One-quarter of unresponsive people with brain injuries are conscious
At least one-quarter of people who have severe brain injuries and cannot respond physically to commands are actually conscious, according to the first international study of its kind1.
Although these people could not, say, give a thumbs-up when prompted, they nevertheless repeatedly showed brain activity when asked to imagine themselves moving or exercising.
“This is one of the very big landmark studies” in the field of coma and other consciousness disorders, says Daniel Kondziella, a neurologist at Rigshospitalet, the teaching hospital for Copenhagen University.
The study included 353 people with brain injuries caused by events such as physical trauma, heart attacks or strokes. Of these, 241 could not react to any of a battery of standard bedside tests for responsiveness, including one that asks for a thumbs-up; the other 112 could.
Everyone enrolled in the study underwent one or both of two types of brain scan. The first was
functional magnetic resonance imaging (fMRI), which measures mental activity indirectly by detecting the oxygenation of blood in the brain. The second was
electroencephalography (EEG), which uses an electrode-covered cap on a person’s scalp to measure brain-wave activity directly. During each scan, people were told to imagine themselves playing tennis or opening and closing their hand. The commands were repeated continuously for 15–30 seconds, then there was a pause; the exercise was then repeated for six to eight command sessions.
Of the physically unresponsive people, about 25% showed brain activity across the entire exam for either EEG or fMRI. The medical name for being able to respond mentally but not physically is cognitive motor dissociation. The 112 people in the study who were classified as responsive did a bit better on the brain-activity tests, but not much: only about 38% showed consistent activity. This is probably because the tests set a high bar, Schiff says. “I’ve been in the MRI, and I’ve done this experiment, and it’s hard,” he adds.