So this is Paul for sure with Adrian Owen, one of the speakers in our BCWT summer school.
And Adrian showed us his latest work, which actually is opening up a whole new
way on how we think about different kinds of neurological disorders.
So Adrian, maybe you want to give us the short version of that. Sure. Yeah.
We've been using fMRI to look at patients who have so-called disorders of consciousness.
These are things like coma, vegetative state, minimally conscious state.
And really, our main aim has been to determine whether fMRI,
and more recently EEG, can be used to detect residual awareness.
So can we put a patient in a scanner and determine that in spite of the fact
that they may appear to be vegetative behaviorally, they are in fact aware?
Aware and we did that a couple of years
ago now with our first patient we've seen
four or five patients since then that are
clearly aware or can be shown to be be aware in the scanner despite having no
behavioral signs of awareness and i suppose our most recent big result if you
like is is to to use this method to communicate with somebody who was incapable
of any form of communication outside of the scanner.
Technically, this person was in a minimally conscious state.
It had been assumed for many years that he was in a vegetative state.
But in the scanner, he was able to answer yes or no questions by modulating his brain activity.
But now, this is an amazing outcome in some sense, right?
Because it's also a scary outcome
because it means we might have been misdiagnosing a lot of these patients.
But now, in some sense, if you want criticism, which is also often fielded against
these approaches, it's like, yeah, but I would not even know whether you're
aware of what I'm just talking to you.
Because it's a typical zombie argument right where okay at
the surface it all might look like you're aware
you're conscious but can i really be sure so so
how can you really be sure that your patient is minimally aware in a way i think
this sort of discussion um you know you could say this is held back um work
in this area i mean what we have with these patients is it's a very simple,
practical problem, which is that some of them might actually be conscious,
but unable to tell us that they're conscious.
Now, by that, I'm not trying to define what consciousness is.
I'm really just trying to say, well, their world is rather like your world or
my world, except they can't move. They can't speak.
They can't blink an eye. So irrespective of what consciousness might be,
either philosophically or psychologically.
Their sense of the world, how they feel about themselves, how they feel about
what they know about what's going on around them, might be similar to yours
and mine, but they're incapable of demonstrating that fact.
Now, we know a lot about the locked-in syndrome.
These are the cases of patients who are able to blink an eye or to move an eyebrow despite being...
Treatments and despite them being cognitively often perfectly intact.
So I think it's very probable that there is a sub-population of patients,
a minority of patients, who are sort of, if you like, totally locked in.
Again, cognitively intact, conscious, if you like, but unable to blink an eye
or move an eyebrow or indicate in any way that they're conscious.
So my concern really is that until now, we have had no practical way of identifying these people.
I mean, it seems logically certain that they exist, but how,
if they cannot respond, if they cannot produce some sort of indication that
they're conscious, how could you ever know they were there?
So, and this is really what we're trying to find out.
I think it's actually a next stage to go back to your question is to say,
well, what is their consciousness like?
Are they really conscious like we are? At the moment, all we know is,
you know, what we know is already very surprising, which is that they're not unconscious.
They're not vegetables. They are, in fact, in some senses, aware of where they
are, what situation they're in, and perhaps, you know, how they got there.
And I think, you know, we need to move on from there now.
But doesn't that imply possibly that maybe the idea of really hanging this on
this hook of consciousness is maybe a big distractor?
Because if I listen to you, if I get it right, in some sense,
you could also argue these are more deficits of, let's say, communication and
interfacing to the world than necessarily of experience and consciousness.
Is that a reasonable interpretation? That's absolutely correct.
And the reason why this gets complicated is because, you know,
it's not really an all-or-nothing condition.
Condition, the vegetative state is part of a whole group of different conditions
that are more or less non-communicative.
Minimally conscious state these are patients who are perhaps one step
up from vegetative they are able to at least on
some occasions indicate that they are aware
by perhaps moving an arm occasionally or
moving an eye and but they are not able to
turn that into any sort of functional communication if
a patient were able to raise their left arm for
a yes or their right arm for a no we would conclude they
were severely disabled probably not minimally conscious
and so on you have all these different sort of types of conditions and
in any given clinical situation it's very very
easy to mix them up you know
a vegetative patient sorry a minimally conscious patient on
a bad day might appear to be vegetative and maybe diagnosed as vegetative and
this obviously can have an impact on their care and an impact on the way people
respond to them and think about them sometimes for many years so you know it
may well be that i mean the patients that we are identifying And I think, yes,
you know, they are not vegetative.
It's clearly not the right description of these people.
They have some form of communication disorder, they are, or responsivity disorder, I suppose.
And actually, sometimes we now describe them as non-responsive patients rather
than vegetative patients, because that is an assumption that is,
you know, I think, based on flawed logic. Right.
So in some sense, this might also then explain some of the criticisms against,
for instance, this 2007 science paper where this main result came out,
where also people would argue, well.
This could just be, let's say, reflex-like automatic responses in the absence of experience.
But in some sense, you could not say yes, but in some...
Maybe that doesn't actually really matter because what we want to provide are
then these new communication channels to also improve quality of life and quality
of care for these patients.
And this whole question about now this additional phenomenon of consciousness is really secondary.
Is that a reasonable way of summarizing your approach?
Yeah, I mean, in that sense, I think you're right that worrying too much about
what consciousness is can be a distraction in that context.
For example, to be able to build a brain-computer interface that would allow
a patient who everybody else thought was vegetative and behaviorally appears
to be entirely non-responsive,
if our brain-computer interface of the future would allow that person to have
a normal interaction with their family members,
honestly, I don't really care whether we believe that person is conscious or
not, or whether I have the scientific evidence to prove that they are conscious or not.
If they are able to communicate with their family, then that's good enough for me.
Absolutely. Sure, I can see that. But now, right now, technically,
it's a bit of cumbersome technology. This is not something you're going to do at home.
So what's the future of this? Do you see this as a portable diagnostic system
somewhere down the line? I do.
And I think it's not as far down the line as we might all think.
We have recently, and I didn't talk about this in my talk today,
but we've recently been exploring ways of transferring the fMRI technology to
EEG. Now, obviously, EEG is cheaper. It's more portable.
In some senses, it's easier to do. It has many problems in this patient population.
One of the problems is to do with the brain damage. EEG systems work very well
with brain-shaped brains.
As soon as your brain is not brain-shaped, and that is often the case in a patient
who's had a traumatic brain injury, has been involved in a car accident,
for example, EEG models have a lot of problems localizing signal.
So that's a big problem. Also, for your EEG model to work effectively,
you really need to have a skull.
And many of our patients have parts of their skulls missing.
This is part of the surgical procedure involved in saving their lives.
And this can cause all sorts of artifacts on the EEG.
The other thing that I think is powerful by its simplicity in the fMRI is that
is to do with the anatomical localization.
At the end of the day, one of the tasks that we use is to ask the patient to
imagine playing a game of tennis.
We look for the characteristic activation in the premotor.
But really, it doesn't actually matter whether it is in the premotor cortex or not.
It also doesn't really matter if the premotor cortex, due to the brain injury,
has been shifted to somewhere that it wasn't previously.
As long as we can replicate it, and every time we ask the patient to imagine
this task, that same area of the brain lights up, and it's robust and reliable.
And we can use that as a communication signal. It's a little harder to do that
with EEG because we don't have the same level of anatomical precision.
Saying that, it's doable.
And I have some people, some postdocs working with me in Cambridge at the moment.
Damien Cruz presented data at a human brain mapping meeting here in Barcelona
earlier this year, showing that it is doable with EEG in a patient who is presumed to be vegetative.
Vegetative now there it doesn't we change the task slightly we don't have them
imagining playing tennis we have them squeezing their imagine squeezing toes
or imagine squeezing the right hand and this produces enough information to
be able to decode the eg signal to.
Determine whether the patient is signaling a yes or signaling a no now you know
we still have some way to go it doesn't work in real time in fmri the patient
is still in the scanner and we We know whether they're saying yes or no.
With EEG, we have to take data away, analyze it, come back several hours later,
and we can correctly deduce what the response was at the time.
So some of the logistics, the technology still has to be worked out.
But I'm quite confident that in a reasonably short time, we will have a portable
system that will allow a patient who is behaviorally entirely non-responsive
to be able to produce yes and no responses.
That's very impressive. But now tell me, in some sense, this sounds a bit counterintuitive
to me that this is right now so difficult.
Because if you look at the existing brain-computer interface technology,
essentially it's like, okay, you use a classifier to associate brain states
to certain kinds of outcomes, certain kinds of behavioral outcomes.
Comes so i would have imagined that you
would exploit this kind of existing bci technology for your
patients but apparently your patients have some special features
that prevent you from doing that so what what makes
them special it's interesting i mean we have um we have
collaborations with some excellent bci people in europe now uh we have a grant
so-called decoder grant for framework 7 grant specifically to try and integrate
existing bti bci technology with is the experience that we have with vegetative
and minimally conscious patients.
But I tell you, I think the most difficult problem is more of a social one or a psychological one.
And it's actually about training.
If you look at the very best BCI systems, they involve some training.
Now, you know, the best ones don't involve a lot of training,
but it's some training. And that training invariably involves a social interaction
between an experimenter, a scientist, a trainer, and a patient,
perhaps a paraplegic patient or somebody who is incapable of moving.
But almost always, that patient is capable of communication.
And, you know, you imagine the scenario. You say to the person,
well, what I want you to do is to, you know, imagine playing tennis.
And when you do, the cursor is going to move on the screen.
And I want you to make it go up with a bit more tennis or down with a bit less
tennis. this. This involves a kind of a complex social interaction that's very
hard to have with a patient that you do not necessarily know in advance is even conscious.
And then this is the more difficult,
situation that we're often faced with with these patients. It's not like having
a normal interaction with somebody where they can say, hang on,
tell me again, I didn't quite understand the instructions. Our patients can't do that.
At the very best, our patients can imagine playing tennis in order to indicate
yes over a five-minute period when we specifically ask them a question like,
did you understand the instructions?
And that whole, you know, just to ascertain that Somebody knew what you wanted
them to do would require, you know, a little bit more effort than it would with
somebody who could just tell you, stop, stop.
I mean, I've lost the plot. Let's go through this again. How do I do it?
And I think that's a, you know, it's a barrier to entry in this situation that
you don't have normal channels of communication. Everything is much slower.
So do you also find examples where you have patients who just don't get it?
Yeah. Did you see they try to do something, but they do the wrong thing?
Yeah. I mean, in many ways, well, yes, we do. I'm sure whether we know what
they're doing or not is another matter.
And I think that's really the problem. I'm like a patient that could talk to
you and say, well, when you said play tennis, did you mean I'm supposed to be
serving from the baseline or should I be up near the net?
We can't have that sort of dialogue. We have to be very prescriptive.
We have to tell people precisely what we want them to do in a way that we hope
they always understand.
And of course, inevitably, some of them won't because we all have different
worldviews of how one plays tennis, for example.
But how quickly do you understand from your average patient that they got it?
Yeah, so this is the great thing about the tennis task, which,
you know, in some senses, it's a bit strange, especially being English.
I'm slightly sensitive having come up with this tennis playing task.
It's a slightly odd thing to do, and perhaps it seems very English.
And, but it could have been cricket, you know, it could have been cricket, but there you go.
We, I think cricket probably would never have worked as well.
And the reason is there are many more degrees of freedom with cricket than there are with tennis.
The, the reason we ended up with tennis is because essentially we're trying
to get people to imagine moving their arms.
That's really all it takes. If you imagine moving your arms in a big gestural
way, you know, waving your arms in the air, like you were waving a flag,
that produces beautiful pre-motor activity.
And I tell you, it works in every single person. This is not something that,
you know, sometimes doesn't work. Absolutely everybody works.
If you say to people, imagine playing cricket, to use your example,
we have actually tried football, soccer before.
What happens in healthy volunteers is typically they choose different things.
I mean, in soccer, somebody might favor playing in goal. So they'll imagine
standing still with a little bit of hand movement, or they might be a striker,
in which case they'll imagine a lot of sprinting up and down the pitch.
Similarly with cricket, are you in bat? Are you bowling?
Are you fielding? It has many degrees of freedom. freedom tennis basically
whichever role you choose to play in
a game of tennis it's going to involve waving your arms around
in the air like you're waving a flag and you know i'm joking aside i think it's
that sort of relative invariance in how people imagine doing the task that makes
it so reliable in the scanner and it means we don't do any training we really
do not tell people or when I say, you know, play tennis,
do it in this way or do it in that way, we are able to just put people in the
scanner and say, the idea is play tennis.
And most we will say, please don't run around too much because that tends to
activate spatial navigation networks as well.
So we tend to say, well, stand still when you're playing tennis and imagine
you're serving or you're receiving on the baseline.
But there's no great training involved and it works every time.
But is it helping you in this case that you are exploiting.
The asymmetries in the body representation here, for instance,
now you involve the hand that will have a larger representation in these body
maps than, for instance, the foot.
Is that helping you? Yeah, we've had a lot more success with hands,
as you say, than with feet.
Which, given that feet are represented more medially than the hands,
perhaps not surprising.
Perhaps that is a good thing. although it tends to be a bilateral activity across
the midline in the premotor cortex that we see when people you know imagine
playing tennis so it's not a lateralization actually it's not a lateralization
people will typically produce bilateral activity,
also controls controls exactly yes but you know again we're quite non-prescriptive
about how people play tennis and people will often move the you know imagine
moving the racket to the other hand we don't say only move your right hand we say you know
We'll try to move your hands around like you're playing tennis.
So, you know, we haven't done sort of fine-tuned the experiment to try and generate
a specific lateralized activity, but in part because it just works so well.
I mean, we've had to fine-tune this experiment in some ways,
but not to a great extent because from very early on, it proved itself to be very reliable.
Whereas other things like we tried imagining swimming, for example,
it just tended to be less reliable. Imagine singing a song in your head.
Again, it was less reliable.
But given the organization of the body representation, then you would expect
if you would take a task that would involve parts of the face,
like the lips, for which you know you have a huge representation,
it might be very effective.
Have you considered that? We have. Now, I think these things probably would
be effective if you were actually doing the thing.
But the important thing here is it's about imagery.
I've been very surprised at how, in the early days when we were developing these
tasks, how unreliable many imagery tasks that I thought would be very reliable would be.
For example, one of the early studies we did with Melanie Boley,
who is also speaking here today, looking at different types of imagery tasks,
we came up with face imagery. We got people to imagine faces.
You know, I naively thought, well, this is going to work in everybody.
We've all got a fusiform face area.
It's in the right fusiform gyrus for all of us. We'll all activate faces.
Now, it turns out it's not true.
You know, some of us will activate our FFA some of the time when we imagine
faces, but a lot of us won't, which makes it clinically useless.
It's not reliable enough to use.
And, you know, when I went back and I questioned people after,
you know, after finding this out, I question people that have done a lot of face work.
Actually, even perceiving faces is not as reliable as we might expect it to
be on an individual subject basis.
If you pull apart those fabulous studies of face perception where people are
actually seeing a face and you look at every individual subject,
I can tell you that not
every subject typically produces significant activity in their fusible face
area you know every time they actually see a face so to expect it to activate
during an imagery task i think it's probably asking too much it's not true of
tennis imagine motor you know it's again it's not it's nothing magical about tennis but imagining,
waving your hands around in the air i'm willing to wage you um it's hard to
find a subject that but that does not produce activity in the premotor cortex.
Yeah, we could want to test.
Then on top of this, in some sense, it's very worrisome, what you're saying
now, because you also showed in your talk that actually if you just look at
activation maps in fMRI, you also cannot distinguish whether you look at a conscious subject,
or an unconscious subject, a patient.
On top of this now, you're saying in my control subjects, I cannot necessarily
have a highly reliable replication of activity when people imagine different kinds of tasks.
However, on the case of tennis, this is effective.
There's high repeatability there.
So how do you account for that? I think it's a sensitivity issue.
I mean, I think every person has a fusiform face area, and I think that area
is perceiving faces in every person when they see faces, and perhaps even when they imagine faces.
But the sensitivity of fMRI is not such that in every participant we will detect
activity in that region when they're doing the task.
But could it also not mean that, let's say, in the fusiform cortex,
the representation of phases is more distributed than the movement of tendons
in your motor cortex, and therefore
it's more difficult to pick it up reliably over different trials?
Would that be a reasonable interpretation? Yeah, I think that's quite possibly true.
Um i think there are many many reasons that could account for the variability you know i think.
Pure imagery reasons too i mean it may well be that
it's easier to imagine waving your hand
around than it is to imagine a face do you imagine the
face of your wife or your child or your dog or
you know i don't know there are many
reasons why this may be um you know
i i know that empirically it's true that face
imagery is less reliable than motor
imagery in the context of imagining playing tennis similarly imagining
i mean we thought for a long time you know sub
vocal rehearsal might be a very good one we're all used to the idea of singing
a song in our heads um in one of our early experiments we had uh participants
singing christmas carols and we were probably doing our scanning in december
or something we had participants imagining christmas carols, singing a carol.
And again, a lot of people, a lot of the time will activate broker's area when
they're singing Jingle Bells, but not everybody all the time.
And the problem is, you need it to be everybody all the time.
If you're going to make a reverse inference, if you're going to look at it and
say, ah, yes, this person is doing what I asked them to do, they're imagining
singing a carol or they're imagining playing tennis.
It's essentially a reverse inference, and you don't have a lot of power in reverse
inferences, unless you have a very reliable and robust result. Right.
So the other aspect of the question had to do with the fact that if you would
just look at the imaging result, you would not be able to say whether that person
was conscious or unconscious.
So how do you interpret that with respect to our understanding now of consciousness
and its expression in the kind of activity, metabolic activity,
that we can actually image with this kind of technology?
Well, I think you have to make a very clear division between,
let's say, what we'll call passive paradigms and active paradigms.
And a passive paradigm is something that the brain will automatically do,
irrespective of whether you are conscious or not.
And that will include speech perception, face perception, all of these things.
Now, if your fusiform face area lights up when you see a face,
if your auditory cortex lights up, activates when you hear speech,
you may well be conscious when that happens, but it will also likely happen
if you are unconscious, even if you are healthy and unconscious, for example.
Anesthetized and therefore we can't
use it as a vehicle for determining that
somebody is conscious you know even if it's highly correlated with consciousness
you know it's it's it's not good enough the other types of paradigms the things
we've been exploring are not dependent on external stimulation and these are
i'll call them active paradigms um because what you're doing is you are
asking somebody to generate a response with their brain.
And this, for me, is analogous to asking somebody to raise their left hand.
It's the same thing. You're saying, activate your premotor cortex when I ask you to.
Now, you're not playing them a sound that you know will automatically activate it.
And we know from the various experiments that we've done over the years usually
to satisfy skeptical reviewers that people are capable of not generating these
responses even when you ask them to.
And the tennis example is a great example. If you say to somebody,
I'm going to ask you to do something and I want you not to do it.
In the ephemera scan, if you say, now imagine playing tennis,
you will not see activation in the premotor cortex.
People are perfectly capable of not generating this.
And it's because it is an active or a willed volitional task. You have to want to do it.
And it's that sort of want that we are using, I suppose, as our marker of consciousness.
Our notion is that, you know, if somebody has the mental capacity to decide
not to do something in spite of being told that they have to do it.
Then we think that's a reasonable marker that they are conscious,
or at least as conscious as you or I am.
And, you know, I think distinguishing between those different fMRI tasks
is really fundamental to this work because it's very very
important that one doesn't think that all fmri means
um you know any fmri activation means
that you're conscious and similarly it isn't true that activation
could just be an automatic thing there are certain types of
activation that simply cannot be automatic okay so then uh if we now take take
that interpretation of what this means for consciousness and we look at the
kind of order that people try to give to the different states of consciousness
you might find a person in,
from let's say coma to fully aware.
Is that structure that we assign to different forms of consciousness actually
helping us or is it more of a hindrance, right, where you would go from coma
to, let's say, minimally aware, et cetera? Yeah.
Actually, I don't know the answer to that. There have been many surprises in
this area over the last 10 or 12 years, and I'm very happy.
I'll be very happy to be, you know, mostly to continue to be surprised.
You know, it may be, for example, that the temporal aspect turns out to be more
important than the depth aspect.
You know, it may be that a lot of minimally conscious patients,
it's not that they're in some intermediate state of consciousness between where
you and I are and between a vegetative patient.
It may be that they are intermittently conscious.
They come in and out of consciousness. I don't find that, you know,
very hard to believe. leave.
I think that's something we can now explore because we, you know,
we have a tool that we can use to more or less say that this person is conscious at this point in time.
And obviously with longitudinal scanning, one could follow this in a minimally
conscious patient and work out, you know, whether it is a temporal rather than a depth thing.
Similarly with coma, you know, we don't, I mean, coma and vegetative state,
they're often mixed up. Coma patients really are quite different.
These are patients who appear to be asleep most of the time,
whereas vegetative patients open their eyes and have sleep-wake cycles and to
some extent appear to be animate.
We've done very little research using these types of imaging approaches with coma patients.
And it may be that we find that a lot of patients who are comatose or appear
to be comatose do in fact have residual cognitive capabilities and perhaps even consciousness.
I hesitate to predict that will be the case, but as I say, many things have
surprised me and to some extent, it wouldn't surprise me if that turned out to be the case.
So I don't think these things are not useful because up until now,
we have to go on what we know and what we know is what we can measure and what
we can measure up until now has been the behavior.
And behaviorally, these are distinct conditions, coma, vegetative state,
minimally conscious state.
And, you know, they can be differentiated based on, you know,
on behavior, whether it turns out that those are useless concepts in terms of
levels of consciousness.
I hope we now have the tools that will help us to answer that question.
That's fantastic. But then, what's the working model of consciousness that you then apply to this?
Like, for instance, also in the discussion this morning, one view is that you would say, well,
you have these particular areas of the neocortex that have to be combined in,
let's say, something you might call a global workspace or have to be massively
integrated in order to be conscious.
An alternative view could be that you say, no, they're actually very primitive
subcortical structures that provide consciousness, while these higher areas
of the cerebral cortex provide content to that ovarian complexity.
It's rather decisive which of these two camps you step into if you now look
at your vegetative state patient.
Yeah. So what's your working hypothesis between these two extremes?
Well, really, I think it's only,
and this goes back to your question this morning, is that you can test it.
I think that the problem until now has been, it's been very hard to come up
with any corroborative evidence.
You know, you can come up with something like a global workspace model of consciousness
and we can say, well, you know, these people, healthy participants that we know
are conscious produce this pattern of activity in their brains.
These machines, animals, vegetative patients that we know are unconscious produce something else.
But you don't really have, in the case of the vegetative patients,
you don't have corroborative evidence. You can't say, we know they are not conscious
and they have this model of consciousness fits.
Now, I think you can. I think we could use the activation paradigm.
As I say, it doesn't answer the question of what is consciousness,
but I think it does allow you to have some sort of corroborative evidence and say, well,
we can test whether these people who appear to be unconscious are actually conscious
and then test these types of models to see whether they stand up.
And, you know, honestly, I don't know whether they will.
I think that's, you know, that's a suggestion that you made this morning.
And I think it's a very good suggestion.
This provides us with a mechanism for testing that.
But if we look at the classics, right, the giants that inspire us like Penfield.
He, at some point in his career, got convinced that there were much more these
subcortical or central encephalic cores course, that would provide the key ingredients
of, let's say, cognition and consciousness,
because lesions to subcortical structures had a way more devastating impact on a patient than,
lesions to the neocortex.
And that then was an argument for him to say, well, we should look more at the
subcortical structures.
Do you also find that in the patients that you look at?
Do we find whether the instruments tend to be… The similar core,
exactly. Well, again, the problem is all, well, all patients are different. That's the problem.
And, you know, I couldn't possibly say, yes, we generally find that's the way
in patients because, you know, in part because there's so much variability in
the site of the damage of the patients.
And in part because, you know, often it's difficult to work out exactly what
the damage is. If you've had a very traumatic brain injury, you know,
this is not a measurable quantity.
You know, you've got a bit of, well, you know, diffuse axonal injury is the
perfect, you know, this is the perfect example where, you know,
you're basically saying it's, you know, it's damage all over the place.
So, you know, I don't think I can really say. I mean, I think we learn a lot
from disorders like the locked-in syndrome where you,
you know, you very often do have a very specific brainstem injury that has resulted
in a situation where a patient is ostensibly cognitively normal but is nevertheless
motorically almost entirely impaired perhaps only able to blink an eye or you know move an eyebrow.
This produces I think the logical certainty that there are likely to be other
patients that are entirely cognitively preserved yet unable to even blink an eye or move an eyebrow.
As a scientist, it's inconceivable to me that the moment, you know,
the lesion that knocks out eye movements also happens to knock out the whole of cognition.
And of course, this is what we're looking at here is some kind of disconnection syndrome.
You know, it's a lesion of a subcortical structure that is essentially disconnecting
an and otherwise intact cortex.
Now, that's why I would be reluctant to...
To accept a view that this therefore makes the subcortical structures more important,
because it could just be that you've cut off the water supply,
you've disconnected the really important stuff up top.
In a sense, it's going back to your comment about communication disorders.
In a sense, what you've done is you've disconnected, you've
severed a channel of communication between the
brain and i say that in quotes that you know the conscious brain and the external
world preventing either external stimulation coming in or um you know or the
will going out you know or in some cases both very good so to to finish up i have two questions,
um so on the one hand i'm you've been around for quite some time um making this
incredible progress as using these really modern advances in imaging technology.
So give me your experience in the way we approach studying the brain and understanding consciousness.
What's the law of Adrian Owen that we should all adhere to?
That's a very unfair question. I don't have a law. I just follow my nose.
You know, I don't have a law. That could be a law.
Follow your nose. I follow my hunches for sure.
There you go. you've told me what my law is. I follow my hunches.
I've had a lot of very strange ideas over the years, and some of them have worked out very well.
Some of them have worked out to be, you know, complete blind alleys.
I think, I mean, in the context of the work I've done in this particular patient
population, what I have learned is very often that,
the prevailing view um you know
is not necessarily the right view and if you have a
hunch however bizarre it might seem then follow
that hunch so yep follow your nose um i you know i don't think 12 years ago
at least i i know that 12 years ago and when we started to talk about these
patients having residual cognitive function there was a tremendous amount of
resistance to this idea because it just didn't seem like it could be at all
likely and we've gradually worked our way through,
you know, through this hierarchy.
And, you know, I think if I maybe followed my nose even earlier than I did,
we would have probably got to where we are today much more quickly than we have.
I think, you know, the idea that somebody could actually be conscious and even
able to communicate met with a tremendous amount of resistance,
even at a time when I think myself So often people working with me,
you know, are pretty sure that this must be the case.
So follow your nose and follow it fast, I would say. Very good.
Last one is, what's the one prediction which you really want to stick your neck out today?
So I can come back to you five years from now and say, Adrian,
show me, were you right or wrong?
I predict that we will have a patient within five years who is entirely behaviorally
incapable of demonstrating any evidence of consciousness awareness,
yet is nevertheless capable of having a normal, and I put that in quotes,
a normal conversation via some form of machinery, be it a brain computer interface
or an fMRI scan with somebody in the outside world.
So this has to be the absolute nightmare scenario, a patient who,
under any form of clinical investigation, any form of behavioral testing,
can exhibit no signs of conscious awareness whatsoever,
yet in some technologically driven situation is able to have a conversation
that most of us would consider to be perfectly normal.
Not just yes, no questions. It's expressing opinions about the world,
about themselves, and about the situation they're in.
I predict we will have that scenario within five years.
Fantastic. Aidan Nolan, thank you very much for this conversation. Thank you.