0:00:12 > 0:00:22Happy birthday to you, happy birthday to you, happy birthday
0:00:22 > 0:00:32
0:00:32 > 0:00:41dear Alex, happy birthday to you! Alex, blow! We are both 19 now so
0:00:41 > 0:00:46we are both grandads! Not the ideal place to envisage him spending his
0:00:46 > 0:00:5190th but you have to make the best of things. You are doing so well
0:00:51 > 0:00:57and looking even more well. As soon as you are home, you can get back
0:00:57 > 0:01:00to the good old days. Stay strong, mate. All my love. He had been out
0:01:00 > 0:01:06with his friends for one of his best friend's 18th birthday party.
0:01:06 > 0:01:10There was a big group coming back on the bus. Pianist is bus stop.
0:01:10 > 0:01:15Alex are being Alex and being extremely impulsive decided he was
0:01:15 > 0:01:20not going to wait, he opened the emergency doors and walked off. It
0:01:20 > 0:01:25was going at 25 miles an hour, he missed his footing, landed on a
0:01:25 > 0:01:29parked car and bounced off and landed on his head. He might make a
0:01:29 > 0:01:32complete recovery, he might make no recovery whatsoever. That is the
0:01:32 > 0:01:37one thing doctors have been consistent about right the way
0:01:37 > 0:01:40through, they cannot tell us anything. Some people with really
0:01:40 > 0:01:43bad brain damage can make incredible recoveries and some
0:01:43 > 0:01:48people with a tiny knock on the head can die.
0:01:48 > 0:01:55This is a film about patients who have no voice. About parents who
0:01:55 > 0:02:01want to communicate with their loved ones. Michael, Michael, it is
0:02:01 > 0:02:05mum and dad. And the people trying to help them. Young men who have
0:02:05 > 0:02:11suffered traumatic brain injuries and emerged from a coma into a
0:02:11 > 0:02:16twilight world, awake but not necessarily a where. I am going to
0:02:16 > 0:02:19ask you a question about you and the way you are feeling. But now
0:02:19 > 0:02:28the hope is to reach inside the closed world of their minds and
0:02:28 > 0:02:34make contact. Imagine. Is this the most significant question you have
0:02:34 > 0:02:38ever asked a patient? By a long shot, yes! If scientists can
0:02:38 > 0:02:44release their thoughts, it can release them from a silent world,
0:02:44 > 0:02:53unlocking feeling and memories and giving them back a voice. That was
0:02:53 > 0:03:03really exciting. You answered the questions right, fabulous. That is
0:03:03 > 0:03:11
0:03:11 > 0:03:16In all the years I have been reporting from the BBC, I have
0:03:16 > 0:03:20wanted to tell the story of these patients, and with a unique access,
0:03:20 > 0:03:23now can. I have come to the Royal Hospital for Neuro-disability in
0:03:23 > 0:03:33London which specialises in the rehabilitation of brain injured
0:03:33 > 0:03:38
0:03:38 > 0:03:42patients. This is Alex. Staff here will try to assess whether he is
0:03:42 > 0:03:47minimally conscious with fragments of understanding or vegetative,
0:03:47 > 0:03:55with no awareness at all. There are thought to be hundreds of patients
0:03:55 > 0:03:59like him in Britain. Hello, Alex, my name is Clare. You are at the
0:03:59 > 0:04:04Royal Hospital for Neuro-disability. We are going to work together now.
0:04:04 > 0:04:09The hospital has pioneered an assessment programme called SMART
0:04:09 > 0:04:15which explores all five senses, looking for the smallest physical
0:04:15 > 0:04:23responses, anything that might show awareness and allow communication.
0:04:23 > 0:04:27Look at no. We are looking at all the individual senses and breaking
0:04:27 > 0:04:31them down separately so we have a chance to know which areas Alex
0:04:31 > 0:04:38might be responding to. We are trying to see where his response
0:04:38 > 0:04:41levels are. The challenge is to work out whether Alex's brain can
0:04:41 > 0:04:47process site and sounds or are his responses just in voluntary
0:04:47 > 0:04:56reflexes. I would like to know if there is recognition, if there is
0:04:56 > 0:05:00consciousness, if he is happy. Yes, basically, what the levels are.
0:05:00 > 0:05:05Nobody can ever tell us what to expect and what the prognosis is
0:05:05 > 0:05:12really going to be but I would like to know where he is, how alert, how
0:05:12 > 0:05:19conscious. The day after his accident we all went to the pub, a
0:05:19 > 0:05:25great excuse to go to the pub, and signed it. That was his first card
0:05:25 > 0:05:30he ever got. Jess is Alex's girlfriend. There had been going
0:05:30 > 0:05:37out for four months when he had his accident. These are the boys, the
0:05:37 > 0:05:46lads. I think that was prom night. The beer in their hands. There is
0:05:46 > 0:05:50Max, Matt, Liam and Alex. Part of his skull had to be removed and his
0:05:50 > 0:05:56brain is compressed. Beset with health problems, he appears on
0:05:57 > 0:06:05responses. Family, tell me a bit about Alex, what was he like before
0:06:05 > 0:06:14his accident? Vibrant! Fun. A nightmare! Always difficult, but
0:06:14 > 0:06:18absolutely wonderful. Sorry. I'll be all right, I'll be all right. It
0:06:18 > 0:06:24is difficult because everyone asks you the same question, how is your
0:06:24 > 0:06:34boy? He is asleep. Does he recognise you? I don't know. Does
0:06:34 > 0:06:35
0:06:35 > 0:06:39he talk? No. You answer that 10 or 15 times a day sometimes.
0:06:39 > 0:06:47He woke up for a little bit but he sort of wakes up for 10 minutes and
0:06:47 > 0:06:51then his of St -- then he is asleep for three hours. You have got to
0:06:51 > 0:06:56patient with it. I talk to him. I think if I was him I would want
0:06:56 > 0:07:06someone to talk to made all the time. I talked to him and tell him
0:07:06 > 0:07:14
0:07:14 > 0:07:22he looks better every day. I hope This is Michael. Hello, Michael.
0:07:22 > 0:07:29Michael, it is mum and dad. knowing if he can remember anything,
0:07:29 > 0:07:34his parents tell him who he is every time he sees him. Your name
0:07:34 > 0:07:39is Michael Edward Taylor. When you went to school we used to take you
0:07:39 > 0:07:44there in the car because it was too far to go by bike. Do you remember
0:07:44 > 0:07:48we used to go over that bridge where dad hit it one day in the ice.
0:07:49 > 0:07:55It scratched his car. You were in there with me at the time. I was
0:07:55 > 0:08:01really cross, wasn't tired? What the families want to know, are
0:08:01 > 0:08:08their words fallen into a void? What is it that remains within? Are
0:08:09 > 0:08:14their thoughts, memories, recognition? Injured in a car
0:08:14 > 0:08:23accident, Michael has already been diagnosed as being in a vegetative
0:08:23 > 0:08:28state. But the RHN has a reputation for detecting awareness that others
0:08:28 > 0:08:32have missed and his parents would like a second opinion. On a good
0:08:33 > 0:08:37day I would like to think there is some level of understanding. But if
0:08:38 > 0:08:43I am really depressed, I am not so sure. I do generally feel there is
0:08:43 > 0:08:48something. One of the problems is, you do not know what he sees. He
0:08:48 > 0:08:52cannot tell us if it is a shadow, an image, light or dark. He may see
0:08:52 > 0:08:58fairly well but he does not understand what he sees. He may not
0:08:58 > 0:09:02even recognise us. That is what this test is all about, is there a
0:09:02 > 0:09:08possibility, is there something inside him? This one area that we
0:09:08 > 0:09:18can work on and maybe things will work out from there. That was
0:09:18 > 0:09:30
0:09:30 > 0:09:39Coffey. To you remember some of the What did we do next? We decided we
0:09:39 > 0:09:45wanted to be a chef. I did not see that one coming. That was sold.
0:09:45 > 0:09:52came to your meals are you did at college. They were really nice. I
0:09:52 > 0:10:02remember the pudding, I think it was a trio of lemon puddings.
0:10:02 > 0:10:14
0:10:14 > 0:10:20X-rays were taken two days ago. Something else which haunts the
0:10:20 > 0:10:25families is the idea their sons could be in pain. Vegetative
0:10:25 > 0:10:35patients make me flex muscle responses. -- reflex muscle
0:10:35 > 0:10:44responses. All right, Alex. Sorry. It looks like real distress but if
0:10:44 > 0:10:54Alex has no awareness, his brain cannot perceive pain. Clearly, it
0:10:54 > 0:10:58
0:10:58 > 0:11:03To minimise any risk of discomfort, Alex is measured for splints. These
0:11:03 > 0:11:09will stretch Lynn's the left and rigid because signals from the
0:11:09 > 0:11:18brain have stopped. It will mean he has something to wear to give him a
0:11:18 > 0:11:27prolonged stretch because at the moment his hands rest quite bent.
0:11:27 > 0:11:37The strapping is all in place. Perfect. That is good. Well done,
0:11:37 > 0:11:42
0:11:42 > 0:11:49Michael's parents are about to get the results following weeks of
0:11:49 > 0:11:58physical assessments at the Royal Hospital for Neuro-disability.
0:11:58 > 0:12:03of the reasons for his admission is for a second opinion. Clinically,
0:12:03 > 0:12:09after all these bedside assessment and SMART assessment and
0:12:09 > 0:12:15assessments by other disciplines as well, it is confirmed that he is in
0:12:15 > 0:12:20a vegetative state. The diagnosis that Barbara and John feared is
0:12:20 > 0:12:25confirmed. But the RHN offers something unusual, a research
0:12:25 > 0:12:32project at Addenbrooke's Hospital in Cambridge where neuroscientists
0:12:32 > 0:12:36will use brain scans to look for hidden awareness. I know we have
0:12:36 > 0:12:40had a fabulous job done here and when they say put your mind at rest,
0:12:40 > 0:12:47it is hardly the feeling you get when you are finally told that
0:12:47 > 0:12:52Michael is in a vegetative state. Although it has closed some doors,
0:12:52 > 0:12:56there are still doors open so I think it is vitally important that
0:12:56 > 0:13:02we go to Addenbrooke's and especially, it bothers us both
0:13:02 > 0:13:10quite a lot, we do not want to think he is ever in pain and we are
0:13:10 > 0:13:15not there to look after him. As a standard finding in a vegetative
0:13:15 > 0:13:22state, they do not perceive pain but they could respond reflexively
0:13:22 > 0:13:27to application of any pain. would jump. That is right.
0:13:27 > 0:13:32diagnosis means Michael is unaware of himself or the world, but it
0:13:32 > 0:13:36also confirms that he is not suffering. Sometimes when he looks
0:13:36 > 0:13:41at me I think, is he trying to get something through. It is very
0:13:41 > 0:13:44difficult to accept that that is probably not the case. I think it
0:13:44 > 0:13:49is a question of coming to terms, is Michael better off in a
0:13:49 > 0:13:53vegetative state, if been totally unaware, or having some awareness
0:13:53 > 0:13:58and living a very difficult life. As a mother, I'm not sure I would
0:13:58 > 0:14:02not choose the vegetative state but you always want hope. The trouble
0:14:02 > 0:14:07is, you want a big improvement, you do not just want some improvement.
0:14:07 > 0:14:12You want life worth living. A what the family would like to know is,
0:14:13 > 0:14:17is there any brain activity or cognitive activity? If it is there,
0:14:17 > 0:14:22then of course that will give them some hope. It it is not there,
0:14:22 > 0:14:31again it is helpful as well because it gives them an opportunity to
0:14:31 > 0:14:34come to terms with the disability Michael is on his way from Putney
0:14:34 > 0:14:36to Addenbrooke's Hospital in Cambridge. After weeks of
0:14:36 > 0:14:46painstaking observation, a brain scanner will search for hidden
0:14:46 > 0:14:56
0:14:56 > 0:15:03awareness. Could a machine find Science may provide the answers the
0:15:03 > 0:15:06families are looking for. And the work of this man, neuroscientist
0:15:06 > 0:15:09Professor Adrian Owen. I first came across Adrian's
0:15:09 > 0:15:13research when he used a brain scanner to detect awareness in a
0:15:13 > 0:15:22patient who was really incapable of responding in any way and seemed to
0:15:22 > 0:15:24be in a vegetative state. And this really is a landmark discovery.
0:15:24 > 0:15:27It's got huge implications, legal implications, implications for
0:15:27 > 0:15:30clinical care, for medical ethics, and so on and so forth.
0:15:30 > 0:15:34So, Adrian, let's start off with a very easy question, what is
0:15:35 > 0:15:40consciousness? Whoa! I thought you were going to
0:15:40 > 0:15:42throw me a soft ball to start off with, Roger! Consciousness.
0:15:42 > 0:15:48Professor Owen is a neuroscientist who specialises in searching for
0:15:48 > 0:15:50consciousness in patients on the edge of awareness. His research,
0:15:50 > 0:15:53published in leading medical journals, has seen him dubbed 'The
0:15:53 > 0:16:01Mind Reader' through the use of fMRI, functional Magnetic Resonance
0:16:01 > 0:16:06Imaging. FMRI is a technique that we use for
0:16:06 > 0:16:08looking at brain function. We've been using it to explore whether
0:16:08 > 0:16:14any patients who appear behaviourally vegetative, or
0:16:14 > 0:16:17minimally conscious, can actually do more with their brains. Is it
0:16:17 > 0:16:20possible that they can activate parts of their brains in a way that
0:16:20 > 0:16:30would allow us to conclude that they've got some residual functions
0:16:30 > 0:16:38that are not apparent from clinical Michael will be given simple
0:16:38 > 0:16:41instructions, to see if he can respond with his mind.
0:16:41 > 0:16:45We're going to ask him to think of certain things and we're going to
0:16:45 > 0:16:50see if we can pick up the brain activity that is associated with
0:16:50 > 0:16:53him thinking those things. OK, you are doing ever so well.
0:16:54 > 0:16:57One of the interesting things about the brain is, if you imagine doing
0:16:57 > 0:17:02some things, the areas that will be activated are the very same areas
0:17:02 > 0:17:06that will be activated if you were to actually do those things.
0:17:06 > 0:17:10And we'll ask him to imagine playing a game of tennis. Now the
0:17:10 > 0:17:12reason we do this is not because we want to know whether he can play
0:17:12 > 0:17:16tennis, but when people imagine playing tennis, it always activates
0:17:16 > 0:17:20an area called the pre-motor cortex, right here. In which case, we'll be
0:17:20 > 0:17:24able to detect that in his brain, and we'll know that he is making a
0:17:24 > 0:17:27response. It's not a response with his body, but it is a response with
0:17:27 > 0:17:31his brain. Well done, you're doing really well
0:17:31 > 0:17:34there. Well done. OK, we're just doing a couple of
0:17:34 > 0:17:36quick structural scans, just to make sure we have Michael in the
0:17:36 > 0:17:41correct position. OK, Michael, we're going to start
0:17:41 > 0:17:45the scan now. We want you to try and imagine something for us. You
0:17:45 > 0:17:49are going to hear just two words. You'll either hear the word
0:17:49 > 0:17:52"tennis" or you'll hear the word "relax." When you hear the word
0:17:52 > 0:17:56"tennis," I want you to really imagine that you are playing a game
0:17:56 > 0:18:00of tennis. Just keep imagining playing tennis, and do that until
0:18:00 > 0:18:06you hear the word "relax," and then what I want you to do is to just
0:18:06 > 0:18:10rest. And we'll do that a few times backwards and forwards between
0:18:10 > 0:18:18imagining playing tennis and then relaxing.
0:18:18 > 0:18:21Off we go, then, guys. So the areas that are in red.
0:18:21 > 0:18:24The scanner can pinpoint the areas of the brain that are working
0:18:24 > 0:18:28hardest while someone is thinking. These receive more oxygen-rich
0:18:28 > 0:18:32blood, which show up as red blobs on the screen.
0:18:32 > 0:18:35So it's the areas in red that we're really interested in.
0:18:35 > 0:18:38Initially, Michael's scan looks promising.
0:18:38 > 0:18:47But as you can see, it's actually very variable.
0:18:47 > 0:18:52Michael's brain activity must follow the pattern of commands for
0:18:52 > 0:18:57the team to conclude that he is responding. Otherwise, it could be
0:18:57 > 0:19:01chance. They said you were absolutely
0:19:01 > 0:19:11brilliant. His parents will get the results
0:19:11 > 0:19:12
0:19:12 > 0:19:14later. The use of brain scans to search
0:19:14 > 0:19:24for awareness has sparked international interest, such as in
0:19:24 > 0:19:28
0:19:28 > 0:19:35Canada. List is the City of London, Ontario. -- this is.
0:19:35 > 0:19:41This is Scott. For over a decade, every medical assessment has
0:19:41 > 0:19:46concluded he is vegetative. But his parents, Jim and Anne, are
0:19:46 > 0:19:53convinced Scott can respond. Give us a thumbs-up, Scott, if you
0:19:53 > 0:19:58want Dad to drive! What do you think? You're not going to make a
0:19:58 > 0:20:04decision. Give us a thumbs-up!
0:20:04 > 0:20:09Or maybe you are saying no? You don't want Mum in your face. I
0:20:09 > 0:20:16think he's shutting us out. You just don't want to respond right
0:20:16 > 0:20:19now, do you? He was crossing an intersection and
0:20:19 > 0:20:29he got hit by a police car, and it just T-boned him, sent him spinning
0:20:29 > 0:20:34
0:20:34 > 0:20:38down the street. And it was just catastrophic.
0:20:39 > 0:20:44Catastrophic, yeah. They really gave us no hope
0:20:44 > 0:20:49whatsoever. They gave him two years to live, and that's 12-and-a-half
0:20:49 > 0:20:55years ago. At the hospital, most of the staff
0:20:55 > 0:21:00go with the party story that he is vegetative.
0:21:00 > 0:21:05Do you think Scott can understand what you're saying to him?
0:21:05 > 0:21:14Oh, yes, yeah, he does. And he responds and he uses his eyes, he
0:21:14 > 0:21:20uses his thumbs, for yes and no. Hi, Scott, it's Brian Young, Dr
0:21:20 > 0:21:26Young here. Could you try just lifting your thumb for me to
0:21:26 > 0:21:30command? Just lift your thumb up? You've been his doctor for ten
0:21:30 > 0:21:37years? Yes, I've seen him repeatedly and
0:21:37 > 0:21:40I've never seen any evidence of responsiveness in Scott. Do you
0:21:40 > 0:21:48think perhaps that it's either that he'll do it for his family, or
0:21:48 > 0:21:51perhaps it's wishful thinking on their part? Yes, it's hard to say.
0:21:51 > 0:21:54It could be that it's inconsistent, that he sometimes does respond in a
0:21:54 > 0:22:04meaningful way to them, but one has to go with one's own observations,
0:22:04 > 0:22:11
0:22:11 > 0:22:19and I think there is the Scott is on his way to the
0:22:19 > 0:22:23University of Western Ontario. There we go.
0:22:23 > 0:22:27He'll meet Professor Owen, who's now based in Canada.
0:22:27 > 0:22:30Scott, right, this is your big chance. We really want you to try
0:22:30 > 0:22:33as hard as you can to imagine playing tennis for us. OK, we're
0:22:33 > 0:22:37going to ask you to imagine playing tennis quite a few times while you
0:22:37 > 0:22:43are in the scanner. And if you can do that, then we'll be able to see
0:22:44 > 0:22:47your brain activating. So I want you to imagine you are standing on
0:22:47 > 0:22:51a tennis court and moving your arm around as much. As you can, all
0:22:51 > 0:22:55right? So we're going to put you in the scanner now, just do your best,
0:22:55 > 0:22:58stay awake. This is a big challenge for brain-
0:22:58 > 0:23:04injured patients. It requires hearing, recall, understanding, a
0:23:04 > 0:23:09functioning mind. OK, Scott, it's Adrian speaking,
0:23:09 > 0:23:19and we're ready to start the first scan. This is where I want you to
0:23:19 > 0:23:25
0:23:25 > 0:23:30We've got a little bit of activity OK, yeah, we've got something.
0:23:30 > 0:23:36OK, this is what we want, here. OK, so we've definitely got more
0:23:36 > 0:23:38activity than we had previously. Something remarkable is happening.
0:23:39 > 0:23:48Confounding more than a decade of medical assessments, Scott is
0:23:49 > 0:23:53
0:23:53 > 0:24:00We're on tennis. Yeah? That's looking pretty good, actually,
0:24:00 > 0:24:04Fergus. That's quite striking, isn't it?
0:24:04 > 0:24:07Yes. Scott's been in the scanner more
0:24:07 > 0:24:14than an hour and needs a rest, but the team feel his responses clearly
0:24:14 > 0:24:24suggest awareness. Didn't you do good in there? I
0:24:24 > 0:24:32
0:24:32 > 0:24:36heard you did real well. He would like you to come back
0:24:36 > 0:24:39tomorrow. Because he said you are doing so well that he'd like to try
0:24:39 > 0:24:43a few more things tomorrow. Do you think you'd be up to it? Where's
0:24:43 > 0:24:53your hand? You trying to give us the thumbs-up? There, we got a nice
0:24:53 > 0:25:03
0:25:03 > 0:25:09big thumbs-up. OK, he's willing to OK, Steven, going to let you listen
0:25:09 > 0:25:14to some of your book, Pillars of the Earth, OK?
0:25:15 > 0:25:24Life can change utterly in a moment. All the families in this film know
0:25:25 > 0:25:29
0:25:29 > 0:25:32He was driving to work when his van came off the road in ice and hit a
0:25:32 > 0:25:38telegraph pole. Are you going to turn your head
0:25:38 > 0:25:41around? Thank you. The clustered shafts of the piers
0:25:41 > 0:25:45rose gracefully through the gallery and became the ribs of the vault,
0:25:45 > 0:25:49curving over to meet in the middle of the ceiling.
0:25:49 > 0:25:52Steven was very easy as a kid. No problems with him. I mean, he
0:25:52 > 0:25:55wasn't a push-over, don't get me wrong. He had his own mind, but
0:25:55 > 0:26:00Steven was the type of person, if you really had a real blow-out with
0:26:00 > 0:26:01him, five minutes later, "Hi, Mum, can you get" you know? He was that
0:26:01 > 0:26:04type of person. He would come around.
0:26:04 > 0:26:09He wouldn't be holding back for days and not speaking, he'd just
0:26:09 > 0:26:14come around, just like that. He was pretty active, into different kinds
0:26:14 > 0:26:20of sports. He had lots and lots of friends. He liked his family, very
0:26:20 > 0:26:22family-oriented. But Steven cannot communicate what
0:26:22 > 0:26:32memories he has of weddings, family celebrations, life before his
0:26:32 > 0:26:33
0:26:33 > 0:26:36accident. Or whether he knows who or where he is.
0:26:36 > 0:26:41The doctor who was on at the time took us aside and said, he
0:26:41 > 0:26:44basically said that he didn't think it was too bad at this point. He
0:26:44 > 0:26:47said that he kind of expected Steven to come around between 12
0:26:47 > 0:26:53and 16 hours. He actually stayed in a coma for three-and-a-half months.
0:26:53 > 0:27:00And then at some point, he did open his eyes. But he didn't wake up in
0:27:00 > 0:27:06the sense. No, no. That we would understand it.
0:27:06 > 0:27:10That's right, yep. Sorry, Steven, this is a little bit
0:27:10 > 0:27:16different from the usual. In the search for answers, Steven's
0:27:16 > 0:27:22parents, originally from Glasgow, have brought him to Professor Owen.
0:27:22 > 0:27:32What are you hoping to learn here? We've always felt that Steven is in
0:27:32 > 0:27:35
0:27:35 > 0:27:39there, right? And we've used different techniques about trying
0:27:39 > 0:27:43to get him to answer for a yes or a no. It might be two blinks of an
0:27:43 > 0:27:46eye for a yes, the raising of his hand for a yes. And definitely, at
0:27:46 > 0:27:50times, he can do that, but it's not consistent. So even ourselves,
0:27:50 > 0:27:54we're always left with, was he just blinking his eye right now, or was
0:27:54 > 0:28:04that just a natural movement, or did he definitely say yes?
0:28:04 > 0:28:05
0:28:05 > 0:28:08John and Ann have been hoping for When you hear the word tennis, what
0:28:08 > 0:28:13we want you to do is to imagine that you're playing a game of
0:28:13 > 0:28:15tennis. Now, I don't need you to run around the court, you can stand
0:28:15 > 0:28:20still. Tennis.
0:28:20 > 0:28:24Yep, that is really, really cool. Just like Scott, Steven's brain
0:28:24 > 0:28:27activity is matching the commands he's being given in the scanner.
0:28:27 > 0:28:31And we're seeing this activity right at the top of his brain, and
0:28:31 > 0:28:35those are in the motor regions. Those are the areas of your brain
0:28:35 > 0:28:39that if you were able to play tennis, those are the areas of your
0:28:39 > 0:28:45brain you'd use to produce those types of movement. So that's very
0:28:45 > 0:28:50exciting. Good, good.
0:28:50 > 0:28:55That was really exciting. This is strong evidence of
0:28:55 > 0:28:59awareness. But can he do more? The question is, what do we do
0:28:59 > 0:29:02next? We could ask a question, something
0:29:02 > 0:29:04that's actually relevant to him. I was wondering if there's
0:29:04 > 0:29:07something that might be relevant to him?
0:29:07 > 0:29:17The team plan a series of personal questions only the family could
0:29:17 > 0:29:21
0:29:21 > 0:29:31He's moving in the scanner - so the team cannot interpret the results.
0:29:31 > 0:29:37
0:29:37 > 0:29:42Steven's sense of identity is still unclear. Part of me wanted to say,
0:29:42 > 0:29:48do you know who you are? That type of thing, because batter so
0:29:48 > 0:29:52important to us, to know that he is aware of who he is. It would be
0:29:53 > 0:29:57nice to know how he is feeling, if he is fearful, try not to be
0:29:57 > 0:30:07fearful because we are always here for him. If he knows we are going
0:30:07 > 0:30:08
0:30:08 > 0:30:18to be his champions, that will make him feel better. Really good, you
0:30:18 > 0:30:19
0:30:19 > 0:30:28did well, excellent. Really good, you did excellent. It is all good,
0:30:28 > 0:30:34man. Going in the right direction. Does that suggest that he is
0:30:35 > 0:30:39conscious? That is what I would conclude, yes. I feel quite
0:30:39 > 0:30:43confident about that. On the basis of a single scan and patients I
0:30:43 > 0:30:50have seen this happen from time to time before, I'm pretty confident
0:30:50 > 0:30:58that he has a level of awareness. think it is hard for people to
0:30:58 > 0:31:02imagine what it must be like to be in its Stephen's situation. Is the
0:31:02 > 0:31:10fact that he is awake and aware, that he is conscious, does it make
0:31:10 > 0:31:14it better for him or worse for him? We do not know the answer. I can
0:31:14 > 0:31:20only imagine it would be like being buried alive. You have no way of
0:31:20 > 0:31:30being able to communicate with the outside world, even to indicate
0:31:30 > 0:31:34that you are awake and aware. you're in. But there is hope. Some
0:31:34 > 0:31:38patients do emerge. In Putney, there is someone who knows what
0:31:38 > 0:31:48it's like to have an active mind trapped in a body he couldn't
0:31:48 > 0:31:53
0:31:53 > 0:31:57control. This is Stewart. As so often it was a car accident that
0:31:57 > 0:32:07left him brain injured and unable to communicate. Doctors thought he
0:32:07 > 0:32:14might be in a vegetative state. were told when we saw the
0:32:14 > 0:32:19consultant, when Stewart was still in intensive care, that basically
0:32:19 > 0:32:24at six months or a year, what if you saw was what you would get.
0:32:25 > 0:32:29That did not seem right to me. I dismissed it straightaway.
0:32:29 > 0:32:34Thankfully, in Strood's case, and it is not always the case, I am
0:32:34 > 0:32:40aware of that, it has proved incorrect and we have got him like
0:32:40 > 0:32:43he is today. -- in Stewart's case. Stewart's slowly emerging
0:32:44 > 0:32:46consciousness was spotted by his family and staff here. He was among
0:32:46 > 0:32:55the early patients sent to Cambridge where brain scans
0:32:55 > 0:33:01confirmed his growing awareness. was really good because Stewart was
0:33:01 > 0:33:06not doing much at the time. He said Stewart had a learning ability and
0:33:06 > 0:33:11he felt that at some point he would use an electric wheelchair. It gave
0:33:11 > 0:33:18us some real hope and determination that there was more in there that
0:33:18 > 0:33:27we would bring out and we have. after four years in Putney, Stewart
0:33:27 > 0:33:31is ready to go home. It is all steam ahead and we are very excited.
0:33:31 > 0:33:40Stewart is counting down the days. But he still remembers a time when
0:33:40 > 0:33:50communication was impossible. How frustrating was it not being
0:33:50 > 0:33:50
0:33:50 > 0:34:57Apology for the loss of subtitles for 67 seconds
0:34:57 > 0:35:07You would scream at a wall? Would In Cambridge, Michael is having
0:35:07 > 0:35:09
0:35:09 > 0:35:13another session in the scanner. His first set of results were negative.
0:35:13 > 0:35:19I guess one of the most important things is we are going to repeat
0:35:19 > 0:35:24what we did on Monday. We will look again to see if we can get a
0:35:24 > 0:35:29response. Will we see some brain activity? That is important because
0:35:29 > 0:35:39these patients all fluctuate. Sundays they may respond and other
0:35:39 > 0:35:40
0:35:40 > 0:35:46days they won't. Hello, Michael, it is Adrian again. You were doing
0:35:46 > 0:35:51really well. We want you to do what we asked you to do in the week.
0:35:51 > 0:36:01Tennis. But from all Michael's scans, the team have not been able
0:36:01 > 0:36:04
0:36:04 > 0:36:11to detect any evidence of awareness. His parents, Barbara and John, have
0:36:11 > 0:36:18just been given the news. This is like a bereavement. It is like a
0:36:18 > 0:36:27bereavement which will not end in two weeks or three weeks. We are
0:36:27 > 0:36:36still treating him exactly the same way now as we did. We are obviously
0:36:36 > 0:36:45upset. I think we will take comfort from it. I am really glad that you
0:36:45 > 0:36:50came and that we scanned my God. We gave him five chances -- that we
0:36:50 > 0:36:58scanned Michael. We gave him five chances to see if he could produce
0:36:58 > 0:37:03a response on Oct. Unfortunately, on five occasions, we did not see
0:37:03 > 0:37:12anything that suggests he is aware of the situation he is in. He had a
0:37:12 > 0:37:19good crack at it. Yes, he did. sure, had he been in some position,
0:37:20 > 0:37:25he would have done. The journey to find a voice for these patients is
0:37:25 > 0:37:31long and hard. But all the families involved in this research, it is a
0:37:31 > 0:37:36journey they must travel, no matter what the odds. We showed something
0:37:36 > 0:37:41like 20 % of these patients can generate these patterns of activity
0:37:41 > 0:37:46with their brains. It was important for us that people keep that in
0:37:46 > 0:37:54proportion. It does not mean all vegetative patients are conscience
0:37:54 > 0:37:59but Ace simple -- eight small minority seem to be. In Putney,
0:37:59 > 0:38:09Alex has not been able to be assessed. Repeat infections mean it
0:38:09 > 0:38:10
0:38:10 > 0:38:14will be a year before he is able to go to Cambridge. In Canada,
0:38:14 > 0:38:19Stephen's parents have brought him back for another opportunity to
0:38:19 > 0:38:29make contact. It is a chance to resolve their biggest question,
0:38:29 > 0:38:29
0:38:29 > 0:38:34does he know where he is? Another go in the scanner. Last time, he
0:38:34 > 0:38:41revealed he could respond in the scanner. Now the communication goes
0:38:41 > 0:38:46much further. Stephen is asked about a family member born three
0:38:46 > 0:38:52years after his accident. I want you to imagine playing tennis, only
0:38:52 > 0:38:56if the answer to the question is yes. The question is, does your
0:38:56 > 0:39:06sister have a daughter? We are going to start the scan now.
0:39:06 > 0:39:13
0:39:13 > 0:39:21Imagines. He is quite still. He is He has this whole band of activity.
0:39:21 > 0:39:26Well done, that was fantastic. That was absolutely wonderful, very good
0:39:26 > 0:39:33activity. We could see your brain lighting up when you were trying to
0:39:33 > 0:39:40answer the question. That was absolutely great. I asked him
0:39:40 > 0:39:45whether his sister Jen, whether he thinks she has a daughter or not.
0:39:45 > 0:39:50That was the question. What we were interested in doing is finding out
0:39:50 > 0:39:54whether he is aware of that and can lay down new memories since his
0:39:54 > 0:39:59accident. He very clearly imagined playing tennis when I asked him to
0:39:59 > 0:40:04do that. He was activating the top part of his brain there which is
0:40:04 > 0:40:09what I told him to did took say yes. There is no question he was
0:40:09 > 0:40:15activating the top part of his brain. I think he does know about
0:40:15 > 0:40:18Kayleigh. I think that is an important piece of information.
0:40:18 > 0:40:27sister will be delighted to hear that as well, the whole family!
0:40:27 > 0:40:32Even Kayleigh! It is another extraordinary moment. Stephen has
0:40:32 > 0:40:37shown he is continuing to create and store memories about his family.
0:40:38 > 0:40:45It suggests he is aware of himself and those around him, but the
0:40:45 > 0:40:49extent of his abilities remains unknown. You did absolutely great.
0:40:49 > 0:40:52I don't know if you heard that, he said you were a superstar. You
0:40:52 > 0:41:02answered the questions right and we will tell Kayleigh that you know
0:41:02 > 0:41:03
0:41:03 > 0:41:07all about her. Fabulous. What will the knowledge that Stephen is able
0:41:08 > 0:41:13to build up memories, what will that mean for the future and the
0:41:13 > 0:41:18way you relate to him? It gives us the impression that he will be able
0:41:18 > 0:41:23to keep up with the books, he will be able to stop at a chapter, start
0:41:23 > 0:41:31at the next chapter, he remembers what he was told previously. It is
0:41:31 > 0:41:35good. It's very good. As we have said before,... We know it is not
0:41:35 > 0:41:44just white noise he is listening to. He is retaining net and eventually
0:41:44 > 0:41:49he will tell us, I don't like that book, I want something else. Scott
0:41:49 > 0:41:59is also back for another session in the scanner and will again confound
0:41:59 > 0:42:01
0:42:02 > 0:42:08the diagnosis that he is vegetative. The question is, is a banana
0:42:08 > 0:42:13yellow? The questions start easy, but Scott has to make complex
0:42:13 > 0:42:18choices. This time, if he wants to answer yes, he has to imagine
0:42:18 > 0:42:28walking around his house which produces another distinct pattern
0:42:28 > 0:42:28
0:42:28 > 0:42:34of brain activity. This is almost exactly the same as it was. There
0:42:34 > 0:42:38is a big peak fare in the imagined task, a trough when he is relaxing.
0:42:39 > 0:42:43Then another peak when he is imagining. It tells us he is saying
0:42:43 > 0:42:50the banana is yellow. We told him to imagine moving around in his
0:42:50 > 0:42:56house when he heard the word imagined. Communication established,
0:42:56 > 0:43:06Scott can in theory be asked anything. Science has given him
0:43:06 > 0:43:13
0:43:13 > 0:43:20But what should you ask a man who last spoke 12 years ago? Probably
0:43:20 > 0:43:24the kind of questions we would like to ask him... Would upset him.
0:43:24 > 0:43:32think. Why do you say that? Because it would be very emotional
0:43:32 > 0:43:42questions. Do you ever feel that Scott might have preferred not to
0:43:42 > 0:43:43
0:43:43 > 0:43:52be here now? The question is quality of life and wonder what he
0:43:52 > 0:43:56would want, most definitely. It has crossed our mind, crossed my mind.
0:43:56 > 0:44:04We want to make the best that we can for him and will continue to do
0:44:04 > 0:44:09so. He was such an active person, both mentally and physically. I
0:44:09 > 0:44:19don't know. He is not one to give up. I think if it was me, I
0:44:19 > 0:44:24
0:44:24 > 0:44:29He is such a clear responder, they reached something of fundamental
0:44:29 > 0:44:33importance to the families, and briefly, they lift the curtain on
0:44:33 > 0:44:36the hidden world of these patients. We're going to ask you a question
0:44:36 > 0:44:40about you this time, a question about you and the way that you are
0:44:40 > 0:44:44feeling, and I want you to try and answer this question for us. I want
0:44:44 > 0:44:50you to tell us whether you are in any pain? Think about your body.
0:44:50 > 0:44:53Does any part of your body actually hurt right now? Are you in pain? If
0:44:53 > 0:44:56the answer to that question is a yes, when you hear the word
0:44:56 > 0:45:01"imagine," I want you to think about moving from room to room in
0:45:01 > 0:45:06your house. Think of all the rooms, and the furniture and the pictures
0:45:06 > 0:45:10on the wall, and where the television is. Look around the room
0:45:10 > 0:45:14in the mind and try to imagine what it's like. If the answer to the
0:45:14 > 0:45:18question is a no, I want you to imagine playing tennis. The
0:45:18 > 0:45:28question for you to think about is, are you in any pain? Does any part
0:45:28 > 0:45:33
0:45:33 > 0:45:43Could you ever imagine Scott making a decision about whether he wanted
0:45:43 > 0:45:47
0:45:47 > 0:45:57Well, if he was able to be able to make that decision, and to, for us,
0:45:57 > 0:46:00
0:46:00 > 0:46:05to be sure that's what he wants, we would have to go with what he wants.
0:46:05 > 0:46:09He would have to bring up the subject. If he was able to, and
0:46:09 > 0:46:14bring it up, then we could, or we would talk about it, but it's not
0:46:14 > 0:46:17something I would ever broach with him, or anything else. It would
0:46:17 > 0:46:23have to be totally his decision, and he would have to bring it up,
0:46:23 > 0:46:28because we're here, and we will be here for him for as long as we can.
0:46:28 > 0:46:31So, no, I wouldn't ever bring up something like that to him.
0:46:31 > 0:46:36If the answer to the question is a no, when you hear the word
0:46:36 > 0:46:44"imagine," I want you to imagine playing tennis. So the question for
0:46:44 > 0:46:48you to think about is, are you in any pain? Imagine.
0:46:48 > 0:46:53Isn't that where we were in the last scan? That is where we were in
0:46:53 > 0:46:58the last scan. Yes, looks like that.
0:46:58 > 0:47:07That's bang-on where we were in the tennis condition. Remember, you
0:47:07 > 0:47:11said it was a little bit further back?
0:47:11 > 0:47:15Relax. Yeah, yeah.
0:47:15 > 0:47:18Ooh. Adrian, what's happening?
0:47:18 > 0:47:20We're seeing activity in exactly the same area of the brain that was
0:47:20 > 0:47:26activated during the tennis condition, which is, of course,
0:47:26 > 0:47:30really a relief. Right, so what does that tell us
0:47:30 > 0:47:33that he's imagining trying to answer?
0:47:33 > 0:47:37It tells us that he's imagining playing tennis, and I've told him
0:47:37 > 0:47:41to imagine playing tennis if the answer to the question is no.
0:47:41 > 0:47:49So that would suggest he's not in pain.
0:47:49 > 0:47:52That would suggest that he's not in pain, which is a big relief.
0:47:52 > 0:48:00Have you ever asked that question before of any patient?
0:48:00 > 0:48:05No. No. That's amazing, that's bang-on where it was in the
0:48:05 > 0:48:12previous scan. It's exactly where it was in the tennis-playing scan
0:48:12 > 0:48:15and it's getting bigger and bigger. And it's in a position far away
0:48:15 > 0:48:18from any of the areas that were active during the spatial
0:48:18 > 0:48:24navigation scan. Could it just be a fluke?
0:48:24 > 0:48:28No, because what we had is two separate networks of brain activity.
0:48:28 > 0:48:32One for tennis and one for spatial imagery. And we're asking him to do
0:48:32 > 0:48:35one of those two things to answer the question. So the chances of one
0:48:35 > 0:48:40of those two things happening again is negligible.
0:48:40 > 0:48:42He's making a conscious choice? He's making a conscious choice
0:48:42 > 0:48:46between two possible responses, and we measured those responses at the
0:48:46 > 0:48:48start of the study. Is this the most significant
0:48:48 > 0:48:54question you've ever asked a patient?
0:48:54 > 0:48:57By a long shot, yes! This is extremely important information.
0:48:57 > 0:49:00This is exactly what we've been working to achieve, to be able to
0:49:00 > 0:49:06ask questions that might actually make a difference to patients'
0:49:06 > 0:49:11lives. You're a pioneer. You're the first
0:49:11 > 0:49:21person that's been able to answer a clinical question like that. That's
0:49:21 > 0:49:24so good, sweetheart, I'm proud of you. Daddy will be proud of you.
0:49:24 > 0:49:30In Britain, the courts have allowed some vegetative patients to die by
0:49:30 > 0:49:34the withdrawal of feeding tubes. This scanning technology is not a
0:49:34 > 0:49:42pathway to ending life. It's impossible to assess the competence
0:49:42 > 0:49:48of patients to make that decision. Rather, the aim of families and
0:49:48 > 0:49:51scientists is to make difficult lives a little better.
0:49:51 > 0:49:55We can ask people if they are depressed, or if there are things
0:49:55 > 0:49:58that we could do to improve the quality of their lives. And these
0:49:58 > 0:50:03might be very simple things like the entertainment that we provide
0:50:03 > 0:50:07them with. Or the times of day that we decide that they should be
0:50:07 > 0:50:12washed or they should be fed. And, you know, all of these things can
0:50:12 > 0:50:14improve people's quality of life. Scott still appears vegetative in
0:50:14 > 0:50:22all physical assessments, but his specialist agrees the scans tell
0:50:22 > 0:50:25the true story. I was amazed, to be honest. He had
0:50:25 > 0:50:31the clinical picture of a typical vegetative patient. No emotional
0:50:31 > 0:50:33response, no fixation, or following with his eyes. He didn't have any
0:50:33 > 0:50:36spontaneous movements that looked meaningful, and I was quite
0:50:36 > 0:50:45impressed and amazed that he was able to show these cognitive
0:50:45 > 0:50:51responses with fMRI. It was really very convincing to me.
0:50:51 > 0:50:54And he believes the research re- writes the rules.
0:50:54 > 0:50:57We can no longer just rely on behavioural responses to tell if a
0:50:57 > 0:51:00person is vegetative or not. Twenty per cent of these patients really
0:51:00 > 0:51:03are capable of showing cognitive responses and we need these special
0:51:03 > 0:51:13techniques to show that. I think that has to be introduced into the
0:51:13 > 0:51:19
0:51:19 > 0:51:22Careful, up the ramp. Alex is finally well enough to be
0:51:22 > 0:51:32assessed in Cambridge. On several occasions in the last year, he's
0:51:32 > 0:51:32
0:51:32 > 0:51:36been critically ill. But the wait is now over.
0:51:36 > 0:51:40You must have thought this day might never come.
0:51:40 > 0:51:44Yeah, almost a year ago that we were supposed to be here. So, yes,
0:51:44 > 0:51:47it's quite exciting. You must have lots of questions
0:51:47 > 0:51:53you'd like answered. Um, yes!
0:51:53 > 0:51:57Obviously, yes, but I just can't think of them at the moment. No, I
0:51:57 > 0:52:00just want to know what's going on, really. We've had such a horrible
0:52:00 > 0:52:06year and it's nice to actually get something going that looks positive
0:52:06 > 0:52:10for a change. Hi, Alex, we're just going to
0:52:11 > 0:52:14straighten your legs down just a little bit. See how straight we can
0:52:14 > 0:52:23get them before we get you in the scanner. Whoops! Where are you
0:52:23 > 0:52:25going? Just relax for us. Relax. Everything is going to be all right.
0:52:25 > 0:52:30Are you going to wake up for us, Alex?
0:52:30 > 0:52:32Well done, you're doing really well. The unique shape of Alex's brain
0:52:32 > 0:52:36presents a challenge to the research team.
0:52:36 > 0:52:39We're going to ask you to do a task for us. You will hear two words.
0:52:39 > 0:52:42You will hear two words. The major problem we actually have
0:52:42 > 0:52:45is that because he's had a craniectomy, so we have got the
0:52:45 > 0:52:48missing part of the skull, so his brain is significantly squished
0:52:48 > 0:52:52here, it's all collapsed in. So we're not quite sure where we are
0:52:52 > 0:52:59going to be looking with the activation.
0:52:59 > 0:53:04Do you want to have a look at that? Yeah, interesting.
0:53:04 > 0:53:08There are so many things that you must want to know?
0:53:08 > 0:53:12Yeah, what he can and can't do would be good. Cos I think he can
0:53:12 > 0:53:14do things that Sally doesn't know if he can do things. So it just
0:53:14 > 0:53:16depends on what the tests say, really.
0:53:16 > 0:53:22Sometimes, when I speak to him, I think he's really listening,
0:53:22 > 0:53:26hopefully that he can. But other times, he's in his own little world.
0:53:26 > 0:53:31So I'm not too sure. 50-50, really. When I'm having a stern word with
0:53:31 > 0:53:35him, he listens. Alex, just relax, calm down. You're
0:53:35 > 0:53:38OK, you are doing really, really well. We're almost finished. We're
0:53:38 > 0:53:42going to show you some things on the screen again.
0:53:42 > 0:53:52Alex is shown a series of images. A chequerboard, colours, shapes,
0:53:52 > 0:53:54
0:53:54 > 0:53:57random objects and faces, The team want to know if his brain
0:53:57 > 0:54:07registers this information as a face, or house, rather than just
0:54:07 > 0:54:07
0:54:07 > 0:54:12light coming in. We've seen some activities, but we
0:54:12 > 0:54:19need to check that they are genuine activities. So still anything that
0:54:19 > 0:54:23we've seen today, we really need to analyse it in a better way.
0:54:23 > 0:54:27The results will come later. In your own mind, do you feel in
0:54:27 > 0:54:29your heart of hearts that he is aware?
0:54:29 > 0:54:34Well, he's strong enough to get through all he's been through
0:54:34 > 0:54:37before, so I don't see how he can't through everything else. I'm just
0:54:37 > 0:54:40praying for him all the time, hopefully he'll get better. You
0:54:40 > 0:54:44know, we've seen him better than this, before the sickness started,
0:54:44 > 0:54:50so if he can get there, he can get there again, definitely.
0:54:50 > 0:54:52You've been an incredible support. I hope he knows that! I think he'd
0:54:52 > 0:55:01have done the same for me, definitely.
0:55:01 > 0:55:04Bye, Alex, see you next week. Love you loads. He doesn't care, does
0:55:04 > 0:55:07he?! Yes, he does!
0:55:07 > 0:55:11After a heartbreaking diagnosis, Michael is back at his permanent
0:55:11 > 0:55:16hospital home. But nothing has changed for his parents. The faith
0:55:16 > 0:55:23of the family endures. You just think he's going to start
0:55:23 > 0:55:26talking to you, don't you? Yes.
0:55:26 > 0:55:33All the staff here seem to think that when we come and talk to him,
0:55:33 > 0:55:38they see something happen when we come, so that's great. It's
0:55:38 > 0:55:46fabulous. We would like to think that he could sense that Mum and
0:55:46 > 0:55:51Dad are here, and we're still here for him.
0:55:51 > 0:55:56Put some music on, then, shall we? I was playing some of the oldies
0:55:56 > 0:56:00the other day. Some of the ones you used to listen to when you were
0:56:00 > 0:56:07little. Who were the two Scottish guys, I would walk 500 miles?
0:56:07 > 0:56:17Proclaimers! Proclaimers. I would walk 500 miles.
0:56:17 > 0:56:37
0:56:37 > 0:56:40And this is why it all matters, for days like this. A moment Stewart
0:56:40 > 0:56:43and his family thought might never come.
0:56:43 > 0:56:49So I'm saying, on behalf of everybody at the Royal Hospital of
0:56:49 > 0:56:52Neuro-disability, to wish you the very, very best for going home.
0:56:52 > 0:56:57These days are, well, if they are special for us, it doesn't compare
0:56:57 > 0:57:00with how special it is for you and your mum and dad. But it's what we
0:57:00 > 0:57:04just live for, days when people can go off and look after themselves,
0:57:04 > 0:57:14be looked after at home, and be so much better than they were, like
0:57:14 > 0:57:30
0:57:30 > 0:57:35you are, so much better than when Is it good, Stewart?
0:57:35 > 0:57:38It's amazing, at long last. It just seems a bit overwhelming at the
0:57:38 > 0:57:48minute. I think it will slowly sink in when the weekend has gone by and
0:57:48 > 0:58:02
0:58:03 > 0:58:06I loved being at home? Alex has returned to Putney.
0:58:06 > 0:58:08Against all the odds, his mum Sally has had good news.
0:58:08 > 0:58:12You did really, really well, sweetheart. You did really well.
0:58:12 > 0:58:17Yeah? The tests showed that you are in there and we've just got to
0:58:17 > 0:58:23fight to get you back out again. The results suggest he is conscious
0:58:24 > 0:58:31some of the time and may be able to recognise the faces of his family.
0:58:31 > 0:58:39Alex's journey has begun. What would your ambition be for him
0:58:39 > 0:58:41for the future? Realistically.
0:58:41 > 0:58:45Realistically, communication, awareness, and as long as he's
0:58:45 > 0:58:49happy. Cos we've had no communication now for 18 months.
0:58:49 > 0:58:55What does that knowledge of his growing awareness mean to you?