Each involved an aware mind that could process spoken commands, follow instructions, understand words and use memory. Dr. Owen reasoned that if she could follow the instructions, the parts of her brain she would use to imagine the tasks would light up. He knew from experiments with healthy volunteers which parts of the brain relate to which task, and that they are easy to tell apart.
And bingo. When he asked her to imagine playing tennis, the correct bits of her brain lit up. When he asked her to imagine visiting all the rooms in her house, a different bit lit up. In fact, her scans were indistinguishable from those of the healthy volunteers.
The paper caused a sensation and pushed Dr. Owen to examine more patients in the scanner, testing to see whether he could help them talk using only their imaginations. Eventually, he could ask a patient to visualize visiting the rooms in a house as a way of saying “yes,” and playing tennis to mean “no.” Different parts of their brains would light up reliably in response. Then he tested them on questions he already had answers to. Is your father’s name Henry? Do you have a sister?
The computers would capture the information and he and his team would crunch the numbers and, days later, figure out what the patient had wanted to say. A big step forward came when the technology improved enough that Dr. Owen could read the scans in real time on the computer in front of him as the patient was in the magnetic scanner.
All of that led to the moment the BBC camera captured when, for the first time, Dr. Owen asked a medical question neither he nor anyone except for the patient could answer: He asked Mr. Routley: “Are you in pain?”
Mr. Routley imagined playing tennis. By prearrangement, that meant “no.”
And Dr. Owen could see it on the screen in front of him.
While the finding has received international applause among clinicians, members of a British physicians group developing guidelines to manage people with severe brain injuries have cautioned that it may be too early to use the scanning technique routinely, as encouraging as the findings are.
In an editorial in the British Medical Journal, they said the technique should be used at this point only on patients in a registered national research program.
“Currently, fMRI techniques are not sufficiently developed to form part of the standards assessment battery…” they wrote. http://www.bmj.com/content/345/bmj.e8045?ijkey=f71702f0da232a1e8542db6fad22155068a4bcde&keytype2=tf_ipsecsha&linkType=FULL&journalCode=bmj&resid=345/nov28_1/e8045
Still, Dr. Owen’s techniques of finding voices once lost forever are so revolutionary that they loom large in a handful of legal cases around the world.
One landmark case at the Supreme Court of Canada involves a patient of his, Hassan Rasouli, left brain-injured after an infection. http://www.theglobeandmail.com/news/national/doctors-await-supreme-court-roadmap-for-right-to-live-cases/article6144038/
Mr. Rasouli’s doctors argue that life support ought to be withdrawn and that further treatment could harm him. His family is opposed, saying the patient is aware of his surroundings but can’t say so. Dr. Owen says he currently cannot discuss the case.
He is quick to emphasize that while a scan might find the lost, it can never do the reverse and show that there is no consciousness. Some patients may simply not be able to communicate this way; it may take new, still-unimagined scientific breakthroughs to hook into their brains.
Even if that happens, the day when humans can live by thought alone does not appear imminent.
However, Dr. Owen says so many people are now working on this technology that in another decade, patients may be able to communicate by thinking the actual word “yes,” and maybe even by thinking a sentence, such as “I’m hungry.”
With great luck, over time, they may be able to do that routinely and inexpensively – as long as they have lots of able-bodied people around to bring the equipment to their door.