My Amazing Brain: Richard's War Horizon

I got home at about quarter past 11,

half past 11 at night,

and I found him clutching his head in the foetal position,

saying, "Stop this effing pain."

And I knew that there was something very, very wrong.

So I called an ambulance, and they took us to our local hospital A&E.

And slowly I saw him slip into a coma.

And at seven o'clock in the morning,

the doctor said to me, "You should call his children in New Zealand."

Which I knew meant that he was probably going to die.

And we got to King's and

they have an amazing set up there.

Everything just kind of kicked into place,

and the surgeon came to ask for our consent to operate,

and said, "We don't know if Richard will survive long enough to

"have the operation.

"And if he does, he may bleed again on the table.

"And if he does that, the prognosis is not good.

"He'll probably be a vegetable."

There was nothing I could do but wait and hope.

Hope that he survived.

Hope that the surgeon had the skill to save his life.

But also hope, if he did survive,

that Richard, my Richard,

would still be there.

My name is Fiona Lloyd-Davies. I'm a film-maker and a journalist,

and for the past four years,

I've been documenting my husband's battle

back to life after suffering a catastrophic brain haemorrhage.

So, the first time that I heard about Richard

was that the on-call neurosurgical

registrar phoned me up and described to me the condition, which was a

patient who was known to be on thinners to thin the blood,

who'd had a possible fall,

and was found with a diminished and decreasing level of consciousness.

And then a head scan and a CT scan

which showed a large area of fresh

bleeding over the surface of the brain,

on the left-hand side of the brain.

In other words, the part of the brain that controls speech,

is involved in memory,

and gives us a lot of the unique features

that make us the individuals we are.

So it was clear that he could well be left with significant deficits in

memory, in speech, in personality,

and he may well have a quality of life that he may not have valued,

or that his family may have felt on his behalf that he didn't value.

But you have to make a decision at that point as to, OK,

what are we going to do? You haven't got long to decide.

And we decided that we should try.

Then it's speed is of the essence.

So we say, "Time is brain," and it really was.

We took him straight into the operating theatre.

We then raised what's called a trauma craniotomy

or a question-mark flap,

which is a cut that covers one side of the skull.

Drill with an air drill through the skull

to lift up a large flap of the skull

on that left-hand side.

That exposes the outer lining of the brain, what's called the dura.

And underneath that you could see that the dura was tense,

it was bulging,

it was blue,

and there was no pulsation of the brain in time with the heartbeat,

which is what you see with a normal person.

And that showed that there was a large clot sitting over the surface

of the brain, compressing the brain,

and actually preventing oxygen and blood getting to the brain,

and so the brain was actively being damaged by the blood clot.

The brain is like a jelly.

It's like a very delicate jelly.

It's not like this wax brain here,

which I can hold very clearly in my hands.

A real brain is incredibly delicate, incredibly soft.

Problem is if you open the lining of the brain, the dura,

to let the clot out, and you do that too quickly,

the brain can actually start to squeeze out

through the opening in the lining that you've made,

rather like toothpaste through a tube.

Obviously that brain that squeezes out like that,

it's going to be irreparably damaged.

You're not going to get that brain back.

So, very carefully, bit by bit, you extend the cut as you go,

removing a bit of clot, making the opening a bit bigger,

removing a bit of clot, making the opening a bit bigger,

so that hopefully by the time you've finished,

you've uncovered the whole

surface of the brain on that left-hand side.

You remove the blood clot,

and the brain has not started to

swell out through the opening in the dura that you've made.

So, having removed the clot from the surface of the brain,

the decision for me was -

"Have I relieved enough pressure so that Richard's

"going to survive this operation?"

So what we did in Richard's case was we didn't put the bone back.

We left the lining of the brain open,

which allowed the brain to swell a little bit.

And we didn't put that skull back.

So, in other words, there was just

skin and muscle over this area of the brain.

So it allows that little bit of wiggle room,

if you want to think about it that way,

for the swelling to occur in the first few days after the operation.

Once the swelling had gone down,

the catastrophic effect of the stroke was

plain to see, and it looked as if he'd lost half his brain.

As a way of coping, I reached out for my camera

and started to record what happened.

And I also kept a written diary.

"Diary entry, Friday 6th of September.

"He's passed the swallow test and no longer needs a feeding tube.

"He's eating puree - giant leap forward."

Sweetie, how are you feeling today?

Because you're much more awake.

But then on day 30, Wednesday 11th of September, I've written,

"I think Richard's regressing mentally.

"I spoke to the speech therapist. It all seems so gloomy.

"He isn't responding well."

And I've written at the bottom, "I mustn't give up. I must keep trying.

"He will surprise me and surpass all expectations.

"I know."

I always tried to be as upbeat as possible when I was with him,

and be as cheerful and positive,

to help, kind of, engage him back into the real world.

Obviously it was hard, you know?

I felt most of the time like someone's

reaching into my chest and ripping my heart out.

It was very difficult because you felt part of him had gone,

and yet he was still there,

and how could I grieve for my husband when he was still there?

Would Richard ever be Richard again?

You don't want me to film?

OK, I'll turn it off, then, darling.

"Diary entry, Monday 11th of November.

"Three-month post stroke.

"Will he ever get better?

"One nurse said, 'Will you come and help?

" 'You might as well start practising.' "

It was awful because there was a realisation then for me that this

could be our future. This could be the rest of our lives together.

By the end of November, there was good news.

Richard was going to see a surgeon

about replacing the missing part of his skull.

So, when I saw Richard in the November,

which was three months after his stroke and his brain injury,

he had quite a lot of disablement.

He was not moving his right-hand side.

He wasn't speaking.

He also had a very large defect on the left side of

his skull, which meant that his brain had actually moved over

significantly to the right-hand side.

The white here shows the contour of

his outline of his bone of his skull,

and this is the missing segment here.

What happens is, after the initial swelling,

atmospheric pressure

starts to push in on the left-hand side.

So if you look at what is the midline here, this, you can see,

has moved over quite markedly as a result,

and the brain can start to tension.

It can get squashed.

You're moving your leg.

That's really good.

So the planned operation, the

cranioplasty, is where we put a custom-made implant,

which would reconstruct the original contour of the bone.

And as a result, the brain would then expand into that space,

and then move over to the left-hand

side and take away that tension on the brain.

And it's that untensioning of the brain that we believe leads to

improvements in blood supply

and, as a result, improve function.

It's a beautiful day.

I think in Richard's case, he evidently

had such an indrawn defect on that

left-hand side that I felt if we

could normalise that, that would actually

lead to an improvement overall,

so that was the working position.

We were told it could be months

before Richard could have the operation,

so the next important stage was for him to start therapy,

and he was transferred to the

Royal Hospital for Neuro-disability in Putney.

All right, Richard. Off we go.

The plan was for him to start intensive physio, hydrotherapy,

occupational, and speech and language therapy.

OK, so, Richard, what we're going to start off today...

Richard had to wear a custom made helmet whenever he was moved out of

the wheelchair so that it protected the exposed left side of his brain.

Have you got your balance, Richard? Can I let go?

Go on.

Hold it, hold it.

One doctor had told me that a sign of a good recovery is if you can sit

up on your own after four months,

but this was nine months later and Richard still couldn't do it.

Ooh, up, up, up, up, up.

Richard, use those tummy muscles. That's it.

Push those feet down into the ground. Good, OK.

So, Richard, what colour is this?

OK. So what I want you to do is to take this, Richard,

and I want you to put it in the ring that's the same colour.

So you need to look at the ring...

So, is there any rings there, Richard?

No. OK.

It was now also becoming clear that he was having huge problems with

understanding concepts such as shape and colour.

So, is that in a ring, Richard?

Go on.

Reach it. Well done.

-Whoa, that was great. And again.

-Very good.

Good. Lovely.

Now, Richard, what you want, basically,

it's just a trim up, is it?

-Just going to wipe your chin.

-Despite everything,

there were moments of normality.

So, darling, just think,

this time next week you'll have had your plate fitted.

And when we heard that Richard was about to have his operation, he went

and had his first haircut in eight months.

That's such good news.

It's fantastic, isn't it?

Yeah.

I bet you're looking forward to that, aren't you, Richard? Eh?

It'll be fine, darling.

Mr Bentley does it all the time.

Pretty good. Are you happy?

All done, darling.

I was under no illusions that this was a very major operation.

Mr Bentley, the surgeon,

had been very clear that the procedure

coupled with Richard's multiple

health problems made him a very high-risk patient.

So, in terms of the risk of the procedure,

in Richard's case he was already on

blood thinning medication prior to his

original incident,

and he had an irregular heartbeat,

and his heart was a little bit enlarged

and wasn't pumping as well as it could have done,

which predisposed him to a stroke.

So, this is a plate, like one Richard had inserted.

It's been made on a model made from the information from the CT scan.

It would have been accessed via the original scar.

We would have then gently dissected the scalp off the underlying brain.

We would have exposed the defect.

And then the plate would have been

placed and secured through these small holes with screws.

It's important to note that the plate has got perforations in it.

And that's to prevent any blood

building up underneath the plate and on the surface of the brain.

And then the scalp is closed - he has a head bandage.

And in Richard's case the drains

would have come out two days after the

operation and we would have restarted him

on his blood thinning medication at that stage.

Six days after Richard's operation, his daughters, Katie, Bridie,

and Lucy, arrive from New Zealand.

Lucy had brought her seven-month-old baby, Noah,

who'd been born just a couple of weeks after Richard's stroke.

Just... Sweetie, small mouthfuls.

So, you've got to suck it up, Dad.

Suck it up. That's what you always told us.

LAUGHTER

Oh, don't be silly.

Isn't he beautiful, Dad?

Do you want some more?

No, thank you. Yes, please.

Go on, go on, go on.

Come on, darling. You can do it, you can do it.

Look at you.

Wow.

Come on. You can do it, sweetie. Come on, come on, come on, sweetie.

Stand to attention. You can do it, you can do it.

You can do it.

You can do it.

It sometimes seemed to be really tortuous for him,

but I knew if he was going to get better

it was going to be really hard work.

They've got you.

There was a significant improvement on day one.

So, he was able to move his leg, his right leg,

which he was unable to do before the operation,

and he looked bright and well orientated.

-Two more seconds.

-Up tall. Come on.

Stand up. Come on. You're doing really well, darling.

-He's wanting to sit down.

-OK.

We haven't seen a big change in the hand,

but I've seen a change in your leg, more spontaneous movement,

which is good.

Very good, darling.

Is he just showing...? Did it just move?

-Yeah.

-His hand?

-Look at it. Are you filming this?

Yes.

Sweetie, are you moving your fingers for us?

Richard, move your...

The moment Richard moved his finger

for the first time was extraordinary.

Because it came out of nowhere, really. Nobody was expecting it,

and suddenly his finger moved and we saw it.

And it just, for me,

was also a spark of hope that something had reconnected,

something was improving that was completely unexpected.

Especially when you're around, he's much more compliant.

He's managing to hold his sitting balance on his own,

he's able to stand up with the rotor stand and the stand hoist.

Today, movement in his hand.

Cool bananas, darling.

Hello.

Are you showing you can turn your head both ways?

Several weeks later,

Richard went back to see Mr Bentley to have his staples removed.

OK, now, Richard, I'm just going to...

Yeah, you tuck that, Richard.

You did say he was a high-risk patient.

He was a high-risk patient from his heart function,

from his bleeding tendencies,

from all sorts of reasons.

And a big shift in the brain, too.

So, as I said,

not many people would have taken Richard on, I'll be honest.

Erm, and...

I... You know, you don't want to make people worse.

As a doctor, that's your first

pledge to the patients. First, do no harm.

But on the other hand, you know,

if there's a chance of improving things,

then obviously we would like to.

There is lots of evidence that suggests

those patients do better after

what they feel is the reconstruction.

They feel more self, more whole,

and their quality of life scores, if

you compare that after the operation,

compared to before, actually do show improvements.

I mean, I don't know whether it's too optimistic

to think he might be able to walk.

I think, you know,

who am I to say?

If we can save people's lives,

as we do in a major trauma centre like this,

that's only half the story.

And that sort of mind and body reconstruction, if you like,

actually makes for a more complete patient overall.

They're far more engaged,

they're far more open to their physio

and their rehabilitation and their

quality of life is enhanced as a result.

So, what I would say on a practical level with this now, just leave this

for the next three days, and then you can wash the hair.

How do you feel, sweetie?

-There you are.

-Do you want your staples?

Do you want to count them?

It was almost a year since Richard's stroke,

and although there were small signs of improvement,

I was told that he had plateaued and probably

wouldn't get any better.

I refused to accept that this was the end of his recovery.

Then, a year to the day of his stroke,

he was transferred to another NHS-funded

neuro rehabilitation unit in Kent.

The Raphael Hospital is run by director Dr Gerhard Florschutz.

We set Raphael Medical Centre up as an acute neuro rehab unit,

but at the same time we realised

that you cannot just deal with the acute

phase of a rehabilitation programme,

but there is a continuum of care that is required.

And our task is to develop a pathway to enable people to go back into

the community to live a normal life.

When we first assessed Richard, his speech was non-existent.

He had a right-sided weakness.

In particular, he couldn't stand up on his legs on his own.

He had no movement on his right arm.

Can you touch left ear and then touch right ear?

Left ear. Where's your ear?

No, that's your shoulder.

Cognitively, he was very impaired.

So he was quite a complex individual.

But behind that, one could

see there was something there.

There was a, sort of, certain spark in Richard.

And I think that is...

If you can connect to that, then I think the work actually can begin.

There's your right shoulder.

Your left shoulder.

Your right shoulder.

Your left shoulder.

With the right leg. I want you to push with the right leg.

Just the right leg.

-Use, use...

-The right leg.

Push.

-No, I feel only the left.

-Push hard.

-Push hard.

-And then, of course,

he was able to go into the hydrotherapy pool.

-Push it.

-Is that the best you can do?

Push it, push it. Show him you're strong.

And I think in Richard's case, that

was probably the most beneficial because he

could begin moving without the

forces of gravity to prevent that from happening.

Richard, don't rush!

-Richard, slow down!

-Slowly, slowly, sweetie.

That really is the basic principle of hydrotherapy.

The weightlessness that you experience,

the float holds you up in the water, you're in this warm,

supporting environment, and then you become...

You are able to achieve movement

that you haven't been able to do before.

And that is really the starting

point of reconnecting with your whole self.

One, two, three, four.

I knew Richard could be pushed to his physical and emotional limits

because he'd been there before.

18...

..19...

..20...

..21...

He was, after all, a seasoned soldier.

Richard had volunteered in 1992 to serve with the United Nations.

He was sent to the Bosnian capital, Sarajevo...

..where he suddenly found himself in

the heart of a vicious, raging conflict.

Snipers corner Sarajevo, as dangerous today as it has ever been.

People taking a back road to work were open to sniper fire...

He was an unarmed peacekeeper in a place where everyone was a target.

Every day, he faced machine guns, sniper attacks

and mortars, as he crossed the front

lines to try and negotiate an end to the killing.

I know that there are people breaking the ceasefire,

but it is a very fine line of who starts it first.

People have been analysing the information

that we gathered from last

night, the firing last night, and when I get back to PDT,

I expect to... I'll know who started firing last night.

Give me your hands.

It was amazing to see Richard's progress in the hydrotherapy pool.

Sweetie, you've improved so much.

Look at him! He's walking.

Six, seven,

eight, nine...

..16, 17,

18, 19...

The clinic's philosophy of consistent and regular therapy

seemed to be having a really positive effect.

..24, 25...

..26.

First of all, the biggest difference is we work, therapy is seven days a

week. I can never understand how you can run a rehab,

particularly an acute rehab unit,

and stop Friday afternoon and then begin again from Monday morning.

You lose two and a half days,

and it takes you two days to get back what you have lost.

So, we start at seven days a week.

OK, ready, steady, and up.

Up you go.

OK. Well done.

Well done.

OK?

Look at me, darling.

Richard?

Look at me. Walk towards me.

Come on.

The process of relearning to walk,

it's often in a certain way a mechanical problem

that the therapist moves your leg to begin with.

You get the connection with your brain again

that programmes how to make

a proper, controlled movement in space.

Well done.

Darling, don't look out of the window,

just concentrate on what you're doing.

Shift the weight, shift the weight, shift the weight.

-Shift the weight.

-Shift, shift, shift.

Well done. That was good.

-That's really good.

-You're doing it, darling! You're walking.

You're walking, darling.

That's brilliant! Look at you go.

Look at you go, sweetie!

Good. That was really good.

-Really good step.

-One more time.

-Really good step.

-The next step was gradually

to be able to regain his balance

and, once he achieves that, the ability to take the first step.

But in between, of course,

there's a lot of work to be done in terms of movement of the legs,

movement of the arm, movement of the whole body,

the awareness of his physicality.

Even though Richard still needed an enormous amount of help,

there were signs that maybe he was going

to be able to walk, and walk on his own.

And I could see that, you know, he was coming back as a person too.

Because he was starting to be able to be in control of his life,

even though it was happening at a very tiny, tiny snail's pace.

He was coming back.

Richard was becoming reconnected to himself.

As a break from the intensive daily routine,

I took him to a centre that

specialises in treating veterans with trauma.

The unique element of the therapy

this place offers is contact with horses.

And as soon as the horse moved towards Richard,

his response was immediate.

Hello.

Hello. I know, I know.

It was amazing to hear him talk so clearly

and spontaneously to the horse.

I know.

Hello.

Hello.

Hello.

And it was the first time I'd really seen him do something like that

since he'd been ill.

As Richard's recovery progressed,

he also started to do exercises for his mind as well as his body.

The traditional therapies very much work on the physical body.

The creative therapies does much

more work on what I call the soul dimension of man,

the feeling and the thinking level.

And I think that is the most important thing.

To have a recovery in a proper, holistic way,

you cannot just deal with the physical disabilities,

but there's more to the human being than just a physical disability.

And that is what we're trying to encompass here.

HE PLAYS MUSICAL SCALE

The stroke had also affected

Richard's ability to see things on his right side.

Visual neglect is the connection between the eyes and the brain

is disturbed.

The eyesight is usually intact, but

the processing in the brain has been damaged.

Well, in Richard's particular case,

he was not able to see one side of his vision.

What we wanted to do is to re-establish the connection between

his neglected side and the pathway in the brain.

And we worked on that mainly with the art therapy.

We have special exercises that

gradually enable the individual to become

more and more aware of his neglected side.

And I think in Richard's case, it worked very well.

Darling, that's fantastic.

With Richard's physical recovery gathering pace,

the team could now look at

other ways to promote his development...

..and suggested an electric wheelchair.

With some people, you would not

recommend an electric wheelchair because

they will never walk again.

In Richard's case, it's quite different.

With his army background,

and his determination and motivation,

he wants to work, he wants to walk,

he wants to be independent.

And the wheelchair enabled him to make that step,

to make the first step in independence,

but not neglecting in the long-term the ability to walk.

So in his case, it was quite

appropriate to have an electric wheelchair.

Do a whole circle.

Do a whole circle, sweetie.

Ta-da!

All the way, all the way!

Yeah!

Ta-da!

For the first time, he had the

freedom to go wherever he wanted to without

the enormous effort he had to put in to walk.

OK, should we go round?

With this freedom, his gung-ho personality returned.

Beep-beep-beep...

SHE GASPS

Careful! God, you're trying to freak me out!

Go on, then. Just, sweetie, don't have an accident.

Richard had been at Raphael for a year. He'd made huge progress,

and now he wanted to come home.

OK?

OK, off you go.

Two years and one day after his stroke, he returned home for good.

It was an incredible moment to see him walk through the front door...

..and to be home once again.

You're in.

Come and sit down, darling. You walked home.

It was something that I wasn't even sure would ever be possible.

Before you sit down... Leave the chair there, please, darling.

Hang on, hang on, move your hand, hang on.

There.

Having Richard back home, of course, was fantastic.

But it was also hugely daunting because

here was somebody who was 100% dependent on me.

So it was a lot to take on board,

and a very steep learning curve.

Well done.

Right. Welcome home.

Things couldn't have been more different than from when we'd met.

You're amazing.

The aircraft came in with a tight turn, a short landing,

and as fast a turnaround as possible.

In July 1992, I'd flown in to Sarajevo.

Can I have somebody to help?

I'd gone to make a film about my sister, Vanessa,

who was a doctor in the British Army.

They've had analgesia. And...

EXPLOSION

Here we go. They've had some analgesia,

we put some iodine in the wounds,

they've got a drip set up and going, so they're getting fluids.

We're keeping them stable and we

want to get them out as soon as possible.

It was through Vanessa that I met Richard.

Richard was a peacekeeper in former Yugoslavia for almost a year.

He saw the horrors of the civil war first-hand.

SHE CRIES

They could destroy the whole city if they want to.

They have enough firepower out there

to flatten this place ten times over.

His time in Sarajevo led to

post-traumatic stress disorder that would

leave his physical and psychological health in tatters.

It was 13 years before I'd see Richard again.

I decided to contact him after the sudden death of my sister, Vanessa.

He moved from New Zealand to London,

and we were married six months later.

My wedding day was the happiest day of my life.

Richard looked amazing in his scarlet mess dress with his medals.

And we got married at Saint Bride's, the journalist church,

surrounded by friends.

And it was a wonderful day.

Sweetie, think about your shoulder.

Move your shoulder forward.

You can do it.

Two weeks after coming home from Raphael,

Richard suddenly started moving his right arm.

That's it.

Something as simple as pushing a

ball into a cup was a real challenge,

but it soon became part of his daily routine.

For seven months, our lives revolved around therapy,

with Richard making steady progress.

Then he was selected to go on an

intensive three-week programme at the

National Hospital for Neurology and Neurosurgery in London.

It's run by Professor Nick Ward.

So when we saw Richard in clinic,

what we saw was somebody who had

some function in his arm and his hand, but he wasn't using it.

He was still very dependent for help

in day-to-day activities, in washing

and dressing, and feeding himself.

And our view was that, given what he had in his arm and his hand,

that we could show him how to use it.

So, to do something like cutting up a banana,

or use a knife and fork to cut up a steak, for example,

you need reasonable control of your limbs and your fingers.

You need good sensation,

so you need to be able to feel what's going on.

But beyond that, you also need a

concept of what a knife and fork is, and

how you might use them together in order to achieve that task.

So we call that planning.

And Richard did have some problems with planning,

so how you put all of those ideas together

in order to execute the task.

Sweetie, it's good for me to see how much you can do,

because you can actually do a lot.

Yeah, so what?

Yeah, so when we get home, I'm going be getting you to start pulling

your weight. Yeah.

So, Richard's deficits in

movement were not just about weakness.

He did have some weakness, he did have sensory loss,

but he did have problems with planning,

and that's likely to be a

consequence of where the damage was in his brain.

Pick up phone and dial 999.

Right.

Yeah, each hand. It doesn't matter.

And then dial. No, with that one.

Dial.

What Richard benefited from was

what we call hand-over-hand assistance,

so where I would place my hand over

his to help guide the movement in the

right plane of direction using the right force, and I would grade that.

As the weeks went on, he needed less and less help.

Good. Lovely.

So, initially Richard needed

prompting to attempt to pick up the pencil.

And once he was able to reach and grasp the pencil, he had difficulty

manipulating the pencil within his hand

and also orientating the pencil to the paper.

Shall we turn it around, so it's...?

There we go.

Then draw a line across it.

Good.

Lovely.

That's OK. Just the one.

LAWN MOWER STARTS

Get in there!

Go on!

His ability to use the arm in day to day tasks dramatically improved.

Richard always had a passion for gardening,

and now that he was able to move around more independently,

he really threw himself back into it.

But, for me, there was a difficult

balance and tension between encouraging

him to do more, but also to hold him back so he didn't overdo things.

Sweetie, don't you think you've done enough?

-What?

-Don't you think you've done enough?

Get out of here.

Go away.

I had to learn to step back and let him take risks,

whatever the outcome might be.

When we've talked to people who've been through the programme,

they do describe it as intensive.

They call it a boot camp.

It's fatiguing,

but actually there's something exhilarating about that,

being given the opportunity to work that hard

is something that I think people really value.

Six months after the upper limb programme,

Richard was making such remarkable progress that he was now able to use

his right hand to copy a daily writing exercise.

One. That's much better.

That's much better. Two.

Five of these. Six.

Very good. Seven.

Very good.

Eight.

Physically, Richard was now pretty independent,

and so when we went for his final assessment

at the upper limb programme,

he was able to walk in on his own unaided.

What's important about the programme is demonstrating change,

so providing evidence that we make a difference.

Because what's important is not just the ability to change after an

intensive three-week programme,

but actually what's absolutely key is that those gains are maintained.

To your ear.

There aren't any other programmes

that work with people this intensively...

..that delivers high dose, high intensity rehabilitation,

specifically for the upper limb.

So our responsibility at a place like Queen's Square

is to show what's possible.

Lovely.

And part of that is measuring what we do,

so we have outcome scores at admission,

at discharge, six weeks, and six months.

And if we can show that there are measurable and meaningful changes in

a higher proportion of people that come through that programme, then

our hope is that this will change the way rehabilitation is delivered.

Richard's recovery had gone far beyond everyone's expectations.

So much so that he could now even climb a flight of stairs.

Slowly, Richard.

Great.

So the scores, though... I mean, the scores have improved a lot.

Yeah.

The action research arm test was 26 out of 57 when you came in.

-It's now 48 now out of 57.

-Yeah.

-Wow.

-So that's an improvement...

-Amazing.

-..of 22 points.

It is emotional. There's something about just giving people some hope.

Hope that we think is realistic, you know?

Reopening those doors, which is...

Yeah, it is quite emotional.

-But look at it. That's...

-That's really improved, hasn't it?

-That's incredible.

-Great progress.

-You're a star.

-Yeah.

You have to use two hands, sweetie.

Despite all the improvements that Richard had made,

we lived in virtual silence.

He was very good at communicating without using words,

but we weren't able to have a conversation.

Tell me how you are. How are you feeling?

HE APPROXIMATES RESPONSE

If he was going to be able to talk and understand language again,

he'd need intensive therapy.

I feel like a paper-based low technology...

After finding a source of funding, Richard was able to start weekly

speech and language sessions with Liz Williamson and her assistant,

Laura.

Fruit. Grapes,

or teddy? What do you do with fruit?

Do you...

-..eat it?

-Yeah.

Yeah? So, which one of these would you eat - grapes or teddy?

He presented as

severely impaired, in terms of his

ability to understand the spoken word.

So, which one of these...

..goes with toothbrush? Cheese, toothpaste,

or globe?

Cheese?

And it's just a little bit like filing away books in a library.

Because Richard's working library was completely thrown up in the air.

And he, or we, needed to re-categorise, slot in place,

all of those words.

How about engine?

Which one of these has an engine?

One of those two. You're right. It is one of those two.

So, we worked on this level for many months, actually.

And he started to show some real improvements.

Which one of those two things has an engine to power it?

Yeah, a car. Well done, Richard.

The last word is locker.

Very good. You need a key to open your locker, don't you?

Fabulous. Well done.

Sometimes Richard's new-found confidence went a bit too far.

Darling, have you fallen over?

Oh, sweetie.

I'm OK. I'm OK.

Darling...

Oh, sweetie.

I just... I'm fine.

Thank you, darling.

Oh, good stuff.

-Thank you.

-Because the thing is you could break your leg, darling.

I'm OK.

I know you're OK now, but you might not be.

-I am.

-You all right, sweetie?

-Yeah.

-You all right?

Richard always loved driving,

so as a treat I arranged a day out

at Brands Hatch to have a go on their

driving simulator.

This wasn't just for fun.

I'd also arranged to meet Professor Mike Merzenich,

one of the world's leading neuroscientists.

He'd agreed to assess Richard

and offer some advice on how we

could push Richard's recovery even further.

-Nice to meet you again.

-Nice to see you.

And you.

Great, thank you.

Have a go at getting in.

-OK.

-Yeah? Just be careful.

Put that leg first.

People that have left sided brain injuries

usually have problems expressed

on the right side of the action, you could say.

Both in movement control,

and if they have any problems with vision,

it'll relate to the right side as opposed to the left side.

So a driving simulator is a pretty good environment to determine...

To show whether or not he has strongly asymmetric control.

It's going to show us whether or not he sees things adequately across the

field of vision. It's going to show us pretty clearly whether he can

control his actions across the horizon.

So it's a good, simple way to get an

overall read of how he's doing in his

action control as he's drinking in information from vision.

That's good.

That's good.

After a bit of a shaky start, Richard was amazing.

He could do it. Follow the road out.

Yeah, you're not on the... Not on the track yet.

It looks like a proper racetrack.

That's good. That's good.

-Getting the hang of it now.

-Well, that's good. He's managing the

lateral peripheral vision pretty well there.

Good.

He has a really excellent control in this complex visual flow field.

Things are coming at him very rapidly.

He's making judgments about how to change his control,

and this is pretty impressive.

He's come a long way.

Before he made the wrong turn on that bit.

Now he's made the correction.

It was great to see him driving.

He was a very good driver once and I think he really enjoyed himself.

How well do you think you did?

Do you think you did a good job?

Well, it was very hard, but I thought it was very good.

Overall, you did a good job.

-Oh, very good.

-Yeah.

It's all about continuing to drive your brain in a continually more

positive direction. He can go a lot farther still.

He's gone a long distance,

but the whole idea is to see life as a progression of getting better and

better in life, as long as you can.

And he has a lot farther that he can go.

-And you're prepared to work hard, aren't you?

-Yes, I do.

Yeah. You're good at that. You're very good at that, sweetie.

After his meeting with Professor Merzenich,

Richard's daily routine now included a new set of exercises and games

designed to stimulate his brain.

No, that's good. That's good.

-No!

-Yes.

Although he didn't enjoy them as much as driving.

Let me show you. Let me show you. Let me show you.

-You're showing wrong.

-No, no, no, look.

I mean, sweetie, if it was easy, there would be no

point doing it, would there?

Less effort.

After all the hard work, Richard's now able to enjoy doing some of

the things that he used to do.

That's it. Pop that thumb back on...

That's brilliant from there.

-That's more like it.

-Now we've got it.

Now we're getting the hang of it.

-One more go.

-Yeah.

I think it's very clear,

having seen what Richard's like now,

that the extent of recovery that

he's had has exceeded what I would have expected or possibly predicted,

and that, you know, makes me feel great.

You know, I think all the staff who were involved in Richard's care,

it really justifies what they did,

and it's the sort of thing that

makes them come back into work each day.

So, I think our increasing awareness of how much potential recovery there

is in the adult brain, which is something that's relatively new...

We've always been taught the adult brain, once damaged, can't recover.

We know that's not the case now.

It means that the onus on us is now not just to save life, but to try

and preserve as much brain as possible

so that the patient has the potential for maximal recovery.

As we say in neurosurgery,

we're taught that the brain doesn't get better in a bucket.

If you remove that bit of brain,

whatever you do, it can never recover.

You want me to switch the lights off?

That's because we're filming. We're filming.

Sorry.

Sorry.

I want you to pick up all of the blocks that aren't blue.

When we first began to appreciate the brain was plastic,

continuously changing itself,

and that we could conceivably control it for human benefit,

I thought that this would sweep

across medicine and science like a flash.

Good job.

But still, it's a hard-won fight to drive this into medicine.

Now that you're doing so well, we have to make it harder.

-OK.

-OK? The coin goes somewhere.

We can apply plasticity to help

people who struggle be in a better position.

Perfect.

Perfect. But it's a resource that's valuable to every human being.

And they should understand they have this potential,

they have this power to drive their brain into a stronger,

better position.

We should all take that to heart.

We should all live life to the advantage of this

and take advantage of it,

to have a better and stronger life.

18 months after Richard left Raphael,

he returned to show them how much progress he'd made.

-That's great.

-It's a great change, great change.

That's really good.

Really good. Thank you.

Looking at his journey over time,

I mean, every time you see him he has done another step.

Of course he will improve. And I think one must never give up.

Rehabilitation is a lifelong process.

And the human being has this wonderful ability

to regenerate in a real sense.

It's like on the parade ground, isn't it?

Look at that.

And I think one never can underestimate the importance of

relatives, particularly close relatives,

as part of the treatment process.

The point is that relatives can be part of the therapy team in the most

important way, and that can be only beneficial.

-Let's demonstrate.

-Great, yeah.

Left, right...

You know, it's an exciting moment

for all of us to see how he continues making his

recovery. And I think that always we have to remember,

never write any individual off.

Everyone has the possibility to make progress.

Good to see you.

Thank you very much.

I hope it all goes well. And keep in touch, yeah?

-That would be great.

-So good to see you.

Thank you very much.

If you see a patient coming in in a vegetative state,

and see them actually walking out of the front door,

that is what our work is about,

and that is the most uplifting experience you can have.

This is coming out as well.

See?

Mm-hm.

Got another one here.

Need to take this one out.

There, see?

That one right there.

MILITARY MARCH PLAYS

30 years of service in the New Zealand Army

and three wars.

I did things that other people weren't prepared to do.

I took extreme risks...

..in an extreme situation.

But life goes on.

For the first time in years, Richard wanted to be part of the annual

ceremony that had meant so much to him throughout his army career.

Anzac Day, the national day of

remembrance for Australia and New Zealand.

They shall not grow old as we that are left grow old.

Age shall not weary them, nor the years condemn.

At the going down of the sun and in the morning,

we will remember them.

MUSIC PLAYS: The Last Post

Richard used to say to me,

"Fi, I'd walk over a mile of broken glass for you."

And the past four years have been my chance to do the same thing for him.

It's been an honour and a privilege to look after him,

and it's probably the most rewarding thing that I've ever done.

-You're fantastic.

-Yeah.

-Yes.

-I know.

-Awesome.

-I know.

Well done, darling. You're brilliant.

I know.

Well, going to go round.

Yeah?