Crash victim's mental tennis

Despite being unable to move or speak, the woman played an imaginary game of tennis in her head when researchers asked her to.

A 23-year-old woman left in a vegetative state after suffering traumatic brain damage in a road accident more than a year ago is capable of understanding and responding to certain commands, scientists claimed yesterday.

Despite being unable to move or speak, the woman, who has not been named, responded to sentences spoken to her and played an imaginary game of tennis in her head, recorded by a brain scanner, in response to a request from the researchers.

It is the first time scientists have found a way to show preserved conscious awareness in a patient diagnosed as vegetative. The findings were hailed yesterday as "spectacular" and, if confirmed, could force a reassessment of attitudes to patients in a vegetative state who until now have been thought to be unaware of their surroundings.

Other scientists remained sceptical and claimed the brain scans showed "responses to stimuli" that were not sufficient to demonstrate consciousness.

Terri Schiavo, an American student who suffered catastrophic brain damage after collapsing at home when she was 26, became the subject of a 15-year court battle between her husband and her parents over whether she had any quality of life and should be allowed to die. After 14 appeals, a Florida court ruled that her feeding tube could be withdrawn and she died on March 31, 2005, aged 41.

The most famous British case is that of Tony Bland, a victim of the 1989 Hillsborough football stadium disaster, who spent three years in a vegetative state before his feeding tubes were withdrawn and he died in 1992.

The latest study was carried out by a team from the Medical Research Council's Cognition and Brian Sciences Unit in Cambridge. They say in the journal Science that the vegetative state is one of the least understood and most ethically troublesome conditions in medicine.

Patients in a vegetative state are awake and will turn their heads in response to a sudden noise or blink at a bright light but are believed to have no awareness of themselves or their surroundings.

Relatives constantly ask whether their words are understood or their caresses felt - and the lack of a clear answer causes continuing distress.

The 23-year-old woman in the current study was asked to imagine herself playing tennis and then to imagine visiting all the rooms in her house.

Her neural responses, recorded by the brain scanner, were indistinguishable from those of healthy volunteers performing the same imaginary tasks.

The researchers say in Science: "Her decision to co-operate ... represents a clear act of intention which confirmed beyond any doubt that she was consciously aware of herself and her surroundings."

Adrian Owen, who led the study, said: "These are very exciting findings. This technique may allow us to identify which patients have some level of awareness.

"But it is important to emphasise that if we don't see responses in a patient it does not necessarily mean that they are not aware. Future work will investigate whether this discovery could lead to a way of communicating with some patients who may be aware, but unable to move or speak."

The researchers warn that their findings cannot be generalised to other patients in a vegetative state, who may have suffered different types of injury leading to different degrees of brain damage. But they say an "important, though very preliminary, implication" for their work may be "diagnosing and customising rehabilitation for certain patients."

The claims were challenged yesterday by Paul Matthews, professor of neurology at the University of Oxford, who said: "Response to stimuli, even complex linguistic stimuli, does not provide evidence of a decision to respond."


Testing the brain

The flickering patterns of activity in the brain of the accident victim were revealed by a functional magnetic resonance imaging (fMRI) scanner at the Wolfson Brain Imaging Centre in Cambridge, England.

The most remarkable results were seen when she was asked to imagine playing tennis or moving around her home.

The team, led by Adrian Owen, found she was able to activate different areas of her brain in the same way as healthy volunteers.

"Her decision to work with us by imagining particular tasks when asked represents a clear act of intent which confirmed beyond any doubt that she was consciously aware of herself and her surroundings," Dr Owen said.

The scientists used fMRI to measure the patient's neural responses as sentences were spoken.

These tests showed she recognised speech.

More complex sentences produced an additional response, indicating her brain understood them.

- INDEPENDENT