Update: Belgian "coma man's" "communication" actually facilitated

Man in vegetative state not really communicating

In a follow-up to the post below about communicating in a vegetative state, a new report indicates that the Belgian man whose alleged communications first opened the window to such studies may not have been saying what was attributed to him.  Rom Houben made headlines around the world when researchers reported that in spite of his having been in a vegetative state for many years following a car accident, he appeared to be functioning at a level high enough to perceive and respond mentally to the world around him. In spite of the optimistic headlines, however, some observers expressed skepticism that Houben was doing the communicating.

Facilitated communication a bit too facilitated

As just reported in Der Spiegel, follow-up testing to address lingering questions about the report seems to indicate that Houben likely was not formulating those responses himself. Instead, the speech therapist appears to have been doing the responding. While the physician conducting the original study said that he had already tested for this possibility, further, more stringent tests demonstrated that Houben lacked even the muscle strength to have typed the responses attributed to him. It is not uncommon in facilitated communication for the person doing the facilitating to unconsciously begin communication their own thoughts or perception of the patient’s thoughts.

Not ruling out consciousness

In spite of these findings, because of the results from imaging of activity of Houben’s brain, there is little doubt that he lives in some kind of consciousness. The imaging suggests a level of activity near that of a healthy brain.  Also of interest is the fact that even though Houben didn’t pass the more stringent set of tests, another patient with a comparable diagnosis did. Thus, the quest to determine the magnitude of consciousness, perception, and response in patients diagnosed as “vegetative” continues.

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Vegetative state or consciousness?

The brain is a funny thing

Brains are funny things, and neuroscientists are learning more and more every day about the unpredictability of the human brain. While a decade ago, experts might have insisted, based on their standard bedside tests, that a person in a persistent vegetative state could not understand anything being said around them, two recent reports have signaled a shift in the dogmatic wind. The first was the celebrated discovery that a Belgian man, who’d been considered PVS for 23 years after a car accident, emerged from his state and reported having been conscious the entire time. The second, just released, indicates that a small percentage of patients in a persistent vegetative state may not only be conscious but also be able to process questions and answer them accurately. In this latter study (available in full text here), investigators used a technique called functional MRI, which provides an image of the blood flow that occurs to areas of the brain that have become active.

A question of ethics?

These findings raise a number of ethical questions. Some issues of concern center on whether or not these patients might be able to express a wish to live or die, and if so, what the response should be. On a more potentially positive note, doctors suggest that they might be able to ask some presumed PVS patients if they’re experiencing pain and take steps to alleviate it if the answer is yes. Some people may remember the Terry Schiavo case, which raised a number of ethical questions about such conditions and end-of-life issues. In her case, her condition arose from oxygen deprivation. Researchers in the most recent study report that only patients who had experienced traumatic brain injury–rather than oxygen deprivation or blood deprivation–were in the group of patients who seemed able to respond to questions.

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