The Mind Reader: Unlocking My Voice Panorama

Happy birthday to you, happy birthday to you, happy birthday

dear Alex, happy birthday to you! Alex, blow! We are both 19 now so

we are both grandads! Not the ideal place to envisage him spending his

90th but you have to make the best of things. You are doing so well

and looking even more well. As soon as you are home, you can get back

to the good old days. Stay strong, mate. All my love. He had been out

with his friends for one of his best friend's 18th birthday party.

There was a big group coming back on the bus. Pianist is bus stop.

Alex are being Alex and being extremely impulsive decided he was

not going to wait, he opened the emergency doors and walked off. It

was going at 25 miles an hour, he missed his footing, landed on a

parked car and bounced off and landed on his head. He might make a

complete recovery, he might make no recovery whatsoever. That is the

one thing doctors have been consistent about right the way

through, they cannot tell us anything. Some people with really

bad brain damage can make incredible recoveries and some

people with a tiny knock on the head can die.

This is a film about patients who have no voice. About parents who

want to communicate with their loved ones. Michael, Michael, it is

mum and dad. And the people trying to help them. Young men who have

suffered traumatic brain injuries and emerged from a coma into a

twilight world, awake but not necessarily a where. I am going to

ask you a question about you and the way you are feeling. But now

the hope is to reach inside the closed world of their minds and

make contact. Imagine. Is this the most significant question you have

ever asked a patient? By a long shot, yes! If scientists can

release their thoughts, it can release them from a silent world,

unlocking feeling and memories and giving them back a voice. That was

really exciting. You answered the questions right, fabulous. That is

In all the years I have been reporting from the BBC, I have

wanted to tell the story of these patients, and with a unique access,

now can. I have come to the Royal Hospital for Neuro-disability in

London which specialises in the rehabilitation of brain injured

patients. This is Alex. Staff here will try to assess whether he is

minimally conscious with fragments of understanding or vegetative,

with no awareness at all. There are thought to be hundreds of patients

like him in Britain. Hello, Alex, my name is Clare. You are at the

Royal Hospital for Neuro-disability. We are going to work together now.

The hospital has pioneered an assessment programme called SMART

which explores all five senses, looking for the smallest physical

responses, anything that might show awareness and allow communication.

Look at no. We are looking at all the individual senses and breaking

them down separately so we have a chance to know which areas Alex

might be responding to. We are trying to see where his response

levels are. The challenge is to work out whether Alex's brain can

process site and sounds or are his responses just in voluntary

reflexes. I would like to know if there is recognition, if there is

consciousness, if he is happy. Yes, basically, what the levels are.

Nobody can ever tell us what to expect and what the prognosis is

really going to be but I would like to know where he is, how alert, how

conscious. The day after his accident we all went to the pub, a

great excuse to go to the pub, and signed it. That was his first card

he ever got. Jess is Alex's girlfriend. There had been going

out for four months when he had his accident. These are the boys, the

lads. I think that was prom night. The beer in their hands. There is

Max, Matt, Liam and Alex. Part of his skull had to be removed and his

brain is compressed. Beset with health problems, he appears on

responses. Family, tell me a bit about Alex, what was he like before

his accident? Vibrant! Fun. A nightmare! Always difficult, but

absolutely wonderful. Sorry. I'll be all right, I'll be all right. It

is difficult because everyone asks you the same question, how is your

boy? He is asleep. Does he recognise you? I don't know. Does

he talk? No. You answer that 10 or 15 times a day sometimes.

He woke up for a little bit but he sort of wakes up for 10 minutes and

then his of St -- then he is asleep for three hours. You have got to

patient with it. I talk to him. I think if I was him I would want

someone to talk to made all the time. I talked to him and tell him

he looks better every day. I hope This is Michael. Hello, Michael.

Michael, it is mum and dad. knowing if he can remember anything,

his parents tell him who he is every time he sees him. Your name

is Michael Edward Taylor. When you went to school we used to take you

there in the car because it was too far to go by bike. Do you remember

we used to go over that bridge where dad hit it one day in the ice.

It scratched his car. You were in there with me at the time. I was

really cross, wasn't tired? What the families want to know, are

their words fallen into a void? What is it that remains within? Are

their thoughts, memories, recognition? Injured in a car

accident, Michael has already been diagnosed as being in a vegetative

state. But the RHN has a reputation for detecting awareness that others

have missed and his parents would like a second opinion. On a good

day I would like to think there is some level of understanding. But if

I am really depressed, I am not so sure. I do generally feel there is

something. One of the problems is, you do not know what he sees. He

cannot tell us if it is a shadow, an image, light or dark. He may see

fairly well but he does not understand what he sees. He may not

even recognise us. That is what this test is all about, is there a

possibility, is there something inside him? This one area that we

can work on and maybe things will work out from there. That was

Coffey. To you remember some of the What did we do next? We decided we

wanted to be a chef. I did not see that one coming. That was sold.

came to your meals are you did at college. They were really nice. I

remember the pudding, I think it was a trio of lemon puddings.

X-rays were taken two days ago. Something else which haunts the

families is the idea their sons could be in pain. Vegetative

patients make me flex muscle responses. -- reflex muscle

responses. All right, Alex. Sorry. It looks like real distress but if

Alex has no awareness, his brain cannot perceive pain. Clearly, it

To minimise any risk of discomfort, Alex is measured for splints. These

will stretch Lynn's the left and rigid because signals from the

brain have stopped. It will mean he has something to wear to give him a

prolonged stretch because at the moment his hands rest quite bent.

The strapping is all in place. Perfect. That is good. Well done,

Michael's parents are about to get the results following weeks of

physical assessments at the Royal Hospital for Neuro-disability.

of the reasons for his admission is for a second opinion. Clinically,

after all these bedside assessment and SMART assessment and

assessments by other disciplines as well, it is confirmed that he is in

a vegetative state. The diagnosis that Barbara and John feared is

confirmed. But the RHN offers something unusual, a research

project at Addenbrooke's Hospital in Cambridge where neuroscientists

will use brain scans to look for hidden awareness. I know we have

had a fabulous job done here and when they say put your mind at rest,

it is hardly the feeling you get when you are finally told that

Michael is in a vegetative state. Although it has closed some doors,

there are still doors open so I think it is vitally important that

we go to Addenbrooke's and especially, it bothers us both

quite a lot, we do not want to think he is ever in pain and we are

not there to look after him. As a standard finding in a vegetative

state, they do not perceive pain but they could respond reflexively

to application of any pain. would jump. That is right.

diagnosis means Michael is unaware of himself or the world, but it

also confirms that he is not suffering. Sometimes when he looks

at me I think, is he trying to get something through. It is very

difficult to accept that that is probably not the case. I think it

is a question of coming to terms, is Michael better off in a

vegetative state, if been totally unaware, or having some awareness

and living a very difficult life. As a mother, I'm not sure I would

not choose the vegetative state but you always want hope. The trouble

is, you want a big improvement, you do not just want some improvement.

You want life worth living. A what the family would like to know is,

is there any brain activity or cognitive activity? If it is there,

then of course that will give them some hope. It it is not there,

again it is helpful as well because it gives them an opportunity to

come to terms with the disability Michael is on his way from Putney

to Addenbrooke's Hospital in Cambridge. After weeks of

painstaking observation, a brain scanner will search for hidden

awareness. Could a machine find Science may provide the answers the

families are looking for. And the work of this man, neuroscientist

Professor Adrian Owen. I first came across Adrian's

research when he used a brain scanner to detect awareness in a

patient who was really incapable of responding in any way and seemed to

be in a vegetative state. And this really is a landmark discovery.

It's got huge implications, legal implications, implications for

clinical care, for medical ethics, and so on and so forth.

So, Adrian, let's start off with a very easy question, what is

consciousness? Whoa! I thought you were going to

throw me a soft ball to start off with, Roger! Consciousness.

Professor Owen is a neuroscientist who specialises in searching for

consciousness in patients on the edge of awareness. His research,

published in leading medical journals, has seen him dubbed 'The

Mind Reader' through the use of fMRI, functional Magnetic Resonance

Imaging. FMRI is a technique that we use for

looking at brain function. We've been using it to explore whether

any patients who appear behaviourally vegetative, or

minimally conscious, can actually do more with their brains. Is it

possible that they can activate parts of their brains in a way that

would allow us to conclude that they've got some residual functions

that are not apparent from clinical Michael will be given simple

instructions, to see if he can respond with his mind.

We're going to ask him to think of certain things and we're going to

see if we can pick up the brain activity that is associated with

him thinking those things. OK, you are doing ever so well.

One of the interesting things about the brain is, if you imagine doing

some things, the areas that will be activated are the very same areas

that will be activated if you were to actually do those things.

And we'll ask him to imagine playing a game of tennis. Now the

reason we do this is not because we want to know whether he can play

tennis, but when people imagine playing tennis, it always activates

an area called the pre-motor cortex, right here. In which case, we'll be

able to detect that in his brain, and we'll know that he is making a

response. It's not a response with his body, but it is a response with

his brain. Well done, you're doing really well

there. Well done. OK, we're just doing a couple of

quick structural scans, just to make sure we have Michael in the

correct position. OK, Michael, we're going to start

the scan now. We want you to try and imagine something for us. You

are going to hear just two words. You'll either hear the word

"tennis" or you'll hear the word "relax." When you hear the word

"tennis," I want you to really imagine that you are playing a game

of tennis. Just keep imagining playing tennis, and do that until

you hear the word "relax," and then what I want you to do is to just

rest. And we'll do that a few times backwards and forwards between

imagining playing tennis and then relaxing.

Off we go, then, guys. So the areas that are in red.

The scanner can pinpoint the areas of the brain that are working

hardest while someone is thinking. These receive more oxygen-rich

blood, which show up as red blobs on the screen.

So it's the areas in red that we're really interested in.

Initially, Michael's scan looks promising.

But as you can see, it's actually very variable.

Michael's brain activity must follow the pattern of commands for

the team to conclude that he is responding. Otherwise, it could be

chance. They said you were absolutely

brilliant. His parents will get the results

later. The use of brain scans to search

for awareness has sparked international interest, such as in

Canada. List is the City of London, Ontario. -- this is.

This is Scott. For over a decade, every medical assessment has

concluded he is vegetative. But his parents, Jim and Anne, are

convinced Scott can respond. Give us a thumbs-up, Scott, if you

want Dad to drive! What do you think? You're not going to make a

decision. Give us a thumbs-up!

Or maybe you are saying no? You don't want Mum in your face. I

think he's shutting us out. You just don't want to respond right

now, do you? He was crossing an intersection and

he got hit by a police car, and it just T-boned him, sent him spinning

down the street. And it was just catastrophic.

Catastrophic, yeah. They really gave us no hope

whatsoever. They gave him two years to live, and that's 12-and-a-half

years ago. At the hospital, most of the staff

go with the party story that he is vegetative.

Do you think Scott can understand what you're saying to him?

Oh, yes, yeah, he does. And he responds and he uses his eyes, he

uses his thumbs, for yes and no. Hi, Scott, it's Brian Young, Dr

Young here. Could you try just lifting your thumb for me to

command? Just lift your thumb up? You've been his doctor for ten

years? Yes, I've seen him repeatedly and

I've never seen any evidence of responsiveness in Scott. Do you

think perhaps that it's either that he'll do it for his family, or

perhaps it's wishful thinking on their part? Yes, it's hard to say.

It could be that it's inconsistent, that he sometimes does respond in a

meaningful way to them, but one has to go with one's own observations,

and I think there is the Scott is on his way to the

University of Western Ontario. There we go.

He'll meet Professor Owen, who's now based in Canada.

Scott, right, this is your big chance. We really want you to try

as hard as you can to imagine playing tennis for us. OK, we're

going to ask you to imagine playing tennis quite a few times while you

are in the scanner. And if you can do that, then we'll be able to see

your brain activating. So I want you to imagine you are standing on

a tennis court and moving your arm around as much. As you can, all

right? So we're going to put you in the scanner now, just do your best,

stay awake. This is a big challenge for brain-

injured patients. It requires hearing, recall, understanding, a

functioning mind. OK, Scott, it's Adrian speaking,

and we're ready to start the first scan. This is where I want you to

We've got a little bit of activity OK, yeah, we've got something.

OK, this is what we want, here. OK, so we've definitely got more

activity than we had previously. Something remarkable is happening.

Confounding more than a decade of medical assessments, Scott is

We're on tennis. Yeah? That's looking pretty good, actually,

Fergus. That's quite striking, isn't it?

Yes. Scott's been in the scanner more

than an hour and needs a rest, but the team feel his responses clearly

suggest awareness. Didn't you do good in there? I

heard you did real well. He would like you to come back

tomorrow. Because he said you are doing so well that he'd like to try

a few more things tomorrow. Do you think you'd be up to it? Where's

your hand? You trying to give us the thumbs-up? There, we got a nice

big thumbs-up. OK, he's willing to OK, Steven, going to let you listen

to some of your book, Pillars of the Earth, OK?

Life can change utterly in a moment. All the families in this film know

He was driving to work when his van came off the road in ice and hit a

telegraph pole. Are you going to turn your head

around? Thank you. The clustered shafts of the piers

rose gracefully through the gallery and became the ribs of the vault,

curving over to meet in the middle of the ceiling.

Steven was very easy as a kid. No problems with him. I mean, he

wasn't a push-over, don't get me wrong. He had his own mind, but

Steven was the type of person, if you really had a real blow-out with

him, five minutes later, "Hi, Mum, can you get" you know? He was that

type of person. He would come around.

He wouldn't be holding back for days and not speaking, he'd just

come around, just like that. He was pretty active, into different kinds

of sports. He had lots and lots of friends. He liked his family, very

family-oriented. But Steven cannot communicate what

memories he has of weddings, family celebrations, life before his

accident. Or whether he knows who or where he is.

The doctor who was on at the time took us aside and said, he

basically said that he didn't think it was too bad at this point. He

said that he kind of expected Steven to come around between 12

and 16 hours. He actually stayed in a coma for three-and-a-half months.

And then at some point, he did open his eyes. But he didn't wake up in

the sense. No, no. That we would understand it.

That's right, yep. Sorry, Steven, this is a little bit

different from the usual. In the search for answers, Steven's

parents, originally from Glasgow, have brought him to Professor Owen.

What are you hoping to learn here? We've always felt that Steven is in

there, right? And we've used different techniques about trying

to get him to answer for a yes or a no. It might be two blinks of an

eye for a yes, the raising of his hand for a yes. And definitely, at

times, he can do that, but it's not consistent. So even ourselves,

we're always left with, was he just blinking his eye right now, or was

that just a natural movement, or did he definitely say yes?

John and Ann have been hoping for When you hear the word tennis, what

we want you to do is to imagine that you're playing a game of

tennis. Now, I don't need you to run around the court, you can stand

still. Tennis.

Yep, that is really, really cool. Just like Scott, Steven's brain

activity is matching the commands he's being given in the scanner.

And we're seeing this activity right at the top of his brain, and

those are in the motor regions. Those are the areas of your brain

that if you were able to play tennis, those are the areas of your

brain you'd use to produce those types of movement. So that's very

exciting. Good, good.

That was really exciting. This is strong evidence of

awareness. But can he do more? The question is, what do we do

next? We could ask a question, something

that's actually relevant to him. I was wondering if there's

something that might be relevant to him?

The team plan a series of personal questions only the family could

He's moving in the scanner - so the team cannot interpret the results.

Steven's sense of identity is still unclear. Part of me wanted to say,

do you know who you are? That type of thing, because batter so

important to us, to know that he is aware of who he is. It would be

nice to know how he is feeling, if he is fearful, try not to be

fearful because we are always here for him. If he knows we are going

to be his champions, that will make him feel better. Really good, you

did well, excellent. Really good, you did excellent. It is all good,

man. Going in the right direction. Does that suggest that he is

conscious? That is what I would conclude, yes. I feel quite

confident about that. On the basis of a single scan and patients I

have seen this happen from time to time before, I'm pretty confident

that he has a level of awareness. think it is hard for people to

imagine what it must be like to be in its Stephen's situation. Is the

fact that he is awake and aware, that he is conscious, does it make

it better for him or worse for him? We do not know the answer. I can

only imagine it would be like being buried alive. You have no way of

being able to communicate with the outside world, even to indicate

that you are awake and aware. you're in. But there is hope. Some

patients do emerge. In Putney, there is someone who knows what

it's like to have an active mind trapped in a body he couldn't

control. This is Stewart. As so often it was a car accident that

left him brain injured and unable to communicate. Doctors thought he

might be in a vegetative state. were told when we saw the

consultant, when Stewart was still in intensive care, that basically

at six months or a year, what if you saw was what you would get.

That did not seem right to me. I dismissed it straightaway.

Thankfully, in Strood's case, and it is not always the case, I am

aware of that, it has proved incorrect and we have got him like

he is today. -- in Stewart's case. Stewart's slowly emerging

consciousness was spotted by his family and staff here. He was among

the early patients sent to Cambridge where brain scans

confirmed his growing awareness. was really good because Stewart was

not doing much at the time. He said Stewart had a learning ability and

he felt that at some point he would use an electric wheelchair. It gave

us some real hope and determination that there was more in there that

we would bring out and we have. after four years in Putney, Stewart

is ready to go home. It is all steam ahead and we are very excited.

Stewart is counting down the days. But he still remembers a time when

communication was impossible. How frustrating was it not being

Apology for the loss of subtitles for 67 seconds

You would scream at a wall? Would In Cambridge, Michael is having

another session in the scanner. His first set of results were negative.

I guess one of the most important things is we are going to repeat

what we did on Monday. We will look again to see if we can get a

response. Will we see some brain activity? That is important because

these patients all fluctuate. Sundays they may respond and other

days they won't. Hello, Michael, it is Adrian again. You were doing

really well. We want you to do what we asked you to do in the week.

Tennis. But from all Michael's scans, the team have not been able

to detect any evidence of awareness. His parents, Barbara and John, have

just been given the news. This is like a bereavement. It is like a

bereavement which will not end in two weeks or three weeks. We are

still treating him exactly the same way now as we did. We are obviously

upset. I think we will take comfort from it. I am really glad that you

came and that we scanned my God. We gave him five chances -- that we

scanned Michael. We gave him five chances to see if he could produce

a response on Oct. Unfortunately, on five occasions, we did not see

anything that suggests he is aware of the situation he is in. He had a

good crack at it. Yes, he did. sure, had he been in some position,

he would have done. The journey to find a voice for these patients is

long and hard. But all the families involved in this research, it is a

journey they must travel, no matter what the odds. We showed something

like 20 % of these patients can generate these patterns of activity

with their brains. It was important for us that people keep that in

proportion. It does not mean all vegetative patients are conscience

but Ace simple -- eight small minority seem to be. In Putney,

Alex has not been able to be assessed. Repeat infections mean it

will be a year before he is able to go to Cambridge. In Canada,

Stephen's parents have brought him back for another opportunity to

make contact. It is a chance to resolve their biggest question,

does he know where he is? Another go in the scanner. Last time, he

revealed he could respond in the scanner. Now the communication goes

much further. Stephen is asked about a family member born three

years after his accident. I want you to imagine playing tennis, only

if the answer to the question is yes. The question is, does your

sister have a daughter? We are going to start the scan now.

Imagines. He is quite still. He is He has this whole band of activity.

Well done, that was fantastic. That was absolutely wonderful, very good

activity. We could see your brain lighting up when you were trying to

answer the question. That was absolutely great. I asked him

whether his sister Jen, whether he thinks she has a daughter or not.

That was the question. What we were interested in doing is finding out

whether he is aware of that and can lay down new memories since his

accident. He very clearly imagined playing tennis when I asked him to

do that. He was activating the top part of his brain there which is

what I told him to did took say yes. There is no question he was

activating the top part of his brain. I think he does know about

Kayleigh. I think that is an important piece of information.

sister will be delighted to hear that as well, the whole family!

Even Kayleigh! It is another extraordinary moment. Stephen has

shown he is continuing to create and store memories about his family.

It suggests he is aware of himself and those around him, but the

extent of his abilities remains unknown. You did absolutely great.

I don't know if you heard that, he said you were a superstar. You

answered the questions right and we will tell Kayleigh that you know

all about her. Fabulous. What will the knowledge that Stephen is able

to build up memories, what will that mean for the future and the

way you relate to him? It gives us the impression that he will be able

to keep up with the books, he will be able to stop at a chapter, start

at the next chapter, he remembers what he was told previously. It is

good. It's very good. As we have said before,... We know it is not

just white noise he is listening to. He is retaining net and eventually

he will tell us, I don't like that book, I want something else. Scott

is also back for another session in the scanner and will again confound

the diagnosis that he is vegetative. The question is, is a banana

yellow? The questions start easy, but Scott has to make complex

choices. This time, if he wants to answer yes, he has to imagine

walking around his house which produces another distinct pattern

of brain activity. This is almost exactly the same as it was. There

is a big peak fare in the imagined task, a trough when he is relaxing.

Then another peak when he is imagining. It tells us he is saying

the banana is yellow. We told him to imagine moving around in his

house when he heard the word imagined. Communication established,

Scott can in theory be asked anything. Science has given him

But what should you ask a man who last spoke 12 years ago? Probably

the kind of questions we would like to ask him... Would upset him.

think. Why do you say that? Because it would be very emotional

questions. Do you ever feel that Scott might have preferred not to

be here now? The question is quality of life and wonder what he

would want, most definitely. It has crossed our mind, crossed my mind.

We want to make the best that we can for him and will continue to do

so. He was such an active person, both mentally and physically. I

don't know. He is not one to give up. I think if it was me, I

He is such a clear responder, they reached something of fundamental

importance to the families, and briefly, they lift the curtain on

the hidden world of these patients. We're going to ask you a question

about you this time, a question about you and the way that you are

feeling, and I want you to try and answer this question for us. I want

you to tell us whether you are in any pain? Think about your body.

Does any part of your body actually hurt right now? Are you in pain? If

the answer to that question is a yes, when you hear the word

"imagine," I want you to think about moving from room to room in

your house. Think of all the rooms, and the furniture and the pictures

on the wall, and where the television is. Look around the room

in the mind and try to imagine what it's like. If the answer to the

question is a no, I want you to imagine playing tennis. The

question for you to think about is, are you in any pain? Does any part

Could you ever imagine Scott making a decision about whether he wanted

Well, if he was able to be able to make that decision, and to, for us,

to be sure that's what he wants, we would have to go with what he wants.

He would have to bring up the subject. If he was able to, and

bring it up, then we could, or we would talk about it, but it's not

something I would ever broach with him, or anything else. It would

have to be totally his decision, and he would have to bring it up,

because we're here, and we will be here for him for as long as we can.

So, no, I wouldn't ever bring up something like that to him.

If the answer to the question is a no, when you hear the word

"imagine," I want you to imagine playing tennis. So the question for

you to think about is, are you in any pain? Imagine.

Isn't that where we were in the last scan? That is where we were in

the last scan. Yes, looks like that.

That's bang-on where we were in the tennis condition. Remember, you

said it was a little bit further back?

Relax. Yeah, yeah.

Ooh. Adrian, what's happening?

We're seeing activity in exactly the same area of the brain that was

activated during the tennis condition, which is, of course,

really a relief. Right, so what does that tell us

that he's imagining trying to answer?

It tells us that he's imagining playing tennis, and I've told him

to imagine playing tennis if the answer to the question is no.

So that would suggest he's not in pain.

That would suggest that he's not in pain, which is a big relief.

Have you ever asked that question before of any patient?

No. No. That's amazing, that's bang-on where it was in the

previous scan. It's exactly where it was in the tennis-playing scan

and it's getting bigger and bigger. And it's in a position far away

from any of the areas that were active during the spatial

navigation scan. Could it just be a fluke?

No, because what we had is two separate networks of brain activity.

One for tennis and one for spatial imagery. And we're asking him to do

one of those two things to answer the question. So the chances of one

of those two things happening again is negligible.

He's making a conscious choice? He's making a conscious choice

between two possible responses, and we measured those responses at the

start of the study. Is this the most significant

question you've ever asked a patient?

By a long shot, yes! This is extremely important information.

This is exactly what we've been working to achieve, to be able to

ask questions that might actually make a difference to patients'

lives. You're a pioneer. You're the first

person that's been able to answer a clinical question like that. That's

so good, sweetheart, I'm proud of you. Daddy will be proud of you.

In Britain, the courts have allowed some vegetative patients to die by

the withdrawal of feeding tubes. This scanning technology is not a

pathway to ending life. It's impossible to assess the competence

of patients to make that decision. Rather, the aim of families and

scientists is to make difficult lives a little better.

We can ask people if they are depressed, or if there are things

that we could do to improve the quality of their lives. And these

might be very simple things like the entertainment that we provide

them with. Or the times of day that we decide that they should be

washed or they should be fed. And, you know, all of these things can

improve people's quality of life. Scott still appears vegetative in

all physical assessments, but his specialist agrees the scans tell

the true story. I was amazed, to be honest. He had

the clinical picture of a typical vegetative patient. No emotional

response, no fixation, or following with his eyes. He didn't have any

spontaneous movements that looked meaningful, and I was quite

impressed and amazed that he was able to show these cognitive

responses with fMRI. It was really very convincing to me.

And he believes the research re- writes the rules.

We can no longer just rely on behavioural responses to tell if a

person is vegetative or not. Twenty per cent of these patients really

are capable of showing cognitive responses and we need these special

techniques to show that. I think that has to be introduced into the

Careful, up the ramp. Alex is finally well enough to be

assessed in Cambridge. On several occasions in the last year, he's

been critically ill. But the wait is now over.

You must have thought this day might never come.

Yeah, almost a year ago that we were supposed to be here. So, yes,

it's quite exciting. You must have lots of questions

you'd like answered. Um, yes!

Obviously, yes, but I just can't think of them at the moment. No, I

just want to know what's going on, really. We've had such a horrible

year and it's nice to actually get something going that looks positive

for a change. Hi, Alex, we're just going to

straighten your legs down just a little bit. See how straight we can

get them before we get you in the scanner. Whoops! Where are you

going? Just relax for us. Relax. Everything is going to be all right.

Are you going to wake up for us, Alex?

Well done, you're doing really well. The unique shape of Alex's brain

presents a challenge to the research team.

We're going to ask you to do a task for us. You will hear two words.

You will hear two words. The major problem we actually have

is that because he's had a craniectomy, so we have got the

missing part of the skull, so his brain is significantly squished

here, it's all collapsed in. So we're not quite sure where we are

going to be looking with the activation.

Do you want to have a look at that? Yeah, interesting.

There are so many things that you must want to know?

Yeah, what he can and can't do would be good. Cos I think he can

do things that Sally doesn't know if he can do things. So it just

depends on what the tests say, really.

Sometimes, when I speak to him, I think he's really listening,

hopefully that he can. But other times, he's in his own little world.

So I'm not too sure. 50-50, really. When I'm having a stern word with

him, he listens. Alex, just relax, calm down. You're

OK, you are doing really, really well. We're almost finished. We're

going to show you some things on the screen again.

Alex is shown a series of images. A chequerboard, colours, shapes,

random objects and faces, The team want to know if his brain

registers this information as a face, or house, rather than just

light coming in. We've seen some activities, but we

need to check that they are genuine activities. So still anything that

we've seen today, we really need to analyse it in a better way.

The results will come later. In your own mind, do you feel in

your heart of hearts that he is aware?

Well, he's strong enough to get through all he's been through

before, so I don't see how he can't through everything else. I'm just

praying for him all the time, hopefully he'll get better. You

know, we've seen him better than this, before the sickness started,

so if he can get there, he can get there again, definitely.

You've been an incredible support. I hope he knows that! I think he'd

have done the same for me, definitely.

Bye, Alex, see you next week. Love you loads. He doesn't care, does

he?! Yes, he does!

After a heartbreaking diagnosis, Michael is back at his permanent

hospital home. But nothing has changed for his parents. The faith

of the family endures. You just think he's going to start

talking to you, don't you? Yes.

All the staff here seem to think that when we come and talk to him,

they see something happen when we come, so that's great. It's

fabulous. We would like to think that he could sense that Mum and

Dad are here, and we're still here for him.

Put some music on, then, shall we? I was playing some of the oldies

the other day. Some of the ones you used to listen to when you were

little. Who were the two Scottish guys, I would walk 500 miles?

Proclaimers! Proclaimers. I would walk 500 miles.

And this is why it all matters, for days like this. A moment Stewart

and his family thought might never come.

So I'm saying, on behalf of everybody at the Royal Hospital of

Neuro-disability, to wish you the very, very best for going home.

These days are, well, if they are special for us, it doesn't compare

with how special it is for you and your mum and dad. But it's what we

just live for, days when people can go off and look after themselves,

be looked after at home, and be so much better than they were, like

you are, so much better than when Is it good, Stewart?

It's amazing, at long last. It just seems a bit overwhelming at the

minute. I think it will slowly sink in when the weekend has gone by and

I loved being at home? Alex has returned to Putney.

Against all the odds, his mum Sally has had good news.

You did really, really well, sweetheart. You did really well.

Yeah? The tests showed that you are in there and we've just got to

fight to get you back out again. The results suggest he is conscious

some of the time and may be able to recognise the faces of his family.

Alex's journey has begun. What would your ambition be for him

for the future? Realistically.

Realistically, communication, awareness, and as long as he's

happy. Cos we've had no communication now for 18 months.

What does that knowledge of his growing awareness mean to you?