Screen from Hitchcock’s “Bang! You’re Dead.”

Neuroscientists at University of Western Ontario in London, Canada  found that a man who was thought to be living in a vegetative state for almost twenty years showed response when an Alfred Hitchhock movie was played in the background. The findings suggest that doctors might want to explore more methods to determine whether or not a possibly vegetative state patient is actually aware or not.

Listening in the background

The patient in question was hit by a blow to the chest during a fight as a teenager, which cut  cut off blood supply to his brain. After spending 3 weeks in a coma, doctors proclaimed him to be in a vegetative state since he seemed to be completely oblivious of his surroundings, despite he would sometimes open his eyes. The incident happened in 1997, and his situations hasn’t improved the slightest since.

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Lorina Naci, a neuroscientist at the University of Western Ontario in London, Canada, showed that it is possible to screen for awareness in unresponsive individuals by asking them to follow commands, such as to imagine playing tennis, then measuring brain activity using an fMRI machine. Despite successful on a few occasions, the method is obviously obstructed by the fact you need brain-damaged people to respond to commands and pay attention. So, Naci and team decided to employ a more passive means of gaining attention: watching television.

To make it easier to both elicit and gauge attention using brain scanning techniques, the researchers decided to go for a thrilling movie and what better choice than a movie made by the master of suspense himself, Alfred Hitchcock. An episode from the TV series Alfred Hitchcock Presents called “Bang! You’re Dead” was selected because of its simple, yet suspenseful plot: a young boy playing with his toy gun finds a real revolver in his uncle’s drawer and starts pointing it at his mother and a little girl in the supermarket. The viewer knows that the gun is lock and loaded, so there a lot of moments that elicit powerful emotions.

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Before presenting it to patients, the researchers first made test rounds with 12 volunteers with normally functioning brains. While watching the clip, the participants had their brain activity scanned with a functional magnetic resonance imaging (fMRI). During the moments of greatest suspense, their frontal parietal brain regions lit up like crazy. This region is known to orchestrate attention. The participants were also asked about their subjective experience, and their review closely matched what researchers could objectively witness from the brain scans – feelings of anxiety and dread.

The team then proceeded with tests on actual brain-impaired patients: a 20-year-old female patient who fell into a coma in 2007 after suffering brain damage of unknown origins, and the 35-year-old man. Both patients had their eyes open during the show. After analyzing the brain scans, researchers found the young woman showed no brain activity in response to the film. The male patient, however, displayed peaks and valleys of brain activity that closely matched those of the healthy volunteers, suggesting that he might have been following the plot.

The findings suggest that not all seemingly vegetative patients are perpetually unaware – some of them might actually be tuning in. It’s yet too early to say if this method could prove to be successful for most apparently unaware and unresponsive brain injury patients, however. For the patient’s family, the results are definitely more than just another science experiment. His father used to take him to the movies once a week for years after his injury, but eventually stopped since he thought it was all useless. Now, there’s yet hope.

Findings appeared in the journal Proceedings of the National Academy of Sciences.