Using a device which detects patterns in brain activity, patients paralysed by ALS can answer ‘yes’ or ‘no’ – and tell doctors they are ‘happy’ with life 
 
 Doctors have used a brain-reading device to hold simple conversations with “locked-in” patients in work that promises to transform the lives of people who are too disabled to communicate. 
 
 
 
 The groundbreaking technology allows the paralysed patients – who have not been able to speak for years – to answer “yes” or “no” to questions by detecting telltale patterns in their brain activity. 
 
 
 
 Three women and one man, aged 24 to 76, were trained to use the system more than a year after they were diagnosed with completely locked-in syndrome, or CLIS. The condition was brought on by amyotrophic lateral sclerosis, or ALS, a progressive neurodegenerative disease which leaves people totally paralysed but still aware and able to think. 
 
 “It’s the first sign that completely locked-in syndrome may be abolished forever, because with all of these patients, we can now ask them the most critical questions in life,” said Niels Birbaumer, a neuroscientist who led the research at the University of Tübingen. 
 
 
 
 Facebook Twitter Pinterest Activation of a “yes” response vs. a “no” response in both the hemisphere of the brain. The blue colour indicates a lesser concentration of oxy-hemoglobin and red indicates and increased concentration. Illustration: Wyss Center, www.wysscenter.ch 
 
 “This is the first time we’ve been able to establish reliable communication with these patients and I think that is important for them and their families,” he added. “I can say that after 30 years of trying to achieve this, it was one of the most satisfying moments of my life when it worked.” 
 
 
 
 All of the patients, who are fed through tubes and kept alive on ventilators, are cared for at home by family members. To train the patients on the system, doctors asked them to think “yes” or “no” in response to a series of simple questions, such as “Your husband’s name is Joachim” and “Berlin is the capital of France.” 
 
 
 
 During the sessions, the patients wore a cap that uses infrared light to spot variations in blood flow in different regions of the brain. As they answered the questions, a computer hooked up to the cap learned to distinguish the blood flow patterns for “yes” and “no” in each patient. 
 
 
 
 When the patients scored at least 70% on the training questions, the doctors moved on to more personal questions. The most important of these were about quality of life. Perhaps unexpectedly, all four patients indicated that they were “happy” with life, suggesting that locked-in syndrome might not be the living hell many presume it to be. 
 
 
 
 But while the renewed ability to communicate with the world was a boon for the patients and their carers, not all of the answers went down well. One patient was a 61-year-old man whose 26-year-old daughter asked whether she should marry her boyfriend, “Mario”. Her father said “no” nine times out of ten. “She went ahead anyway,” Birbaumer told the Guardian. He did not ask if she regretted ever posing the question. 
 
 
 
 The findings, reported in the journal Plos Biology, do not mean that all locked-in patients are content with their lives. The four patients involved in the study had all chosen to be kept alive on a ventilator once their own breathing had failed, a decision that suggested they did not wish to die. Only a small percentage of CLIS patients who are moved on to ventilators survive the transition. “We have never had a patient who survived outside family care,” Birbaumer said. 
 
 
 
 But patients with locked-in syndrome have reported a good quality of life before, even matching that of healthy people of the same age. Birbaumer said the reasons are unclear, but he wonders if patients become focused on the good social interactions around them, and even experience something akin to a state of meditation because they cannot feel or move their bodies. “We find that they see life in a more positive way,” he said. 
 
 
 
 For his next project, Birbaumer wants to build a system that allows patients to communicate more proactively, rather than simply answer questions. In the 1990s, the French journalist, Jean-Dominique Bauby, who became locked-in after a massive stroke, dictated his bestselling memoir, The Diving Bell and the Butterfly, by blinking his left eye to select letters from the alphabet. Birbaumer believes a system that reads brain activity could achieve the same ends for completely locked-in patients who cannot even move their eyelids. 
 
 
 
 Adrian Owen, a neuroscientist at the University of Western Ontario, has been exploring whether the same technology, known as functional near-infrared spectroscopy, or fNIRS, can be used to communicate with other kinds of brain-injured patients, including those who are presumed to be in a vegetative state. “The results of this study suggest that we are on the right track,” he said. 
 
 
 
 “Finding a portable, cost-effective and reliable means for communicating with patients who are entirely physically non-responsive is the holy grail for those of us working in this field. If these findings can be replicated in a larger group of patients they suggest that fNIRS may be the answer. 
 
 
 
 “One of the most surprising outcomes of this study is that these patients reported being ‘happy’ despite being physically locked-in and incapable of expressing themselves on a day-to-day basis, suggesting that our preconceived notions about what we might think if the worst was to happen are false. Indeed, previous research has shown that most locked-in patients are actually reasonably satisfied with their quality of life,” he added. ||||| NEW YORK (Reuters Health) - Imagine you were a devoted husband, waiting to hear from your wife about her due date after a visit to the obstetrician, and you saw these on your phone: 
 
 "every where thinging days nighing" 
 
 "Some is where!" 
 
 That's what happened last December to a Boston-area man, who knew that autocorrect - known for its bizarre replacements - was turned off on his 11-week-pregnant wife's phone. 
 
 You'd probably be tempted to make sure your wife, 25, got to the emergency room. When she did, doctors noted several signs of a stroke, including disorientation, inability to use her right arm and leg properly and some difficulty speaking. 
 
 A magnetic resonance imaging scan - MRI - revealed that part of the woman's brain wasn't getting enough blood, clinching the diagnosis. Fortunately, her symptoms went away quickly, and the rest of the pregnancy went just fine after she went home from the hospital on low-dose blood thinners. 
 
 The case, say three doctors from Boston's Harvard Medical School who reported it online today in the Archives of Neurology, suggests that "the growing digital record will likely become an increasingly important means of identifying neurologic disease, particularly in patient populations that rely more heavily on written rather than spoken communication." 
 
 The authors describe the phenomenon as "dystextia," which is the word used by other doctors in an earlier case involving a migraine, and symptoms of a stroke diagnosed for other reasons. 
 
 "In her case, the first evidence of language difficulties came from her unintelligible texts," one of the report's authors, Dr. Joshua Klein, told Reuters Health by email. 
 
 Strokes are rare in women aged 15 to 34, with about 11,000 per year, according to data from the U.S. Centers for Disease Control and Prevention published last year. 
 
 Dr. Sean Savitz, who directs the stroke program at the University of Texas Health Science Center in Houston, said he has seen a few patients who sent emails suggesting they were having difficulty with language, a condition known as aphasia. 
 
 Such clues usually come with other information however. In this case, for example, the patient's obstetrician's office later remembered that she had trouble filling out a form. And they might have caught the language difficulty earlier had the woman not had a weak voice, thanks to a recent upper respiratory infection. 
 
 "So, this case report per se does not indicate to me if dystextia is going to be more common to pick up strokes," Savitz told Reuters Health by email, "but I do think it will be a valuable addition to the collection of information that neurologists should obtain when taking a history." 
 
 "The main stroke warning signs with respect to texting would be unintelligible language output, or problems reading or comprehending texts," said Klein. "Many smartphones have an ‘autocorrect' function which can introduce erroneous word substitutions, giving the impression of a language disorder." 
 
 Autocorrect, said Savitz, a professor of neurology, can confuse matters - even for doctors. 
 
 "I have often joked with my colleagues when using the dictation of the smartphone, that it gives me an aphasia," he said. "Potential for lots of false positives!" 
 
 SOURCE: Archives of Neurology, online December 24, 2012.
– Four paralyzed patients unable to communicate for years were finally able to do so through a potentially groundbreaking brain-reading system. And it turns out that one of them really didn't want his daughter to marry her boyfriend. The patients all had advanced ALS and were unable to control even their eyes, reports the Guardian. In other words, they had "locked-in syndrome," meaning total motor paralysis in spite of normal cognitive and emotional processing. Researchers at the University of Tübingen in Germany fitted the patients with caps through which they could observe changes in blood flow in different parts of the brain, they explain in the journal PLOS Biology. They first asked the patients to think yes or no in response to simple statements such as their spouse's name, and moved on to more personal questions when that was mastered. “It’s the first sign that completely locked-in syndrome may be abolished forever, because with all of these patients, we can now ask them the most critical questions in life,” says researcher Niels Birbaumer. The patients, all of whom are on ventilators and being cared for at home, range in age from 24 to 76. The team did stumble on a couple surprises. For instance, all four patients suggested they were "happy" with their lives in spite of being locked-in. (Birmbaumer suggests this might be because of something akin to meditation.) And one patient, who is 61, answered "no" nine times out of 10 when his 26-year-old daughter asked if she should marry her boyfriend Mario. "But they got married," one of the researchers tells the BBC. "Nothing can come between love." (Researchers can't explain how Stephen Hawking has lived this long.)