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Dr. Steven Laureys, one of the authors of the study, examines a patient at the University Hospital in Liege, Belgium. In November 2009, Laureys made headlines by finding awareness in a 46-year-ancient man who had been diagnosed as being vegetative for 23 years. (Yves Logghe/Associated Press)

Scientists have detected glimmers of awareness in some vegetative brain-injury patients and have even communicated with one of them — findings that push the boundaries of how to assess and care for such people.

The new research suggests that standard tests may overlook patients who have some consciousness, and that someday some kind of communication may be possible.

In the strongest example, a 29-year-ancient patient was able to answer yes-or-no questions by visualizing specific scenes the doctors questioned him to imagine. The two visualizations sparked different brain activity viewed through a scanning machine.

“We were stunned when this happened,” said one study author, Martin Monti of Medical Research Council Cognitive and Brain Sciences Unit in Cambridge, England. “I find it literally incredible. This was a patient who was believed to be vegetative for five years.”

Ever since a research paper four years ago showed apparent signs of awareness in a vegetative patient — one who was included in the new study — families of patients have been clamouring for brain scans, said Dr. James Bernat of Dartmouth Medical School, a spokesman for the American Academy of Neurology.

In fact, a spokeswoman for a patient advocacy group said the organization will urge families to question about the type of brain imaging used by the researchers.

But experts said more study is needed before the specialized brain scans could be used routinely. “It’s still a research tool,” Bernat said.

Experts also emphasized that only a few tested patients showed evidence of awareness. And they said it’s not clear what degree of consciousness and mental abilities the signs imply.

Response limited to traumatic brain injuries

They also noted that the positive signals appeared only in people with traumatic brain injury — not in patients whose brains had been deprived of oxygen, as can happen when the heart stops. Terri Schiavo, the vegetative woman at the centre of a U.S. controversy before her feeding tube was removed and she was allowed to die in 2005, suffered oxygen deprivation.

The new work, published online Wednesday by the New England Journal of Medicine, came from researchers in Britain and Belgium.

One author is Dr. Steven Laureys at the University of Liege in Belgium. He made headlines in November by showing awareness in Rom Houben, a 46-year-ancient man who had been diagnosed as being vegetative for 23 years. (Houben was excluded from the new study because he could not keep his head still enough in the brain scanner to produce a usable scan; his awareness was revealed by bedside behavioural tests.)

The new study used brain scanning called functional MRI, or fMRI, for 23 patients in a vegetative state and 31 diagnosed as minimally conscious.

Patients are diagnosed as being in a vegetative state if they are tested and found unable to do such things as go on command or follow a moving object with their eyes. (Their eyes are open; in contrast, comatose people’s eyes are closed.) Minimally conscious patients show signs of awareness, but they are minimal and intermittent.

While in the fMRI scanner, the patients were questioned to imagine two situations. One was that they were standing on a tennis court, hitting a ball to an instructor; the other was that they were navigating familiar streets or walking from room to room in their homes. The two tasks produce different patterns of brain activity in healthy people.

The study found those patterns appeared in five patients when they were questioned to imagine the scenes. Four of those patients had been diagnosed as vegetative.

“It just says how much we can learn from looking directly at somebody’s brain,” Monti said.

But he said the results cannot be taken to indicate how commonly a vegetative brain holds hidden signs of awareness. And the findings certainly don’t mean all vegetative patients have that capacity, he said.

The 29-year-ancient, who was injured in a traffic accident, was questioned 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 right answer.

Monti and Laureys said it is not clear whether such patients have the mental capacity to answer more vital 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.

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 question about after a serious brain injury.

Connors said some people might want to use such brain scans to help them choose 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.

Dr. Steven Laureys, one of the authors of the study, examines a patient at the University Hospital in Liege, Belgium. In November 2009, Laureys made headlines by finding awareness in a 46-year-ancient man who had been diagnosed as being vegetative for 23 years. (Yves Logghe/Associated Press)

Scientists have detected glimmers of awareness in some vegetative brain-injury patients and have even communicated with one of them — findings that push the boundaries of how to assess and care for such people.

The new research suggests that standard tests may overlook patients who have some consciousness, and that someday some kind of communication may be possible.

In the strongest example, a 29-year-ancient patient was able to answer yes-or-no questions by visualizing specific scenes the doctors questioned him to imagine. The two visualizations sparked different brain activity viewed through a scanning machine.

“We were stunned when this happened,” said one study author, Martin Monti of Medical Research Council Cognitive and Brain Sciences Unit in Cambridge, England. “I find it literally incredible. This was a patient who was believed to be vegetative for five years.”

Ever since a research paper four years ago showed apparent signs of awareness in a vegetative patient — one who was included in the new study — families of patients have been clamouring for brain scans, said Dr. James Bernat of Dartmouth Medical School, a spokesman for the American Academy of Neurology.

In fact, a spokeswoman for a patient advocacy group said the organization will urge families to question about the type of brain imaging used by the researchers.

But experts said more study is needed before the specialized brain scans could be used routinely. “It’s still a research tool,” Bernat said.

Experts also emphasized that only a few tested patients showed evidence of awareness. And they said it’s not clear what degree of consciousness and mental abilities the signs imply.

Response limited to traumatic brain injuries

They also noted that the positive signals appeared only in people with traumatic brain injury — not in patients whose brains had been deprived of oxygen, as can happen when the heart stops. Terri Schiavo, the vegetative woman at the centre of a U.S. controversy before her feeding tube was removed and she was allowed to die in 2005, suffered oxygen deprivation.

The new work, published online Wednesday by the New England Journal of Medicine, came from researchers in Britain and Belgium.

One author is Dr. Steven Laureys at the University of Liege in Belgium. He made headlines in November by showing awareness in Rom Houben, a 46-year-ancient man who had been diagnosed as being vegetative for 23 years. (Houben was excluded from the new study because he could not keep his head still enough in the brain scanner to produce a usable scan; his awareness was revealed by bedside behavioural tests.)

The new study used brain scanning called functional MRI, or fMRI, for 23 patients in a vegetative state and 31 diagnosed as minimally conscious.

Patients are diagnosed as being in a vegetative state if they are tested and found unable to do such things as go on command or follow a moving object with their eyes. (Their eyes are open; in contrast, comatose people’s eyes are closed.) Minimally conscious patients show signs of awareness, but they are minimal and intermittent.

While in the fMRI scanner, the patients were questioned to imagine two situations. One was that they were standing on a tennis court, hitting a ball to an instructor; the other was that they were navigating familiar streets or walking from room to room in their homes. The two tasks produce different patterns of brain activity in healthy people.

The study found those patterns appeared in five patients when they were questioned to imagine the scenes. Four of those patients had been diagnosed as vegetative.

“It just says how much we can learn from looking directly at somebody’s brain,” Monti said.

But he said the results cannot be taken to indicate how commonly a vegetative brain holds hidden signs of awareness. And the findings certainly don’t mean all vegetative patients have that capacity, he said.

The 29-year-ancient, who was injured in a traffic accident, was questioned 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 right answer.

Monti and Laureys said it is not clear whether such patients have the mental capacity to answer more vital 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.

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 question about after a serious brain injury.

Connors said some people might want to use such brain scans to help them choose 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.

Kathy O’Rourke prepares to throws skip rock on Wednesday. (Nathan Denette/Canadian Press)

Kathy O’Rourke took sole possession of first place the hard way Wednesday night at the Tournament of Hearts, defeating none other than the two-time defending champion.

O’Rourke, competing in her first Hearts as skip and second overall, led Prince Edward Island to a 9-5 victory over Team Canada’s Jennifer Jones in Draw 14 at the Essar Centre in Sault Ste. Marie, Ont.

O’Rourke rallied from 5-3 down with six unanswered points — two in each of the last three ends — to jolt Jones and improve her record to 7-2 with three draws remaining.

O’Rourke whipped Quebec’s Eve Belisle 7-3 earlier Thursday.

“After last night’s game against Ontario, we didn’t play very well,” O’Rourke said. “They beat us pretty soundly.

“We got together this morning and just said, ‘Girls, we’ve got to start making shots or people are going to start beating us.’ We came out really strong this morning against Quebec and just tried to carry that through against Team Canada.”

“Obviously, they played very well,” conceded Jones, who curls out of Winnipeg. “We just had the terrible end to the game and that’s not characteristic of us.

“It was a terrible ninth end. I wish we could play it over again but we can’t, so we’ll have to come out sharper tomorrow.”

Jones, who beat Belisle 9-4 in eight ends, is in a three-way tie for second place at 6-3 with fellow Manitoban Jill Thurston and Ontario’s Krista McCarville.

Thurston prevailed 10-5 over McCarville and trimmed Sharon Cormier of the Northwest Territories/Yukon 8-6, but not before Cormier upset McCarville 7-5 in the afternoon draw.

“We’re still in the hunt which is a excellent thing,” McCarville said. “We only have three losses, so it’s still in our control.

“We don’t have to worry about other teams winning or losing for us. It’s still in our hands.”

Ditto for British Columbia’s Kelly Scott and Amber Holland of Saskatchewan, both at 5-4.

Holland, who won a national junior title in 1992, slipped past Scott 5-4 in the morning draw and later stifled Nova Scotia’s Nancy McConnery 5-2.

Scott, a former world champion and two-time Hearts winner, regrouped in the nightcap, scoring two in the 10th end and the winning point in the 11th in an 8-7 victory over McConnery.

Belisle, meantime, is deadlocked at 4-5 with New Brunswick’s Andrea Kelly and Shelley Nichols of Newfoundland and Labrador, followed by Cormier and Alberta’s Valerie Sweeting — both at 3-6 — and McConnery (1-8).

With files from The Canadian Press