Consciousness – and what the concept means – has been debated for centuries by philosophers and scientists alike.
We are conscious because we can communicate with one another through our behaviour and language – but how do we know the state or extent of consciousness for those individuals rendered unable to communicate due to traumatic brain injury?
This is the research question postdoctoral fellow Lorina Naci has been tackling for the past few years as part of the Owen Lab at Western’s Brain and Mind Institute.
Her work, which has definitively shown some patients in non-responsive vegetative states are, indeed, conscious and able to experience emotions in the same way as healthy individuals, is being recognized with a L’Oréal-UNESCO Women in Science International Rising Talents Award in Paris, France this week.
The award, which comes with grant funding and mentorship as well as networking opportunities, recognizes only 15 young researchers, worldwide, each year.
“I’m extremely humbled, very inspired and very excited to promote science and the progression of women in science,” said Naci. “I’m also excited to be given a platform with a little bit of visibility for my research and a small financial grant that will serve as seed funding for my continuing work.”
Mel Goodale, Director of the Brain and Mind Institute, said he was delighted to learn Naci was honoured with the L’Oréal-UNESCO Women in Science.
“Lorina’s work on communicating with patients in vegetative state is truly groundbreaking. In addition, she has been a terrific citizen both at the Brain and Mind Institute and at Western in general, taking the lead, for example, in working with the School of Graduate and Postdoctoral Studies in making sure postdoctoral fellows at Western get the recognition they deserve.”
In 2014, after discovering the brains of 60 healthy individuals responded the same way after watching a short Alfred Hitchcock film, Naci observed the very same brain activity in a person who was behaviourally non-responsive and thought to lack consciousness for more than 16 year, in response to the same film.
“What I found is there’s an underlying neurocode that supports the shared conscious experience we would have if we were watching the movie. We all, more or less, understand the same thing – we’re all taken for a ride and have those ups and downs of excitement and suspense,” said Naci. “The patient in the vegetative state showed exactly the same response. This left no doubt in my mind of his consciousness and I was very excited about that.”
Since that time, Naci has expanded her method to include engaging audio narrative or music for patients who have their eyes closed. She hopes to develop relevant methods for patients in a coma as a result of brain injury. According to Naci, comatose patients are an incredibly vulnerable population because, unlike patients in a vegetative state, they are in an acute, unstable state.
“In the early days after injury is when medical professionals are making very important decisions about whether to withdraw lifesaving therapies or not. It’s extremely important we understand how comatose patients might progress. There are currently no clinical tools that can tell us, at the individual patient level, if they are likely to do well and continue to live, or if they will not. We have no real way to determine this.”
Often, said Naci, this uncertainty influences medical teams to make the decision to withdraw lifesaving therapies as early as 72 hours after the initial injury. Her hope is to be able to develop tools sensitive and easy enough to add onto initial medical scans that can help to better assess brain function at a crucial juncture.
“My hypothesis, based on my work with more chronic patients, is that a proportion of comatose patients may be covertly aware. If we could test them, and see how preserved their brain function is, then we might be able to continue lifesaving therapies for longer and, in some cases, save the patient’s life. I’m very excited by the potential implications of this work and I think it could have huge implications for end of life decisions for this very vulnerable population.”
Naci is headed to Dublin, Ireland this spring to join the Global Brain Health Institute and take on the role of assistant professor of Psychology at Trinity College. She is looking forward to starting up her own laboratory as a principal investigator and is thankful for her time at Western.
“I’m very grateful for all of the opportunities and the amazing people I’ve been able to work with here at Western – this has built the foundation of my success.”