New research may help unlock vegetative and minimally conscious patients.
25 Juni 2009 Jam 08:45:49, Admin PERDOSSI Pusat, Hits : 16221

State of Mind

Seventeen months ago, Joshua Hummel, now 24, was sleeping in his Seattle home when someone attacked him with an ax. He survived, but the penetrating blows to his skull left him in a minimally conscious state. Today he lives with his parents and two siblings in a St. Louis suburb. As I talk with his family in the kitchen, Joshua sits next to us in a wheelchair that he can't move himself. After a $17,000 remodel, his wheelchair can fit into the accessible bathroom, but he can't use the handrails on the walls. In the den there's a standing frame—when his mom uses a Hoyer lift to transfer him into it, the frame can support his body in a standing position, which is important for his circulation.

As a resident in physical medicine and rehabilitation, I handle the medical rehabilitation of people after disabling injuries. Severe traumatic brain injuries constitute one of my most challenging ICU consultations. After neurosurgery has saved lives (in Joshua's case, by cutting out portions of skull so that the swelling brain can expand), we're called in to answer the family's burning question: What's the potential for meaningful recovery? Unlike in brain death, where we can look for flat-lined brain waves or the cessation of intracranial blood flow, doctors don't have confirmatory tests for consciousness and its shades of gray. That's one reason studies uncover alarming rates of misdiagnosis of the vegetative state. About one-third of the time, "vegetative" patients are minimally conscious or even better.

Examining these patients can make me feel as if I'm apishly tapping on a black box flight recorder trying to get it to make sounds, cough, sputter, or blink when one day I'll simply plug it into the right data retrieval port, but I believe future clinicians won't view us as barbarians. We know that the location of the brain damage matters, and a surprising amount of brain tissue can be lost before there is no potential for recovery. The mechanism of injury also weighs strongly—losing blood flow to the brain during a heart attack (like Terri Schiavo) can result in a predictably permanent vegetative state.

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