Communicating from a Vegetative State
You may remember the story that made the rounds in late 2009 concerning a Belgian man named Rom Houben. Mr. Houben was in a coma for 23 years, totally unresponsive to external stimuli. In 2006, he was diagnosed with locked-in syndrome based on the results of fMRI testing. After years of therapy, he began communicating to the world with the aid of a facilitator. In deeply moving and perfectly cogent prose, he described the agony of being a thinking consciousness imprisoned in an immobile and withered husk.
Once the news broke, it was only a matter of hours before the first neurologists cried fowl that the facilitated communication present in this video was impossible for a man in Mr. Houben’s condition. By sensing the most subtle gestures from the patient, the facilitator claims to know which keys on a modified keyboard he intends to press. Even the patient’s own doctor, Steven Laureys, has voiced skepticism over the methodology.
Recent research published by scientists from the University of Cambridge (of whom the same Steven Laureys is a co-author), shows a manner in which communicating with some people trapped in a vegetative state is definitively possible. These scientists prompted the patient to think about two separate activities: playing a game of tennis and walking through his home, and then mapped his brain’s activity through an fMRI. Noticing the fluxuations in activity when posed with these two hypotheticals, doctors realized that he was capable of understanding and responding to their requests. They then described to him that they were going to ask a series of questions, and if he wanted to respond with a “yes” he should think about playing tennis or “no” by reflecting on walking through his home. The questions they asked were direct, such as, “Is your father’s name Thomas” (“No”), followed by “Is your father’s name Alexander” (“Yes”). The cognitive patterns were clear replications of those used as primers, and the patient answered all six questions correctly.
This is exciting and encouraging news for doctors and families who care for those in a persistent vegetative state. The study’s authors caution that, “Cortical activation does not provide evidence of an internal ‘stream of thought'”, and that it would be misrepresenting the research to claim that brain activity indicates higher level cognition. With further research and additional technological innovation, the guess work and controversy around cases like Rom Houben’s will be unnecessary. Capturing complex emotional states and decoding them will enable a much more detailed view of reality for comatose and locked-in patients. Following the break-away growth of fully immersive virtual reality over the next twenty years, sufferers of these impairments may one day be enabled to hold their children, play a game of basketball, or make love once again.
UPDATE – 15 February 2010: Follow-up analysis conducted by Dr. Laureys and his team confirmed that Mr. Houben was not, in fact, communicating through his therapist. It appears as though the therapist was guided unconsciously by the ideomotor effect or worse, she was using him in some way for her own gain.
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