Monti and colleagues report that a patient in a persistent vegetative state was able to use a technique to answer yes or no to questions during functional MRI. However, we believe that a concern should be addressed to avoid weakening the strength of this message. The functional MRI studies in patients in a vegetative state should be conducted hierarchically. As we know, it is not possible to comprehend speech unless it can be perceived. Until the investigators confirm that all lower levels of cognition are preserved using functional MRI, they could assess the patient's ability to generate willful, neuroanatomi-cally specific responses during two established mental-imagery tasks. Such tasks would increase in complexity systematically from basic acoustic processing of nonspeech to more complex aspects of responses during two established mental-imagery tasks.
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