Consciousness and Communication

Background, Motivation and Research Goals

Understanding consciousness is one of the most difficult problems facing science. We hope to gain a deeper knowledge of consciousness by trying to extend the communication abilities of people who suffer from disorders of consciousness and communication.

In particular, we aim to extend the communication abilities of patients with post-coma unresponsiveness. This includes patients in the vegetative state (VS), permanent vegetative state (PVS), minimally conscious state (MCS) or the locked-in state (LIS). Following awaking from coma, patients in these states have either no or limited ability to communicate. This is because these patients usually have a reduced level of conscious awareness and are often not able to behave in a functional and reliable manner sufficient for communication.

In order to communicate with suitable VS, PVS, MCS or LIS patients we plan to ask patients objective "yes"/"no" type questions and determine their answers to these questions by detecting MRI-based signals of brain activity. To answer a question the patient will be instructed to perform one of three mental imagery tasks depending on whether they wish to answer "yes", "no" or "I don't know". If the brain activity patterns correspond to the first mental imagery task, one infers the patient has answered "yes". If the activity patterns correspond to the second mental imagery task, one infers the patient has answered "no". If the signal patterns correspond to the third mental imagery task, one infers the patient has answered "I do not know". If the signal patterns do not correspond well with the expected patterns for the first, second or third mental imagery tasks, then we infer that the patient has not answered "yes", "no", or "I do not know" to the question. This process will be repeated to ensure reliablitiy of the answers. Moreover, the same paradigm will be applied to healthy individuals to determine which brain areas should be active if the patients are really doing the tasks properly.

Below is an illustrative schematic of the brain imaging based communication task: Patients will be instructed to answer questions by performing mental imagery tasks. For example, to answer "yes" they will imagine navigating their home, this will activate visuo-spatial and memory areas in the brain (highlighted in green). To answer "no" they will imagine playing tennis, which will activiate motor areas of the brain (highlighted in blue). To answer "I do not know" they will perform mental calculations, activating frontal working memory regions (highlighted in red).

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Support

This research is supported by a grant from the Helen Macpherson Smith Trust.