This article (or podcast) refers to one particular patient encountered by Adrian Owen in his investigations with people in coma. It is a short and very moving account of how clinicians used fMRI to enable a 38 year-old man in deep coma to communicate with the people caring for him. By imagining how to play tennis at particular moments Scott Routley was able to signal (either yes or no according to how the question was framed) by firing up his prefrontal cortex on the fMRI image, even though to neutral observers he seemed to be still deep in his coma, unable to move. For the previous 12 years of coma, all behavioural tests of consciousness had been negative.
This raises profound issues about the nature of coma, and what might be hidden from us by an injured person’s inability to move, speak, or even make any facial expressions. Using the fMRI technique, Scott was able to tell the clinicians that he was not in pain. There is a Panorama clip of the episode when Scott was first asked this, his reaction, and Professor Owen’s reaction to Scott’s fMRI answer on the BBC website (http://www.bbc.co.uk/news/health-20268044 ).
Scott was also able to express his preferences about TV programmes, to indicate that he knew how much time had passed since his accident, and that he knew the name of his main carer. It raises the uncomfortable question of how many other similar people have the same level of awareness, unbeknownst to their carers and loved ones.
This is at once a moving film/ article, but it is also uncomfortable. It raises profound issues about consent, about decision-making when there is no apparent response, about goal-setting for rehabilitation, and even asks questions about the nature of consciousness.
This short account is published on the Guardian website as a Long Read, and also as a podcast. It is an extract from Into the Grey Zone: A Neuroscientist Explores the Border Between Life and Death by Adrian Owen (2017 London, Faber).
The Panorama documentary, The Mind Reader: Unlocking My Voice, (60 mins) looks at Adrian Owen’s research with several differing patients in apparent vegetative states. It was broadcast on 13 November 2012 but it is currently not available on the BBC website. It has been posted on YouTube (https://www.youtube.com/watch?v=m03K-Cl8hoY ).