to be normal, and apparently his personality survived too; after several hours of being queried and quizzed by Schiff’s team, he used the board to spell G-E-T O-U-T.

Schiff’s team helped him acquire a head mouse, which allows him to use a computer by moving his head to control the cursor. He slowly continued to improve. Last winter, this man—who not long ago might have been abandoned as hopeless—sent Schiff’s group an e-mail. "Hi," it said; "I’m doing well." It was a telegram from a future world.

There is hope that many more people will soon be able to be brought out of coma to once again be treated as a human being and not as the living dead.

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