It’s a technology that might have come out of a science fiction story just 60 years ago: the functional Magnetic Resonance Imaging (fMRI). Today the machinery is real and medical scientists have just successfully used it to communicate with a man in a coma.
Research into ways to communicate with those that suffer from brain injuries or are comatose has been going on for centuries. Doctors have searched for methods to allow significant communication but until recently, all attempts met with frustrating failure.
Now scientists have discovered a way—by tweaking an existing high-tech medical device—to provide a “voice” for a 39-year-old Canadian man who has remained comatose for longer than 10 years. The attempt at communication was successful and the patient, Scott Routley, made clear to the scientific team attempting communication with him that he is not in pain despite his vegetative condition.
Textbooks need to be revised
According to a report about the breakthrough by the BBC News, “It’s the first time an uncommunicative, severely brain-injured patient has been able to give answers clinically relevant to their care.”
Overjoyed with the success, Routley’s attending physician declared that all the neurology textbooks need to be revised.
For the past several years, researchers have suspected that MRI technology might be adapted to permit communication with patients unable to communicate. Those researchers believed the brain could be scanned in such a way to make communication possible.
History and methodology of MRI scanning
Magnetic resonance imaging is a technology that employs a special imaging method allowing detailed images of the body’s internal organs, circulatory system, muscles and more. The images are harvested by fine-tuning a radiological device using nuclear magnetic resonance that captures high resolution images of atomic nuclei.
The powerful magnetic field that surrounds the patient’s body aligns the nuclei using radio frequencies that alter and modify the scan with a rotating magnetic field. From that an image can be obtained and depending on the intensity, angle (gradient) and rotation of the scanning field both 2D and 3D images can be created.
The entire body can be scanned, or only an area of particular medical interest. In the case of Routley, his comatose brain was scanned.
The technology is not new. Resonance imaging was first developed by Herman Carr in 1952. Carr successfully produced a flat image using the technique. He wrote about it in the Ph.D. thesis he submitted to Harvard Medical School.
Eight years after Carr’s momentous achievement, Vladislav Ivanov of the USSR filed a medical technology form at Leningrad’s “Soviet State Committee for Inventions and Discovery” for a new device that also employed a type of magnetic resonance scanning.
Despite the early success, the imaging technology didn’t really come into its own for patient use until the 1980s. By the 1990s MRI use for scanning to assist diagnosis began expanding across the world.
The fMRI technique is special imaging used primarily in body and brain scans to create a detailed picture of neural activity. The technology is normally applied to map functions within the brain and the spinal cord. To accomplish this the fMRI detects and creates an image of the energy used by brain or nerve cells by magnetically imaging what medical technicians call the “hemodynamic response,” or flow of blood.
Communication breakthrough with an aware brain
Routley, who had an auto accident in 2000 that left him with a severe brain injury, has been unresponsive since slipping into a coma. Attending physicians agree that the man hasn’t exhibited any ability to communicate in any physical way for more than a decade.
Despite Routley’s seemingly hopeless state, Professor Adrian Owen, a British neuroscience at the Brain and Mind Institute, University of Western Ontario, and leader of the research team, told the BBC that he never believed Routley was in a fully vegetative state and that communication with the patient’s mind was feasible.
“Scott has been able to show he has a conscious, thinking mind. We have scanned him several times and his pattern of brain activity shows he is clearly choosing to answer our questions. We believe he knows who and where he is,” Owen told the BBC. “Asking a patient something important to them has been our aim for many years. In future we could ask what we could do to improve their quality of life. It could be simple things like the entertainment we provide or the times of day they are washed and fed.”
Routley’s neurologist for the last 10 years is Professor Bryan Young at University Hospital. After the scientific team were able to establish meaningful communication with his patient’s brain, the professor remarked, “I was impressed and amazed that he was able to show these cognitive responses. He had the clinical picture of a typical vegetative patient and showed no spontaneous movements that looked meaningful.”
