Psych 202 W5L1 slide notes

Testing for Conscious Awareness in Disorders:
- Unresponsive wakefulness state/vegetative state
- fMRI imagery paradigms
- Study replications
- Communication scans
- EEG paradigms
Future Directions:
- Exploring ethical challenges in these investigations.

Wakefulness: Refers to physiological state, such as eye-opening.
Awareness: Defined as oriented behavior, which is integral to conscious experience.

Locked-in Syndrome: Patients are aware and awake but cannot move or communicate verbally due to complete paralysis.
Minimally Conscious State (MCS):
- MCS+: Command following capabilities.
- MCS-: Non-reflexive movements without clear command following.
Coma: A state of deep unconsciousness.
Unresponsive Wakefulness Syndrome (Vegetative State): Patients exhibit wakefulness but no signs of awareness.

26-year-old patient in a vegetative state after viral infection (there are other causes that can cause this other than brain trauma).
Experiment Setup: Scanned using PET to observe brain activity when shown familiar faces.
Findings: Activation in the fusiform face area (FFA) similar to healthy individuals suggested potential awareness.
Discussion Point: Did this mean Kate had consciousness despite her outward appearance? The brain is capable of processing even when unconscious.

Detection of Awareness in Vegetative State:
- Explored through fMRI, evaluating brain activity when asked to imagine specific scenarios (e.g., playing tennis).
- A significant finding was the ability of some patients to modulate brain activity when prompted, suggesting awareness.

Larger studies involving 23 vegetative state patients found 4 could intentionally modulate brain activity,
indicating potential awareness (Owen et al., 2006).

Instructions included:
- "Imagine playing tennis" (to test communication through brain activity).
- "Visualize walking through your home" (to evaluate spatial navigation).

Objective: To establish whether patients could answer yes/no questions through modulated brain activity.
Effective communication demonstrated potential for conscious awareness in otherwise unresponsive patients.

Further study on a 26-year old male in vegetative state reiterated previous findings regarding awareness and ability to respond to questions (Fernández-Espejo & Owen, 2013).

A notable example of communication from a long-term vegetative patient who confirmed he was not in pain, illustrating that even minimal responses can yield important clinical insights.

fMRI Limitations:
- Availability, cost, patient stress, and movement artifacts (metal implants)z.
Benefits of EEG:
- More accessible, cheaper, and appropriate for bedside monitoring.
EEG Study Findings:
- In a study with 16 vegetative patients, a significant number showed precise brain activity patterns suggesting awareness when prompted to imagine specific movements (Cruse et al., 2011).

Findings from 37 studies:
- Approximately 23% of patients (varied between MCS and VS) demonstrated covert awareness and ability to follow commands.

Cognitive-Motor Dissociation (CMD): Discusses implications on prognosis and treatment decisions.
- The relationship of CMD to recovery and management decisions must be further explored.
Impact of Diagnostic Testing:
- Involves potential benefits vs. harmful effects based on brain activity levels detected in patients.

Need for well-designed multicenter studies to monitor functional recovery outcomes over time (Claassen et al., 2024).
Ethical dilemmas surrounding patient care decisions when patients show signs of minimal consciousness.
Implications for the allocation of therapies based on detection of awareness in patients with CMD.