The new and innovative Halifax Consciousness Scanner is changing how doctors treat people with brain injuries.
The Halifax Consciousness Scanner is revolutionizing how we measure a person’s level of conscious awareness—and soon it could mean better treatment for those with brain injuries.
In 2010, The Globe and Mail reported on the tragic story of Arnie Hake, who was only 30 years-old when his black Trans Am left a Nova Scotia road and hit a pole. He was airlifted to a Halifax hospital where his mother, Joan Brown, was told her son was in a persistent vegetative state, a term used for those who are still awake but who’ve lost all brain function and have no awareness of themselves or their environment.
As the months and years passed, however, and as Brown kept up her daily bedside vigil, she began to believe he was “in there.” “Every day I’d kiss him and say, ‘Pucker up, give Mum a kiss,’” she told the newspaper. “After a while, I started to see his tongue move or his lip move.”
Wanting to know if her son did, in fact, have some level of conscious awareness, she had then Halifax-based neuroscientist Dr. Ryan D’Arcy and his team at the NRC Institute for Biodiagnostics test Hake in 2001. At the time, they were developing a way to use brain waves instead of behavioural responses to assess a patient’s level of conscious awareness. Although Hake couldn’t communicate with his body, the test found that he could understand what was said to him.
The research that underpinned that test led to the Halifax Consciousness Scanner (HCS), a portable and wireless device connected to a tablet computer that measures brain activity using electroencephalography (EEG) technology. In five minutes, it can give an accurate picture of a person’s level of awareness—more accurate, researchers have seen, than the Glasgow Coma Scale (GCS), which is also known as the “gold standard” for recording a person’s conscious state.
“The current Glasgow Coma Scale needed to be updated,” says D’Arcy, who came up with the idea for the HCS while driving home from work one night in 2010. “At best, the current estimates put [GCS] misdiagnosis at about one in two. So imagine it’s your loved one that was in a car accident. The measure we’ve been using to find out what their functional brain status is can be as good as flipping a coin.”
Mindful Scientific, the company behind the HCS, was the bronze winner for the Halifax Chamber of Commerce Innovative Business of the Year Award in January, and within the next year it hopes to begin selling the device to hospitals, ski resorts and anywhere else it could be used to assess those with possible brain injuries.
Although the HCS might look simple enough—a black headband with electrodes and ear buds—the technology behind it is anything but. When tones and words are broadcasted into the person’s ears, the HCS uses five indicators—sensation, perception, attention, memory and language—to measure the ability of the person’s brain to respond to those sounds. That data are then converted to a score out of 15; 15 out of 15 indicating complete conscious awareness.
“From my perspective, [the HCS] is important because it helps us identify people who have either major or minor brain injuries so that we’re better able to treat them,” says Dalhousie University professor Dr. Don Weaver, who’s recently been helping the HCS gain clinical and medical validation. He’s Mindful Scientific’s chief medical officer and co-inventor of the HCS.
Traditionally, decisions about that treatment are based on the person’s ability to show a physical response, which is what the GCS records. “Probably the most important decision happens after they stabilize you,” says D’Arcy, now a professor and Foundation B.C. Leadership Chair in Multimodal Technology at Simon Fraser University and Surrey Memorial Hospital/Fraser Health. “The [healthcare staff] has to decide whether they undergo aggressive rehabilitation. If they think you’re not in there and not processing, they’re not going to do that because it costs a lot of money and they wouldn’t have a reason to do it,” he explains.
But the problem is that these decisions are being made with an unreliable tool, the GCS. The HCS aims to change that. Based on two successful studies that showed the device could evaluate level of conscious awareness after brain trauma, it appears the HCS will play an important role in better answering how doctors treat brain-injured patients who can’t respond. In particular, Weaver believes it will help identify coma patients who may be able to respond to more stimulation during rehab.
The HCS will likely affect end-of-life decisions too, such as the one facing Toronto doctors and the family of Hassan Rasouli. He was hospitalized in 2010 after routine brain surgery left him unconscious and battling a meningitis infection in his brain. Doctors say he’s in a persistent vegetative state and that his ventilator should be removed. His family says they’ve seen him show signs of awareness and that he should be kept alive. The Supreme Court of Canada will soon decide who can make that decision—a decision that in the future could be better informed with an objective awareness test like the one performed by the HCS.
“At the end of the day, we’re providing better diagnostics,” says D’Arcy. “It doesn’t mean that the diagnostic is going to be critical and necessarily the factor in end-of-life decisions, but if you believe and buy the premise that the physician needs the best state-of-the-art information possible, that’s what we’re doing. It’s up to the clinical care team and the family to determine those sorts of issues, but I don’t really think they should be making those decisions on measures that we know are inaccurate.”
We’ll never know if the HCS would have had an impact on Hake’s care. He died of pneumonia just six months after taking the awareness test. We do know, however, that if the HCS continues to show promising results and Mindful Scientific is successful in getting it to market, D’Arcy’s idea won’t be relegated to the pages of a dusty journal. It may one day be used to improve the quality of life for people like Hake.
“I’m not one of those scientists who is just content to discover things and let them wind up in libraries,” says D’Arcy. “When you work in medical research, the responsibility is on you to make sure that you actually work on ways to help people. Hospitals don’t buy journal articles, they buy products.”