Research explains how some patients in a vegetative state can retain awareness, despite being unable to respond with movement
Home > News and events > News > Research explains how some patients in a vegetative state can retain awareness, despite being unable to respond with movement
The findings, published in JAMA Neurology, identify structural damage between the thalamus and primary motor cortex as the obstacle between covert awareness and intentional movement.
The team of researchers hope that their study, the first to understand the phenomenon, will pave the way for the development of restorative therapies for thousands of patients.
Dr Davinia Fernández-Espejo, from the University of Birmingham, explained, “A number of patients who appear to be in a vegetative state are actually aware of themselves and their surroundings, able to comprehend the world around them, create memories and imagine events as with any other person.”
“However, before we take the crucial step of developing targeted therapies to help these patients, we needed to identify the reason for the dissociation between their retained awareness and their inability to respond with intentional movement.”
“In highlighting damage to the pathways that physically connect the thalamus, one of the hubs of consciousness if you will, and the motor cortex, which drives our voluntary muscular activity, as the reason behind the dissociation we have provided an important explanation”.
A patient who produced repeated evidence of covert awareness across multiple examinations, despite being in a vegetative state for over 12 years, was observed in a case study at the imaging centre at the Brain and Mind Institute, at Western University (Canada).
A fellow patient with similar clinical variables, but capable of intentional movement, and 15 healthy control volunteers were also monitored using functional magnetic resonance imaging (fMRI) and fiber tractography.
Participants were asked to respond to commands, for example, asking them to imagine moving their hand in response to the keyword “move”, while their brain activity was measured. Additionally, the researchers assessed the integrity of the structural pathways that were revealed as essential for successful motor execution (those connecting the thalamus with the motor cortex).
Dr Fernández-Espejo added, “The ultimate aim is to use this information in targeted therapies that can drastically improve the quality of life of patients. For example, with the advances being made in assistive technology, if we can help a patient to regain even limited movement in one finger it opens up so many possibilities for communication and control of their environment.”
Though it may be a number of years before an effective therapy is developed, the team believe that a significant milestone has been reached with the discovery.
Dr Fernández-Espejo is working to consolidate this research at Birmingham, which is the ideal setting due to the regional concentration of academic and clinical expertise, care homes who monitor the long term care of severe brain injury patients and world class facilities available between the University and University Hospitals Birmingham NHS Foundation Trust; including the Birmingham University Imaging Centre and Institute of Translational Medicine.
Home > Schools and Departments > Birmingham Law School > Study Law > LLB > Careers > Law in the City 2014?
In the very early morning, long before sunrise, a group of intrepid students, all suited and booted, set off for London to discover as much as they could about being a city lawyer. Despite the rain and lack of sleep all were keen to meet representatives from the five host firms: Allen & Overy, Freshfields, Herbert Smith Freehills, Hogan Lovells and Slaughter and May. Such ambitions were briefly thwarted by the closure of the motorway but no one let this deter them from making the most of the opportunity to tackle the serious questions such as “what do trainees do?” and “what are the applications really asking?”.
First was a Q and A with a panel of trainees. This gave a real insight into the cultures of firms as everyone was given a chance to compare the trainee's experiences. Several students had wanted to find out more about the ‘mysterious’ life of a trainee and whilst we did hear about long hours we also learnt about the excitement of challenging work with interesting colleagues.
After a lunch spent networking with the trainees everyone was divided into teams for a negotiation exercise led by HSF. We completed a mock M and A deal and tried to get the most favorable terms for our clients without alienating the other team. It was really helpful to receive feedback and guidance from trainees throughout. This was a fun way to engage in a situation which reflects aspects of working for a city law firm as well as being useful for assessment days.
After a tour of Freshfields, the last formal event was another Q and A panel on applications and interviews tips. The one thing that really came across was the importance of being yourself - honesty and enthusiasm can really make your application stand out. Before we all got back on the coach there was again time for some more informal networking over canapés and drinks.
We were all very fortunate to be invited to London and to be given the opportunity to get to explore the firms in depth. Applications can be daunting and the competition off-putting but CEPLER ‘Law in the City’ highlighted the positive attitude with which these challenges should be faced. One thing all the firms shared was a commitment to recruiting the best trainees, who as everyone knows come from Birmingham!
Everyone had a fantastic day and left feeling motivated, if a little tired from all the excitement. I suppose all that’s left is to actually knuckle down to applying before it’s too late.
A dramatic police chase took place on the M6 Toll and M42 - after an elderly motorist was caught driving the wrong way.
Traffic cops were first alerted at around 10.30am this morning to reports of a man driving towards traffic on the M6 Toll near Lichfield .
The driver failed to stop for Staffordshire Police officers and was later detained after he had joined the M42 near Curdworth - again on the wrong side of the carriageway.
The driver was stopped by Central Motorway Police Group officers on the M42 (Image: Central Motorway Police Group)
The Central Motorway Police Group tweeted: "We have safely stopped an elderly gentleman who drove the wrong way along the m6 toll and m42.
Staffordshire Police confirmed that colleagues in Warwickshire stopped the vehicle. The age of the driver was not knonw.
Motorway officers, following the incident, warned people who have elderly residents that are still driving to check on their health.
The CMPG account said: "Have you an elderly relative whose health concerns you in relation to their driving? They can surrender their licence at DVLA.GOV ."
Birmingham will has submitted its initial pitch to be UK City of Culture 2013. Terry Grimley looks at the bid and the chances of success.
A new state-of-the-art library, a city centre university campus and an international autumn festival are three pillars of Birmingham’s bid to be the first UK City of Culture.
Friday was the deadline for entering the Government’s competition, and Birmingham will be one of an anticipated 22 cities throwing their hats into the ring for 2013, along with Manchester, Sheffield, Brighton and Swansea.
The coincidence that the Library of Birmingham and expanded Birmingham Repertory Theatre are scheduled to open during 2013 is the linchpin around which the city is constructing its bid. The year also happens to be the Rep’s centenary.
Other events planned for 2013 are the opening of a new Eastside campus for Birmingham City University, including many of its arts departments and the launch of a festival over nine weekends in the autumn.
Provisionally titled Birmingham Autumn, this will be programmed by a different guest curator each year and will feature new collaborations between arts organisations in the city and international partners. The cost of the festival is estimated at almost £9 million, of which around half would be recovered through earned income.
Other new developments linked in to the bid, which has been given the theme “Big City Culture”, include the redevelopment of New Street Station, phase one of which should be completed by 2013 and new galleries at Birmingham Museum & Art Gallery devoted to the history of the city, funded by a £4.6 m grant from the Heritage Lottery Fund.
The bid is being promoted by the Birmingham Cultural Consortium, whose partners include the city council, Advantage West Midlands, Marketing Birmingham and a range of cultural organisations.
Plans for a UK City of Culture, to be awarded every four years, were announced by culture secretary Ben Bradshaw in July, following the success of Liverpool’s year as European Capital of Culture in 2008.
Discounting the capital costs of the library and university campus, it is estimated that Birmingham’s proposed programme would require approximately an additional £20 m above existing funding.
Although there is no cash prize for winning the competition, it is understood that the Government would encourage support for the winning city from various sources including the Lottery. It is likely that a number of high-profile national events, including the Turner Prize and the Brit Awards, would be held there, as they were in Liverpool during 2008.
When the list of cities planning an initial bid was announced, culture minister Margaret Hodge said: “The city or place winning the title for 2013 will enjoy a golden opportunity to have the spotlight of national attention focused on them.”
The competition defines cities loosely to include regions and bidders include the whole of Cornwall. It requires candidates to demonstrate not only a strong existing cultural infrastructure but a strategy in which the year can deliver a permanent step-change, with a lasting social and economic legacy.
Birmingham’s 30-page bid document points to the strongest artistic infrastructure in an English city outside London, with world-class organisations and facilities including the City of Birmingham Symphony Orchestra, Birmingham Royal Ballet, Symphony Hall and the Hippodrome, Britain’s busiest theatre outside London.
On the downside, it points out that external perceptions of the city lag stubbornly behind the reality while cultural participation among the population is significantly below the national average. The city has also suffered disproportionately in the current recession, with the UK’s highest level of unemployment.
Suggested explanations for the relatively low cultural take-up among the city’s population are its socio-economic make-up, the sheer size of the city, which makes the city centre remote for many people, and the lack of cultural infrastructure in the neighbourhoods.
The council is currently taking an audit of cultural activity outside the city centre through its Big Blank Canvas website www.canvasbirmingham.com which was launched last month and is intended to provoke a debate on how more cultural opportunities can be spread outside the city centre.
The city is playing up its youthful demographic and has plans for a significant part of the programme to be organised by young people.
As well as raising levels of participation among citizens, the bid strategy ultimately aims to make a significant difference to the city’s economic prospects by transforming external perceptions of it as an attractive and liveable place, encouraging tourism and investment.
However, none of the main building blocks of the bid are dependent on Birmingham winning the competition. Plans for the Birmingham Autumn Festival emerged from the recommendations of consultants who have been looking at the city’s portfolio of festivals since March last year.
It follows the success of the biennial Manchester International Festival, which has brought Birmingham’s north-west rival huge publicity since it was launched with Damon Albarn’s Monkey: Journey to the West in 2007.
Coun Martin Mullaney, Birmingham’s cabinet member for leisure, sport and culture, said he was confident that the new festival would be affordable. “We will put ArtsFest into that, which costs £4-6m,” he said.
“I’ve said all along that if we don’t get City of Culture we will deliver all this anyway. If we do, it will be the icing on the cake. We’re also growing all the niche festivals like Rhubarb Rhubarb and Supersonic. There is also some money to start new individual festivals which may be a bit quirky, a bit wacky.”
The new autumn festival, aimed to establish Birmingham as a major cultural centre, will fit more than 250 performances into nine weekends during October and November. Each weekend would see a “mini-festival” from Friday afternoon until Sunday evening.
It is anticipated that it would sell 152,000 tickets in its first year, raising £3.3 m at the box office and attracting £3.5 m of media coverage. Attendances could double in three years, with a net impact of £50 m on the economy and 35 per cent of its audiences from outside the West Midlands, 15 per cent from abroad.
Coun Mullaney said he believed that the scale of Birmingham and its ability to make a big impact, was in its favour.
“We need to make a step change, in that the view of the city in the rest of the country is not good,” he said. “We’ve still got a long way to go to sort out perceptions from London.”
The 22 cities and regions which declared their intention of submitting an initial bid in October are Aberdeen, Barnsley, Birmingham, Bradford, Brighton and Hove, Cheshire West and Chester, Chichester, Cornwall, Derry, Durham, Gloucester and Cheltenham, Hull and East Yorkshire, Ipswich and the Haven Gateway, Lancaster, Manchester/Salford, Norwich, Pennine Lancashire, Portsmouth and Southampton, Sheffield, Southend-on-Sea, Swansea Bay, and Wakefield. The definitive list will be announced by the Department of Culture, Media and Sport early next week.
Birmingham’s bruising experience of bidding for European Capital of Culture 2008 demonstrated how difficult it is to anticipate a process which could be deeply political.
Manchester would seem to be the biggest threat, and in September Paddy Power made it the favourite at 4-1, with Birmingham second at 5-1. But to award City of Culture to Manchester so soon after Liverpool hosted European Capital of Culture might look too much like north-west favouritism.
A shortlist will be drawn up next month and those chosen will have until May 28 to submit a full and final bid, with the winner being announced in the summer.
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