Study Could Help Identify 'Coma' Patients More Likely To Recover

A study published this week could help doctors to identify patients with brain injuries, in seemingly unresponsive states, who are more likely to recover.

In the study, published in the journal Brain on Monday, researchers identified what may be the source of a curious phenomenon known as "hidden consciousness" or cognitive motor dissociation (CMD).

Hidden consciousness is seen in patients with acute brain injury who appear to be in a coma or other unresponsive state.

Patients with CMD seem to be able to hear and comprehend verbal commands even though they cannot carry out those instructions because the body does not respond, study author Jan Claassen, a researcher at Columbia University and critical care neurologist at New York-Presbyterian/Columbia University Irving Medical Center, said in a statement.

The CMD phenomenon has only been identified in the past few years and is still poorly understood.

Methods have been developed to detect CMD in unresponsive patients. These include analyzing changes in electrical activity or cerebral blood flow recorded by an electroencephalogram (EEG) or functional magnetic resonance imaging (fMRI) respectively. But both of these methods currently have their limitations.

Nevertheless, it is thought that around 15 to 20 percent of patients who appear to be in a coma or another unresponsive state display signs of CMD when evaluated with such methods, Claassen told Newsweek. The detection of CMD is reshaping their understanding of patients in comatose or other unresponsive states.

Clinicians define when a patient is in a "coma" purely based on the clinical examination, Claassen said. They apply this label to patients who display a complete absence of arousal (for example, eye opening) and awareness.

Patients with CMD do not seem to be able to follow commands and may in clinical examination appear to be in a coma.

But an analysis of EEG or functional MRI, recorded while patients are given verbal commands, reveals that the brains of these unresponsive patients are being activated in a similar way to conscious patients, Claassen said. This supports the interpretation that patients with CMD are to some degree conscious.

Identifying patients with CMD has important clinical implications for interactions, communication with families and the guidance of therapeutic decisions, according to the study.

Importantly, in prior research, Claassen and colleagues have been able to associate CMD with the recovery of consciousness and long-term recovery of independence in brain-damaged patients.

Researchers have been trying to develop more effective screening methods to identify which patients are likely to be in a state of hidden consciousness. But progress has been hampered by the fact that the brain mechanisms underlying the phenomenon have remained a mystery. This is where the latest study comes in.

In previous research, Claassen and colleagues found that subtle brainwaves detectable with EEG are the strongest predictor of hidden consciousness and eventual recovery for patients with brain injuries.

For the latest study, the scientists used EEG to examine 107 unresponsive patients with acute brain injury. Almost half of the patients appeared comatose, while one quarter were in a vegetative state—i.e. their eyes were open but they could not follow commands.

The remaining patents were in a minimally conscious state—meaning they could track an examiner with their eyes or look at them but were not able to follow any commands.

Using the EEG, scientists can identify when patients are trying, but are unable, to respond to a command such as "keep opening and closing your right hand."

This method detected CMD in 21 of the patients. The scientists then analyzed structural MRI brains scans from all the patients.

Using a special analysis technique, the team were able to identify patterns of brain injury that the patients with CMD shared and contrast those to the individuals who did not display signs of hidden consciousness.

The researchers found that all of the CMD patients had intact brain structures related to arousal and command comprehension. This supports the idea that they were able to hear and understand the verbal commands.

But they also found that the CMD patients had damage to brain regions responsible for integrating and carrying out motor commands, which is why they were unable to take action.

"Our study suggests that patients with hidden consciousness can hear and comprehend verbal commands, but they cannot carry out those commands because of injuries in brain circuits that relay instructions from the brain to the muscles," Claassen said in the statement.

The findings could lead to more frequent and earlier diagnosis of CMD. This, in turn, could help better predict which brain-injured individuals are more likely to recover with rehabilitation, according to the scientists.

More research is required before the approaches documented in the study can be applied to clinical practice. But the latest study shows that it may be possible to screen for CMD using widely available structural brain-imaging techniques.

Due to the technical complexity of CMD detection, at this time it is only available in a few academic centers. As a result, the vast majority of patients with hidden consciousness in the United States and around the world remain undiagnosed.

"Not every critical care unit may have resources and staff that is trained in using EEG to detect hidden consciousness, so MRI may offer a simple way to identify patients who require further screening and diagnosis," Claassen said in the statement.

How Crying Can Help You, Here Is What A Study Says

It may be good to cry out loud. (Photo: Getty Images)

They say that there's no sense in crying over spilled milk. But what do they know? Crying can get you another glass of milk if you do it loud enough. Plus, crying may serve a real physiologic purpose, according to a study published recently in Emotion, meaning the journal and not in an Emo-kind of way.

For the study, three researchers from the University of Queensland (Leah S. Sharman, Genevieve A. Dingle, and Eric J. Vanman) and one from Tilberg University (Ad J. J. M. Vingerhoets) recruited 197 female undergraduate students. They said that they choose all women rather than including men because pilot testing of sad videos had revealed that more women than men cried or at least more women revealed that they were crying. This did not account for the men who cried inside or used some bro-language or high fives to hide the crying.

The research team then showed each of the study participants either a video that are supposed to make them feel sad (sad videos) or a video that was not supposed to elicit any emotion (neutral videos) like something from a documentary or a ted talk. Each video lasted for close to 18 minutes. After the video, the researchers noted whether or not each participant had cried while watching the video. Ultimately, 65 participants watched the neutral video, 71 watched the sad video and cried during it, and 61 watched the sad video and did not cry. Presumably, no one cried during the neutral video. But then again, actor Bryce Dallas Howard was able to cry when Conan O'Brien talked about Home Depot in this Conan clip:

Then, each participant underwent a Cold Pressor Stress Test (CPT), which involved placing the participant's left hand, up to the wrist, in cold 0° to 5°C water. Unless you are the Iceman or Killer Frost, this is supposed to be painful. The research team measured how long each participant could stay in this position until pulling her hand out of the water. During the study, the research team continuously measured each participant's heart rate and respiratory rate and periodically measured cortisol levels from saliva samples. Cortisol is a stress-hormone that's produced by the body.

Also, at four points during the study, participants answered questions from the Positive and Negative Affect Scale short form (PANAS). These questions asked the degree to which the participant was experiencing ten different emotions and to rank each on a five-point scale that ranged from a one (very slightly or not at all) to a five (extremely).

When it came to cortisol levels and how long the participants could keep their hands submerged in the cold water, the study ended up finding not much difference between the neutral video watchers, the sad video non-criers, and the sad video criers. So if you are about to dunk yourself in cold water or take a cold shower, it may not help to cry first.

But here's a difference that the study found. Are you ready? Take a deep breath. The difference was breathing rates. While watching the videos, the non-criers tended to have elevations in their breathing rates, whereas, by contrast, the criers tended to maintain their initial breathing rates. In other words, tearing up could have helped participants better control their breathing rates. This provides further evidence that crying may help you better regulate arousal, serving as an emotional release.

Another interesting finding was that right before crying, participants tended to experience decreases in their heart rates, seemingly in anticipation of the crying. Once the crying began, their heart rates then tended to creep back up but not above where their heart rates had been before everything began. This may be further evidence that crying has a beneficial regulatory effect on your physiology.

So perhaps next time you start crying you can tell people that you are regulating your physiology. You've probably heard of people saying that they had a good cry and feel better after they've let the tears flow. It can be important to find reasonable ways to periodically release your emotions. Otherwise, you may end up bottling everything up like a hot air balloon that can explode when you least expect it.

Moreover, crying can be a way of communicating. It's really the only way that babies can express their needs before they learn how to say things like "why you throwing shade on me," or "I'm not Gucci." Crying can help communicate to others that you need more sympathy, comfort, or help. Of course, this can be misused. You don't want to cry every time your order at a restaurant doesn't come out right. And of course, there is the whole concept of crocodile tears: people crying to get something when they don't really mean it.

Crying can also be a way of communicating with yourself. Even when you cry alone, you may be telling yourself about your own state because, like many people, you could be terrible at reading your own emotions and situation. Tears could be your body's way of saying, "hey, take a break," or "something's not right," or "take care of yourself." Tearing up can then be a way of your body literally crying out to you.

Your body is a complex system. Crying can be complex. Your tears can flow when you are very sad, very angry, or even very happy. Better understanding what causes us to cry and what happens as a result could help us better handle their emotions and stress.