Facilitated communication, or FC, has nothing to do with coma but is relevant to this case because of some of the media reports. FC is the technique of holding a patient’s hand to “help” them communicate by pointing to letters on a board. When FC was first proposed to the therapy community, it seemed like a powerful new technique – countless children who were thought to be too brain damaged to communicate were believed, due to FC, to actually have almost intact intellects trapped inside a non-communicating body. Unfortunately, FC was promoted prior to proper scientific validation. When it was studied in properlyh(sic) controlled blinded trials it turned out the the facilitator, and not the client, was doing all the communicating. FC is nothing but a well-meaning delusion. But it is also a dangerous one – FC testimony has led to the false conviction of adults accused of abuse.
While we do not want to miss any cases of a person’s hidden ability to communicate, the FC experience teaches us to be cautious. We must always ask – is communication (or any sign of consciousness) real? Has it been validated in an objective and controlled way?
Now comes the tricky part – the clinical correlation. Looking at brain anatomy and activity is important, but must be placed into a proper clinical context. At present, the clinical exam is still critical. I don’t know what Mr. Houben’s exam is. But I do have a video of him communicating. What I can say with high confidence is that this is a video of bogus facilitated communication. The “facilitator” appears to not just be supporting Houben’s hand, but moving it around the keyboard. Houben is looking in the general direction of the keyboard, but at times not directly at it (which is necessary for single finger typing). It is not clear if he can even see, and since his eyes are not in line it is not clear which eye he would be using.
His hand is also in a brace; his finger is not touching the board – the plastic of the brace is – so he would have little sensory feedback.
And yet his hand flies dextrously across the board typing very quickly. It seems impossible that someone with his level of paralysis, and years of inactivity, would be able to type so quickly with just a little “support”. There is little doubt, in other words, that his typing is the product of bogus FC – the facilitator is doing the communicating, not Houben.
Reporting of his typing is without skepticism, and so basic questions are not addressed. It would also be almost trivial to test whether or not the communication were legitimate – the report says he responds in Flemish – so have a non-Flemish speaking facilitator hold his hand. Apparently, he also understands English so you could have a non-English speaking facilitator answer questions posed in English. Or blind the facilitator to the keyboard or visual information that Houben has access to. What would not be sufficient, however, is a knowledge test – asking Houben about events in the past or about his life, for example. This is too difficult to tightly control – a facilitator may have been contaminated, or may just make obvious or lucky guesses. In an interview for NPR, Laureys reports that the family came up with the method of communication, and it was validated by having Houben identify objects that were show to him – that’s it. Laureys also reports that the medical doctors were skeptical of this communication, and it seems right that they were.
Until a tightly controlled test is done, the FC evidence is worthless.
Regardless of whether Houben is locked-in or in a vegetative state, what is being shown on the videos above and described in the the news reports is indeed, as Randi put it, a cruel farce that allows the same cranks who claimed that Terri Schiavo wasn't in a persistent vegetative state to hijack the Houbens case as "proof that they might have been right."
For those who may need further evidence for my contention, the proof can be found at http://tinyurl.com/ye9d9lp -- where it is clearly seen that the “facilitator” is looking directly at the keyboard, while the subject is asleep! There can be no further doubt. This FC claim is simply untrue, a farce, a lie – and the “facilitator” knows it! And no, this man is not going to write a book, but the "facilitator" is, and if this humbug is not stopped, she'll make a fortune doing so. Put a stop to this, someone!"