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Brain injury: The search for consciousness

by Access Legal


Up to 12,000 people aged under 40 suffer a traumatic brain injury (TBI) every year.

According to Professor John Pickard, Head of Neurosurgery at Addenbrookes Hospital, there are serious deficiencies in their care and a tendency for some patients with serious brain injury to be left languishing on general medical, surgical and orthopaedic wards.

Patients with severe brain damage may progress through stages of unconsciousness with eyes closed (coma), to unconsciousness with eyes open (vegetative state), to a stage of 'inconsistent, erratic responsiveness' (minimally conscious state - MCS).

Normally, the patient's cerebral cortex is impaired or destroyed, but their brain stem remains intact. Their breathing and vegetative functions are therefore normal and they don't need to be on a ventilator. Their limbs don't show any voluntary movement, but there's a wide range of stimulus reaction.

Such patients are sometimes described as 'living shells' - they are alive, but the person they once were has gone.

It's not known whether patients in MCS can process emotion. MCS is thought to have a more favourable outcome than persistent vegetative state.

A recent BBC Radio 4 documentary discussed the work of neuroscientist Dr Adrian Owen and his colleagues at the Medical Research Council's Brain Sciences Unit using functional MRI scans.

Functional MRI (fMRI) is a new technique used to study the workings of the brain. Rather than taking a single scan, fMRI scanning takes repeated scans, usually one-per-second, which are used to track the movement of blood through the brain.

By studying the blood's movement it's possible to tell which sections of the brain are particularly active in real time and to see how the brain reacts to outside events and activities. They can show evidence of brain activity in patients thought to have none.

The use of fMRI scans in patients thought to be in a state of 'minimal consciousness' or in a 'persistent vegetative state' (PVS) is particularly important, as little is known about these conditions and rehabilitation is difficult due to lack of PCT funding for referral to specialist centres. They are different from brain death, where there's total destruction of all brain areas and the consequent collapse of heart-lung function.

The research involved the team showing pictures to patients thought to be in a minimally conscious state or a PVS and then monitoring which areas of the brain were active and comparing these to healthy volunteers. Effectively, questions can be put to them and they can answer them using their brain and their answers can be shown on the fMRI.

A person's brain patterns can therefore be shown as normal, but it's important to distinguish between genuine conscious answers and those that may be purely reflexive responses.

The researchers asked very straightforward biographical questions requiring strict yes or no answers.

Subjects were asked to imagine playing tennis if they wanted to answer 'Yes', as this type of brain activity shows up in the 'supplementary motor cortex'.

If they wanted to say 'No', the subjects were asked to try to imagine finding their way from one place to another, as this type of brain activity produces a reliable activation pattern in real time whilst a person is in the fMRI scanner.

A 37-year-old teacher, Kate Bainbridge, thought to be in a vegetative state after suffering a viral infection, proved able to communicate and can now do so from a wheelchair using a letter board. She could have been written off and trapped inside her body if this research hadn't been conducted.

Hopefully, this will lead to improved diagnosis and care for some patients with these conditions. It is thought that around 20% of the subject group may benefit. The tendency for patients with these conditions to be shunted off to nursing homes will hopefully diminish.

However, there is not universal agreement in the medical profession, with experts in the USA stating the research doesn't show the actual nature of the consciousness.

Access Legal specialises in brain injury claims and has clients who are in states of minimal consciousness or in a vegetative state following accidents. If you have any queries about making a claim, please don't hesitate to call 03700 868 686.

In a recent case handled by one of our specialist Solicitors we acted for a 37 year old man knocked off of his bicycle by a car who unfortunately suffered a serious brain injury leaving him in a state of minimal consciousness. We were able to appoint a financial deputy at the Court of Protection within 3 months of the accident and ensure that he was transferred from his local Neurological Unit to the specialised unit at the Royal Hospital for Neuro-disability in Putney, London where he received specialised care and assessment.


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