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Dr. Laureys Admits Facilitated Communication Failure

by Steven Novella, Feb 15 2010

I have been covering the story of Dr. Steven Laureys, a Belgium neurologist whose research involves disorders of consciousness, and his most famous patient, Rom Houben. Houben is a 46 year old man who is the victim of a car accident at the age of 23. For the latter half of his life he has been in an apparent persistent vegetative state -except recently it was discovered that he has more brain activity (almost normal) than expected.

So Dr. Laureys attempted to establish communication with Houben as if Houben were in a locked in state – someone who is conscious but paralyzed. All they could get Houben to move was his foot to depress a pedal, and that could theoretically be used to answer yes/no questions. But Houben has too much spasticity and he could not lift his foot off the pedal.

This is where the story gets interesting, and where it became an international controversy. Enter Linda Wouters – a speech therapist who uses facilitated communication (FC). She claimed that after months of training she could communicate with Houbens by sensing the subtle movements of his right hand, which he could use to direct her across a computer screen keyboard.

FC, unfortunately, is pure pseudoscience. It was introduced in the late 1980s as a wonderful new method for communicating with children with cognitive disorders, on the assumption that they were more verbally than mentally impaired. Many therapists were convinced, and many parents were overjoyed as their previously non-communicative children starting writing poetry expressing their love for their parents. (And there was also a dark side as some children, through FC, started reporting physical and sexual abuse by parents and caretakers.)

When people got around to actually testing FC scientifically it turned out, rather unequivocally, that all the communication was being done subconsciously by the facilitator – a phenomenon called the ideomotor effect. They were not just supporting the hand of their client, they were directing it. Well-designed studies showed that the facilitator was always doing all the communication. FC then shrank to a fringe phenomenon – but its adherents would not give up, and FC continues to this day (even sometimes in courtroom testimony), hoodwinking the unawares and having to be debunked all over again and again.

It is very unfortunate that Dr. Laureys was unfamiliar with FC. Had he known more about it he could have nipped this travesty in the bud. But he was taken in by it, claiming that he tested Wouters and it looked to him as if Houben was doing the communication. This story, in fact, is a good cautionary tale about why mainstream scientists need to be familiar with the pseudosciences that touch their specialty.

Regarding Rom Houben video showing Wouters performing FC with Houben clearly showed that he could not be doing the communication. In one video Houben was not even looking at the keyboard, and may not have even been awake. But in every video Wouters was moving his hand across the keyboard at unbelievable speeds – not even a neurologically intact person could direct another to keystrokes with such speed an accuracy by just moving one finger.

But to Laureys credit he promised a more thorough test – although he seemed confident such test would validate the FC communication with Houbens. Well finally we have the results of this further testing. Spiegel Online reports:

Laureys has now carried out those tests, and his results hold that it wasn’t Houben doing the writing after all. The tests determined that he doesn’t have enough strength and muscle control in his right arm to operate the keyboard. In her effort to help the patient express himself, it would seem that the speech therapist had unwittingly assumed control…

In the more recent test, Houben was shown or told a series of 15 objects and words, without a speech therapist being present. Afterward, he was supposed to type the correct word — but he didn’t succeed a single time.

Good for Laureys for doing proper tests and sharing the results with the world. This is, of course, what skeptics like myself predicted would be the results of proper testing. We also warned about the pitfall of doing less than rigorous testing, like those that initially convinced Laureys. Once again pseudoscience fails under properly designed scientific testing.

Unfortunately, is appears that Laureys’ conversion to FC skeptic is not yet complete. He is also quoted as saying,

This doesn’t necessarily discredit facilitated communication altogether. Laureys analyzed another paralyzed test subject who answered all 15 control questions correctly despite having a comparable brain-damage diagnosis. “That means it is really necessary to verify every single case,” Laureys says.

Laureys does not seem to appreciate that he is claiming here that he has overturned 20 years of FC research showing that it is not legitimate. You cannot casually claim from a single case that you have demonstrated a highly implausible phenomenon that has previously been rejected by carefully controlled studies. What are the details of this new case he is referring to? Is is really FC? I could find nothing published, and there are no further details in the report. It is possible that the reporting itself is inaccurate – this requires further follow up.

The rest of the Spiegel article deals with the very legitimate and interesting research of Laureys and others involving attempts at using various brain imaging technology to better assess, and possibly even communicate with those who are locked in or in a minimally conscious state. I discussed this research recently here. This article adds a discussion of the research of Marie Bruno – who is using EEGs (electroencephalogram) to communicate. The idea is that the EEG can detect difference in brain wave activity in different brain states voluntarily created by the subject. The method is still crude, and will likely require years of research to become useful. But it is promising.

Rom Houben’s story has grown to encapsulate the plight of those with disorders of consciousness, our attempts to better assess and communicate with them through advancing technology, and the mischief that can still be caused by lingering pseudosciences. It is truly a scandal that FC is still around. Like homeopathy, therapeutic touch, and many similar medical pseudosciences – their persistence is not a failure of science, which has adequately shown them to be nothing but illusions, but rather of collective rationality

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14 Responses to “Dr. Laureys Admits Facilitated Communication Failure”

  1. Dave says:

    Excellent article, gives a good summary of what FC is and why it’s nonsense !

  2. Robo Sapien says:

    If FC were truly plausible, then there would be no need for a therapist, as a simple Ouija board would suffice.

    My uneducated, amateurish insight tells me that there is little hope of establishing communication with this man. At best, they could possibly record some subconscious reactions to sensory input. It is my understanding that the human body’s survival protocol is to shut down unneeded bodily systems and concentrate resources on those which it needs to survive the longest under present conditions. This is why we black out when starved of oxygen, as the body’s mechanical response is to shut down the seemingly unneeded consciousness in order to keep vital systems running for as long as possible.

    With that in mind, it seems plausible that Houben’s consciousness is “offline” in his current state, despite what his eyeballs and fingers are doing. His body simply has more important things to do than think about anything.

    They should send this Wouters broad packing, and bring in Robbie Thomas. If some hardcore psychic justice doesn’t move this man, I don’t know what will.

    • Max says:

      “If FC were truly plausible, then there would be no need for a therapist, as a simple Ouija board would suffice.”

      Does Stephen Hawking’s speech synthesizer count?

  3. Matt says:

    I’d like to hear more about FC. I have heard there are cases where people have started out with a therapist, but are now able to communicate on their own. Many in the Autism community believe FC works quite well.

    • stargazer9915 says:

      Many in the autism community also ‘believe’ that vaccines cause autism. Doing just a small bit of research on FC will show that it is a sham and probably more harmful than useful. Ask yourself “if many in the autism community believe it works quite well, then why do most courts of law not allow it?”

      There is as much evidence for FC as there are for phschic mediums (see previous article).

  4. Robo- what you say is generally true. However, the brain generally has the highest priority in terms of resources. Your body does not shut down your brain to keep other systems going – it gives highest priority to brain function.

    The only exception to this is catastrophic situations in which death is otherwise imminent, like shock. This does not apply to Houben.

    • Robo Sapien says:

      I’m only asserting that his body may be keeping his consciousness “offline” as a programmatic response to the conditions it observes. Of course the brain itself can’t shut down, or nothing else would work :O

  5. Sara says:

    These alternatives are thriving because the Medical Community is advocating them. My mother was recently in the hospital for a month. She was visited several times by 2 women who were Theraputic Touch therapists. They were apparently part of the hospital staff since at one point they knew my mother was suffering from an odd hand cramp (unrelated to her illness).

    When a hospital employs and sends around a touch therapist – people assume that this is solid science. Authority has spoken.

  6. Hospitals are now a major source of medical pseudoscience – specifically the marketing departments of hospitals, who see it as a revenue stream, and don’t seem to care about scientific legitimacy.

    • SeanG says:

      Someone operating a shop on the corner is one thing. Seeing this in hospitals is distressing. I recently took my dad to a physical therapy appointment at a local hospital. I was dismayed to see a placard advertising acupuncture at the front desk. Granted, this was a private practice within the hospital. Aren’t there boards or something that regulate what goes on in a hospital?

  7. MadScientist says:

    I’m still suspicious of Laureys and still think that his institution should investigate him for fraud. Perhaps he’s just not that good a scientist to see that FC is BS, but it’s hard to believe he can be that stupid and yet claim to make real progress in diagnosing victims like Houben.

  8. Patrick says:

    Articles like this are why I come to this website. There’s another layer to the reporting here. This is something most other blogs leave out.

  9. Jeshua says:

    While i totally agree that what has been done so far with FC has not worked, the idea just seems too attractive to abandon altogether. Isn’t it possible that someone could come up with a different approach to FC that could work? It doesn’t seem as though there is any solid theoretical reason why it shouldn’t work, just as there is no solid theoretical evidence that time travel is not possible. BTW, I have no personal reason to be hopeful about FC, but who wouldn’t like to travel back in time?

    • stargazer9915 says:

      Theoretical evidence is an oxymoron. There is no such thing, just like FC. Yes, it would be nice if it were true, but all, and I mean ALL, evidence points to the contrary. Giving false hope in the form of FC is out-and-out despicable. These people should be prosecuted for fraud.

      I know it’s a hard line, but I feel someone needs to take it.