Programme of Research
The group typically investigates 20-25 persons with impaired consciousness each year at Addenbrookes Hospital in Cambridge. Over the course of one week the group run a battery of novel electrophysiological and brain imaging paradigms designed to (a) explore the pathophysiology underlying conditions of impaired consciousness, (b) reveal evidence of residual cognitive function, and (c) monitor interventions to facilitate recovery. Through this programme of investigation the group hopes to build a greater understanding of conditions such as coma, vegetative state and minimally conscious state, develop a series of objective tests to inform the current diagnostic process, improve the accuracy of diagnosis and prognosis and create a standard assessment approach for widespread use. Moreover, through an improved understanding of the pathophysiology and residual function of individuals with impaired consciousness the group hope to develop interventions to improve a person's quality of life and facilitate recovery where possible.
Underlying pathophysiology
We currently have a limited understanding of the pathophysiology underlying conditions of impaired consciousness. We are therefore developing and applying a series of electrophysiology and brain imaging paradigms to explore these processes in greater detail. One such technique, currently being applied, is the use of diffusion tensor magnetic resonance imaging, which enables us to explore the location and extent of white matter loss in the brain.
Residual cognitive function
Unfortunately, the only way another person can demonstrate they are aware, is to move or speak, both of which are typically very difficult for a person who has suffered a severe brain injury. The group are therefore working to develop a series of hierarchal paradigms that can be used clinically to quantify the extent of residual cognitive function a person retains without requiring them to move or speak. It is hoped this will not only reduce the high rates of misdiagnosis known to exist because of the subjective nature of interpreting a person's behaviour, but also provide a much more detailed insight into the residual functional abilities of a person unable to move or speak. For instance, where a person has demonstrated the ability to comprehend speech and respond by manipulating their neural activity, we may be able to create novel communication devices.
Interventions to facilitate recovery
At present there are no empirically proven interventions to facilitate recovery. Whilst it should always be remembered that brain injuries leading to conditions of impaired consciousness are very severe and a large number of victims may never recover consciousness, it is possible that we may discover pharmacological, surgical or even mechanical interventions that bring either some improvement in function or quality of life to a few individuals. The groups work is therefore focused upon developing tools to identify those persons who might benefit from further intervention, identifying treatable pathophysiology and developing novel communication solutions, such as brain computer interfaces.
Further information
If you would like to learn more about our research, please contact Evelyn Kamu, Research Nurse, ek369@cam.ac.uk or telephone +44 1223 348135.