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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  • Comment number 107.

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

  • rate this
    +8

    Comment number 106.

    I wonder why so many people assume that this man wants to be put to death. there are many reasons that he may wish to live.

    He may postulate on the nature of the universe
    He may just enjoy watching Jeremy Kyle

    Any question relating to euthanasia must be impeccably structured so as to not exert undue pressure to die based on the prejudices of the questioner

    Assume makes an ASS out of U and ME

  • Comment number 105.

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

  • rate this
    +2

    Comment number 104.

    This man has confirmed that he is not in pain (cause for joy in itself) and therefore I don't think his is a case to discuss with regards euthanasia.

    There are too many other patients being kept alive for days longer than necessary in extreme physical anguish causing great suffering to their families for whom the euthanasia topic is more relevant now.

  • rate this
    -20

    Comment number 103.

    Show us the proof please!

    Doctors, scientists ect can no longer be trusted

  • Comment number 102.

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

  • rate this
    +2

    Comment number 101.

    97. Alasdair BM Macleod

    why does simply being God give him the right to create and destroy life on a whim??
    And why did God create sin and make us capable of sin if He wouldn't want us to do so?

  • Comment number 100.

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

  • rate this
    +1

    Comment number 99.

    In my opinion it should all come down to personal choice, if someone wants to die they should be allowed to even if that means they need help to do so. (im in favour of euthanasia but against abortions for non medical reasons (thats just a personal view point)) In this case if its been shown he can answer, did they ask him if he was happy? I cant imagine living like that and I wouldnt want to.

  • rate this
    +14

    Comment number 98.

    75Alasdair BM Macleod

    Every human being is made in the image of God and given life by God. God gives life and takes it away.
    ===
    Without any evidence that's just an opinion and carries no weight. If you have credible evidence please present it.

    PS. It'd be good if you first define what you mean by God.

  • Comment number 97.

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

  • 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
    +7

    Comment number 95.

    With the work done on mental control of prosthetics, robotics and now this, it is possible that many people might benefit from technolgy to improve their lives.
    Onie day we may be able to heal such patients but for now we have a choice:
    Try to help ... or give up bothering to improve anything.

    I know, lets ask the taxpayers alliance - pay less tax and not bother saving lives... :-(

  • rate this
    +4

    Comment number 94.

    @75 Alasdair BM Macleod.
    These sort of silly arguments always fail to stack up. One could also argue that it is morally wrong to artificially preserve life by medical means when your God clearly meant it to end.

  • rate this
    +6

    Comment number 93.

    89 - kk. I meant exciting in the sense medicine is moving on and this will always potentially help those who are ill now and those who become ill in the future. I am sure Fleming's work was hailed as exciting even though it couldn't prevent some people dying at the time.

  • rate this
    +2

    Comment number 92.

    I wonder how many patients have been murdered by incorrect diagnosis of brain death when the problem is communication.

    I fear future generations will look back at the incompetence of the 21st century medical practise of "allowing to die" patients who cannot argue.

  • rate this
    +8

    Comment number 91.

    This is no place for the euthanasia debate as the article above gives nowhere near enough information on this but is simply reporting a scientific breakthrough which is truly remarkable.

    We don't know how this man experiences 'consciousness' and cannot know if he's in a living hell of frustrating inability, or if he can look forward to future discoveries which will restore his life to him fully.

  • rate this
    +8

    Comment number 90.

    #52 ConnorMacleod

    Science certainly played a part. As did the inspirational efforts of professor Young.

    But so too did the ethical practice of keeping the patient alive, while he himself wasn't able:-)

    Stunning research by the way. One wonders where this can go with robotics now being able to respond to electrical stimulus from the brain.

  • rate this
    -3

    Comment number 89.

    #19 John

    "For now we have learnt there is something beyond a vegetative state and further work needs to be done."

    For now, we are learning that previous medical opinion is no more than opinion.

    "Where we are at now is very exciting."

    For the researchers, maybe. I'm not sure that someone in a semi-vegetative state would describe it as 'exciting', even if they could communicate..

  • rate this
    +5

    Comment number 88.

    For all those people that comment against the idea of giving someone the right to die, put yourself into that situation first. I was and after watching somone I loved with every inch of my body suffer for 17 months, after putting them through test after test to see if there was anything, taking our 2 year old daughter to see her parent like that, then tell me that what I did was wrong

 

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