Woman in vegetative state responds to commands

A 23-year-old woman left in a vegetative state after suffering 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.

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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 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 After 14 appeals a Florida court ruled that her feeding tube could be withdrawn and she died on 31 March 2005 aged 41.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1989 Hillsborough football stadium disaster, who spent three years in a vegetative state before his feeding tubes were withdrawn and he died in 1992.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 study was carried out by a team from the Medical Research Council's cognition and Brain 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 modern 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 is a source of continuing distress.

The 23-year-old woman was asked to imagine herself playing tennis and visiting all the rooms in her house. Her neural responses were found to be 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 Paul Matthews, professor of neurology at the University of Oxford, challenged the claims: "When patients are in a vegetative state they can react to stimuli but not in a truly meaningful way. Contrary to the claim of the authors, the observations do not establish either that the patient made a 'decision to co-operate' or that she had self-awareness. Response to stimuli does not provide evidence of a decision to respond."