Each night when you dream, your mind is active, yet your body is largely unresponsive unless woken up. A similar situation exists for some brain-injured patients who have lost consciousness—although these patients do not visibly respond to speech, touch, or other stimuli, they may still think and feel, with no means of communicating with the outside world. Unlike a person who is dreaming, however, some of these patients may also be aware of outside voices, sights, vibrations, and smells. But how can the patient’s doctor or family ever know that such a patient is conscious?
This problem, known as covert consciousness, is one focus of research in my lab, led by Dr. Martin Monti at UCLA. Patients who are in a vegetative state, also known as unresponsive wakefulness syndrome, are experiencing a condition in which they may open their eyes and show reflexive movements, but never voluntarily respond to stimuli. Understanding which of these patients still have minds glowing with the light of consciousness might sound like an impossible task. Without any behavior, how can we ever know what, if anything, these patients are thinking or feeling?
“Researchers found a clever way to communicate with one unresponsive individual, referred to as Patient 23, asking him to answer yes by imagining tennis and no by imagining walking through his home!”
Earlier in his career, my boss worked on this problem with Dr. Adrian Owen, a neuroscientist now at the University of Western Ontario. Monti, Owen, and their colleagues wanted to find out which unresponsive brain-injured patients were actually covertly conscious using functional magnetic resonance imaging, or fMRI. By asking patients in the scanner to either imagine themselves playing tennis or walking through their homes, the researchers could determine with fMRI if the patient had heard the request and generated the appropriate pattern of mental imagery. This works because imagining yourself playing tennis—a motor imagery task—activates different brain regions in the fMRI than imagining walking through your house—a spatial imagery task. In fact, they found that 9 percent of patients were able to generate mental imagery on-demand, a finding published in the New England Journal of Medicine in 2010. Besides demonstrating that a sizable fraction of unresponsive patients were covertly conscious, the researchers actually found a clever way to communicate with one unresponsive individual, referred to as Patient 23, by asking him to answer yes by imagining tennis and no by imagining walking through his home! To read more about Monti and Owen’s work, look for the full interview with both scientists following the excerpt below.
Since this landmark study, a similar task has been used by a group of researchers at the University of Michigan. Rather than looking for covert consciousness in unresponsive brain-injured patients, this group of researchers looked for evidence of consciousness—and found it—in a healthy volunteer put under with general anesthesia. So, much like a person who is asleep and dreaming, many people who appear to be unaware and unresponsive retain a private, mental life. Yet unlike a person who is dreaming, they may often be aware of their surrounding environment. Whether we are looking for patients who are aware under anesthesia or after being diagnosed with a vegetative state, the challenge of detecting covert consciousness is enormous. In a recent piece published in Aeon, a Knowing Neurons partner, I write about how a certain brain region’s lack of involvement in consciousness may give important clues on how to build the first consciousness detector:
In 2014, a month-long bout of dizziness and vomiting brought a 24-year-old woman in China to the hospital. She was no stranger to these symptoms: she’d never been able to walk steadily and suffered from dizziness nearly her whole life. These were serious, debilitating symptoms. And yet, they might have seemed almost mild once CT and Magnetic resonance imaging, a technique for viewing the stru... scans presented a diagnosis: the woman was missing the majority of her brain – in a manner of speaking. Yes, most of the players on the brain’s ‘stage’ were present: the cerebral cortex, the largest, outermost part of the brain responsible for most of our thinking and cognition, was present and accounted for; the subcortex and the midbrain, with their myriad functions involving movement, memory and body regulation – also present; the The part of the brain found just above the spinal cord (in r..., essential for controlling breathing, sleep and communicating with the rest of the body – present and accounted for.
But none of these arenas hold the majority of the brain’s currency – neurons, the cells that fire impulses to transmit information or relay motor commands. This distinction goes to the Brain structure involved in coordination, balance, posture, ..., a structure situated behind the brainstem and below the cerebral cortex. Latin for ‘little brain’, the highly compact cerebellum occupies only 10 per cent of the brain’s volume, yet contains somewhere between 50 and 80 per cent of the brain’s neurons. And indeed, it was in this sense that the hospitalised Chinese woman was missing the majority of her brain.
Want to read more? Click the link here to read the rest of the post on Aeon.co. Or wait, you’re still here? No problem, you’re in for a treat—below, you can read my full interview with Monti and Owen about their fMRI tennis task.
How was the idea for the fMRI tennis task conceived?
Owen: Melanie Boly [a neurologist and neuroscientist known for her work in consciousness] had been collaborating on a project, trying to find tasks that healthy participants could imagine performing in the scanner and that would produce reliable and different patterns of brain activity. We’d come up with singing in your head, imagining faces, and spatial navigation. The spatial-navigation task worked well—people easily imagined walking through their homes: we saw a flicker of fMRI activity in the parahippocampal gyrus in all but one participant. The nursery-rhymes scans were inconsistent: some people’s brains activated; some didn’t. And among those that activated, the brain activity was often in completely different places! The scans in which the participants were asked to imagine faces of people they loved were also disappointing, but for a different reason. Although the activity in the brain was fairly consistent from person to person, many participants reported that it was just too hard to do. It wasn’t that they couldn’t easily imagine the face of a person they loved, but it was impossible to hold that image in mind long enough for us to capture it with our scanner.
One task out of three was usable in patients. It wasn’t enough. We needed something else—a killer task that would work in everybody all the time. Melanie mentioned that she had been reviewing the scientific literature on mental imagery, and it seemed that complex tasks worked better than simple ones. What we needed was something complex that was easy to imagine. And then I hit on it. As Melanie recalled recently, I suddenly yelled, “What about tennis!?”
“Perhaps I struck upon this idea because it was late June and Wimbledon was in full swing. Everyone knows what’s involved in playing tennis.”
Perhaps I struck upon this idea because it was late June and Wimbledon was in full swing. Or maybe the tennis idea was just dumb luck. But that was definitely the pivotal moment when I came up with the idea. Everyone knows what’s involved in playing tennis. You stand holding a racket and wave your arms around in the air trying to hit a ball. And that’s all we needed; something that was easy to convey (“Imagine playing tennis”), but which would result in people’s imagining a similar but complex series of movements.
How did you decide on tennis, specifically, as the motor imagery task, and walking around rooms of one’s house as the spatial imagery task?
Monti: The choice was dictated by the neuroanatomical basis of each task. The two tasks tend to involve very different neuroanatomical substrates: one is closer to the top, or dorsal, of the brain, where we think there are mechanisms to plan and execute motor actions. The other one is close to the bottom, or ventral, part of the brain, where there seem to be mechanisms relating to representing spaces, locations, and visual maps.
Owen: I think I have answered why we used ‘tennis’ above. It really was the first idea I came up with once we started to think about complex motor imagery tasks. As for spatial navigation, in many ways, this decision was easier. There already existed a substantial literature showing that the parahippocampal gyrus was important for spatial navigation tasks and that this region could be activated reliably in individual participants. I had worked a little on this myself – in a paper in J. Cognitive Neuroscience in 1996 I showed that the right parahippocampal gyrus is important for memory of objects in places and this was a natural extension of that idea. But to work well in this new context we had to come up with a version of the task that had two important additional properties. First, it had to be very easy to convey to untrained individuals. This was absolutely key – we had to be sure that patients in the scanner would easily understand what they had to do. Second, they had to do be able to continue doing the tasks for 30 seconds at a time. Clearly, imagining a single object in space does not take much time. But asking someone to walk through the rooms of their house imaging all the objects and their locations one after the other, is something that can easily be performed for 30 seconds or more. So, in the late 1990s, we took these two ideas, combined with the existing literature about the parahippocampal gyrus and space and developed the spatial navigation task (“Imagine walking from room to room in your house”). It eventually appeared in its final form in a paper in 2003 (Curran et al., 2003). Although that 2003 study used Electroencephalogram, a technique that places electrodes on ..., it did show that the task worked very well: people easily imagined walking through their homes for 30 seconds at a time and it produced good results in individual participants.
How did you come up with the specific questions to ask the patient?
Monti: There was a lot of debate surrounding which questions to ask. My view was that we needed “easy” matter-of-fact questions which could be easily verified. When I piloted this in healthy volunteers, we decided to ask about siblings and family members, so we thought we’d do the same with the patients.
Owen: Early on, the most basic questions were decided upon by Marin Monti and I. We were playing around, trying to see how easily we could answer questions with me in the scanner and him in the control room. So, we spontaneously came up with questions that were easy to answer (simple “yes” or “no” responses) but that he would not know the answer to (like “Have you got any brothers or sisters?”). Martin then went on and used the same basic questions to assess 16 healthy volunteers. Here’s an excerpt from my book describing that:
Martin scanned sixteen strangers, using the technique we had developed: playing tennis for yes; moving around your house for no. Sixteen people, three questions each. It took a couple of weeks to complete the experiment. When we were done, Martin bounded into my office, beaming from ear to ear. I knew what the result was, it was written all over his face. Amazingly, just by looking at the patterns of activation in the brain in response to each question, Martin was able to correctly decode the answers to every single one of the forty-eight questions posed in the experiment. It worked! Reliable two-way communication with fMRI was possible!
So when it came to scanning the patient we started with those same basic questions. The reason for this is not obvious to everyone. We had to begin by asking questions that were concrete and verifiable to prove that the patient was communicating and correctly answering questions. We also wanted questions that we didn’t know the answer to, so we were ‘blinded’ to the result. So, we went with the same sort of demographic questions that we had used with the healthy volunteers….do you have any brothers? Etc.
How the session ended is something quite different. Again, I described it in detail in my book:
Things were happening so fast that we’d run out of questions. We hadn’t even considered what to do if the patient got this far. I suppose we just didn’t believe it would happen! “Audrey wants to know if we should ask him if he likes pizza,” Martin said. Audrey’s suggestion raised an important issue. So far, we had only asked questions that had definitive yes or no answers that could be verified by interviewing the family after the scan. Questions such as “Have you got any brothers?” are definitive. You either have or you haven’t. They can also be verified with family members. But questions such as “Do you like pizza?” are not. I like mushroom pizza, but I don’t like pepperoni. My answer to the question, then, is “It depends on what kind of pizza.”
In addition, my preference for pizza is not something that is a checkable, unassailable fact, such as whether I have a brother. We agreed that asking John his father’s name was a good option, as well as where he had last gone on vacation before his accident five years earlier. The family was contacted and gave some possible answers, some right and some wrong, and Audrey went back to the scanner. We had time for just one more question. Melanie called Steven on the phone for his advice.
“Ask him if he wants to die,” Steven said.
Melanie was taken aback. “Are you sure? Shouldn’t we ask him if he’s in any pain?”
“No!” Steven responded. “Ask him if he wants to die.”
It was a harrowing moment. We’d decided to push things further than we’d ever pushed them before, and now we were facing the possibility of pushing them in a new—and frankly terrifying—direction. What if he replied yes? What would we do? Even if he replied no, we could do nothing much but accept that at least we now knew what his wishes were.
None of us, including Steven, had thought through the ethical conundrum that this situation posed. For almost ten years I’d been working toward this—working toward communicating with patients in the gray zone and asking them their wishes—but now that we were there, I had no idea what we were going to do with the answer. I wasn’t even sure that we should be asking the question! But in Liège, Steven ran the show and the decision was his. I suspect he knew that ultimately this was the important question—the question that the family wanted to ask.
It’s hard to say whether what happened next was good or bad—in many ways it got us out of a difficult situation, but I can’t pretend that I wasn’t disappointed. The results of John’s scan when he was asked “Do you want to die?” were inconclusive. Despite answering the previous five questions clearly and accurately, John’s brain activity when he was asked whether he wanted to die was impossible to decode. It wasn’t that there was no response, it was just impossible to say whether he was imagining playing tennis or walking through the rooms of his home. He appeared to be doing neither. It was impossible to know whether his answer was “Yes, I want to die” or “No, I do not want to die.” I have no idea why this happened, but I suspect that like “Do you like pizza?,” for most of us “Do you want to die?” does not have a clear yes or no answer. Perhaps John’s reaction was “Well, it depends on what the alternative is!” Or “What are the chances that you will find a way to get me out of this situation within another five years?” Or “Can you give me some time to think about it?” The possibilities are many, and any one of them would have yielded a confusing pattern of brain activity that we would find impossible to decipher, because John was neither imagining playing tennis nor moving through the rooms of his home—and these were the only two brain states that we could reliably interpret and understand.
How did it feel to “establish communication” with Patient 23? What was the reaction like from the team when you decoded this patient’s responses?
Monti: Well, of course we were very excited to see that this approach could work in this patient cohort – also since as we and others have shown, it works remarkably well in healthy volunteers.
Owen: Oh, it was incredible. It blew my mind (no pun intended). I’d been working since 1997 (when we scanned our first patient) for this moment…gradually moving closer and closer to the day when we might actually communicate with a patient through brain activity alone. There had been so many steps leading up to that moment…first showing that some supposedly vegetative patients could activate their brains at all, then showing that some were actually conscious and aware and could modulate their brain activity to command and finally, communication. It was a pivotal moment and one that I will remember for the rest of my life.
Why was only one patient in the New England Journal of Medicine study asked autobiographical questions? How many patients have been asked these autobiographic questions using the tennis task since the study was published?
Monti: That study was the report of several years of doing “tennis/spatial navigation” in patients – and it started well before I had started working with Dr. Owen in Cambridge. So we only started developing the communication task well after we had started the overall experiment.
To me, the most important aspect of this is that since we published the result, a number of other groups have reported similar results – though each with a slightly different approach and questions, which is also important since it means that this strategy is robust to different methodologies.
Owen: Because he was the very first patient we tried this on. We’d been working on the method while we and others had been scanning other patients imaging playing tennis and walking through the rooms of their homes. This was then the first time we tried to actually communicate with a patient. The first version of that paper was a single case study – just the patient who had communicated – but NEJM felt it gave an unfair impression about the likely frequency of such things. They wanted to know how many other patients we had scanned and what the results were. Fortunately, between Steven’s group and mine we had scanned 54 patients so we could provide the extra detail, but we had only tried to communicate with one patient at that point. In some ways it’s unfortunate because many people read the paper thinking that only one patient could communicate, when in fact, we only tried it in one patient. Still, we went on later (in other papers) to describe other patients doing the same thing so I guess it all worked out fine in the end…..I’m not sure exactly how many patients have been asked these questions. In my lab, it’s probably around 20, but there was an extensive review by Kondziella et al., in 2016 which shows that many patients around the world (more than a thousand) have been given the imagery tasks. I presume that many of these were also asked questions…..
What feedback did you get from families? How did members of Patient 23’s family feel about researchers using the tennis task to communicate with their loved one?
Monti: Well, families are usually very happy to hear “science based” feedback from us, but if I recall correctly, the family said they “knew that their loved one was conscious”, which is not unusual.
“I think for [the relatives], regardless of the outcome, the sense that they have ‘gone the extra mile’ and did everything they could for the patient gives them some closure.”
Owen: I did not communicate directly with that patient’s family so I do not know what their response was. He was only in Liège for a week. He’d been transferred from Eastern Europe for his assessment by Steven’s group, and it was time for him to return home. Many years later I asked Melanie what had become of him. After he returned home, the team had lost touch with the family. The phone numbers they had provided were disconnected, and there was no other way to make contact. I have spoken to many other families over the years and their response has been overwhelmingly positive. I think for them, regardless of the outcome, the sense that they have ‘gone the extra mile’ and done everything they could for the patient (and more) gives them some closure. In many instances, hearing that their loved one is conscious after all reaffirms what many of them have suspected all along.
What was your reaction to learning that 5 out of the 54 participants were covertly conscious? How did this finding match with your expectations?
Monti: I think we knew we would have found some patients who would have been in this category, but at the time it was not easy to predict just how many. I think what is more remarkable is the fact that, 10 years later, similar results have been reported in these patients by other groups, confirming our initial report, and similar findings have also been shown much earlier than we ever thought – that is, early after injury, when we thought patients were in a coma and therefore unconscious. Turns out, even patients who appear in a coma can have more cognitive function that can be observed with standard clinical methods.
“what are the chances that this [patient] is the only one?”
Owen: I have always said from the very beginning of this research programme, that this phenomenon must be more widespread than any of us think. The reason is logical and simple. When we showed for the first time in 2006 that a patient who fulfilled all of the criteria for a vegetative state diagnosis was, in fact, conscious, my first feeling was “what are the chances that this is the only one?”. And of course, the chances were tiny. How could it be that the only patient in this position happened to be the first one we asked to play tennis? I know back then that this must be relatively “common”. When I moved to Canada in 2010, the very first patient I was introduced to turned out to be our very best communicator – we scanned him and communicated with him many times over a 14 month period. Again, I asked myself, what are the chances of me moving across the Atlantic to a small town and that small town has one of only a handful of patients worldwide? Of course the answer is “none”. We know now that there are patients like this in every town and that adds up to many thousands worldwide. If anything, I am surprised that only 5 out of those first 54 were covertly conscious. I suspect many more of them were, we just failed to detect it at the time.
Have any patients who participated in the study made substantial recoveries? Is so, is there any evidence that these patients remember participating in the study?
Monti: It is hard to tell since it is not easy to follow-up over long periods of time these patients. However, while I have often, informally, asked patients who did recover to the point of being communicative at the bedside, nobody has told me they clearly remembered engaging in these tasks. I have to stress, though, this was just an informal question, and we are talking about a very small sample.
Owen: Oh yes. We had a spectacular example of one young man in Canada who we scanned and then he recovered many months later. He remembered absolutely every detail about the procedure, even though it was 9 months later! We’d made a list of all the places we’d taken him in London—the hospital, the ambulance, the scanning suite—and a list of the people who had assessed him. We found pictures of those places and pictures of those faces. Then we assembled a matched series of “control” places and faces. Pictures of places he hadn’t been, graduate students who were working on other projects in the lab at the time and had not been. His answers were astonishing. Yes, he remembered being scanned—going into a dark tube and being afraid. He remembered us asking him to imagine playing tennis. He recalled one of my graduate students called Steve: “He put electrodes on my head and had a deep voice.” Steve does indeed have a deep voice and “he put electrodes on my head” is a pretty good lay description of EEG. Juan remembered everything about his first visit, down to the tiniest detail.
How do you feel about the Huang et al 2018 Scientific Reports study (that used a similar paradigm to show that 1 in 5 patients under propofol anesthesia are covertly conscious)?
Monti: I had two reactions. The first one was “wow!” and “scary!”, the second was some pride that yet again another group could use our approach to explore the boundaries of conscious states.
Owen: I think it’s very interesting! As I am sure you know, the study shows that at least one participant rendered behaviourally non-responsive with propofol was able to produce the characteristic fMRI pattern when asked to imagine playing tennis. This is important for several reasons – first, it verifies the phenomenon that we first observed (that is, that there can be a complete dissociation between motor output and cognition). Second, it shows that brain damage is not necessary for this to occur. The one thing I found curious about the study was that the participant did not remember performing the mental imagery task. This was put down to the amnestic effects of propofol – which makes sense – but of course that is where our results differ. That is to say, we now have seen DOC [disorder of consciousness] patients who exhibit the same phenomena, yet can recall the experience much later. But it is a very interesting paper.
Do you ever see the fMRI tennis task (or something similar) eventually being used to ask patients questions that would guide or even terminate their care? If so, what are the major obstacles towards achieving this?
Monti: This is a discussion that we had in the group as this study was unfolding and I thought there was no way we could ask, at that early stage, such questions. With the benefit of 10 years of distance, I think it is still hard to think of this approach as a routine clinical approach. On the one hand, when we get positive evidence, it seems to be fairly unambiguous. On the other hand, studies have shown that fMRI is not as sensitive to the presence of consciousness as other approaches are (e.g., Positron emission tomography (PET) involves injecting a mole... or joint TMS-EEG). So my current view is that while these fMRI studies have led to a scientific revolution, this might not be the best approach to apply to the clinic, where, for routine use, we need something simpler and more robust to noise.
“What is most tantalizing about this prospect is that it would allow a seriously brain-injured patient to express their current wishes.”
Owen: Yes, I do see this as a certainty. I have written an awful lot about it over the years and I don’t really want to repeat that all here. I’d rather refer you to the literature. But I will say this much: Our findings undoubtedly have important implications for end of life decision-making and the law; in particular, for the increasing number of legal cases that have raised the possibility of using fMRI to inform judicial decisions about the prolongation, or otherwise, of life after severe brain injury. In most of these cases, the key medical and legal decisions revolve around several inter-related factors: i) whether the patient is conscious or ‘aware’ of their condition ii) whether there is any chance of significant recovery; and iii) what the patient would have said, had they had been consulted about their current condition in advance. It is now absolutely unassailable that fMRI can detect covert awareness in some patients who appear to be entirely vegetative and, subject to the appropriate quality controls and scientific guidance, there is no a priori reason why such data could not be used to guide a court’s opinion about “whether the patient is conscious or ‘aware’ of their condition”. The case for using functional Techniques for viewing the brain and its activity, especiall... to predict whether a patient might experience some recovery is also compelling. For example, Di et al. (2008), reviewed 15 separate studies involving 48 published cases and concluded that functional neuroimaging can predict recovery from the vegetative state with 93% specificity and 69% sensitivity. Similarly, in a study of 41 patients, Coleman et al. (2009) showed that the results of fMRI testing correlated significantly with subsequent recovery, while a specialist behavioural assessment did not. The third factor is perhaps more controversial, but in my opinion, equally compelling; using the technique introduced in our NEJM paper, it is entirely possible to ask a covertly aware patient if they want to continue living in their current situation, obviating any need to determine what they “would have wanted” in advance. What is most tantalizing about this prospect is that it would allow a seriously brain-injured patient to express their current wishes, which may well have changed radically in the interval (sometimes decades) since they expressed any premorbid opinion. With that said, would a “yes” or a “no” response be sufficient to be sure that the patient retained the necessary cognitive and emotional capacity to make such an important decision? Clearly much more work needs to be done and many more questions would need to be asked of a patient before one could be sure that this was the case and, even then, new ethical and legal frameworks would need to be introduced to determine exactly how such situations are managed, and by whom. But ultimately, the morally challenging question of whether theirs is a life that is “worth living” (Kahane and Savulescu, 2009) is one that could be answered directly by the patient, using fMRI.
What are you most proud of regarding this study?
Monti: To me, the best part of the study was seeing how this work was followed up by a number of studies either showing similar results or, even better, presenting new (and enhanced) ways to detect consciousness covertly, from other fMRI approaches, to PET, to EEG in coma patients, to TMS-EEG. Having been involved in this at the beginning and being part of the team that got the ball rolling on this is something I am proud of.
Owen: Oh, I think that should be obvious. Combined with our Science paper in 2006, I think the NEJM paper more or less rewrote the book on i) whether any vegetative patients have covert cognitive abilities (and even preserved conscious awareness) and ii) showed that people can modulate their brain activity to communicate with the outside world without any physical response. Combine these two things and you have real time communication with an individual who was thought to be entirely unaware/vegetative and therefore, by definition, unable to communicate. I am very proud of the enormous impact these two papers seem to have had on many fields, including medicine, neuroscience, ethics and law, as well as the knock on effects that they have had on public opinion and the general media. It’s astonishing to me that, almost 10 years on, I am still called at least once per week by someone in the media to comment on this work and I guess that’s a measure of its long term impact.
How have most media or news reports characterized the study? Has most coverage been accurate or are there frequent characterizations by journalists?
Monti: For the most part, in a world of quick consumption catchy news, the coverage has been at times wonderful and at times “less than accurate.” These are undoubtedly complex conditions not easy to appreciate in all their nuance, particularly when, as it often happens, a journalist has less than 24 hours to become educated enough on the topic (and write a piece, and send it to their editor, and check every detail, and still send it to press by evening). In addition, these are often hot-button issues, which touch some deep and complex ethical and moral (and legal) issues, so there also is a political dimension to the reporting which does at times color the narrative. Nonetheless, I have also encountered my fair share of very professional journalists who have done a wonderful job at portraying the science of “disorders of consciousness” in a balanced and insightful way. Just recently Joanna Faryon of the LA Times has done one of the finest jobs I recall in reporting the stories of patients such as those we described in that study (https://www.latimes.com/california/story/2019-08-21/omar-salgado-consciousness-mystery).
Owen: I have worked very closely with the media for 20 years and I can honestly say that most of the reporting has been very respectful and, in most cases, accurate. Apart from small misunderstandings like the one I mention above (“Only one of 54 patients was able to communicate”) and terminology errors (our patients are often called ‘brain dead’ by the media), I think the reporting has been careful and accurate and I am grateful for that.
When you talk to families about other work being done in the Monti Lab, does this study come up a lot? Do you ever encounter families who ask why you can’t just put their comatose relative in the scanner to see if they’re conscious?
Monti: Yes, the fMRI study comes up at times when I talk to families and I always try my best to give a balanced assessment of its pros and cons.
Were there any major setbacks or frustrations while doing this work? Or, anything that turned out much better than expected?
Monti: Well, the reality of clinical work is much more frustrating and complex than “standard” scientific work in healthy populations – though not to say these studies cannot also be pretty complex and difficult to carry out! However, in carrying out studies with these patients we have often been derailed by things such as a “missing MR-compatible oxygen tank” which we have to chase for half-an-hour, coughing during the MR scan, and once we had a patient soil himself on the MR bed – which made for a pretty bad morning. So yes, quite some frustrations, but no more no less than my colleagues experience.
Owen: I am a very positive person. I don’t really do ‘setbacks’. My group has always just conducted experiments and then written up the results, regardless of what they are. I have always believed this is the only way to do good science. Of course there have been frustrations. Sometimes it’s been hard to recruit enough patients for our studies, sometimes you put a patient in the scanner who you know is conscious but you can’t get good data because they move too much or their spasticity prevents you getting them into a good position. But these are just the day to day ups and downs of doing science with challenging patient populations. Before I got into this area in 1997 I was a regular ‘brain mapper’ – charting the frontal lobes of the brain. The work was interesting and impactful but the procedure of doing the science was very predictable (always easy to find healthy participants, the scans more or less always ‘worked’). In that sense, what I do now interests me far more because it is more challenging and less predictable.
Did anything from the fMRI-tennis ask work turn out better than expected?
Owen: Well, yes, my entire career! In 1997, when we first put a vegetative state patient into a scanner, I would never have dreamed that the results would change my life forever. That work has taken me around the world, it’s introduced me to state leaders, politicians and royalty, it’s allowed me to give talks to audiences of 5000 or more, it gave me the material for a best-selling book (which is set to become a movie), but mostly, it actually seems to have had an impact on people; not just the patients and their families, but normal people – people who might not usually think about science and how important it is to society.
Isn’t consciousness research so fascinating? Such findings and methods could open up doors for providing better care for patients in a vegetative state with covert consciousness. It would be great to hear your thoughts in the comments section below.
Interested in more? Give our podcast on consciousness a listen, it’s another great interview lead by Dave Farina (from: Professor Dave Explains, Professor Dave Debates) featuring our very own Joel Frohlich.
— Written by Joel Frohlich. Illustrated by Alexa Erdogan.