The statements of a Belgian man believed to be in a coma for 23 years, but recently discovered to be conscious, are poignant, but experts say they may not be his words at all.

Rom Houben's account of his ordeal, repeated in scores of news stories since appearing Saturday in Der Spiegel, appears to be delivered with assistance from an aide who helps guide his finger to letters on a flat computer keyboard. Called "facilitated communication," that technique has been widely discredited, and is not considered scientifically valid.

"If facilitated communication is part of this, and it appears to be, then I don't trust it," said Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics. "I'm not saying the whole thing is a hoax, but somebody ought to be checking this in greater detail. Any time facilitated communication of any sort is involved, red flags fly."

Facilitated communication came to prominence in the late 1970s after an Australian teacher reportedly used it to communicate with 12 children rendered speechless by cerebral palsy and other disorders. Over the next two decades, it gained some adherents in patient and medical communities, but failed to produce consistent results in controlled, scientific settings.

Researchers said that facilitators were unconsciously or consciously guiding patients' hands. Multiple professional organizations, including the American Association on Intellectual and Developmental Disabilities and the American Academy of Pediatrics, say that facilitated communication is not credible.

Far more credible, however, is emerging research on patients thought to be in vegetative states, but revealed by brain-scanning technology to be at least minimally conscious, and even aware of what is happening around them. These two strains of research have collided in the figure of Houben. In 2006, a full 23 years after a horrific car accident left him paralyzed and apparently unconscious, tests run by the University of Liege's Coma Science Group showed that Houben's brain was active, and almost normal. He wasn't a vegetable, but aware, and trapped silently in the prison of his ruined body.

Houben has since proven able to answer yes-or-no questions with slight movements of his foot. It's a tremendous accomplishment, and raises the chilling possibility that, as estimated by Coma Science Group leader Steven Laureys in a Monday New York Times story, as many as four in 10 people considered utterly comatose may be misdiagnosed. But the legitimacy of interviews given by Houben and his facilitator to Der Spiegel, and shown on video by the BBC, may not be as certain.

"I believe that he is sentient. They've shown that with MRI scans," said James Randi, a prominent skeptic who during the 1990s investigated the use of facilitated communication for autistic children. But in the video, "You see this woman who's not only holding his hand, but what she's doing is directing his fingers and looking directly at the keyboard. She's pressing down on the keyboard, pressing messages for him. He has nothing to do with it."

According to Randi, facilitated communication could only be considered credible if the facilitator didn't look at the keyboard or screen while supporting Houben's hand, and helped him type messages in response to questions she had not heard, thus ensuring that Houben's responses are entirely his own.

The James Randi Educational Foundation has offered a million-dollar prize to a valid demonstration of facilitated communication, and Randi invited Houben to participate. "Our prize is still there," he said.

In the Der Spiegel interview, Houben and his facilitator recounted his ordeal. "I would scream, but no sound would come out," they wrote. "I became the witness to my own suffering, as doctors and nurses tried to speak to me and eventually gave up." Of the correct diagnosis, they wrote, "I will never forget the day they finally discovered what was wrong — it was my second birth."

According to Caplan, Houben's apparent lucidity after spending more than two decades in complete isolation — circumstances known to be psychologically and cognitively damaging — is hard to believe.

"You're going to lie for 23 years in a hospital bed with almost no stimuli, and then sound completely coherent and cogent?" he said. "Something is wrong with that picture. The messages are almost poetic. It sounds too lucid, like someone prepared these things to say. I'm not saying it's all a fraud, but I want to hear a lot more."

Whatever the final verdict on Houben's facilitated communication, however, it does not alter the fact of his misdiagnosis. Laureys could not be reached for comment, but said in an Agence France Presse story that "every patient should be tested at least 10 times before they are categorically defined as 'vegetative.'"

Image: Yves Logghe/AP

See Also:

Brandon Keim's Twitter stream and reportorial outtakes; Wired Science on Twitter. Brandon is currently working on a book about ecosystem and planetary tipping points.