http://www.bbc.co.uk/news/health-20268044

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.

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.

"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.

"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.

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