Facilitated communication

Amidst the ads in the Sunday Magazine largely targeted to the 1% that the New York Times claims to hate is an article on facilitated communication. I had a clinical experience with it 30 years ago that you might be interested in.

As a neurologist I was asked to do an Independent Medical Evaluation (IME) on an unfortunate man who was electrocuted at work (he worked on high voltage transmission lines). He went into cardiac arrest and sustained severe brain damage. The issue was not fault, which the power company readily admitted, but whether in what appeared to be a vegetative state, with no visible response to verbal commands, he was in fact conscious but unable to respond. In the latter case the reward to the family would have been substantially larger (for pain and suffering in addition to loss of consortium, etc. etc.). It was claimed that facilitated communication showed that he was able to write the answer to simple calculations given verbally, not visually.

Reviewing the chart before seeing the man, showed that he and his wife were admirable individuals, adopting children that no one else wanted and raising them despite limited income. He was seen at the rehab facility, with attorneys for the insurer for the power compony and his family present. It was apparent that the people caring for him were quite devoted, both to him and his wife and were very sincere, especially one of his young therapists.

The neurologic exam showed that although he did react to deep pain (sternal compression), he did not follow simple commands (e.g. blink). He appeared to be in a coma. Following the neurologic examination the young therapist then demonstrated how when he held the man’s hand to which a pencil was attached, the man could actually perform calculations — add 2 and 2 produce a 4, etc. etc. Several such calculations were produced all with correct answer.

What do you think I did next?

No peeking. Think about it.

I took the first sheet of paper away, placed a clean sheet under the man’s hand and asked for a repeat (this time with the therapist’s eyes closed).

This produced a bunch of random lines, nothing more.  When the therapist opened his eyes and saw the results, he was visibly shaken and close to tears.

Was he faking the whole time? At any time? I seriously doubt it. A faker could have produced a reasonable number with his eyes shut. Try it. He didn’t.

“You can’t con an honest man” — http://www.amazon.com/The-Sting-Man-Inside-Abscam/dp/0143125273

True, but you certainly can con yourself.

For another example, this time perpetrated by nurses, see how an 11 year old girl (Emily Rosa) put a definitive end to “Therapeutic Touch” and became the youngest co-author ever of an article in the Journal of the American Medical Association — http://jama.jamanetwork.com/article.aspx?articleid=187390

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