When the story broke in November that a paralyzed Belgian man, who had been diagnosed as being in a vegetative state for 23 years supposedly typed words, people across the world were captivated.
"I shall never forget the day when they discovered what was truly wrong with me -- it was my second birth," 46-year-old Rom Houben supposedly told the German magazine Der Spiegel, communicating via a keyboard and an assistant.
Houben's doctors have now concluded those words were not his own, but say brain scans show activity and the diagnosis that he is in a vegetative state still appears to be wrong.
Immediately after Houben appeared in the media, skeptics cried foul over the facilitated communication method in which an assistant holds the hand of the paralyzed person over a keyboard and waits for slight movements as a signal to type.
According to a Feb. 20 interview with Agence France Presse, Houben's neurologist Dr. Steven Laureys said additional testing showed that facilitated communication indeed "did not work in the majority of cases."
For example, if an object was shown just to Houben while his assistant typist was out of the room, Houben could not describe it when the assistant came back to help him type. Critics of facilitated communication guess either slight involuntary movements are misinterpreted by the assistant, or assistants may even be intentionally speaking for the paralyzed.
Yet, brain scans still show that Houben's mind is far too active for him to be considered in a vegetative state. Now that his words typed out by facilitated communication have been debunked, exactly what Houben is thinking or how much he is thinking is still a mystery.
What Could be Happening in Houben's Mind?
After Houben's car crash in 1983, doctors diagnosed him as being in a vegetative state -- meaning his brain is so damaged that he is incapable of conscious thoughts, but his brain stem is working well enough to keep him alive and for Houben to go through wake and sleep cycles.
As Dr. James L. Bernat of the American Academy of Neurology explained, "awake" can be different from "conscious."
The Difference Between Awake and Conscious
"One is called wakefulness; eyes open, eyes moving -- that element is conducted primarily by the brainstem," Bernat said. "The second dimension of consciousness requires self-awareness -- they (the patients) are aware of what's going on, they can feel, they can think.
A person in a vegetative state may be awake, but is not conscious. A vegetative state is also different from a coma, which is a state of full paralysis and full unconsciousness similar to the experience of going under anesthesia.
Decades after Houben's accident, he was sent to Laureys of the University of Liege in Belgium, where doctors use new brain imaging to retest patients who were diagnosed as being in a vegetative state.
In a small imaging study of 44 patients thought to be in a vegetative state, Laureys found 18 of them responded to communication, according to the Gaurdian.
In a separate paper published in the journal Neuroradiology, Laureys wrote that he found three patients, including Houben, were misdiagnosed as being in a vegetative state with an old technique called the Glasgow Coma Scale, which is a 15-point check list of eye and motor movements in response to questions.
Doctors could tell Houben was not in a vegetative state, but they couldn't tell from scans alone exactly how conscious he was. He could be "locked-in," meaning he was fully conscious and aware but too paralyzed to communicate, or he could be what's called "minimally conscious."
Unlike a coma or a vegetative state, neurologists define a third state in people with brain injuries as "minimally conscious," which is a state of semi-consciousness and limited self-awareness.
In 1994, an article in the New England Journal of Medicine estimated there were 15,000 to 30,000 people living in a vegetative state in the United States. A 2002 article in the journal Neurology estimated between 112,000 to 280,000 people in the United States are living in what is known as a "minimally conscious" state.
In a minimally conscious person, "there may be parts of the brain that are able to generate certain types of thoughts similar to what a conscious person would do, but they're still quite devastated and quite injured," said Dr. Paul M. Vespa, director of Neurocritical Care at the David Geffen School of Medicine at the University of California, Los Angeles.
"There are probably a very small number of patients who are in this minimally conscious state," Vespa said. "The exciting thing is, is that maybe there's a potential for rehabilitation."