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.

Read the blog

"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
    +5

    Comment number 87.

    75.Alasdair BM Macleod
    God gives life and takes it away. We do not have the right to take someones life. Euthanasia is an evil idea.

    Yet strangely you believe it isn't evil when God takes away life.
    Why should we all be forced to obey his laws, and why is God above all laws?
    That makes him the greatest dictator possible in the universe.
    Excuse me if I think the idea of God as stupid.

  • rate this
    +1

    Comment number 86.

    Maybe they should check the dead are really dead as well.

  • rate this
    +7

    Comment number 85.

    There are always degrees of impairment or damage. Look at Stephen Hawking, an exceptional mind that has continued to overcome his disability. Sometimes the brain compensates automatically, sometimes it is powerless to do so. The possible variation from the assumed persistent vegetative mind has great potential. In the end, it will be the personal choice of the mind that makes the life decision.

  • Comment number 84.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    +4

    Comment number 83.

    # 75 - Whilst I respect your religious views there is no place for the divine in medical science. Think of the horror these patients could be living through if they are genuinely conscious but unable to respond in any way. In truth I find your comment irresponsible at best…

  • rate this
    +4

    Comment number 82.

    I know it isn't proven how much function this guy has, but now he has made himself understood, I hope to God that he continues to have this opportunity, and isn't left without means of communication for the next 12 years - that really would be unbearably cruel. Certainly more like playing God than asking if he wants to stay alive this way!

  • 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.

  • rate this
    +7

    Comment number 79.

    Maybe he would like to view all the comments about him on HYS?

    Maybe one day he will be able to submit some of his own!

  • rate this
    +9

    Comment number 78.

    This kinda makes it worse - don't hit 'vote down' yet, i'm explaining:

    The person is aware of their inability to do anything - and i can think of nothing more horrible.

    Should they be able to communicate, ask them if they want to live to try to find a cure, or pass on to escape the cage their body has become for their mind.


    I know what i'd choose.

  • rate this
    +3

    Comment number 77.

    He could now ask to die, every day for the rest of his life, but not be allowed to because he is not able to take action himself, and anyone who helps him would be imprisoned.

  • rate this
    +2

    Comment number 76.

    Who's this God fellow then? Sorry Alasdair, you're way off mark

  • Comment number 75.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    -13

    Comment number 74.

    We have 2 parts of the Brain, one of which is all knowing as well as connected all objects as existed; leaving the other to develop itself through our actions through absorbing pain or pleasure from the surrounding which we are creating but nothing is true.The moment we control our fickle mind from running running around,one can see TRUTH everywhere and not much pain or pleasure to oneself .

  • rate this
    +4

    Comment number 73.

    42.Pixelvision
    "I'd rather die than be trapped and aware."

    I probably would have said the same thing 20 years ago but now I've changed my mind. Discoveries like this give me hope for these people and with further scientific advances, who knows whether some kind of cure won't be possible in another 10 or 20 years. I for one would want to stay alive to hold out for that possibility...

  • rate this
    0

    Comment number 72.

    Sorry Peter_Sym, I agree with you, but the moderator removed the post that said that. meant to say balloon rake was wrong.
    56.James Wakefield; I don't think he did, since he can't do anything.
    37.gkaloys; What? Our 'belief' in science? That isn't how science works, you don't need to believe in it, it just is, since it is reality.

  • rate this
    -4

    Comment number 71.

    It's great that the officious, interfering, busybody euthanisers did not get to him and that he's still alive. Where there's life, there's hope.

  • Comment number 70.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    -8

    Comment number 69.

    For those stating how awful it would be to live 12 years like that - the man's brain is in a vegatitive state, i.e his brain isn't fucntioning like yours or mine, his brain is probably functioning enough to keep his body alive. This isn't the same as that poor chap who had locked in syndrome.

  • rate this
    -1

    Comment number 68.

    One individual's experience, assessed under sketchy pretenses, can in no way apply to everyone in a coma until more evidence is uncovered, so Prof Youn can stop in his tracks in suggesting any medical textbooks should be rewritten.

 

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