Friday, April 24, 2009

New research may help unlock vegetative and minimally conscious patients - Slate Magazine

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.

More ...

http://www.slate.com/id/2216595/pagenum/all/#p2