Severely brain-injured Scott Routley hasn’t spoken in 12 years. But scientists using an MRI to peer into his brain, can “see” what he’s thinking as various parts of his brain light up.

Essentially, his brain is doing the talking for him, say leading scientists at the University of Western Ontario’s Brain and Mind Institute.

As a result of breakthrough work on brain activity, the 39-year-old motor vehicle accident victim from London, Ont. has responded to a series of questions, including letting researchers know that he is not in pain.

“It became very clear that Scott had some awareness and he could respond in the scanner to the task we asked him to do while he was in there,” British neuroscientist professor Adrian Owen, who leads the research team, told the Toronto Star Tuesday.

“What we have done here for the very first time is ask a patient a question that is actually relevant to their clinical care.

“Asking somebody whether they are in pain in tremendously important, because of course if the answer had been yes, we could do something,” he said.

Owen said there is no doubt that being able to communicate in this way with a person thought to be a vegetative state is a first and it is hoped will lead to routine communications with at least one in five people in this uncommunicative state.

“That’s where we are trying to get to. We are trying to create what’s called a brain computer interface … some form of a machine that could allow somebody like Scott to routinely communicate with the outside word . . . We would like to give these patients a voice to enable them to actually communicate their wishes and needs,” he told the Star.

By using a functional magnetic imaging procedure he said they can tell by how different parts of Routley’s brain light up that he is responding to suggestions and questions.

“We put him in an MRI scanner and while he is in the scanner we ask him to imagine doing certain things in his mind . . . for example, we ask him to imagine using his arms. Scott is unable to use his arms in reality but it turns out he is perfectly able to imagine moving his arms. And we can pick that up on the scanner and we can tell he’s doing what we ask him to do,” Owen said.

The professor noted in an earlier interview with the Star that while functional magnetic resonance imaging machines, or fMRI images are the gold standard, they are expensive — machines can cost up to $2 million — and it is both costly and disruptive to move patients to the scanners in hospitals.

Owens says it’s quite possible that a portable high-end EEG machine, costing about $75,000, can be used at a patient’s bedside. An EEG uses scalp electrodes to measure the electrical signals coming from neurons in the brain.

Owen said command-following is a routine method of telling if a person is conscious and aware, “and with Scott we can tell he is activating his brain when we ask him to do so.”

“And when we say ‘now stop doing that imagining’ and then we see the little blob in the brain disappear. But when we say start it again now the blob lights up again,” he said.

Owen said Routley on two occasions through a series of question and commands “responded that he wasn’t in any pain.”

This research also raises ethical questions about whether these patients, once they are able to communicate, should be able to direct their care — and the end of their lives.

“It could change the way we make end-of-life care decisions in Canada,” Kerry Bowman, a bioethicist at the University of Toronto's Joint Centre for Bioethics, said in a previous interview.

Owen said being able to begin rudimentary communications with patients like Routley “opens the door to answering . . . how much do these patients know about their situation, how much do they remember, what happened to them and so on and so forth.

“And that’s what we are beginning to explore now.”

Owen said the brain scan allows researchers to get around a patient’s physical disabilities and access their residual function based solely on the pattern of activity in their brain.

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“It is an extremely powerful technique for trying to understand a lot more about what it’s like to be in this condition,” he said.

The research team’s breakthrough with Routley in June is being highlighted on the BBC’s Panorama program, which followed several vegetative and minimally-conscious patients in Britain and Canada for more than a year.

With files from Megan Ogilvie