Brain Imaging Reveals Communication with Previously Unconscious Patients
- Brain imaging has allowed a man who was previously considered unconscious to answer questions.
- The study challenges the definition of consciousness and provides an opportunity to communicate with those who show no signs of awareness.
- The findings have sparked a debate over consciousness in vegetative patients.
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和訳お願いします Brain imaging has allowed a man who was previously considered unconscious to answer a series of yes-or-no question. The study, published this week in New England Journal of Medicine, challenges clinicians' definition of consciousness and provides an unprecedented opportunity to communicate with those who show no outward signs of awareness. Patients are classified as unconscious, or being in a vegetative state, if they are unable to respond in any fashion to an extensive series of questions and requests. But if the patient is completely unable to move, an aware or communicative mind could go unrecognized by this method of assessment. The conundrum with the vegetative state is that it's a diagnosis made on lack of evidence, says neuroscientist Adrian Owen of the Medical Research Council's Cognition and Brian Sciences Unit in Cambridge, UK. Owen and his colleagues made headlines three years ago when they used a brain-scanning technique called functional magnetic resonance imaging(fMRI) to demonstrate that a woman in a vegetative state could respond to verbal commands. When researchers directed her to imagine playing a game of tennis or walking through her house, the fMRI scan revealed that she activated the same areas of her brain as healthy subjects who were asked to do the same. The findings sparked a debate over whether or not the woman was actually conscious(see Thoughts of woman in waking coma revealed).Some argued that Owen and his collaborators saw was nothing more than an automatic activation of those brain regions on hearing certain words. One such critic was Lionel Naccache, a neuroscientist at the Pitie-Salpetriere hospital in Paris, who urged caution before concluding that the woman was indeed conscious. This latest evidence of communication with a vegetative patients, however, has Naccache convinced. This is clear-cut evidence of consciousness he says.
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脳の画像化によって、以前、意識不明であると思われた人が、一連の「はい・いいえ」の質問に答えられるようになりました。この研究は、今週、ニューイングランド・ジャーナル・オヴ・メディスンに発表されましたが、臨床医の唱える意識の定義に疑問を呈して、見た目では認識の徴候を示さない人々と意思疎通を図る先例のない機会を提供しています。 患者は、一連の広範囲な質問や要求にいかなる形でも応えることができない場合、意識不明、すなわち、植物状態と分類されます、しかし、患者が、完全に動くことができないのであれば、認識を持った精神、あるいは、意思疎通を図ろうとする精神は、この評価方法では、見過ごされてしまう可能性があります。植物状態にまつわる難しい問題は、それが、証拠が不十分なままなされる診断であると、英国ケンブリッジの医療審議会・認知・脳科学部の神経学者ブライアン・エイドリアン・オーエンは言います。 オーエンと彼の同僚は、3年前、新聞の見出しを飾りましたが、この時、彼らは、機能的磁気共鳴映像法（fMRI）と呼ばれる脳の検査技術を用いて、植物状態の女性が、ことばの命令に応えることができることを証明しました。研究者が、彼女にテニスの試合をしている、あるいは、彼女の家の中を歩いていることを想像するように指示すると、彼女が、同じことをするよう頼まれた健康な被験者と同じ脳の領域を活発化させることが、fMRI検査で分かったのです。 この研究成果は、その女性が、実際に、意識があるのかどうかということをめぐる議論に火をつけました（「明らかにされた目覚めているこん睡状態の女性の思考」を参照）。オーエンと彼の協力者が見たものは、特定の言葉を聞いた場合のそれらの脳領域の自動的な活性化に過ぎないと主張する人もいました。 こうした批判者の一人は、パリのピティエ・サルペティリエ病院の神経学者ライオネル・ナケイシュでした、彼は、その女性が、本当に、意識があると結論付ける前に、慎重を期すことを求めました。 しかし、植物状態の患者との意思疎通に関する今回の最新の証拠は、ナケイシュを納得させました。これは、意識の明確な証拠であると、彼は言っています。
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Dr. Adrian Owen is a professor of neuroscience at Cambridge University. Dr. Owen’s team concentrates on the diagnosis and effect of brain injuries, and the development of treatments for such patients. He was not satisfied with the accepted methods of diagnosing comatose patients. Typically, when someone cannot respond to any questions or requests, they will be diagnosed as “vegetative.” However, a significant number of so-called vegetative patients are actually conscious, but completely unable to respond to questions. In a previous study, Dr. Owen put healthy volunteers into an fMRI scanner and asked them to imagine playing tennis. After mapping the area that becomes active when people imagine that activity, they put a vegetative patient into the scanner and asked her to imagine playing tennis. To the team’s great joy, the patient’s brain lit up just like that of the healthy volunteers. Since she could respond to their request to imagine playing tennis, she showed them that she was conscious ― all this despite being completely still, having her eyes closed and showing no signs of consciousness. Another patient was told to use a code to communicate with the research team. To signify “Yes,” he was to imagine playing tennis. To signify “No,” he was to imagine walking around in his house. He was asked yes-or-no questions about his personal history, and correctly answered, proving that despite his appearance he was conscious and could communicate. Next, the research team plans to ask unverifiable questions, in an attempt to communicate more deeply with these patients who can manipulate their brains, but not their bodies. よろしくお願いしますorz
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Shocked to hear that his friend was waiting for a heart transplant,Robert Test decided to become an organ donor. This is what he wrote about his decision. At a certain moment,a doctor will decide that my brain has stopped functioning. When that happens, do not attempt to revive my body by the use of a machine. Give my eyes to a man who has never seen a sunrise,a baby's face, or love in the eyes of a woman. Give my heart to a person whose own heart has caused him nothing but days of endless pain. Give my blood to a teenager who was seriously injured in a traffic accident,so that he or she might live and see his or her grandchildren playing.
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和訳お願いします Owen and his collaborators repeated their fMRI experiment on 54 patients who had previously been classified as either vegetative or minimally conscious(a consistently respond to commands, but cannot communicate interactively). They found that five of these 54 patients responded to commands to imagine playing tennis or navigating thought a familiar house. Four of those five patients had classified as vegetative, but when clinicians repeated their assessment following the fMRI study, they found evidence that two of those four should instead have been classified as minimally conscious. One of the responsive patients, a 22-year-old man who had been diagnosed as vegetative for five years after a traffic accident left him with a traumatic brain injury, was selected for further study. Because it is difficult-if not impossible-to determine whether someone is thinking yes or no, the reseachers instead asked the patient to imagine playing tennis when the answer to imagine playing tennis when the answer to a question was yes, and to imagine walking through a house when the answer was no. Visualizing these two activities stimulates different parts of the brain that are easily distinguished using fMRI. They asked the patient a series of simple yes-or-no question pertaining to his personal history, such as Is your father's name Alexander? He answered five out of six question correctly. No brain activity was observed in response to the sixth question. The results suggest that fMRI could be useful in diagnosing unresponsive patients, says Owen. There are things that are just not going to manifest themselves in outward behavior , says Owen. This method can tell us which patients are aware, and it can tell us what they are capable of. For Naccache, it is the patient's ability to respond using the code suggested by Owen and his team that indicates he is truly conscious. When you are conscious, you have the ability to use an arbitrary code to communicate with somebody, he says. Parashkev Nachev, a neuroscientist at University College London who was not affiliated with the work, cautions that it is important not to over-interpret the results. The patient only answered a series of very basic questions, he notes, and the results in his view do not necessarily suggest that the patient is fully conscious or has the potential for recovery. There is no doubt that it does merit further research, he says, but I could not see using it as a clinical tool at this stage. As a next step, Owen and his colleagues intend to ask the patient a series of questions with unverifiable answers. For example, the technique could be used to ask whether they are experiencing any pain-a question that frequently troubles family members and hospital staff. But should a vegetative patient be asked whether they want to live or die? I think there's an enormous problem with that, says Owen. Just because a patient is able to respond with yes or no doesn't tell you if they have the necessary level of competence to answer difficult, ethically challenging questions about their destiny.
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和訳お願いします Owen and his collaborators repeated their fMRI experiments on 54 patients who had previously been classified as either vegetative or minimally conscious(a condition in which a patient may inconsistently respond to commands, but cannot communicate interactively). They found that five of these 54 patients responded to commands to imagine playing tennis or navigating though a familiar house. Four of those five patients had classified as vegetative, but when clinicians repeated their assessment following the fMRI study, they found evidence that two of those four should instead have been classified as minimally conscious. One of the responsive patients, a 22-year-old man who had been diagnosed as vegetative for five years after a traffic accident left him with a traumatic brain injury, was selected for further study. Because it is difficult-if not impossible-to determine whether someone is thinking yes or no, the reseachers instead asked the patient to imagine playing tennis when the answer to imagine playing tennis when the answer to a question was yes, and to imagine walking through a house when the answer was no. Visualizing these two activities stimulates different parts of the brain that are easily distinguished using fMRI. They asked the patient a series of simple yes-or-no question pertaining to his personal history, such as Is your father's name Alexander? He answered five out of six question correctly. No brain activity was observed in response to the sixth question. The results suggest that fMRI could be useful in diagnosing unresponsive patients, says Owen. There are things that are just not going to manifest themselves in outward behavior , says Owen. This method can tell us which patients are aware, and it can tell us what they are capable of. For Naccache, it is the patient's ability to respond using the code suggested by Owen and his team that indicates he is truly conscious. When you are conscious, you have the ability to use an arbitrary code to communicate with somebody, he says. Parashkev Nachev, a neuroscientist at University College London who was not affiliated with the work, cautions that it is important not to over-interpret the results. The patient only answered a series of very basic questions, he notes, and the results in his view do not necessarily suggest that the patient is fully conscious or has the potential for recovery. There is no doubt that it does merit further research, he says, but I could not see using it as a clinical tool at this stage. As a next step, Owen and his colleagues intend to ask the patient a series of questions with unverifiable answers. For example, the technique could be used to ask whether they are experiencing any pain-a question that frequently troubles family members and hospital staff. But should a vegetative patient be asked whether they want to live or die? I think there's an enormous problem with that, says Owen. Just because a patient is able to respond with yes or no doesn't tell you if they have the necessary level of competence to answer difficult, ethically challenging questions about their destiny.
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JAPAN TIMESの記事よりわからない箇所がありました。 Japan is in dire need of role models who manage to have a large family and find happens there, of a society that makes it possible for mothers, single or attached, to work and thrive. France, for one country, is striving to create such a society, and achieved, in 2006, the highest birthrate in Europe, at 2,01 children per woman of childbearing age. In contrast,in much of southern Europe, even where government policies have aided woman,People's condescending attitudes to single mothers and children born out of wedlock have kept birthrate low. 長文でお手数おかけしますが、どなたかお答えいただけたら嬉しいです！
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