Pioneering new possibilities with the RAINDROP trial

Improving outcomes

In collaboration with the University of Birmingham, the PDOC (Prolonged Disorder of Consciousness) team are currently working on a pioneering research project which aims to assess awareness and responsiveness for patients with ongoing disorders of consciousness.

Until recently, it was assumed that people in states of disordered consciousness, were unaware of themselves and their surroundings. However, a landmark study has changed these perceptions. We now know that as many as one in five of these patients could be 'covertly' aware of sensory input such as sounds and touch, but unable to respond.

This has prompted further research at The Wellington Hospital to explore the clinical implications of stimulating awareness in PDOC patients. "This is incredibly exciting research – the first of its kind," says consultant neuropsychologist, Dr Antonio Incisa. "The aim is to establish new channels of communication and support patients’ long-term rehabilitation using innovative methods and interventions."

Expanding possibilities

"We know now that many non-responsive patients experience a much higher level of consciousness than we thought," says Dr Davinia Fernández-Espejo, Associate Professor at the University of Birmingham and chief investigator for the RAINDROP trial. "Many experience thoughts, volitions and retain memories. They may well be aware of their orientation in space and time. This is all quite remarkable when you compare it to what they're able to show externally."

"This new research explores whether it's possible to reactivate the neural networks that control voluntary movement by restoring lost connections between different parts of the brain. In these patients, we believe that the link between volition and motor movement has been severed."

A pioneering approach

The team are currently working with patients to assess levels of covert awareness and directly stimulate specific regions of the brain to respond. The approach uses advanced neuroimaging in conjunction with a non-invasive form of electrical brain stimulation, transcranial direct current stimulation (tDCS).

"We've designed the protocol of this study with clinical rehabilitation in mind," says Dr Fernández-Espejo. "We wanted it to be something that could feasibly be delivered as a therapeutic intervention within the acute rehabilitation unit at The Wellington Hospital. I would like to see it developed for use within a therapy context, to help open channels of communication between therapist and patient."

"This research promises to give us a window into the minds of our non-responsive PDOC patients," says Dr Incisa "For the first time ever, we're creating a real 3D view of what's going on deep in the brain. If we can demonstrate a patient is aware, it could have profound implications for their care. Whatever the discoveries and outcomes, it has the potential to influence clinical policy and routine practice in the UK."

Find out more about our Prolonged Disorders of Consciousness service