Vegetative patient Scott Routley says 'I'm not in pain'

 

The moment when Prof Owen asked patient Scott whether he was in pain

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A Canadian man who was believed to have been in a vegetative state for more than a decade, has been able to tell scientists that he is not in any pain.

It's the first time an uncommunicative, severely brain-injured patient has been able to give answers clinically relevant to their care.

Scott Routley, 39, was asked questions while having his brain activity scanned in an fMRI machine.

His doctor says the discovery means medical textbooks will need rewriting.

Vegetative patients emerge from a coma into a condition where they have periods awake, with their eyes open, but have no perception of themselves or the outside world.

Mr Routley suffered a severe brain injury in a car accident 12 years ago.

Panorama: Find out more

  • Fergus Walsh presents The Mind Reader: Unlocking My Voice - a Panorama Special
  • BBC One, Tuesday, 13 November, at 22:35 GMT
  • BBC World News on Saturday, 17 November, at 09:10 GMT and on Sunday, 18 November, at 02:10 & 15:10 GMT

None of his physical assessments since then have shown any sign of awareness, or ability to communicate.

But the British neuroscientist Prof Adrian Owen - who led the team at the Brain and Mind Institute, University of Western Ontario - said Mr Routley was clearly not vegetative.

"Scott has been able to show he has a conscious, thinking mind. We have scanned him several times and his pattern of brain activity shows he is clearly choosing to answer our questions. We believe he knows who and where he is."

Prof Owen said it was a groundbreaking moment.

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"Asking a patient something important to them has been our aim for many years. In future we could ask what we could do to improve their quality of life. It could be simple things like the entertainment we provide or the times of day they are washed and fed."

Scott Routley's parents say they always thought he was conscious and could communicate by lifting a thumb or moving his eyes. But this has never been accepted by medical staff.

Prof Bryan Young at University Hospital, London - Mr Routley's neurologist for a decade - said the scan results overturned all the behavioural assessments that had been made over the years.

FMRI SCANNING

Prof Adrian Owen and team with patient at scanner
  • Functional Magnetic Resonance Imaging measures the real-time activity of the brain by tracking the flow of oxygen-rich blood
  • The patients were repeatedly asked to imagine playing tennis or walking around their home
  • In healthy volunteers each produces a distinct pattern of activity, in the premotor cortex for the first task and the parahippocampal gyrus for the second
  • It allowed the researchers to put a series of yes or no questions to severely brain-injured patients. A minority were able to answer by using the power of thought
  • In 2010 Prof Owen published research showing that nearly one in five of the vegetative patients were able to communicate using brain activity

"I was impressed and amazed that he was able to show these cognitive responses. He had the clinical picture of a typical vegetative patient and showed no spontaneous movements that looked meaningful."

Observational assessments of Mr Routley since he responded in the scanner have continued to suggest he is vegetative. Prof Young said medical textbooks would need to be updated to include Prof Owen's techniques.

The BBC's Panorama programme followed several vegetative and minimally-conscious patients in Britain and Canada for more than a year.

Another Canadian patient, Steven Graham, was able to demonstrate that he had laid down new memories since his brain injury. Mr Graham answers yes when asked whether his sister has a daughter. His niece was born after his car accident five years ago.

The Panorama team also followed three patients at the Royal Hospital for Neuro-disability (RHN) in Putney, which specialises in the rehabilitation of brain-injured patients.

It collaborates with a team of Cambridge University neuroscientists at the Wolfson Brain Imaging Centre at Addenbrooke's hospital, Cambridge.

Panorama's Fergus Walsh meets Professor Adrian Owen to learn what the brain is like when in a vegetative state

One of the patients is diagnosed as vegetative by the RHN, and he is also unable to show awareness in an fMRI machine.

A second patient, who was not able to be fully assessed by the RHN because of repeated sickness, is later shown to have some limited awareness in brain scans.

The Mind Reader: Unlocking My Voice - a Panorama Special - will be broadcast on Tuesday, 13 November, at 22:35 on BBC One. It wil be on BBC World News on Saturday, 17 November, at 09:10 GMT and on Sunday, 18 November at 02:10 & 15:10 GMT. Alternatively, catch up later on the BBC iPlayer using the link above.

 

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  • rate this
    +10

    Comment number 189.

    Exciting observations. Perhaps one day we will discover what reality a person in a vegetative state experiences. Is it the reality that we know or some form of dreamlike reality. How do they spend their day and as stated below, what can we provide perceptually to enhance their living experience.

  • rate this
    +31

    Comment number 118.

    I think the most exciting thing about this story is not actually the communication with Mr. Routley, as wonderful as that is, but the potential future development of medical science in this area.

    We know so little about the brain and how it functions - this is a huge step forward, and the possibilities are fantastic.

  • rate this
    +16

    Comment number 96.

    I think the brain takes a long time to repair and as a human race we haven't got that far yet to know what to do to assist the repair. I agree with the other comment that as time moves on more discoveries will be made and fixes will be found. If the man in the coma can understand things like questions and show answers in a scan, at least show him DVD,s to stimulate interest . I wish him well.

  • rate this
    +36

    Comment number 81.

    As the son of a woman that has Locked-In-Syndrome this is not really news to me. One of the biggest challenges I faced in the NHS in 2005 when my mother's stroke occurred was trying to convince doctors that she was in fact conscious. They said I saw what I wanted to see. The biggest surprise was how little neurologists actually know about the brain, practically nothing in fact.

  • rate this
    +50

    Comment number 80.

    I sincerely hope that they ask the patients, "Do you want to continue living in your current condition?" And then take action on the answer the patient provides whatever it may be.

 
 

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