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The 29-year-old, who had been injured in a traffic accident, was asked simple questions about his life, such as "Is your father's name Alexander?" He was told to answer "yes" or "no" by thinking about one or the other of the imagined scenes about playing tennis or navigating streets or his home. For five of the six questions, his brain activity matched the correct answer.
Monti and Laureys said it is not clear whether such patients have the mental capacity to answer more important but complicated questions, such as whether they wish to go on living.
"I'm trying to figure out what is the best way to tackle this," Laureys said.
Laureys also said fMRI technology isn't practical for routine assessments of vegetative patients or for enabling communication. So he is working to develop a more portable and less expensive approach based on sampling brain waves.
Now that communication has been demonstrated, it brings an urgency to finding ways to capitalize on that ability, said Dr. Nicholas Schiff at New York-Presbyterian Hospital/Weill Cornell Medical Center. Schiff is collaborating with Laureys and others on such research.
Some experts, like Dr. Ross Zafonte of Harvard Medical School, who was not involved in the study, said the brain patterns also don't reveal anything about whether patients have retained significant memory and other important mental abilities.
"But it's provocative and exciting because this is a cohort of people that everybody had given up on, and now there's reason to say ... there might be something there to manipulate," he said.
Maybe brain scans could identify patients with a better chance than others to improve with specialized treatment, he said.
Susan Connors, president and CEO of the Brain Injury Association of America, an advocacy group, said the study means there's hope for people with brain injury.
She said her group will now add fMRI testing to the list of things they recommend families ask about after a serious brain injury.
Connors said some people might want to use such brain scans to help them decide whether to keep a loved one with a brain injury alive. But that shouldn't be the deciding factor, she said, adding that families are still going to have to rely on the person's wishes, religious and cultural beliefs and medical advice.
"This is going to give us more information, but it's not going to give us the final answer," she said.
On the Net:
New England Journal: http://www.nejm.org/
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