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
    0

    Comment number 247.

    Please ask him if he wants to be here. If he says no what are we going to do. Nothing. I wish him all the luck in the world.

  • rate this
    0

    Comment number 246.

    80. Dr Helio Proctosis
    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.

    Editors pick! You're perhaps not a doctor of medicine or law. There's no opportunity to act on his wishes at all, you have to 'live' if you cant take your own life, no matter what.

  • rate this
    0

    Comment number 245.

    There is also research that if you give people who have been brain damaged after a car accident.etc.a tablet called Stilnoct (a sleeping pill) it can trigger a switch in their brain as to re-awaken brain cells thought to have been, "dead brain cells". It's a discovery that happened quite by accident when a GP was told to prescribe a sleeping pill to one such patient. Told you, Science, "Baffles"!

  • rate this
    0

    Comment number 244.

    I'm not surprised by this finding I'm a neuropsychologist working with clinical psychophysiological interventions (neurofeedback/biofeedback) I did an assessment on a person in coma and even though her EEG didn't respond to me it did to her husband's voice/messages Her husband was so surprised with her response that he become very stressed and anxious and I had to stop A very nice experience

  • rate this
    0

    Comment number 243.

    That's not a very good question to ask a patient who can little respond if at all; for tomorrow, next week, next month or next year, he could be in awful pain only for them to think he is in no pain. Science, sometimes baffles me!

  • rate this
    0

    Comment number 242.

    I can relate to Mr. Scott Routley story. My farther is in a vegetative state and this new observation excites and gives me hope. There are times when my farther give us slight response that encourages us. Discovery by professor Adrian Owen and his team makes us optimistic about future of vegetative patients. I wish him success and hope neuro- sciences can make more concrete progress in future.

  • rate this
    0

    Comment number 241.

    Vegetative state for 12 years,now poked,proded and put under all kinds of scans by doctors and such,anybody wondered to find out if Scott would like to move on with some diginity and peace rather than being used like a "Lab Rat" and have no say in it.

  • rate this
    0

    Comment number 240.

    Considering we already have the technology to control devices using brainwaves, I wonder how long it will be before we can create a virtual world for people like Scott. Keep them on life support, have 3D virtual reality glasses in front of their eyes and let them live in a virtual world in the internet, perhaps with other PVS sufferers. It could even let family members visit them.

  • rate this
    +2

    Comment number 239.

    Scott was my friend in high school. I used to play tennis with him a lot and smiled when the researcher asked him to think about playing tennis. He would certainly remember this. I am so glad to hear he is not in pain and that he is helping to re-write a part of neuroscience. He always did have a scientific mind. Besides tennis partner, he was my calculus tutor too! Blessings on you Scott!

  • rate this
    +1

    Comment number 238.

    Euthanasia has been brought up by so many contributors to these comments I felt I had to say something. While euthanasia is a no-no to most people, there are many people suffering with chronic, disabling pain who have no quality of life who would appreciate the legal right to suicide. Without being in their body, nobody can understand their pain. It should be their decision, not other peoples.

  • rate this
    0

    Comment number 237.

    @222 Celticace
    There is a huge difference between PVS and brain stem death, and a PVS patient would not show brain stem death on testing. Your ignorance on this issue demonstrated in your post just helps cloud an already difficult issue.

  • rate this
    +1

    Comment number 236.

    Can this be shown in a double blind test? We have seen many people claiming many things over the years that didn't hold up under that scrutiny. People WANT to find something amazing. That influences their perceptions.

  • rate this
    +2

    Comment number 235.

    My son has been labelled in a persistent vegetative state now for 10 1/2 yrs. I live in the USA. Here, this label is political. As long as "they" can keep that label on a person, they don't have to acknowledge them as a person and only give them the minimal care required by law. . My son is able to communicate, too. Shame on all the medical staff for ignoring the brain injured.

  • rate this
    +3

    Comment number 234.

    This possibly demonstrates how little we still know about the human body and how much there is still to learn.

  • rate this
    +1

    Comment number 233.

    US health care insurance was at its best when it was 20/80, you paid the bills up front for the treatment you wanted and the insurance re-embursed you either the full 80% or less if they thought you should have had a less expensive treatment. Today's HMO's, co-pays, and for profit run up the bills by running all kinds of tests on healthy people - no money left for the sick.

  • rate this
    +1

    Comment number 232.

    In Scott's case maybe both the family and the doctors are seeing what they want to see.

    In re to the religious debate - and to flip it - perhaps you wind up in this state because the doctor's kept alive a person whose number was in in Gods plan.

  • rate this
    -1

    Comment number 231.

    When the vet gave our dog an injection "to stop the inching" I wondered how they know it works. "Well they stop scratching as much". Now that does not automatically mean it itches less: Maybe it now hurts, maybe the drug caused an apathy or numbed the whole body. The point is at this level of "communication" one can read things into it. How do we know the patient understood the Q asked.

  • rate this
    +1

    Comment number 230.

    No. 80 - "I sincerely hope that they ask the patients, "Do you want to continue living...'"
    I understand the sentiment here, and if someone is in pain, I think we ought to offer them this choice. But, as soon as we make any kind of illness or disability a grounds for suicide, that opens up a lot of doors. For instance, should someone diagnosed with clinical depression be allowed to end their life?

  • rate this
    +1

    Comment number 229.

    "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. "

    For a valid double blind study, the people asking the question and interpreting the results should not have known the correct answer in advance.

  • rate this
    +1

    Comment number 228.

    The fact is that science can be trusted but to a certain extent... there is still much to be discovered..much to be learn and in the mean time, we ought to be appreciative to those who are against euthanasia.. not all people in such a state are suffering. Many cases have reported the contrary

 

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