RESEARCH: 'Vegetative' Patients Might Still 'Be In There'

Six years after Terri Schiavo's husband fought to remove her feeding tubes, two researchers are working to discern whether some brain-injured patients could eventually regain some level of consciousness and once again function normally.

An article recently published in Discover magazine details in length a series of research and experiments conducted by Joseph Giacino, director of rehabilitation neuropsychology at Spaulding Rehabilitation Hospital in Boston, and Nicholas Schiff, a neurologist at Weill Cornell Medical Center. According to Giacino and Schiff's research, not all brain-damaged patients are the same. The article explains how disorders of consciousness are all very different and range from severely impaired -- the "vegetative state" many are familiar with -- to a minimally-conscious state, in which patients switch back and forth between unconsciousness and awareness.

The researchers seek to find out just what "consciousness" and "unconsciousness" really mean. Their work suggests patients often referred to as vegetative and given no hope of recovery could possibly still think, feel and "be in there." In three separate studies conducted in part by Giacino, up to 41 percent of patients diagnosed as vegetative were in actuality at least partly aware.

The condition many know and refer to as a "vegetative" state -- in which a brain-injured patient is awake but unresponsive and unconscious -- was first given its label in 1972.

More than 30 patients have now been profiled via this new research, according to the Discovery article. Using deep brain simulation techniques, the researchers submit patients to positron emission tomography (PET) scans and CT scans to see how much energy their brains are using. An fMRI machine is used to look at brain activity and find evidence of any awareness. All the while, Giacino and Schiff are looking for fluctuations in hopes of coming up with a diagram for the recovery of a patient's consciousness.

Comments

[dawnlight48]

06:01 PM on 07/12/2011

Whether they are still "in there" or not, the solution is NOT to starve them to death! I have a "do not resuscitate" order in my living will - and I would want a nice peaceful shot of sleeping potion if I were like Terri Shiavo, which is a courtesy we provide our suffering pets, but not our fellow humans.

[Marsha McClelland]

12:58 PM on 07/12/2011

My heart lurched when I saw Terry Schiavo's picture here. Yes, some of these patients are still in there & some of them want to live, as in Terry's case. I know, I was with her all the way leading activists from the left, right & center to try to save her. Bush pretended to try & could have used executive order as he did to take us to the invasion & occupancy of Iraq.

Terry cried the day they took her tube out. She was not on life support. She screamed, "I, I, I, I", over & over as she'd been coached to say, "i want to live," by her Mom & Dad. The lady cop guarding her door had to be replaced because she was sobbing, uncontrollably.

A prior time Michael, her hubby, tried to kill her, I believe it was Congresswoman Debbie Wasserman Schultz asked Terry's Dad to put the phone to her ear. She became frantic trying to get up. Her Dad asked what was said to frustrate her & was told, "I told her if she didn't get out of that chair, they were going to kill her."

There's a whole lot more to the truth behind Terry but it's too hard to open this old wound to go into detail. I never could understand how the horror her real family was put through, trying to save her, didn't kill her Mom & Dad, too. It almost did me!

[Marsha McClelland]

01:17 PM on 07/12/2011

My sister didn't have the chance she deserved & was quickly dealt with such as Terry by her husband, too, last February. One word for these monsters. KARMA!

[Martha Rice]

12:38 PM on 07/11/2011

I could never pull the plug. I would leave that decision up to God. He has always been better at decisions in my life. Any time I ran my own life I really messed up. That is just my opinion on my life as I see it. He has never let me down.

[alisamoran99]

02:57 AM on 07/09/2011

most of people not aware about the Vegetative health problem but vegetative patient and their families have lost of courage to face this problem.
Regards,
Alisa Moran

[aviandonn]

06:01 PM on 07/09/2011

So they may still be in there. What this means is those of you who have living wills or are so inclined need to leave instructions about what you want done if you find yourself spending your days staring vacantly at the walls and maybe occasionally focusing on some movement.

I'm sure this will fuel the flames between "it's about the quality of life' people and those who think as long as that heart is beating - or can be kept beating by modern technology, that that is a life to be saved.

I still remember the 10 year battle over Karen Ann Quinlan.

This is yet another example where modern science has advanced faster than humans can keep up in terms of new ethic and moral raised by those advancements. Quinlan and Schiavo, and who knows how many unnamed people in their situation, make it imperative we start having a serious national discussion about how to deal with these issues. Families shouldn't have to go bankrupt fighting legal battles to let a loved one go.

[french queen13]

12:31 AM on 07/10/2011

Well said, Aviandonn. For me, the thought of "being in there" is the most terrifying - the ultimate prison, unable to move, unable to communicate, utterly helpless, possibly blind, yet still conscious. That's a recipe for madness, not something to be prized, and I would want OUT immediately.

[sunnybunny]

01:32 PM on 07/08/2011

So if they are aware, wouldn't that be a case for setting them free? Putting them out of their misery?

[onionboy]

05:31 PM on 07/09/2011

I sure wouldn't want to sit idly as a prisoner in my own body, unable to communicate.

[french queen13]

12:32 AM on 07/10/2011

My thoughts exactly.

[bsege]

10:40 AM on 07/08/2011

In addition, the autopsy revealed that Terri Schaivo had "relative preservation" of her frontal and temporal lobes. According to neurologist, Dr. Thomas Zabiega said, “Complex cognition and executive decisions as well as emotional output are often associated with the frontal lobe, while the temporal lobes are often associated with memory, as well as hearing. Therefore Terri Schiavo's ability to think, react with appropriate emotions, memory, and hearing could have all be intact at the time the feeding tube was removed. The same may have been true about her memory since damage to the hippocampus could have been caused by the dehydration and starvation."

Speaking of physicians, why is it rarely, if ever mentioned that there were 40 affidavits submitted to the court, some of which are from the most renowned neurologist in our country all testifying that either Terri was not in a PVS and/or could have been helped with ongoing therapy and rehabilitation. Don't take my word for it, read them here: http://terrisfight.org/medical-affidavits/

[cable1977]

11:06 AM on 07/08/2011

"if ever mentioned that there were 40 affidavits submitted to the court"

There are affidavits of scientists who say that intelligent design is true, that vaccines cause autism, and that climate changes doesn't exist. Simply because a group of experts are going to sign an affidavit doesn't make their findings true. Did all 40 of those affidavits come with physical examinations?

The final point of the first affidavit listed says:

"A physical, medical examination was not performed by the undersigned"

The second affidavit:

"While I have not physically examined..."

The third affidavit:

"While I have not physically examined..."

#4:

"I have not physically examined...."

#5

"I have not physically examined..."

So, you're putting forth a list of experts where the first five on the list never even examined the patient yet you want their opinions on her condition to carry weight? Not quite sure how that is a valid argument.

[GraniteSkyline]

05:36 PM on 07/09/2011

Terri Schaivo was used a a political football.

Then-president George W. Bush even got involved in her case. Many right-to-life advocates came forward to help her die. By establishing where exactly life ends is a critical step in establishing the reverse--when life begins. They were hoping to use her as a tool to overturn Roe vs. Wade.

[bsege]

10:39 AM on 07/08/2011

The autopsy only revealed what was already known, that Terri Schiavo had a profound brain injury. The IME, Dr. Jon Thogmartin, who conducted Terri Schiavo's autopsy, stated in his findings, on more than one occasion that it cannot be determined whether or not Terri Schiavo was in a Persistent Vegetative State (PVS) because the person must be alive in order to make this diagnosis. In addition, Neuropathologist, Stephen J. Nelson, M.D., who took part in her autopsy, stated that it could not be "ruled out" that Terri Schiavo was in a Minimally Conscious State (MCS) for this same reason - the person must be alive.

It's remarkable how the media has and continues to make these blanket statements that the autopsy "proved" that Terri was in a PVS or that she could not be helped because of her massive brain injury, or that her brain was half its size at the time of autopsy, failing to mention that she went almost two-weeks without and food or water. Naturally, the brain is going to significantly shrink because of this. It doesn't take a neurologist or any physician, for that matter, to watch some of the videos of Terri Schiavo to recognize that she has some level of awareness.

[cable1977]

12:28 PM on 07/08/2011

" Naturally, the brain is going to significan­tly shrink because of this."

No, it doesn't, not to the degree implied by the brain weights. There was significant neuronal loss throughout multiple areas of the brain. Do you have any evidence to support your claim that this was

"Neuropatho­logist, Stephen J. Nelson, M.D., who took part in her autopsy, stated that it could not be "ruled out" that Terri Schiavo was in a Minimally Conscious State (MCS) for this same reason - the person must be alive"

No, that isn't what Dr. Nelson said in the autopsy. What he wrote is that neuropathologic examination alone of a decedents brain cannot prove PVS vs. MCS. The diagnosis of PVS includes far more than just the neuropathologic examination. Dr. Nelson certainly didn't state that "the person must be alive" anywhere in his report.

What I find remarkable is how many people can offer an opinion on a medical diagnosis yet never have actually examined the patient at all (paging Dr. Frist).

[cable1977]

12:29 PM on 07/08/2011

That should read:

"Do you have any evidence to support your claim that this was due to the starvation and dehydration?"

[choo-chew]

09:46 AM on 07/08/2011

Let's say someone is in a minimally conscious state, laying on that bed for 5 years or longer. Is there a general feeling among these researchers that we should allow that to continue because they might be having fun inside that head? Maybe we can figure out a way to give them popcorn and chips and a good juicy steak intravenously. What a wonderful world it will be, to have millions of centenarians lying in hospital beds living it up the minimally conscious way--sounds like a wonderful jobs program for the healthcare industry.

[cable1977]

12:48 AM on 07/08/2011

There is really no evidence that Terry Schiavo was in a minimally-conscious state rather than a true vegetative state as is implied by the first sentence of the article as well as the picture attached.

http://en.wikipedia.org/wiki/Terri_Schiavo_case#Final_local_motions.2C_death_and_autopsy

Her autopsy revealed massive destruction of her brain tissue. It weighed half of what it should have. There was massive damage to all areas of her brain, including the loss of all of the pyramidial neurons essential for function of the cerebral cortex. Her visual cortex was completely destroyed (i.e. she was blind), despite the argument that many were making that she followed people with her eyes. There was no chance for improvement and no consciousness possible.

[grammy11]

09:43 AM on 07/08/2011

Being in this condition is not living. The power of artificially keeping the heart beating after the brain has turned to mush is not living as a human being. It is living on a machine so must be making the body a machine. Losing a loved one is sad for those left behind but keeping them going artificially is not keeping them alive. Because of this story, I immediately made a living will. I would never want to put my family in this position of keeping me for selfish reasons. When all hope of having a respectable and even half way normal life is gone, it is gone period.

[cable1977]

10:55 AM on 07/08/2011

I agree. There may be cases where someone in a minimally conscious state has the potential for recovery, but Terry Schiavo was definitely not one of those cases.

[monique rn]

09:39 PM on 07/07/2011

A long time ago when I was a nursing student we were doing a rotation at a nursing home. One of my assigned patients was a young man who had been in some type of altered state since being involved in a horrible motorcycle accident years before. I was green and anxious, and it was an experience I remember well. There was a tape that he had liked for his tape player, if he was in there he had gotten sick of it a long time ago. After freshening him and his bed I felt compelled to touch his forehead and he seemed to jerk away. My intentions were pure but I felt I had made a mistake.

[Anwer Pasha]

08:27 PM on 07/07/2011

There is nothing new. Most of the care givers of such patient knew this and many were claiming it but these were the doctors and neurologists who were denying it since many decades.I am telling it since years. This is story of my son.
http://www.paklinks.com/gs/all-views/295291-pakistan-a-brain-injury-persistent-vegetative-state-patients-jawad-pasha.html?daysprune=14