0:00:11 > 0:00:14I got home at about quarter past 11,
0:00:14 > 0:00:15half past 11 at night,
0:00:15 > 0:00:19and I found him clutching his head in the foetal position,
0:00:19 > 0:00:21saying, "Stop this effing pain."
0:00:21 > 0:00:25And I knew that there was something very, very wrong.
0:00:25 > 0:00:31So I called an ambulance, and they took us to our local hospital A&E.
0:00:31 > 0:00:35And slowly I saw him slip into a coma.
0:00:38 > 0:00:41And at seven o'clock in the morning,
0:00:41 > 0:00:44the doctor said to me, "You should call his children in New Zealand."
0:00:46 > 0:00:49Which I knew meant that he was probably going to die.
0:00:51 > 0:00:53And we got to King's and
0:00:53 > 0:00:55they have an amazing set up there.
0:00:55 > 0:00:58Everything just kind of kicked into place,
0:00:58 > 0:01:02and the surgeon came to ask for our consent to operate,
0:01:02 > 0:01:06and said, "We don't know if Richard will survive long enough to
0:01:06 > 0:01:08"have the operation.
0:01:08 > 0:01:12"And if he does, he may bleed again on the table.
0:01:12 > 0:01:15"And if he does that, the prognosis is not good.
0:01:15 > 0:01:17"He'll probably be a vegetable."
0:01:28 > 0:01:31There was nothing I could do but wait and hope.
0:01:31 > 0:01:34Hope that he survived.
0:01:34 > 0:01:37Hope that the surgeon had the skill to save his life.
0:01:37 > 0:01:40But also hope, if he did survive,
0:01:40 > 0:01:42that Richard, my Richard,
0:01:42 > 0:01:44would still be there.
0:01:48 > 0:01:52My name is Fiona Lloyd-Davies. I'm a film-maker and a journalist,
0:01:52 > 0:01:54and for the past four years,
0:01:54 > 0:01:56I've been documenting my husband's battle
0:01:56 > 0:02:00back to life after suffering a catastrophic brain haemorrhage.
0:02:24 > 0:02:27So, the first time that I heard about Richard
0:02:27 > 0:02:29was that the on-call neurosurgical
0:02:29 > 0:02:33registrar phoned me up and described to me the condition, which was a
0:02:33 > 0:02:36patient who was known to be on thinners to thin the blood,
0:02:36 > 0:02:39who'd had a possible fall,
0:02:39 > 0:02:44and was found with a diminished and decreasing level of consciousness.
0:02:46 > 0:02:48And then a head scan and a CT scan
0:02:48 > 0:02:51which showed a large area of fresh
0:02:51 > 0:02:53bleeding over the surface of the brain,
0:02:53 > 0:02:55on the left-hand side of the brain.
0:02:57 > 0:03:01In other words, the part of the brain that controls speech,
0:03:01 > 0:03:03is involved in memory,
0:03:03 > 0:03:05and gives us a lot of the unique features
0:03:05 > 0:03:07that make us the individuals we are.
0:03:09 > 0:03:12So it was clear that he could well be left with significant deficits in
0:03:12 > 0:03:15memory, in speech, in personality,
0:03:15 > 0:03:19and he may well have a quality of life that he may not have valued,
0:03:19 > 0:03:23or that his family may have felt on his behalf that he didn't value.
0:03:23 > 0:03:26But you have to make a decision at that point as to, OK,
0:03:26 > 0:03:29what are we going to do? You haven't got long to decide.
0:03:29 > 0:03:31And we decided that we should try.
0:03:37 > 0:03:38Then it's speed is of the essence.
0:03:38 > 0:03:42So we say, "Time is brain," and it really was.
0:03:42 > 0:03:44We took him straight into the operating theatre.
0:03:47 > 0:03:49We then raised what's called a trauma craniotomy
0:03:49 > 0:03:51or a question-mark flap,
0:03:51 > 0:03:54which is a cut that covers one side of the skull.
0:03:54 > 0:03:57Drill with an air drill through the skull
0:03:57 > 0:03:59to lift up a large flap of the skull
0:03:59 > 0:04:01on that left-hand side.
0:04:01 > 0:04:05That exposes the outer lining of the brain, what's called the dura.
0:04:05 > 0:04:08And underneath that you could see that the dura was tense,
0:04:08 > 0:04:10it was bulging,
0:04:10 > 0:04:11it was blue,
0:04:11 > 0:04:14and there was no pulsation of the brain in time with the heartbeat,
0:04:14 > 0:04:16which is what you see with a normal person.
0:04:16 > 0:04:19And that showed that there was a large clot sitting over the surface
0:04:19 > 0:04:21of the brain, compressing the brain,
0:04:21 > 0:04:25and actually preventing oxygen and blood getting to the brain,
0:04:25 > 0:04:27and so the brain was actively being damaged by the blood clot.
0:04:33 > 0:04:35The brain is like a jelly.
0:04:35 > 0:04:37It's like a very delicate jelly.
0:04:37 > 0:04:39It's not like this wax brain here,
0:04:39 > 0:04:41which I can hold very clearly in my hands.
0:04:41 > 0:04:45A real brain is incredibly delicate, incredibly soft.
0:04:45 > 0:04:48Problem is if you open the lining of the brain, the dura,
0:04:48 > 0:04:51to let the clot out, and you do that too quickly,
0:04:51 > 0:04:53the brain can actually start to squeeze out
0:04:53 > 0:04:56through the opening in the lining that you've made,
0:04:56 > 0:04:58rather like toothpaste through a tube.
0:04:58 > 0:05:01Obviously that brain that squeezes out like that,
0:05:01 > 0:05:03it's going to be irreparably damaged.
0:05:03 > 0:05:05You're not going to get that brain back.
0:05:05 > 0:05:09So, very carefully, bit by bit, you extend the cut as you go,
0:05:09 > 0:05:12removing a bit of clot, making the opening a bit bigger,
0:05:12 > 0:05:14removing a bit of clot, making the opening a bit bigger,
0:05:14 > 0:05:17so that hopefully by the time you've finished,
0:05:17 > 0:05:18you've uncovered the whole
0:05:18 > 0:05:21surface of the brain on that left-hand side.
0:05:21 > 0:05:22You remove the blood clot,
0:05:22 > 0:05:24and the brain has not started to
0:05:24 > 0:05:26swell out through the opening in the dura that you've made.
0:05:31 > 0:05:34So, having removed the clot from the surface of the brain,
0:05:34 > 0:05:36the decision for me was -
0:05:36 > 0:05:39"Have I relieved enough pressure so that Richard's
0:05:39 > 0:05:41"going to survive this operation?"
0:05:43 > 0:05:46So what we did in Richard's case was we didn't put the bone back.
0:05:46 > 0:05:48We left the lining of the brain open,
0:05:48 > 0:05:50which allowed the brain to swell a little bit.
0:05:50 > 0:05:52And we didn't put that skull back.
0:05:52 > 0:05:53So, in other words, there was just
0:05:53 > 0:05:55skin and muscle over this area of the brain.
0:05:55 > 0:05:58So it allows that little bit of wiggle room,
0:05:58 > 0:06:00if you want to think about it that way,
0:06:00 > 0:06:03for the swelling to occur in the first few days after the operation.
0:06:21 > 0:06:24Once the swelling had gone down,
0:06:24 > 0:06:26the catastrophic effect of the stroke was
0:06:26 > 0:06:30plain to see, and it looked as if he'd lost half his brain.
0:06:32 > 0:06:35As a way of coping, I reached out for my camera
0:06:35 > 0:06:37and started to record what happened.
0:06:38 > 0:06:40And I also kept a written diary.
0:06:41 > 0:06:45"Diary entry, Friday 6th of September.
0:06:45 > 0:06:48"He's passed the swallow test and no longer needs a feeding tube.
0:06:48 > 0:06:51"He's eating puree - giant leap forward."
0:06:56 > 0:06:59Sweetie, how are you feeling today?
0:06:59 > 0:07:00Because you're much more awake.
0:07:02 > 0:07:06But then on day 30, Wednesday 11th of September, I've written,
0:07:06 > 0:07:08"I think Richard's regressing mentally.
0:07:08 > 0:07:11"I spoke to the speech therapist. It all seems so gloomy.
0:07:11 > 0:07:13"He isn't responding well."
0:07:13 > 0:07:17And I've written at the bottom, "I mustn't give up. I must keep trying.
0:07:17 > 0:07:20"He will surprise me and surpass all expectations.
0:07:20 > 0:07:21"I know."
0:07:32 > 0:07:36I always tried to be as upbeat as possible when I was with him,
0:07:36 > 0:07:39and be as cheerful and positive,
0:07:39 > 0:07:44to help, kind of, engage him back into the real world.
0:07:44 > 0:07:47Obviously it was hard, you know?
0:07:47 > 0:07:49I felt most of the time like someone's
0:07:49 > 0:07:51reaching into my chest and ripping my heart out.
0:07:54 > 0:07:57It was very difficult because you felt part of him had gone,
0:07:57 > 0:07:59and yet he was still there,
0:07:59 > 0:08:02and how could I grieve for my husband when he was still there?
0:08:02 > 0:08:04Would Richard ever be Richard again?
0:08:05 > 0:08:07You don't want me to film?
0:08:08 > 0:08:10OK, I'll turn it off, then, darling.
0:08:15 > 0:08:18"Diary entry, Monday 11th of November.
0:08:18 > 0:08:20"Three-month post stroke.
0:08:20 > 0:08:22"Will he ever get better?
0:08:23 > 0:08:25"One nurse said, 'Will you come and help?
0:08:25 > 0:08:27" 'You might as well start practising.' "
0:08:30 > 0:08:34It was awful because there was a realisation then for me that this
0:08:34 > 0:08:37could be our future. This could be the rest of our lives together.
0:08:44 > 0:08:47By the end of November, there was good news.
0:08:47 > 0:08:49Richard was going to see a surgeon
0:08:49 > 0:08:52about replacing the missing part of his skull.
0:08:52 > 0:08:55So, when I saw Richard in the November,
0:08:55 > 0:08:58which was three months after his stroke and his brain injury,
0:08:58 > 0:09:02he had quite a lot of disablement.
0:09:02 > 0:09:06He was not moving his right-hand side.
0:09:06 > 0:09:08He wasn't speaking.
0:09:08 > 0:09:11He also had a very large defect on the left side of
0:09:11 > 0:09:16his skull, which meant that his brain had actually moved over
0:09:16 > 0:09:18significantly to the right-hand side.
0:09:19 > 0:09:22The white here shows the contour of
0:09:22 > 0:09:24his outline of his bone of his skull,
0:09:24 > 0:09:26and this is the missing segment here.
0:09:26 > 0:09:29What happens is, after the initial swelling,
0:09:29 > 0:09:31atmospheric pressure
0:09:31 > 0:09:34starts to push in on the left-hand side.
0:09:34 > 0:09:38So if you look at what is the midline here, this, you can see,
0:09:38 > 0:09:41has moved over quite markedly as a result,
0:09:41 > 0:09:43and the brain can start to tension.
0:09:43 > 0:09:45It can get squashed.
0:09:45 > 0:09:46You're moving your leg.
0:09:46 > 0:09:48That's really good.
0:09:48 > 0:09:51So the planned operation, the
0:09:51 > 0:09:55cranioplasty, is where we put a custom-made implant,
0:09:55 > 0:09:58which would reconstruct the original contour of the bone.
0:09:58 > 0:10:03And as a result, the brain would then expand into that space,
0:10:03 > 0:10:06and then move over to the left-hand
0:10:06 > 0:10:10side and take away that tension on the brain.
0:10:10 > 0:10:13And it's that untensioning of the brain that we believe leads to
0:10:13 > 0:10:15improvements in blood supply
0:10:15 > 0:10:17and, as a result, improve function.
0:10:17 > 0:10:20It's a beautiful day.
0:10:20 > 0:10:23I think in Richard's case, he evidently
0:10:23 > 0:10:26had such an indrawn defect on that
0:10:26 > 0:10:28left-hand side that I felt if we
0:10:28 > 0:10:31could normalise that, that would actually
0:10:31 > 0:10:33lead to an improvement overall,
0:10:33 > 0:10:35so that was the working position.
0:10:36 > 0:10:37We were told it could be months
0:10:37 > 0:10:39before Richard could have the operation,
0:10:39 > 0:10:42so the next important stage was for him to start therapy,
0:10:42 > 0:10:44and he was transferred to the
0:10:44 > 0:10:46Royal Hospital for Neuro-disability in Putney.
0:10:50 > 0:10:53All right, Richard. Off we go.
0:10:53 > 0:10:56The plan was for him to start intensive physio, hydrotherapy,
0:10:56 > 0:11:00occupational, and speech and language therapy.
0:11:00 > 0:11:03OK, so, Richard, what we're going to start off today...
0:11:03 > 0:11:06Richard had to wear a custom made helmet whenever he was moved out of
0:11:06 > 0:11:10the wheelchair so that it protected the exposed left side of his brain.
0:11:13 > 0:11:16Have you got your balance, Richard? Can I let go?
0:11:17 > 0:11:18Go on.
0:11:18 > 0:11:21Hold it, hold it.
0:11:21 > 0:11:25One doctor had told me that a sign of a good recovery is if you can sit
0:11:25 > 0:11:27up on your own after four months,
0:11:27 > 0:11:30but this was nine months later and Richard still couldn't do it.
0:11:31 > 0:11:33Ooh, up, up, up, up, up.
0:11:33 > 0:11:36Richard, use those tummy muscles. That's it.
0:11:36 > 0:11:39Push those feet down into the ground. Good, OK.
0:11:39 > 0:11:41So, Richard, what colour is this?
0:11:43 > 0:11:46OK. So what I want you to do is to take this, Richard,
0:11:46 > 0:11:50and I want you to put it in the ring that's the same colour.
0:11:50 > 0:11:51So you need to look at the ring...
0:11:51 > 0:11:54So, is there any rings there, Richard?
0:11:54 > 0:11:55No. OK.
0:11:55 > 0:11:59It was now also becoming clear that he was having huge problems with
0:11:59 > 0:12:02understanding concepts such as shape and colour.
0:12:02 > 0:12:04So, is that in a ring, Richard?
0:12:08 > 0:12:10Go on.
0:12:10 > 0:12:12Reach it. Well done.
0:12:12 > 0:12:15- Whoa, that was great. And again. - Very good.
0:12:16 > 0:12:19Good. Lovely.
0:12:32 > 0:12:34Now, Richard, what you want, basically,
0:12:34 > 0:12:36it's just a trim up, is it?
0:12:36 > 0:12:38- Just going to wipe your chin. - Despite everything,
0:12:38 > 0:12:40there were moments of normality.
0:12:40 > 0:12:42So, darling, just think,
0:12:42 > 0:12:45this time next week you'll have had your plate fitted.
0:12:45 > 0:12:48And when we heard that Richard was about to have his operation, he went
0:12:48 > 0:12:51and had his first haircut in eight months.
0:12:51 > 0:12:52That's such good news.
0:12:52 > 0:12:54It's fantastic, isn't it?
0:12:54 > 0:12:55Yeah.
0:12:55 > 0:12:58I bet you're looking forward to that, aren't you, Richard? Eh?
0:13:00 > 0:13:02It'll be fine, darling.
0:13:02 > 0:13:04Mr Bentley does it all the time.
0:13:07 > 0:13:09Pretty good. Are you happy?
0:13:11 > 0:13:12All done, darling.
0:13:23 > 0:13:26I was under no illusions that this was a very major operation.
0:13:27 > 0:13:29Mr Bentley, the surgeon,
0:13:29 > 0:13:31had been very clear that the procedure
0:13:31 > 0:13:33coupled with Richard's multiple
0:13:33 > 0:13:35health problems made him a very high-risk patient.
0:13:37 > 0:13:40So, in terms of the risk of the procedure,
0:13:40 > 0:13:43in Richard's case he was already on
0:13:43 > 0:13:46blood thinning medication prior to his
0:13:46 > 0:13:48original incident,
0:13:48 > 0:13:50and he had an irregular heartbeat,
0:13:50 > 0:13:52and his heart was a little bit enlarged
0:13:52 > 0:13:54and wasn't pumping as well as it could have done,
0:13:54 > 0:13:57which predisposed him to a stroke.
0:14:00 > 0:14:05So, this is a plate, like one Richard had inserted.
0:14:05 > 0:14:10It's been made on a model made from the information from the CT scan.
0:14:10 > 0:14:13It would have been accessed via the original scar.
0:14:15 > 0:14:20We would have then gently dissected the scalp off the underlying brain.
0:14:20 > 0:14:23We would have exposed the defect.
0:14:23 > 0:14:25And then the plate would have been
0:14:25 > 0:14:30placed and secured through these small holes with screws.
0:14:30 > 0:14:34It's important to note that the plate has got perforations in it.
0:14:34 > 0:14:39And that's to prevent any blood
0:14:39 > 0:14:43building up underneath the plate and on the surface of the brain.
0:14:43 > 0:14:46And then the scalp is closed - he has a head bandage.
0:14:46 > 0:14:49And in Richard's case the drains
0:14:49 > 0:14:52would have come out two days after the
0:14:52 > 0:14:55operation and we would have restarted him
0:14:55 > 0:14:57on his blood thinning medication at that stage.
0:15:02 > 0:15:07Six days after Richard's operation, his daughters, Katie, Bridie,
0:15:07 > 0:15:09and Lucy, arrive from New Zealand.
0:15:11 > 0:15:13Lucy had brought her seven-month-old baby, Noah,
0:15:13 > 0:15:17who'd been born just a couple of weeks after Richard's stroke.
0:15:17 > 0:15:20Just... Sweetie, small mouthfuls.
0:15:23 > 0:15:26So, you've got to suck it up, Dad.
0:15:26 > 0:15:29Suck it up. That's what you always told us.
0:15:29 > 0:15:31LAUGHTER
0:15:37 > 0:15:38Oh, don't be silly.
0:15:40 > 0:15:42Isn't he beautiful, Dad?
0:15:46 > 0:15:48Do you want some more?
0:15:48 > 0:15:50No, thank you. Yes, please.
0:15:51 > 0:15:53Go on, go on, go on.
0:15:53 > 0:15:55Come on, darling. You can do it, you can do it.
0:15:55 > 0:15:57Look at you.
0:15:57 > 0:15:59Wow.
0:15:59 > 0:16:01Come on. You can do it, sweetie. Come on, come on, come on, sweetie.
0:16:01 > 0:16:04Stand to attention. You can do it, you can do it.
0:16:04 > 0:16:06You can do it.
0:16:06 > 0:16:07You can do it.
0:16:09 > 0:16:12It sometimes seemed to be really tortuous for him,
0:16:12 > 0:16:14but I knew if he was going to get better
0:16:14 > 0:16:16it was going to be really hard work.
0:16:16 > 0:16:18They've got you.
0:16:18 > 0:16:21There was a significant improvement on day one.
0:16:22 > 0:16:26So, he was able to move his leg, his right leg,
0:16:26 > 0:16:28which he was unable to do before the operation,
0:16:28 > 0:16:32and he looked bright and well orientated.
0:16:32 > 0:16:33- Two more seconds.- Up tall. Come on.
0:16:34 > 0:16:39Stand up. Come on. You're doing really well, darling.
0:16:39 > 0:16:41- He's wanting to sit down.- OK.
0:16:43 > 0:16:45We haven't seen a big change in the hand,
0:16:45 > 0:16:48but I've seen a change in your leg, more spontaneous movement,
0:16:48 > 0:16:50which is good.
0:16:50 > 0:16:52Very good, darling.
0:16:52 > 0:16:54Is he just showing...? Did it just move?
0:16:54 > 0:16:56- Yeah.- His hand?- Look at it. Are you filming this?
0:16:56 > 0:16:57Yes.
0:16:59 > 0:17:02Sweetie, are you moving your fingers for us?
0:17:02 > 0:17:04Richard, move your...
0:17:04 > 0:17:06The moment Richard moved his finger
0:17:06 > 0:17:08for the first time was extraordinary.
0:17:08 > 0:17:12Because it came out of nowhere, really. Nobody was expecting it,
0:17:12 > 0:17:15and suddenly his finger moved and we saw it.
0:17:15 > 0:17:16And it just, for me,
0:17:16 > 0:17:21was also a spark of hope that something had reconnected,
0:17:21 > 0:17:24something was improving that was completely unexpected.
0:17:25 > 0:17:29Especially when you're around, he's much more compliant.
0:17:29 > 0:17:32He's managing to hold his sitting balance on his own,
0:17:32 > 0:17:36he's able to stand up with the rotor stand and the stand hoist.
0:17:36 > 0:17:38Today, movement in his hand.
0:17:38 > 0:17:40Cool bananas, darling.
0:17:40 > 0:17:41Hello.
0:17:42 > 0:17:45Are you showing you can turn your head both ways?
0:17:50 > 0:17:51Several weeks later,
0:17:51 > 0:17:54Richard went back to see Mr Bentley to have his staples removed.
0:17:57 > 0:17:59OK, now, Richard, I'm just going to...
0:17:59 > 0:18:00Yeah, you tuck that, Richard.
0:18:00 > 0:18:03You did say he was a high-risk patient.
0:18:03 > 0:18:05He was a high-risk patient from his heart function,
0:18:05 > 0:18:08from his bleeding tendencies,
0:18:08 > 0:18:10from all sorts of reasons.
0:18:10 > 0:18:12And a big shift in the brain, too.
0:18:12 > 0:18:15So, as I said,
0:18:15 > 0:18:18not many people would have taken Richard on, I'll be honest.
0:18:18 > 0:18:20Erm, and...
0:18:21 > 0:18:25I... You know, you don't want to make people worse.
0:18:26 > 0:18:30As a doctor, that's your first
0:18:30 > 0:18:33pledge to the patients. First, do no harm.
0:18:34 > 0:18:36But on the other hand, you know,
0:18:36 > 0:18:38if there's a chance of improving things,
0:18:38 > 0:18:40then obviously we would like to.
0:18:40 > 0:18:43There is lots of evidence that suggests
0:18:43 > 0:18:45those patients do better after
0:18:45 > 0:18:48what they feel is the reconstruction.
0:18:48 > 0:18:50They feel more self, more whole,
0:18:50 > 0:18:51and their quality of life scores, if
0:18:51 > 0:18:54you compare that after the operation,
0:18:54 > 0:18:57compared to before, actually do show improvements.
0:18:57 > 0:18:59I mean, I don't know whether it's too optimistic
0:18:59 > 0:19:01to think he might be able to walk.
0:19:01 > 0:19:03I think, you know,
0:19:03 > 0:19:06who am I to say?
0:19:06 > 0:19:08If we can save people's lives,
0:19:08 > 0:19:10as we do in a major trauma centre like this,
0:19:10 > 0:19:12that's only half the story.
0:19:12 > 0:19:17And that sort of mind and body reconstruction, if you like,
0:19:17 > 0:19:20actually makes for a more complete patient overall.
0:19:20 > 0:19:22They're far more engaged,
0:19:22 > 0:19:24they're far more open to their physio
0:19:24 > 0:19:26and their rehabilitation and their
0:19:26 > 0:19:28quality of life is enhanced as a result.
0:19:28 > 0:19:32So, what I would say on a practical level with this now, just leave this
0:19:32 > 0:19:35for the next three days, and then you can wash the hair.
0:19:35 > 0:19:38How do you feel, sweetie?
0:19:38 > 0:19:40- There you are.- Do you want your staples?
0:19:40 > 0:19:41Do you want to count them?
0:19:48 > 0:19:50It was almost a year since Richard's stroke,
0:19:50 > 0:19:53and although there were small signs of improvement,
0:19:53 > 0:19:56I was told that he had plateaued and probably
0:19:56 > 0:19:57wouldn't get any better.
0:19:57 > 0:20:00I refused to accept that this was the end of his recovery.
0:20:02 > 0:20:05Then, a year to the day of his stroke,
0:20:05 > 0:20:08he was transferred to another NHS-funded
0:20:08 > 0:20:10neuro rehabilitation unit in Kent.
0:20:17 > 0:20:22The Raphael Hospital is run by director Dr Gerhard Florschutz.
0:20:22 > 0:20:27We set Raphael Medical Centre up as an acute neuro rehab unit,
0:20:27 > 0:20:29but at the same time we realised
0:20:29 > 0:20:32that you cannot just deal with the acute
0:20:32 > 0:20:34phase of a rehabilitation programme,
0:20:34 > 0:20:37but there is a continuum of care that is required.
0:20:38 > 0:20:44And our task is to develop a pathway to enable people to go back into
0:20:44 > 0:20:46the community to live a normal life.
0:20:55 > 0:20:59When we first assessed Richard, his speech was non-existent.
0:20:59 > 0:21:02He had a right-sided weakness.
0:21:02 > 0:21:06In particular, he couldn't stand up on his legs on his own.
0:21:08 > 0:21:11He had no movement on his right arm.
0:21:11 > 0:21:16Can you touch left ear and then touch right ear?
0:21:18 > 0:21:21Left ear. Where's your ear?
0:21:22 > 0:21:25No, that's your shoulder.
0:21:25 > 0:21:27Cognitively, he was very impaired.
0:21:27 > 0:21:30So he was quite a complex individual.
0:21:30 > 0:21:34But behind that, one could
0:21:34 > 0:21:36see there was something there.
0:21:36 > 0:21:39There was a, sort of, certain spark in Richard.
0:21:39 > 0:21:41And I think that is...
0:21:41 > 0:21:44If you can connect to that, then I think the work actually can begin.
0:21:44 > 0:21:46There's your right shoulder.
0:21:48 > 0:21:50Your left shoulder.
0:21:50 > 0:21:52Your right shoulder.
0:21:52 > 0:21:54Your left shoulder.
0:21:57 > 0:22:00With the right leg. I want you to push with the right leg.
0:22:00 > 0:22:02Just the right leg.
0:22:02 > 0:22:04- Use, use...- The right leg.
0:22:04 > 0:22:05Push.
0:22:05 > 0:22:08- No, I feel only the left.- Push hard.
0:22:08 > 0:22:10- Push hard.- And then, of course,
0:22:10 > 0:22:13he was able to go into the hydrotherapy pool.
0:22:13 > 0:22:15- Push it.- Is that the best you can do?
0:22:15 > 0:22:18Push it, push it. Show him you're strong.
0:22:18 > 0:22:20And I think in Richard's case, that
0:22:20 > 0:22:23was probably the most beneficial because he
0:22:23 > 0:22:25could begin moving without the
0:22:25 > 0:22:28forces of gravity to prevent that from happening.
0:22:28 > 0:22:30Richard, don't rush!
0:22:30 > 0:22:33- Richard, slow down! - Slowly, slowly, sweetie.
0:22:33 > 0:22:36That really is the basic principle of hydrotherapy.
0:22:36 > 0:22:38The weightlessness that you experience,
0:22:38 > 0:22:41the float holds you up in the water, you're in this warm,
0:22:41 > 0:22:45supporting environment, and then you become...
0:22:45 > 0:22:47You are able to achieve movement
0:22:47 > 0:22:49that you haven't been able to do before.
0:22:49 > 0:22:51And that is really the starting
0:22:51 > 0:22:54point of reconnecting with your whole self.
0:22:54 > 0:22:57One, two, three, four.
0:22:57 > 0:23:01I knew Richard could be pushed to his physical and emotional limits
0:23:01 > 0:23:03because he'd been there before.
0:23:04 > 0:23:0518...
0:23:07 > 0:23:09..19...
0:23:09 > 0:23:12..20...
0:23:12 > 0:23:13..21...
0:23:13 > 0:23:15He was, after all, a seasoned soldier.
0:23:17 > 0:23:22Richard had volunteered in 1992 to serve with the United Nations.
0:23:22 > 0:23:24He was sent to the Bosnian capital, Sarajevo...
0:23:27 > 0:23:29..where he suddenly found himself in
0:23:29 > 0:23:32the heart of a vicious, raging conflict.
0:23:32 > 0:23:35Snipers corner Sarajevo, as dangerous today as it has ever been.
0:23:35 > 0:23:38People taking a back road to work were open to sniper fire...
0:23:39 > 0:23:44He was an unarmed peacekeeper in a place where everyone was a target.
0:23:48 > 0:23:51Every day, he faced machine guns, sniper attacks
0:23:51 > 0:23:53and mortars, as he crossed the front
0:23:53 > 0:23:57lines to try and negotiate an end to the killing.
0:23:57 > 0:24:00I know that there are people breaking the ceasefire,
0:24:00 > 0:24:05but it is a very fine line of who starts it first.
0:24:07 > 0:24:10People have been analysing the information
0:24:10 > 0:24:12that we gathered from last
0:24:12 > 0:24:15night, the firing last night, and when I get back to PDT,
0:24:15 > 0:24:19I expect to... I'll know who started firing last night.
0:24:26 > 0:24:27Give me your hands.
0:24:33 > 0:24:37It was amazing to see Richard's progress in the hydrotherapy pool.
0:24:38 > 0:24:40Sweetie, you've improved so much.
0:24:40 > 0:24:42Look at him! He's walking.
0:24:47 > 0:24:51Six, seven,
0:24:51 > 0:24:54eight, nine...
0:24:54 > 0:24:58..16, 17,
0:24:58 > 0:25:0118, 19...
0:25:01 > 0:25:04The clinic's philosophy of consistent and regular therapy
0:25:04 > 0:25:07seemed to be having a really positive effect.
0:25:07 > 0:25:08..24, 25...
0:25:09 > 0:25:11..26.
0:25:11 > 0:25:15First of all, the biggest difference is we work, therapy is seven days a
0:25:15 > 0:25:19week. I can never understand how you can run a rehab,
0:25:19 > 0:25:21particularly an acute rehab unit,
0:25:21 > 0:25:25and stop Friday afternoon and then begin again from Monday morning.
0:25:25 > 0:25:26You lose two and a half days,
0:25:26 > 0:25:29and it takes you two days to get back what you have lost.
0:25:29 > 0:25:31So, we start at seven days a week.
0:25:31 > 0:25:35OK, ready, steady, and up.
0:25:35 > 0:25:37Up you go.
0:25:37 > 0:25:40OK. Well done.
0:25:40 > 0:25:42Well done.
0:25:42 > 0:25:43OK?
0:25:44 > 0:25:45Look at me, darling.
0:25:46 > 0:25:48Richard?
0:25:48 > 0:25:50Look at me. Walk towards me.
0:25:51 > 0:25:53Come on.
0:25:53 > 0:25:55The process of relearning to walk,
0:25:55 > 0:25:58it's often in a certain way a mechanical problem
0:25:58 > 0:26:01that the therapist moves your leg to begin with.
0:26:01 > 0:26:04You get the connection with your brain again
0:26:04 > 0:26:07that programmes how to make
0:26:07 > 0:26:10a proper, controlled movement in space.
0:26:12 > 0:26:15Well done.
0:26:15 > 0:26:17Darling, don't look out of the window,
0:26:17 > 0:26:19just concentrate on what you're doing.
0:26:19 > 0:26:22Shift the weight, shift the weight, shift the weight.
0:26:22 > 0:26:24- Shift the weight.- Shift, shift, shift.
0:26:29 > 0:26:31Well done. That was good.
0:26:33 > 0:26:36- That's really good.- You're doing it, darling! You're walking.
0:26:36 > 0:26:38You're walking, darling.
0:26:38 > 0:26:41That's brilliant! Look at you go.
0:26:41 > 0:26:43Look at you go, sweetie!
0:26:43 > 0:26:45Good. That was really good.
0:26:45 > 0:26:47- Really good step.- One more time.
0:26:47 > 0:26:51- Really good step.- The next step was gradually
0:26:51 > 0:26:55to be able to regain his balance
0:26:55 > 0:26:58and, once he achieves that, the ability to take the first step.
0:27:01 > 0:27:03But in between, of course,
0:27:03 > 0:27:06there's a lot of work to be done in terms of movement of the legs,
0:27:06 > 0:27:09movement of the arm, movement of the whole body,
0:27:09 > 0:27:11the awareness of his physicality.
0:27:13 > 0:27:17Even though Richard still needed an enormous amount of help,
0:27:17 > 0:27:19there were signs that maybe he was going
0:27:19 > 0:27:21to be able to walk, and walk on his own.
0:27:23 > 0:27:27And I could see that, you know, he was coming back as a person too.
0:27:30 > 0:27:35Because he was starting to be able to be in control of his life,
0:27:35 > 0:27:40even though it was happening at a very tiny, tiny snail's pace.
0:27:40 > 0:27:42He was coming back.
0:27:42 > 0:27:44Richard was becoming reconnected to himself.
0:27:52 > 0:27:55As a break from the intensive daily routine,
0:27:55 > 0:27:56I took him to a centre that
0:27:56 > 0:27:59specialises in treating veterans with trauma.
0:28:04 > 0:28:06The unique element of the therapy
0:28:06 > 0:28:08this place offers is contact with horses.
0:28:11 > 0:28:13And as soon as the horse moved towards Richard,
0:28:13 > 0:28:15his response was immediate.
0:28:16 > 0:28:19Hello.
0:28:19 > 0:28:22Hello. I know, I know.
0:28:25 > 0:28:28It was amazing to hear him talk so clearly
0:28:28 > 0:28:30and spontaneously to the horse.
0:28:31 > 0:28:33I know.
0:28:33 > 0:28:35Hello.
0:28:39 > 0:28:41Hello.
0:28:42 > 0:28:44Hello.
0:28:44 > 0:28:47And it was the first time I'd really seen him do something like that
0:28:47 > 0:28:48since he'd been ill.
0:28:58 > 0:29:00As Richard's recovery progressed,
0:29:00 > 0:29:04he also started to do exercises for his mind as well as his body.
0:29:06 > 0:29:11The traditional therapies very much work on the physical body.
0:29:11 > 0:29:14The creative therapies does much
0:29:14 > 0:29:18more work on what I call the soul dimension of man,
0:29:18 > 0:29:20the feeling and the thinking level.
0:29:20 > 0:29:24And I think that is the most important thing.
0:29:24 > 0:29:27To have a recovery in a proper, holistic way,
0:29:27 > 0:29:29you cannot just deal with the physical disabilities,
0:29:29 > 0:29:32but there's more to the human being than just a physical disability.
0:29:32 > 0:29:35And that is what we're trying to encompass here.
0:29:35 > 0:29:39HE PLAYS MUSICAL SCALE
0:29:44 > 0:29:45The stroke had also affected
0:29:45 > 0:29:48Richard's ability to see things on his right side.
0:29:53 > 0:29:58Visual neglect is the connection between the eyes and the brain
0:29:58 > 0:30:00is disturbed.
0:30:00 > 0:30:02The eyesight is usually intact, but
0:30:02 > 0:30:06the processing in the brain has been damaged.
0:30:06 > 0:30:09Well, in Richard's particular case,
0:30:09 > 0:30:13he was not able to see one side of his vision.
0:30:13 > 0:30:18What we wanted to do is to re-establish the connection between
0:30:18 > 0:30:21his neglected side and the pathway in the brain.
0:30:21 > 0:30:25And we worked on that mainly with the art therapy.
0:30:25 > 0:30:27We have special exercises that
0:30:27 > 0:30:30gradually enable the individual to become
0:30:30 > 0:30:32more and more aware of his neglected side.
0:30:32 > 0:30:35And I think in Richard's case, it worked very well.
0:30:46 > 0:30:48Darling, that's fantastic.
0:30:53 > 0:30:56With Richard's physical recovery gathering pace,
0:30:56 > 0:30:58the team could now look at
0:30:58 > 0:31:00other ways to promote his development...
0:31:02 > 0:31:04..and suggested an electric wheelchair.
0:31:07 > 0:31:09With some people, you would not
0:31:09 > 0:31:11recommend an electric wheelchair because
0:31:11 > 0:31:12they will never walk again.
0:31:12 > 0:31:14In Richard's case, it's quite different.
0:31:14 > 0:31:17With his army background,
0:31:17 > 0:31:19and his determination and motivation,
0:31:19 > 0:31:20he wants to work, he wants to walk,
0:31:20 > 0:31:22he wants to be independent.
0:31:22 > 0:31:25And the wheelchair enabled him to make that step,
0:31:25 > 0:31:27to make the first step in independence,
0:31:27 > 0:31:31but not neglecting in the long-term the ability to walk.
0:31:31 > 0:31:32So in his case, it was quite
0:31:32 > 0:31:35appropriate to have an electric wheelchair.
0:31:37 > 0:31:39Do a whole circle.
0:31:39 > 0:31:41Do a whole circle, sweetie.
0:31:41 > 0:31:43Ta-da!
0:31:46 > 0:31:48All the way, all the way!
0:31:48 > 0:31:51Yeah!
0:31:51 > 0:31:52Ta-da!
0:31:58 > 0:31:59For the first time, he had the
0:31:59 > 0:32:02freedom to go wherever he wanted to without
0:32:02 > 0:32:05the enormous effort he had to put in to walk.
0:32:05 > 0:32:07OK, should we go round?
0:32:07 > 0:32:10With this freedom, his gung-ho personality returned.
0:32:10 > 0:32:12Beep-beep-beep...
0:32:12 > 0:32:14SHE GASPS
0:32:14 > 0:32:18Careful! God, you're trying to freak me out!
0:32:18 > 0:32:21Go on, then. Just, sweetie, don't have an accident.
0:32:23 > 0:32:27Richard had been at Raphael for a year. He'd made huge progress,
0:32:27 > 0:32:29and now he wanted to come home.
0:32:40 > 0:32:42OK?
0:32:46 > 0:32:48OK, off you go.
0:32:48 > 0:32:52Two years and one day after his stroke, he returned home for good.
0:33:00 > 0:33:03It was an incredible moment to see him walk through the front door...
0:33:05 > 0:33:09..and to be home once again.
0:33:09 > 0:33:11You're in.
0:33:11 > 0:33:14Come and sit down, darling. You walked home.
0:33:14 > 0:33:17It was something that I wasn't even sure would ever be possible.
0:33:17 > 0:33:21Before you sit down... Leave the chair there, please, darling.
0:33:21 > 0:33:24Hang on, hang on, move your hand, hang on.
0:33:24 > 0:33:25There.
0:33:29 > 0:33:32Having Richard back home, of course, was fantastic.
0:33:32 > 0:33:36But it was also hugely daunting because
0:33:36 > 0:33:40here was somebody who was 100% dependent on me.
0:33:40 > 0:33:43So it was a lot to take on board,
0:33:43 > 0:33:46and a very steep learning curve.
0:33:46 > 0:33:47Well done.
0:33:47 > 0:33:50Right. Welcome home.
0:33:52 > 0:33:55Things couldn't have been more different than from when we'd met.
0:33:55 > 0:33:57You're amazing.
0:34:02 > 0:34:05The aircraft came in with a tight turn, a short landing,
0:34:05 > 0:34:07and as fast a turnaround as possible.
0:34:07 > 0:34:11In July 1992, I'd flown in to Sarajevo.
0:34:11 > 0:34:14Can I have somebody to help?
0:34:14 > 0:34:17I'd gone to make a film about my sister, Vanessa,
0:34:17 > 0:34:19who was a doctor in the British Army.
0:34:20 > 0:34:23They've had analgesia. And...
0:34:23 > 0:34:25EXPLOSION
0:34:25 > 0:34:27Here we go. They've had some analgesia,
0:34:27 > 0:34:29we put some iodine in the wounds,
0:34:29 > 0:34:31they've got a drip set up and going, so they're getting fluids.
0:34:31 > 0:34:33We're keeping them stable and we
0:34:33 > 0:34:35want to get them out as soon as possible.
0:34:37 > 0:34:39It was through Vanessa that I met Richard.
0:34:45 > 0:34:50Richard was a peacekeeper in former Yugoslavia for almost a year.
0:34:50 > 0:34:52He saw the horrors of the civil war first-hand.
0:34:52 > 0:34:55SHE CRIES
0:35:00 > 0:35:02They could destroy the whole city if they want to.
0:35:02 > 0:35:04They have enough firepower out there
0:35:04 > 0:35:07to flatten this place ten times over.
0:35:10 > 0:35:12His time in Sarajevo led to
0:35:12 > 0:35:14post-traumatic stress disorder that would
0:35:14 > 0:35:18leave his physical and psychological health in tatters.
0:35:22 > 0:35:25It was 13 years before I'd see Richard again.
0:35:27 > 0:35:30I decided to contact him after the sudden death of my sister, Vanessa.
0:35:32 > 0:35:35He moved from New Zealand to London,
0:35:35 > 0:35:36and we were married six months later.
0:35:38 > 0:35:42My wedding day was the happiest day of my life.
0:35:42 > 0:35:47Richard looked amazing in his scarlet mess dress with his medals.
0:35:47 > 0:35:51And we got married at Saint Bride's, the journalist church,
0:35:51 > 0:35:53surrounded by friends.
0:35:53 > 0:35:57And it was a wonderful day.
0:36:03 > 0:36:05Sweetie, think about your shoulder.
0:36:05 > 0:36:07Move your shoulder forward.
0:36:07 > 0:36:09You can do it.
0:36:09 > 0:36:12Two weeks after coming home from Raphael,
0:36:12 > 0:36:15Richard suddenly started moving his right arm.
0:36:15 > 0:36:17That's it.
0:36:17 > 0:36:19Something as simple as pushing a
0:36:19 > 0:36:21ball into a cup was a real challenge,
0:36:21 > 0:36:23but it soon became part of his daily routine.
0:36:37 > 0:36:40For seven months, our lives revolved around therapy,
0:36:40 > 0:36:42with Richard making steady progress.
0:36:44 > 0:36:45Then he was selected to go on an
0:36:45 > 0:36:47intensive three-week programme at the
0:36:47 > 0:36:50National Hospital for Neurology and Neurosurgery in London.
0:36:53 > 0:36:55It's run by Professor Nick Ward.
0:36:58 > 0:37:00So when we saw Richard in clinic,
0:37:00 > 0:37:01what we saw was somebody who had
0:37:01 > 0:37:05some function in his arm and his hand, but he wasn't using it.
0:37:05 > 0:37:07He was still very dependent for help
0:37:07 > 0:37:09in day-to-day activities, in washing
0:37:09 > 0:37:12and dressing, and feeding himself.
0:37:12 > 0:37:16And our view was that, given what he had in his arm and his hand,
0:37:16 > 0:37:18that we could show him how to use it.
0:37:23 > 0:37:26So, to do something like cutting up a banana,
0:37:26 > 0:37:29or use a knife and fork to cut up a steak, for example,
0:37:29 > 0:37:32you need reasonable control of your limbs and your fingers.
0:37:32 > 0:37:34You need good sensation,
0:37:34 > 0:37:37so you need to be able to feel what's going on.
0:37:37 > 0:37:39But beyond that, you also need a
0:37:39 > 0:37:41concept of what a knife and fork is, and
0:37:41 > 0:37:45how you might use them together in order to achieve that task.
0:37:45 > 0:37:47So we call that planning.
0:37:47 > 0:37:50And Richard did have some problems with planning,
0:37:50 > 0:37:52so how you put all of those ideas together
0:37:52 > 0:37:55in order to execute the task.
0:37:55 > 0:37:59Sweetie, it's good for me to see how much you can do,
0:37:59 > 0:38:01because you can actually do a lot.
0:38:01 > 0:38:03Yeah, so what?
0:38:03 > 0:38:08Yeah, so when we get home, I'm going be getting you to start pulling
0:38:08 > 0:38:11your weight. Yeah.
0:38:11 > 0:38:13So, Richard's deficits in
0:38:13 > 0:38:15movement were not just about weakness.
0:38:15 > 0:38:17He did have some weakness, he did have sensory loss,
0:38:17 > 0:38:20but he did have problems with planning,
0:38:20 > 0:38:21and that's likely to be a
0:38:21 > 0:38:25consequence of where the damage was in his brain.
0:38:25 > 0:38:27Pick up phone and dial 999.
0:38:27 > 0:38:28Right.
0:38:30 > 0:38:32Yeah, each hand. It doesn't matter.
0:38:34 > 0:38:36And then dial. No, with that one.
0:38:36 > 0:38:38Dial.
0:38:39 > 0:38:42What Richard benefited from was
0:38:42 > 0:38:45what we call hand-over-hand assistance,
0:38:45 > 0:38:47so where I would place my hand over
0:38:47 > 0:38:50his to help guide the movement in the
0:38:50 > 0:38:54right plane of direction using the right force, and I would grade that.
0:38:54 > 0:38:57As the weeks went on, he needed less and less help.
0:38:59 > 0:39:00Good. Lovely.
0:39:03 > 0:39:06So, initially Richard needed
0:39:06 > 0:39:10prompting to attempt to pick up the pencil.
0:39:10 > 0:39:14And once he was able to reach and grasp the pencil, he had difficulty
0:39:14 > 0:39:17manipulating the pencil within his hand
0:39:17 > 0:39:21and also orientating the pencil to the paper.
0:39:21 > 0:39:23Shall we turn it around, so it's...?
0:39:23 > 0:39:24There we go.
0:39:25 > 0:39:28Then draw a line across it.
0:39:28 > 0:39:29Good.
0:39:35 > 0:39:36Lovely.
0:39:38 > 0:39:40That's OK. Just the one.
0:39:47 > 0:39:50LAWN MOWER STARTS
0:39:52 > 0:39:54Get in there!
0:39:54 > 0:39:56Go on!
0:39:56 > 0:39:59His ability to use the arm in day to day tasks dramatically improved.
0:40:03 > 0:40:06Richard always had a passion for gardening,
0:40:06 > 0:40:08and now that he was able to move around more independently,
0:40:08 > 0:40:11he really threw himself back into it.
0:40:12 > 0:40:14But, for me, there was a difficult
0:40:14 > 0:40:16balance and tension between encouraging
0:40:16 > 0:40:21him to do more, but also to hold him back so he didn't overdo things.
0:40:21 > 0:40:23Sweetie, don't you think you've done enough?
0:40:23 > 0:40:25- What?- Don't you think you've done enough?
0:40:25 > 0:40:26Get out of here.
0:40:26 > 0:40:28Go away.
0:40:28 > 0:40:31I had to learn to step back and let him take risks,
0:40:31 > 0:40:33whatever the outcome might be.
0:40:34 > 0:40:38When we've talked to people who've been through the programme,
0:40:38 > 0:40:40they do describe it as intensive.
0:40:40 > 0:40:42They call it a boot camp.
0:40:42 > 0:40:44It's fatiguing,
0:40:44 > 0:40:47but actually there's something exhilarating about that,
0:40:47 > 0:40:50being given the opportunity to work that hard
0:40:50 > 0:40:52is something that I think people really value.
0:40:59 > 0:41:01Six months after the upper limb programme,
0:41:01 > 0:41:05Richard was making such remarkable progress that he was now able to use
0:41:05 > 0:41:08his right hand to copy a daily writing exercise.
0:41:20 > 0:41:22One. That's much better.
0:41:22 > 0:41:24That's much better. Two.
0:41:24 > 0:41:26Five of these. Six.
0:41:26 > 0:41:28Very good. Seven.
0:41:28 > 0:41:30Very good.
0:41:30 > 0:41:31Eight.
0:41:33 > 0:41:37Physically, Richard was now pretty independent,
0:41:37 > 0:41:39and so when we went for his final assessment
0:41:39 > 0:41:40at the upper limb programme,
0:41:40 > 0:41:43he was able to walk in on his own unaided.
0:41:44 > 0:41:49What's important about the programme is demonstrating change,
0:41:49 > 0:41:52so providing evidence that we make a difference.
0:41:52 > 0:41:56Because what's important is not just the ability to change after an
0:41:56 > 0:41:58intensive three-week programme,
0:41:58 > 0:42:02but actually what's absolutely key is that those gains are maintained.
0:42:04 > 0:42:06To your ear.
0:42:06 > 0:42:08There aren't any other programmes
0:42:08 > 0:42:10that work with people this intensively...
0:42:12 > 0:42:16..that delivers high dose, high intensity rehabilitation,
0:42:16 > 0:42:18specifically for the upper limb.
0:42:21 > 0:42:25So our responsibility at a place like Queen's Square
0:42:25 > 0:42:26is to show what's possible.
0:42:26 > 0:42:28Lovely.
0:42:28 > 0:42:30And part of that is measuring what we do,
0:42:30 > 0:42:33so we have outcome scores at admission,
0:42:33 > 0:42:35at discharge, six weeks, and six months.
0:42:35 > 0:42:39And if we can show that there are measurable and meaningful changes in
0:42:39 > 0:42:44a higher proportion of people that come through that programme, then
0:42:44 > 0:42:49our hope is that this will change the way rehabilitation is delivered.
0:42:50 > 0:42:55Richard's recovery had gone far beyond everyone's expectations.
0:42:55 > 0:42:58So much so that he could now even climb a flight of stairs.
0:43:00 > 0:43:01Slowly, Richard.
0:43:05 > 0:43:07Great.
0:43:07 > 0:43:09So the scores, though... I mean, the scores have improved a lot.
0:43:09 > 0:43:11Yeah.
0:43:11 > 0:43:16The action research arm test was 26 out of 57 when you came in.
0:43:16 > 0:43:18- It's now 48 now out of 57.- Yeah.
0:43:18 > 0:43:20- Wow.- So that's an improvement...
0:43:20 > 0:43:22- Amazing.- ..of 22 points.
0:43:22 > 0:43:26It is emotional. There's something about just giving people some hope.
0:43:26 > 0:43:28Hope that we think is realistic, you know?
0:43:28 > 0:43:31Reopening those doors, which is...
0:43:31 > 0:43:33Yeah, it is quite emotional.
0:43:34 > 0:43:37- But look at it. That's...- That's really improved, hasn't it?
0:43:37 > 0:43:40- That's incredible.- Great progress. - You're a star.- Yeah.
0:43:47 > 0:43:49You have to use two hands, sweetie.
0:43:53 > 0:43:56Despite all the improvements that Richard had made,
0:43:56 > 0:43:58we lived in virtual silence.
0:43:59 > 0:44:02He was very good at communicating without using words,
0:44:02 > 0:44:04but we weren't able to have a conversation.
0:44:06 > 0:44:09Tell me how you are. How are you feeling?
0:44:09 > 0:44:16HE APPROXIMATES RESPONSE
0:44:23 > 0:44:27If he was going to be able to talk and understand language again,
0:44:27 > 0:44:29he'd need intensive therapy.
0:44:29 > 0:44:32I feel like a paper-based low technology...
0:44:32 > 0:44:36After finding a source of funding, Richard was able to start weekly
0:44:36 > 0:44:39speech and language sessions with Liz Williamson and her assistant,
0:44:39 > 0:44:42Laura.
0:44:42 > 0:44:44Fruit. Grapes,
0:44:44 > 0:44:47or teddy? What do you do with fruit?
0:44:47 > 0:44:48Do you...
0:44:50 > 0:44:52- ..eat it?- Yeah.
0:44:52 > 0:44:56Yeah? So, which one of these would you eat - grapes or teddy?
0:44:56 > 0:44:58He presented as
0:44:58 > 0:45:01severely impaired, in terms of his
0:45:01 > 0:45:05ability to understand the spoken word.
0:45:05 > 0:45:06So, which one of these...
0:45:08 > 0:45:12..goes with toothbrush? Cheese, toothpaste,
0:45:12 > 0:45:14or globe?
0:45:15 > 0:45:17Cheese?
0:45:17 > 0:45:20And it's just a little bit like filing away books in a library.
0:45:22 > 0:45:30Because Richard's working library was completely thrown up in the air.
0:45:30 > 0:45:36And he, or we, needed to re-categorise, slot in place,
0:45:36 > 0:45:38all of those words.
0:45:38 > 0:45:41How about engine?
0:45:43 > 0:45:45Which one of these has an engine?
0:45:45 > 0:45:48One of those two. You're right. It is one of those two.
0:45:48 > 0:45:52So, we worked on this level for many months, actually.
0:45:52 > 0:45:55And he started to show some real improvements.
0:45:55 > 0:45:58Which one of those two things has an engine to power it?
0:46:00 > 0:46:03Yeah, a car. Well done, Richard.
0:46:03 > 0:46:05The last word is locker.
0:46:07 > 0:46:09Very good. You need a key to open your locker, don't you?
0:46:09 > 0:46:11Fabulous. Well done.
0:46:20 > 0:46:25Sometimes Richard's new-found confidence went a bit too far.
0:46:25 > 0:46:27Darling, have you fallen over?
0:46:27 > 0:46:30Oh, sweetie.
0:46:30 > 0:46:32I'm OK. I'm OK.
0:46:32 > 0:46:33Darling...
0:46:34 > 0:46:35Oh, sweetie.
0:46:35 > 0:46:37I just... I'm fine.
0:46:42 > 0:46:44Thank you, darling.
0:46:44 > 0:46:46Oh, good stuff.
0:46:46 > 0:46:49- Thank you.- Because the thing is you could break your leg, darling.
0:46:49 > 0:46:50I'm OK.
0:46:50 > 0:46:53I know you're OK now, but you might not be.
0:46:53 > 0:46:55- I am.- You all right, sweetie?
0:46:55 > 0:46:57- Yeah.- You all right?
0:47:05 > 0:47:07Richard always loved driving,
0:47:07 > 0:47:08so as a treat I arranged a day out
0:47:08 > 0:47:11at Brands Hatch to have a go on their
0:47:11 > 0:47:12driving simulator.
0:47:16 > 0:47:17This wasn't just for fun.
0:47:17 > 0:47:20I'd also arranged to meet Professor Mike Merzenich,
0:47:20 > 0:47:24one of the world's leading neuroscientists.
0:47:24 > 0:47:26He'd agreed to assess Richard
0:47:26 > 0:47:27and offer some advice on how we
0:47:27 > 0:47:30could push Richard's recovery even further.
0:47:32 > 0:47:34- Nice to meet you again. - Nice to see you.
0:47:34 > 0:47:36And you.
0:47:38 > 0:47:40Great, thank you.
0:47:40 > 0:47:42Have a go at getting in.
0:47:42 > 0:47:43- OK.- Yeah? Just be careful.
0:47:43 > 0:47:46Put that leg first.
0:47:46 > 0:47:48People that have left sided brain injuries
0:47:48 > 0:47:50usually have problems expressed
0:47:50 > 0:47:52on the right side of the action, you could say.
0:47:52 > 0:47:54Both in movement control,
0:47:54 > 0:47:55and if they have any problems with vision,
0:47:55 > 0:47:59it'll relate to the right side as opposed to the left side.
0:47:59 > 0:48:02So a driving simulator is a pretty good environment to determine...
0:48:02 > 0:48:07To show whether or not he has strongly asymmetric control.
0:48:07 > 0:48:10It's going to show us whether or not he sees things adequately across the
0:48:10 > 0:48:14field of vision. It's going to show us pretty clearly whether he can
0:48:14 > 0:48:16control his actions across the horizon.
0:48:16 > 0:48:18So it's a good, simple way to get an
0:48:18 > 0:48:20overall read of how he's doing in his
0:48:20 > 0:48:24action control as he's drinking in information from vision.
0:48:24 > 0:48:26That's good.
0:48:26 > 0:48:27That's good.
0:48:29 > 0:48:32After a bit of a shaky start, Richard was amazing.
0:48:32 > 0:48:34He could do it. Follow the road out.
0:48:36 > 0:48:39Yeah, you're not on the... Not on the track yet.
0:48:39 > 0:48:41It looks like a proper racetrack.
0:48:41 > 0:48:44That's good. That's good.
0:48:44 > 0:48:48- Getting the hang of it now.- Well, that's good. He's managing the
0:48:48 > 0:48:51lateral peripheral vision pretty well there.
0:48:52 > 0:48:54Good.
0:48:56 > 0:49:00He has a really excellent control in this complex visual flow field.
0:49:00 > 0:49:02Things are coming at him very rapidly.
0:49:02 > 0:49:06He's making judgments about how to change his control,
0:49:06 > 0:49:08and this is pretty impressive.
0:49:08 > 0:49:09He's come a long way.
0:49:13 > 0:49:15Before he made the wrong turn on that bit.
0:49:15 > 0:49:17Now he's made the correction.
0:49:18 > 0:49:20It was great to see him driving.
0:49:20 > 0:49:23He was a very good driver once and I think he really enjoyed himself.
0:49:23 > 0:49:25How well do you think you did?
0:49:25 > 0:49:26Do you think you did a good job?
0:49:26 > 0:49:29Well, it was very hard, but I thought it was very good.
0:49:29 > 0:49:31Overall, you did a good job.
0:49:31 > 0:49:32- Oh, very good.- Yeah.
0:49:34 > 0:49:38It's all about continuing to drive your brain in a continually more
0:49:38 > 0:49:41positive direction. He can go a lot farther still.
0:49:41 > 0:49:43He's gone a long distance,
0:49:43 > 0:49:48but the whole idea is to see life as a progression of getting better and
0:49:48 > 0:49:50better in life, as long as you can.
0:49:50 > 0:49:53And he has a lot farther that he can go.
0:49:53 > 0:49:55- And you're prepared to work hard, aren't you?- Yes, I do.
0:49:55 > 0:49:58Yeah. You're good at that. You're very good at that, sweetie.
0:50:00 > 0:50:02After his meeting with Professor Merzenich,
0:50:02 > 0:50:06Richard's daily routine now included a new set of exercises and games
0:50:06 > 0:50:08designed to stimulate his brain.
0:50:09 > 0:50:11No, that's good. That's good.
0:50:11 > 0:50:13- No!- Yes.
0:50:13 > 0:50:16Although he didn't enjoy them as much as driving.
0:50:16 > 0:50:19Let me show you. Let me show you. Let me show you.
0:50:19 > 0:50:22- You're showing wrong.- No, no, no, look.
0:50:22 > 0:50:24I mean, sweetie, if it was easy, there would be no
0:50:24 > 0:50:25point doing it, would there?
0:50:32 > 0:50:34Less effort.
0:50:34 > 0:50:36After all the hard work, Richard's now able to enjoy doing some of
0:50:36 > 0:50:39the things that he used to do.
0:50:39 > 0:50:42That's it. Pop that thumb back on...
0:50:42 > 0:50:44That's brilliant from there.
0:50:45 > 0:50:47- That's more like it. - Now we've got it.
0:50:47 > 0:50:50Now we're getting the hang of it.
0:50:50 > 0:50:52- One more go.- Yeah.
0:50:56 > 0:50:58I think it's very clear,
0:50:58 > 0:51:00having seen what Richard's like now,
0:51:00 > 0:51:02that the extent of recovery that
0:51:02 > 0:51:06he's had has exceeded what I would have expected or possibly predicted,
0:51:06 > 0:51:09and that, you know, makes me feel great.
0:51:09 > 0:51:12You know, I think all the staff who were involved in Richard's care,
0:51:12 > 0:51:14it really justifies what they did,
0:51:14 > 0:51:15and it's the sort of thing that
0:51:15 > 0:51:17makes them come back into work each day.
0:51:17 > 0:51:21So, I think our increasing awareness of how much potential recovery there
0:51:21 > 0:51:24is in the adult brain, which is something that's relatively new...
0:51:24 > 0:51:27We've always been taught the adult brain, once damaged, can't recover.
0:51:27 > 0:51:29We know that's not the case now.
0:51:29 > 0:51:32It means that the onus on us is now not just to save life, but to try
0:51:32 > 0:51:35and preserve as much brain as possible
0:51:35 > 0:51:38so that the patient has the potential for maximal recovery.
0:51:38 > 0:51:40As we say in neurosurgery,
0:51:40 > 0:51:43we're taught that the brain doesn't get better in a bucket.
0:51:43 > 0:51:45If you remove that bit of brain,
0:51:45 > 0:51:47whatever you do, it can never recover.
0:51:47 > 0:51:50You want me to switch the lights off?
0:51:50 > 0:51:53That's because we're filming. We're filming.
0:51:53 > 0:51:54Sorry.
0:51:54 > 0:51:56Sorry.
0:51:57 > 0:52:01I want you to pick up all of the blocks that aren't blue.
0:52:04 > 0:52:07When we first began to appreciate the brain was plastic,
0:52:07 > 0:52:09continuously changing itself,
0:52:09 > 0:52:13and that we could conceivably control it for human benefit,
0:52:13 > 0:52:15I thought that this would sweep
0:52:15 > 0:52:17across medicine and science like a flash.
0:52:17 > 0:52:19Good job.
0:52:19 > 0:52:24But still, it's a hard-won fight to drive this into medicine.
0:52:24 > 0:52:27Now that you're doing so well, we have to make it harder.
0:52:27 > 0:52:30- OK.- OK? The coin goes somewhere.
0:52:30 > 0:52:33We can apply plasticity to help
0:52:33 > 0:52:36people who struggle be in a better position.
0:52:36 > 0:52:38Perfect.
0:52:38 > 0:52:42Perfect. But it's a resource that's valuable to every human being.
0:52:42 > 0:52:44And they should understand they have this potential,
0:52:44 > 0:52:47they have this power to drive their brain into a stronger,
0:52:47 > 0:52:49better position.
0:52:49 > 0:52:51We should all take that to heart.
0:52:51 > 0:52:53We should all live life to the advantage of this
0:52:53 > 0:52:55and take advantage of it,
0:52:55 > 0:52:57to have a better and stronger life.
0:53:07 > 0:53:1018 months after Richard left Raphael,
0:53:10 > 0:53:13he returned to show them how much progress he'd made.
0:53:18 > 0:53:20- That's great.- It's a great change, great change.
0:53:20 > 0:53:22That's really good.
0:53:22 > 0:53:24Really good. Thank you.
0:53:24 > 0:53:26Looking at his journey over time,
0:53:26 > 0:53:29I mean, every time you see him he has done another step.
0:53:29 > 0:53:33Of course he will improve. And I think one must never give up.
0:53:33 > 0:53:37Rehabilitation is a lifelong process.
0:53:37 > 0:53:40And the human being has this wonderful ability
0:53:40 > 0:53:42to regenerate in a real sense.
0:53:45 > 0:53:48It's like on the parade ground, isn't it?
0:53:48 > 0:53:50Look at that.
0:53:50 > 0:53:53And I think one never can underestimate the importance of
0:53:53 > 0:53:57relatives, particularly close relatives,
0:53:57 > 0:53:59as part of the treatment process.
0:53:59 > 0:54:04The point is that relatives can be part of the therapy team in the most
0:54:04 > 0:54:07important way, and that can be only beneficial.
0:54:07 > 0:54:09- Let's demonstrate.- Great, yeah.
0:54:09 > 0:54:11Left, right...
0:54:11 > 0:54:12You know, it's an exciting moment
0:54:12 > 0:54:15for all of us to see how he continues making his
0:54:15 > 0:54:18recovery. And I think that always we have to remember,
0:54:18 > 0:54:21never write any individual off.
0:54:21 > 0:54:24Everyone has the possibility to make progress.
0:54:24 > 0:54:26Good to see you.
0:54:26 > 0:54:28Thank you very much.
0:54:28 > 0:54:31I hope it all goes well. And keep in touch, yeah?
0:54:31 > 0:54:33- That would be great.- So good to see you.
0:54:33 > 0:54:35Thank you very much.
0:54:35 > 0:54:38If you see a patient coming in in a vegetative state,
0:54:38 > 0:54:42and see them actually walking out of the front door,
0:54:42 > 0:54:44that is what our work is about,
0:54:44 > 0:54:47and that is the most uplifting experience you can have.
0:54:52 > 0:54:55This is coming out as well.
0:54:55 > 0:54:56See?
0:54:56 > 0:54:58Mm-hm.
0:54:58 > 0:55:00Got another one here.
0:55:00 > 0:55:01Need to take this one out.
0:55:03 > 0:55:05There, see?
0:55:05 > 0:55:06That one right there.
0:55:36 > 0:55:41MILITARY MARCH PLAYS
0:55:43 > 0:55:4730 years of service in the New Zealand Army
0:55:47 > 0:55:49and three wars.
0:55:55 > 0:55:57I did things that other people weren't prepared to do.
0:56:06 > 0:56:07I took extreme risks...
0:56:10 > 0:56:12..in an extreme situation.
0:56:15 > 0:56:16But life goes on.
0:56:27 > 0:56:31For the first time in years, Richard wanted to be part of the annual
0:56:31 > 0:56:34ceremony that had meant so much to him throughout his army career.
0:56:36 > 0:56:38Anzac Day, the national day of
0:56:38 > 0:56:42remembrance for Australia and New Zealand.
0:56:42 > 0:56:47They shall not grow old as we that are left grow old.
0:56:49 > 0:56:53Age shall not weary them, nor the years condemn.
0:56:54 > 0:56:58At the going down of the sun and in the morning,
0:56:58 > 0:57:01we will remember them.
0:57:02 > 0:57:06MUSIC PLAYS: The Last Post
0:57:25 > 0:57:27Richard used to say to me,
0:57:27 > 0:57:30"Fi, I'd walk over a mile of broken glass for you."
0:57:30 > 0:57:34And the past four years have been my chance to do the same thing for him.
0:57:34 > 0:57:37It's been an honour and a privilege to look after him,
0:57:37 > 0:57:40and it's probably the most rewarding thing that I've ever done.
0:57:54 > 0:57:56- You're fantastic.- Yeah.
0:57:56 > 0:57:58- Yes.- I know.
0:57:58 > 0:57:59- Awesome.- I know.
0:58:01 > 0:58:03Well done, darling. You're brilliant.
0:58:03 > 0:58:04I know.
0:58:09 > 0:58:11Well, going to go round.
0:58:11 > 0:58:12Yeah?