20 DISCOVERMAGAZINE.COM
PAT GREENHOUSE/THE BOSTON GLOBE VIA GETTY IMAGEStreatment for decompression sickness
that involves a person breathing pure
oxygen in a pressurized room or
chamber. Helen also gave him herbal
supplements, and she held ice to his
feet and coffee grains below his nose
in an attempt to trigger physiological
reactions and memories.
Did any of this help Stephen recover?
I don’t think so. There’s no science that
shows these techniques are effective for
people in vegetative states. While we have
learned a tremendous amount about the
brain and the tenuous, fragile nature of
consciousness, we’re only now starting to
figure out why some people recover from
brain injury and some do not.
STEPHEN’S RETURN
Months after I had first examined him,
Stephen began his return. It all started
when he laughed at an offhand comment
by his mother. Gradually he started
speaking, eating on his own, brushing
his teeth and regaining the ability to
walk through physical therapy, although
most of the time he used a wheelchair to
get around.
I invited Stephen to visit us so we
could better understand how he had
recovered and what he remembered, if
anything, of our tests.
He described in detail the many tests
he had undergone while he appeared to
be in a vegetative state. He remembered
the electrodes being placed on his head
for the EEG and being inside the fMRI
scanner. We showed him pictures of lab
workers — some who tended to him dur-
ing his lab stay and others who did not.
And we showed him pictures of rooms
where he was examined and pictures of
rooms where he wasn’t. Stephen cor-
rectly identified the people who worked
with him and the rooms he was in.
A year later, I drove out to his house
for another follow-up. “What do you
want to talk to me about?” said Stephen,
now an intense-looking 21-year-old with
trimmed dark hair and dark eyes. I sug-
gested he tell me about his experiences in
the hospital’s ICU after his brain injury.
“I felt like I was trapped,” he said.
“But I wasn’t terrified or despairing. I
knew that I was going to get through it.”
He said he was not in pain and that he
constantly tried to communicate.
“It was like being inside my body, but
not being able to control it.”TALKING TO BRAINS
There is no medical term for Stephen’s
condition: being conscious yet com-
pletely unable to communicate and
control body movement. Locked-in syn-
drome comes close, but those patients
are able to move their eyes (helpful when
responding to questions), something
Stephen could not intentionally do.
Clinically speaking, he was in a
vegetative state. But how could we have
missed his flickering consciousness?
Oxygen deprivation damages brain
areas randomly. A person might sustain
slight damage to the motor cortex and
end up paralyzed on one side. Another
person might endure damage to areas of
the brain that connect the motor cortex
with the thalamus, which we know
regulates consciousness, and results in a
vegetative state.The second scenario is likely what
happened to Stephen. Damage to
this area can also mask brain activity
normally picked up with scans, explain-
ing why we missed it. Stephen recovered
because the connection between two
regions in his brain either regrew or the
brain linked them in a new way.
His case underscores the limitations
of fMRI and EEG for determining
consciousness. An alternative has
recently emerged: f NIRS, or functional
near infrared spectroscopy, which
uses a laser to detect brain activity by
measuring oxygenation in the blood.
It’s portable and less expensive than
fMRI. And it’s shown promise in
detecting active areas of the brain more
accurately than an EEG.
Eventually fNIRS could be used in
patients’ homes so they can communi-
cate with family members. They might
ask, “Do you feel good or bad today?”
To respond “good,” the person might
be instructed to imagine one task (such
as playing tennis) that would light up a
specific region of the brain. To respond
“bad,” they would be asked to imagine
something that activates a different part
of the brain (such as walking through
the rooms of their home). Recently
the device was used in the ICU of a
Canadian hospital to ease communica-
tion between a patient and his doctors.
While there’s still no medically proven
way to bring someone back from the
gray zone between life and death, a
portable fNIRS could increase the
quality of life of a nonresponsive but
cognitively aware person.
As for Stephen, his quality of life
continues to improve. He is studying life
sciences at a university, and is close to
leaving his wheelchair behind.^ DAdrian Owen is a neuroscientist at
Western University in Ontario, Canada.
This story was adapted from his book
Into the Gray Zone: A Neuroscientist Explores
the Border Between Life and Death. The cases
described in Vital Signs are real, but names
and certain details have been changed.This wallet-sized fNIRS device developed
at Tufts University uses a laser to detect brain
activity. The unit, which has been shown to
be more accurate than an EEG, is held on a
patient’s forehead and linked to a computer.Vital
Signs