For the brother of Terri Schiavo, Wednesday's news that a team of researchers in England were able to use a novel scanning technology to establish limited communication with a man in a persistent vegetative state was bittersweet.
Bobby Schindler said that while the test using functional magnetic resonance imaging (fMRI) likely holds promise for the families of minimally conscious and persistently vegetative patients, he wishes his sister had been afforded this technology before a court ruling allowed her husband Michael Schiavo to remove her feeding tube in 2005 leading to her death.
"It's upsetting to me when I see this type of research," Schindler said. "We were looking to afford these kinds of tests for Terri, but the court did not allow us to perform these kinds of tests."
Schiavo's case ignited a firestorm of publicity in between 1998 and 2005. Ultimately, the courts sided with doctors who testified that Schiavo was in a persistent, vegetative state with no hope of recovery -- though doctors that the Schindlers brought to court said there was a chance of recovery.
The case eventually went to the U.S. Supreme Court, which refused to intervene.
The new study released Wednesday that could spell hope for many families likely will arouse a measure of controversy as well.
"I think it shows that if you just use the conventional bedside-type of exam [to determine consciousness], you can get it wrong," Schindler said.
In the new study, researchers found that a 34-year-old man was able to answer simple yes or no questions by imagining different types of activity, which caused changes in brain activity that could be seen in the machine, according to Martin Monti of the Medical Research Council Cognition and Brain Sciences Unit in Cambridge, England, and colleagues.
The finding showed that at least some patients who are otherwise unresponsive may have some residual awareness, the researchers reported online in the New England Journal of Medicine.
"The incredible thing is that we could never do something like that at the bedside," Monti told MedPage Today. Outside of the fMRI machine, he said, the patient remained unresponsive to standard tests.
Monti, too, conceded that the study could spur controversy, particularly in light of cases like Schiavo's.
"People will have a tendency to over-interpret this," Monti said. "This finding in one patient does not imply that all patients may or may not have the ability to do this."
Indeed, the researchers tested 54 people and found only five who apparently could respond to direction by imagining either motor or spatial activity. Imagining those activities uses different parts of the brain and their activation can be seen by the fMRI scan.
Several of the responders were already in what is called a "minimally responsive" state, meaning that occasionally they were able to react to external stimuli.
Of those five, the researchers only tried to communicate with one -- the man in a persistent vegetative state -- using his ability to reliably activate different brain areas when asked to imagine either playing tennis or looking around a room in his house.
While in the machine, he was asked simple questions, such as whether his father's name was Alexander. To answer "yes," he was to imagine playing tennis, while for "no" he was to imagine looking around the room.