So I'm just going to place this in here, so please keep your eyes closed. That feels a bit weird, sort of looks like a bathing cap. What weÕre doing here is taking the science of consciousness and building tools that we can use at the bedside to assess patients after brain injury to have a better estimate of how conscious they might be, even if they can't express that in their behaviour. So you just basically are measuring activity from somebody's brain... without making any invasive measurements, you're placing an electrode on the skull, measuring that minor electrical activity and that gives us a clue that this person might be conscious. Dr Srivas Chennu is a neuroscientist at the University of Kent. He has devised a technique which aims to uncover the true level of brain activity in patients believed to be in vegetative or minimally conscious states. Costas is a healthy subject demonstrating how the technique works. For 10 minutes, we collect activity from 128 sensors from their brain and then from the data we collect, we look at the pattern of connections between brain alias, as measured by these senses and it turns out that, in the healthy young adult brain, the strongest connections tend to be between frontal and parietal areas Ð areas of the front of the brain and the back of the brain. And we know from a lot of neuroscience that these are the areas that sustain consciousness in the healthy brain and that's exactly what you see here Ð this mohawk as I like to call it of connections that are strongest between those front and back areas, those arcs indicate the strength of the connections. If you compare that to the next image: this is of a patient who is in a so-called vegetative state and what you see is a dramatic loss of those connections compared to the healthy brain where there are far fewer connections and also much weaker when they are there. In the third image now, you can see patients who has behaviourally the same profile as the previous patient. In this patient too, there is no evidence at the bedside that we can measure that indicates any awareness. They score the same on any clinical test and, for all intents and purposes, they look like they're in a vegetative state. But if you measure the brain activity with the technique we've just shown, they produces rich and detailed mohawk-like connectivity that is very similar to that seen in a healthy adult. In the UK, there is estimated to be up to 24,000 people in a vegetative or semi-conscious state. This means that, although at times the patient seems awake, they have either limited awareness or no awareness of themselves or their environment. At present the only way medical consultants can assess brain activity in a patient is to complete behavioral tests. Dr Chennu's technique approaches this assessment in a new way by assessing the brain itself. What we do know from a lot of neuroscience of consciousness is that these brain areas Ð what we call the frontal parietal cortex Ð they have key areas that seem to connect with each other, that seem to be talking to each other when people report having a sense of self, having a sense of experiencing the fact that they are there. And what turns out to be the case is that there are some patients in whom, though they have no evidence of behaviour, you can see activity potentially coming from those brain areas registering on the EEG signal. Although he didn't really respond to anything, I knew he was there, just by looking into his eyes. I knew my husband was there. Because he was in the low awareness state sometimes his response is, like I would say to him Ôlook at meÕ and IÕd move and it could be two minutes later, three minutes later, and his eyes would move and that's when I thought Ôhe's thereÕ. We had a telephone call at about half past ten at night, saying that Ruth had gone into a, well, had some sort of heart, yeah it was actually cardiac arrest. Nobody actually said to us that Ruth would not recover. Often the first thing they want to know is are they going to improve? Are they going to get better? Is there anything you can do? What can we do to make things better? Assessing brain activity is not a new practice but until now it has never been assessed at the bedside so easily. A previous technique breakthrough came when patients were assessed in an MRI machine while being asked to imagine playing tennis. When we imagined doing some sort of physical kinaesthetic action, there's a particular bit of your brain that lights up in an MRI scanner and that's called the supplementary motor area. And by measuring activity there, we're demonstrating that even if this patient can't actually play tennis, they are well able to imagine that action on demand, and that's why that task became really popular as a means to assess what we would now call hidden awareness or covert awareness that isn't expressed at the bedside. The areas of the brain that sort of create an awareness of oneÕs own self, that create an awareness of the fact that somebodyÕs asking you to do something and then enable you to actually perform that task Ð those are the brain areas that weÕre measuring activity from with the EEG. By doing that, what we're trying to do is assess patients more easily. We don't have to ask them to do something and also we can do it at the bedside, because remember with the tennis you need an MRI scanner which is very expensive and most patients can't go in one. And what's more, many patients might be unable to understand instructions because of aphasia, so damage to the language areas so might not be able to play tennis but might still be conscious. So what weÕre trying to do with this task, the simple assessment with EEG is to just ask them to be at rest and measure the brain activity during that time. Headway House is a centre for patients who have suffered from a brain injury these patients are now free from life support interventions and are working towards as full a recovery as possible. I went out one Christmas, went to a pub. A friend of mine got a fibreglass sports car for Christmas. He said: ÔIf you're still here when I get back, I'll give you a lift home.Õ So he came back, I suppose about 10 minutes before the pub closed. We had one more drink and then he drove me home. My 15-minute cycle journey lasted about six months. He, um, lost control going up a hill and hit a telegraph pole. Neither of us wearing seat belts but they weren't obligatory then. As I come out of the dashboard, I've caught a glance and blow on the telegraph pole which caused all damage on the left-hand side. Got to hospital they called in my parents. Apparently I said 'I'm very very sorry' to my parents and then didn't know another thing for about four weeks. During that four weeks, I had some very very interesting experiences within my own mind. Some of the patients we see who have what we call severe brain injury Ð much more severe Ð donÕt necessarily wake up as quickly as you have Ð right? And that's a challenge. That is particularly problematic in a hospital where doctors are trying to understand how much brain injury there is, what chances are for recovery. So what we have tried to do is try and understand how what we know about consciousness and the brain tell us about how much recovery is possible, how long is it going to take? Etc etc... It's likely that these patients are conscious but they're not conscious in the way that you might experience consciousness, and that's the most remarkable thing Ð that you can have consciousness as you perceive it in the absence of memory. Although that's another interesting thing, right Ð do we actually exist without memory? Very good question. This is really philosophical - these are hard questions. The aim of being here today is for us to first of all understand the experiences of patients who've been through brain injury but are now able to tell us what it was like. But also for us to be able to explain the science to them and inform the general public and inform patients about whatÕs possible. Informing the public on scientific advancements is obviously very important as is the accurate reporting of cases which feature brain injury by the media. The generic word 'coma' is used a lot in the media. It's nice and short for headlines Ð everyone thinks they understand what a coma is. Professor Jenny Kitzinger is the co-director of the Coma and Disorders of Consciousness Research Centre. She has conducted a study of 2000 news reports over the last 10 years to assess the accuracy of the language used. The term 'vegetative' may be less likely to be used and the term 'minimally conscious' even less likely. So the media both sensationalises this but also promulgates confusion about these different diagnostic categories. Vegetative state has sort of come to sort of stick with us but is ultimately pejorative in the sense that it is automatically implying that somebody in a vegetative state could have no cognition Ð no more than a vegetable and, of course, that's far from what we find. And hence a new term is something clinicians and I have been proposing should be used and that's called the 'unresponsive wakefulness syndrome'. I do think we need to find new terminology Ð it's something me and my colleagues are always talking about the world over. If you say to a family member, 'your loved one's in a vegetative state', what 99% of the time they hear is 'your loved one's a vegetable' And we get that told to us numerous times by the families of our patients that they hear 'vegetable' they don't hear 'vegetative'. It means nothing to them. I do think there's a good reason for understanding brain activity particularly in areas of disorder of consciousness. We know that many people are misdiagnosed as being in a vegetative state when actually their awareness is much higher. We know we can miss people that are in a locked-in syndrome, because we don't understand at the moment of the accident, or shortly after, what activity is there? We did ask for a brain scan at one stage, didn't we? But I didn't want to know the results. I would be... I would like to know. I would like to know of the brain's activities, um, because at that stage it seems to me, um, you'd be more aware of what is or is not possible. And I think I would like to know that. Glass half full, glass half empty. I don't want to know what the limitations are and I think if you want to know how far you can go forward, you've also got to be aware of what the limitations are. I don't want to know that.