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
    +4

    Comment number 207.

    This type of research was being done in 2006, my mother had it, its nothing new at all. Although science is trying to help these patients, over the years it has bitterly let them down. Their view was an apparent absence of evidence of consciousness was evidence of absence and often relatives can even see the consciousness but the doctors cannot.

  • rate this
    +6

    Comment number 206.

    As someone with chronic pain disabilities myself I have "met" online people who live with severe and enduring pain - and yet do not wish to end their lives or think that they should never have been born. It's very dangerous to judge someone else's quality of life simply in terms of more or less pain.

    This is also why I don't support aborting foetuses that would be born disabled.

  • rate this
    0

    Comment number 205.

    While this is hugely interesting, it should be noted that this research is neither new nor unequivocal. As Nachev et al point out in Scence (2007), it makes an "assumption that the association between a behavior and a pattern of brain activation implies the converse", which is not necessarily true. Food for thought nonetheless.

  • rate this
    +3

    Comment number 204.

    The word 'vegetative' is disgusting, reflecting the bloated intellectual arrogance that pervades much of the medical profession, this also being a factor in the disgraceful lack of remorse when something like this is established. The family of Terri Schiavo were pilloried and ridiculed by stuck-up medics (and journalists), but now science has caught up with what they already knew.

  • rate this
    0

    Comment number 203.

    I wonder if one could somehow allow such a patient, possibly with great effort, to create a poem? If all they could do was answer 'yes' or 'no', and they could be taught morse code, it might be possible.

  • rate this
    0

    Comment number 202.

    As a Medical Speech-language Pathologist, I am not convinced, but am very hopeful that this information is what the article claims it to be. I will watch the special, and also try to find the complete report of the study. People should not be misled by statements such as "Scott SAYS 'I'M NOT IN PAIN'. I think that the fMRI is miraculous. I read nothing that validates this headline, however.

  • rate this
    +3

    Comment number 201.

    199.Monika has made a good point. A recent French study actually showed that after a period of time the majority of Locked-In patients became content with their life and didn't want to die. There is an initial shock period which when overcome a new norm appears through which these patients live. My own mother is in this period now and is looking for to the birth of her grand-daughter in March.

  • rate this
    +2

    Comment number 200.

    This is a very interesting method that has been used. Scientists cannot 'read' minds, but with a simple brain matching exercise, they have been able to discover something about his thoughts. Who knows if the patient even thought of tennis at all, as long as he was consistent.

    What worries me is, what if he was trying hard "not" to think of tennis? That could lead to thinking of it. Try it!

  • rate this
    +5

    Comment number 199.

    Strangely the most voted up comments are those which presume patient's wish to die. I would have thought most people want to live as long as possible, unless in a deep depression?
    As for a doctor asking me a "Do you want to die?" question, I would reply "No, I want to change the doctor"

  • rate this
    +7

    Comment number 198.

    192.ProfPhoenix
    Is this discussion going to turn into another BBC discussion on euthanasia?"
    **
    Possibly. I'm just relieved it's not yet another BBC article about euthanasia.Those seem to repeat here on a regular basis.

  • rate this
    +5

    Comment number 197.

    We really cannot begin to know how these people live. 5 sense reality is the limit for us, even though we cannot decode most frequencies in sound and can only see a tiny amount (visible light) when we have other forms of light (e.g. infra-red). We should stop looking upon people as mentally/physically ill and consider that maybe they're just experiencing a different aspect of 'reality'....

  • Comment number 196.

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

  • rate this
    +4

    Comment number 195.

    @190 Considering that in the West we have freedom of expression & religion, I see no problem w/ people bringing their god into any argument that they like. I can choose to accept or reject their arguments as I like.

  • rate this
    -2

    Comment number 194.

    Is this good news? I would think that for family and friends of a person with 'locked in syndrome' this research would make the horrible situation even more unbearable. To think that someone who cannot move or communicate is actually aware and able to respond to instructions is desperate.

  • rate this
    +5

    Comment number 193.

    One wonders why the relatives could see a pattern of response then but the medics could not? Were they perhaps too quick to dismiss the relatives as subjectve? Perhaps they should now reassess these signals as that could be a very cost-effective way of asessing patients perhaps.

  • rate this
    +2

    Comment number 192.

    Is this discussion going to turn into another BBC discussion on euthanasia?

  • rate this
    -1

    Comment number 191.

    170:Coney:This presumes that people can't be healed in other ways. See http://en.wikipedia.org/wiki/Andr%C3%A9_Bessette for someone who prayed for thousands and they recovered. Of course for those of us who don't have that gift, we at least have science.

    190:bob:At the end of the article they had a patient who didn't react to the fMRI, so it doesn't work for everyone.

  • rate this
    +1

    Comment number 190.

    #26
    This is not a debate about euthanasia, but if it was, NEVER bring God into the argument, don't force religion on others.

    Very good news, but I doubt it will actually work on 100% of cases.

  • 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.

  • Comment number 188.

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

 

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