"Vegetative state"

There is a Panorama special on BBC 1 tonight giving an insight into the lives of patients in a vegetative state and the consequent effect on their families.

However there is not complete agreement on the topic of vegetative patients, what does it mean to be "vegetative"?

The group of patients involved in the programme have all suffered from brain injuries, usually through trauma such as a car accident or perhaps another condition such as a stroke or viral infection.

The patients are different to "locked-in patients" whom I have previously written about, those who are paralysed however their brain function is normal and they can often communicate through eye movements. Vegetative patients are different as the brain damage suffered is so severe it leaves them with nothing but core reflexes, ie no brain function. They may be able to move their limbs or eyes but it cannot be due to command or controlled.

The Royal Hospital of Unpredictability (RHN) in London involved in the programme invented a vegetative assessment technique, SMART, which explores all five senses to detect any potential form of cognitive awareness or an ability to communicate.

In addition a fascinating brain scanning technique has been developed by Prof. Adrian Owen and his team which uses functional Magnetic Resonance Imaging (fMRI) to detect hidden awareness amongst patients who may be deemed vegetative by observational assessments.

The technique has recently been used to show hidden awareness in a Canadian patient, Scott Routley, who was believed to have been in a vegetative state for over ten years! Assessments since the car accident twelve years ago (the cause of the brain damage) have shown no signs of awareness or communication until now.

The patterns shown by the scans of brain activity show he is clearing choosing to answer questions. During the research healthy volunteers were asked simple questions and asked to think of the answer for a period of time, before saying it, whilst their brains were scanned. The same questions were then asked to brain damaged, vegetative patients and the images recorded were compared to those of the healthy volunteers and in Scott's case they showed cognitive function and understanding.

Observational assessments of Scott's behaviour since the brain scan continue to suggest he is in a vegetative state. In the future will scans such as the one using fMRI be used in addition to observational assessments to decide if someone is in a vegetative state?

Finally Prof. Adrian Owen said "asking a patient something important to them has been our aim for many years. In future we could ask what we could do 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." (Source:BBC)