1 00:00:11,800 --> 00:00:14,520 I got home at about quarter past 11, 2 00:00:14,520 --> 00:00:16,240 half past 11 at night, 3 00:00:16,240 --> 00:00:19,240 and I found him clutching his head in the foetal position, 4 00:00:19,240 --> 00:00:22,000 saying, "Stop this effing pain." 5 00:00:22,000 --> 00:00:25,640 And I knew that there was something very, very wrong. 6 00:00:25,640 --> 00:00:30,840 So I called an ambulance, and they took us to our local hospital A&E. 7 00:00:31,480 --> 00:00:35,240 And slowly I saw him slip into a coma. 8 00:00:38,360 --> 00:00:41,240 And at seven o'clock in the morning, 9 00:00:41,240 --> 00:00:44,440 the doctor said to me, "You should call his children in New Zealand." 10 00:00:46,720 --> 00:00:49,520 Which I knew meant that he was probably going to die. 11 00:00:51,920 --> 00:00:54,000 And we got to King's and 12 00:00:54,000 --> 00:00:55,960 they have an amazing set up there. 13 00:00:55,960 --> 00:00:58,720 Everything just kind of kicked into place, 14 00:00:58,720 --> 00:01:03,040 and the surgeon came to ask for our consent to operate, 15 00:01:03,040 --> 00:01:07,040 and said, "We don't know if Richard will survive long enough to 16 00:01:07,040 --> 00:01:09,240 "have the operation. 17 00:01:09,240 --> 00:01:12,520 "And if he does, he may bleed again on the table. 18 00:01:12,520 --> 00:01:15,800 "And if he does that, the prognosis is not good. 19 00:01:15,800 --> 00:01:17,640 "He'll probably be a vegetable." 20 00:01:28,360 --> 00:01:31,600 There was nothing I could do but wait and hope. 21 00:01:31,600 --> 00:01:34,360 Hope that he survived. 22 00:01:34,360 --> 00:01:37,640 Hope that the surgeon had the skill to save his life. 23 00:01:37,640 --> 00:01:40,120 But also hope, if he did survive, 24 00:01:40,120 --> 00:01:43,160 that Richard, my Richard, 25 00:01:43,160 --> 00:01:44,640 would still be there. 26 00:01:48,720 --> 00:01:52,840 My name is Fiona Lloyd-Davies. I'm a film-maker and a journalist, 27 00:01:52,840 --> 00:01:54,560 and for the past four years, 28 00:01:54,560 --> 00:01:57,000 I've been documenting my husband's battle 29 00:01:57,000 --> 00:02:00,440 back to life after suffering a catastrophic brain haemorrhage. 30 00:02:25,040 --> 00:02:27,400 So, the first time that I heard about Richard 31 00:02:27,400 --> 00:02:29,520 was that the on-call neurosurgical 32 00:02:29,520 --> 00:02:33,480 registrar phoned me up and described to me the condition, which was a 33 00:02:33,480 --> 00:02:37,080 patient who was known to be on thinners to thin the blood, 34 00:02:37,080 --> 00:02:39,440 who'd had a possible fall, 35 00:02:39,440 --> 00:02:44,360 and was found with a diminished and decreasing level of consciousness. 36 00:02:46,800 --> 00:02:49,040 And then a head scan and a CT scan 37 00:02:49,040 --> 00:02:51,440 which showed a large area of fresh 38 00:02:51,440 --> 00:02:53,920 bleeding over the surface of the brain, 39 00:02:53,920 --> 00:02:55,480 on the left-hand side of the brain. 40 00:02:57,920 --> 00:03:01,720 In other words, the part of the brain that controls speech, 41 00:03:01,720 --> 00:03:03,640 is involved in memory, 42 00:03:03,640 --> 00:03:05,840 and gives us a lot of the unique features 43 00:03:05,840 --> 00:03:07,720 that make us the individuals we are. 44 00:03:09,320 --> 00:03:12,880 So it was clear that he could well be left with significant deficits in 45 00:03:12,880 --> 00:03:15,800 memory, in speech, in personality, 46 00:03:15,800 --> 00:03:19,440 and he may well have a quality of life that he may not have valued, 47 00:03:19,440 --> 00:03:23,520 or that his family may have felt on his behalf that he didn't value. 48 00:03:23,520 --> 00:03:27,160 But you have to make a decision at that point as to, OK, 49 00:03:27,160 --> 00:03:30,000 what are we going to do? You haven't got long to decide. 50 00:03:30,000 --> 00:03:31,640 And we decided that we should try. 51 00:03:37,200 --> 00:03:39,000 Then it's speed is of the essence. 52 00:03:39,000 --> 00:03:42,720 So we say, "Time is brain," and it really was. 53 00:03:42,720 --> 00:03:45,040 We took him straight into the operating theatre. 54 00:03:47,600 --> 00:03:49,920 We then raised what's called a trauma craniotomy 55 00:03:49,920 --> 00:03:51,560 or a question-mark flap, 56 00:03:51,560 --> 00:03:54,720 which is a cut that covers one side of the skull. 57 00:03:54,720 --> 00:03:58,200 Drill with an air drill through the skull 58 00:03:58,200 --> 00:04:00,040 to lift up a large flap of the skull 59 00:04:00,040 --> 00:04:01,920 on that left-hand side. 60 00:04:01,920 --> 00:04:05,360 That exposes the outer lining of the brain, what's called the dura. 61 00:04:05,360 --> 00:04:08,840 And underneath that you could see that the dura was tense, 62 00:04:08,840 --> 00:04:10,240 it was bulging, 63 00:04:10,240 --> 00:04:11,800 it was blue, 64 00:04:11,800 --> 00:04:14,880 and there was no pulsation of the brain in time with the heartbeat, 65 00:04:14,880 --> 00:04:16,960 which is what you see with a normal person. 66 00:04:16,960 --> 00:04:19,960 And that showed that there was a large clot sitting over the surface 67 00:04:19,960 --> 00:04:22,040 of the brain, compressing the brain, 68 00:04:22,040 --> 00:04:25,280 and actually preventing oxygen and blood getting to the brain, 69 00:04:25,280 --> 00:04:28,120 and so the brain was actively being damaged by the blood clot. 70 00:04:33,600 --> 00:04:35,440 The brain is like a jelly. 71 00:04:35,440 --> 00:04:37,800 It's like a very delicate jelly. 72 00:04:37,800 --> 00:04:39,720 It's not like this wax brain here, 73 00:04:39,720 --> 00:04:41,920 which I can hold very clearly in my hands. 74 00:04:41,920 --> 00:04:45,400 A real brain is incredibly delicate, incredibly soft. 75 00:04:45,400 --> 00:04:49,160 Problem is if you open the lining of the brain, the dura, 76 00:04:49,160 --> 00:04:51,840 to let the clot out, and you do that too quickly, 77 00:04:51,840 --> 00:04:54,120 the brain can actually start to squeeze out 78 00:04:54,120 --> 00:04:56,760 through the opening in the lining that you've made, 79 00:04:56,760 --> 00:04:59,000 rather like toothpaste through a tube. 80 00:04:59,000 --> 00:05:01,440 Obviously that brain that squeezes out like that, 81 00:05:01,440 --> 00:05:03,480 it's going to be irreparably damaged. 82 00:05:03,480 --> 00:05:05,880 You're not going to get that brain back. 83 00:05:05,880 --> 00:05:09,640 So, very carefully, bit by bit, you extend the cut as you go, 84 00:05:09,640 --> 00:05:15,040 removing a bit of clot, making the opening a bit bigger, 85 00:05:15,040 --> 00:05:17,320 so that hopefully by the time you've finished, 86 00:05:17,320 --> 00:05:18,920 you've uncovered the whole 87 00:05:18,920 --> 00:05:21,320 surface of the brain on that left-hand side. 88 00:05:21,320 --> 00:05:23,160 You remove the blood clot, 89 00:05:23,160 --> 00:05:24,480 and the brain has not started to 90 00:05:24,480 --> 00:05:26,800 swell out through the opening in the dura that you've made. 91 00:05:31,680 --> 00:05:34,440 So, having removed the clot from the surface of the brain, 92 00:05:34,440 --> 00:05:36,760 the decision for me was - 93 00:05:36,760 --> 00:05:39,480 "Have I relieved enough pressure so that Richard's 94 00:05:39,480 --> 00:05:41,360 "going to survive this operation?" 95 00:05:43,280 --> 00:05:46,320 So what we did in Richard's case was we didn't put the bone back. 96 00:05:46,320 --> 00:05:48,480 We left the lining of the brain open, 97 00:05:48,480 --> 00:05:50,720 which allowed the brain to swell a little bit. 98 00:05:50,720 --> 00:05:52,560 And we didn't put that skull back. 99 00:05:52,560 --> 00:05:54,120 So, in other words, there was just 100 00:05:54,120 --> 00:05:56,200 skin and muscle over this area of the brain. 101 00:05:56,200 --> 00:05:58,440 So it allows that little bit of wiggle room, 102 00:05:58,440 --> 00:06:00,360 if you want to think about it that way, 103 00:06:00,360 --> 00:06:03,720 for the swelling to occur in the first few days after the operation. 104 00:06:22,160 --> 00:06:24,320 Once the swelling had gone down, 105 00:06:24,320 --> 00:06:26,960 the catastrophic effect of the stroke was 106 00:06:26,960 --> 00:06:30,160 plain to see, and it looked as if he'd lost half his brain. 107 00:06:33,040 --> 00:06:35,440 As a way of coping, I reached out for my camera 108 00:06:35,440 --> 00:06:37,600 and started to record what happened. 109 00:06:38,920 --> 00:06:40,600 And I also kept a written diary. 110 00:06:41,840 --> 00:06:45,400 "Diary entry, Friday 6th of September. 111 00:06:45,400 --> 00:06:48,880 "He's passed the swallow test and no longer needs a feeding tube. 112 00:06:48,880 --> 00:06:51,720 "He's eating puree - giant leap forward." 113 00:06:56,920 --> 00:06:59,600 Sweetie, how are you feeling today? 114 00:06:59,600 --> 00:07:01,040 Because you're much more awake. 115 00:07:02,320 --> 00:07:06,360 But then on day 30, Wednesday 11th of September, I've written, 116 00:07:06,360 --> 00:07:08,920 "I think Richard's regressing mentally. 117 00:07:08,920 --> 00:07:11,840 "I spoke to the speech therapist. It all seems so gloomy. 118 00:07:11,840 --> 00:07:14,080 "He isn't responding well." 119 00:07:14,080 --> 00:07:17,960 And I've written at the bottom, "I mustn't give up. I must keep trying. 120 00:07:17,960 --> 00:07:20,680 "He will surprise me and surpass all expectations. 121 00:07:20,680 --> 00:07:21,840 "I know." 122 00:07:33,000 --> 00:07:36,760 I always tried to be as upbeat as possible when I was with him, 123 00:07:36,760 --> 00:07:39,480 and be as cheerful and positive, 124 00:07:39,480 --> 00:07:44,680 to help, kind of, engage him back into the real world. 125 00:07:45,120 --> 00:07:47,280 Obviously it was hard, you know? 126 00:07:47,280 --> 00:07:49,200 I felt most of the time like someone's 127 00:07:49,200 --> 00:07:51,640 reaching into my chest and ripping my heart out. 128 00:07:54,280 --> 00:07:57,840 It was very difficult because you felt part of him had gone, 129 00:07:57,840 --> 00:07:59,640 and yet he was still there, 130 00:07:59,640 --> 00:08:03,160 and how could I grieve for my husband when he was still there? 131 00:08:03,160 --> 00:08:04,800 Would Richard ever be Richard again? 132 00:08:06,040 --> 00:08:07,320 You don't want me to film? 133 00:08:08,640 --> 00:08:10,400 OK, I'll turn it off, then, darling. 134 00:08:15,280 --> 00:08:18,440 "Diary entry, Monday 11th of November. 135 00:08:18,440 --> 00:08:20,760 "Three-month post stroke. 136 00:08:20,760 --> 00:08:22,280 "Will he ever get better? 137 00:08:23,720 --> 00:08:26,160 "One nurse said, 'Will you come and help? 138 00:08:26,160 --> 00:08:27,800 " 'You might as well start practising.' " 139 00:08:30,880 --> 00:08:34,600 It was awful because there was a realisation then for me that this 140 00:08:34,600 --> 00:08:37,720 could be our future. This could be the rest of our lives together. 141 00:08:44,880 --> 00:08:47,640 By the end of November, there was good news. 142 00:08:47,640 --> 00:08:49,520 Richard was going to see a surgeon 143 00:08:49,520 --> 00:08:52,640 about replacing the missing part of his skull. 144 00:08:52,640 --> 00:08:55,640 So, when I saw Richard in the November, 145 00:08:55,640 --> 00:08:59,080 which was three months after his stroke and his brain injury, 146 00:08:59,080 --> 00:09:03,160 he had quite a lot of disablement. 147 00:09:03,160 --> 00:09:06,560 He was not moving his right-hand side. 148 00:09:06,560 --> 00:09:08,600 He wasn't speaking. 149 00:09:08,600 --> 00:09:11,600 He also had a very large defect on the left side of 150 00:09:11,600 --> 00:09:16,680 his skull, which meant that his brain had actually moved over 151 00:09:16,680 --> 00:09:18,920 significantly to the right-hand side. 152 00:09:19,960 --> 00:09:22,480 The white here shows the contour of 153 00:09:22,480 --> 00:09:24,960 his outline of his bone of his skull, 154 00:09:24,960 --> 00:09:27,120 and this is the missing segment here. 155 00:09:27,120 --> 00:09:29,600 What happens is, after the initial swelling, 156 00:09:29,600 --> 00:09:31,360 atmospheric pressure 157 00:09:31,360 --> 00:09:34,560 starts to push in on the left-hand side. 158 00:09:34,560 --> 00:09:38,520 So if you look at what is the midline here, this, you can see, 159 00:09:38,520 --> 00:09:41,200 has moved over quite markedly as a result, 160 00:09:41,200 --> 00:09:43,320 and the brain can start to tension. 161 00:09:43,320 --> 00:09:45,360 It can get squashed. 162 00:09:45,360 --> 00:09:46,720 You're moving your leg. 163 00:09:46,720 --> 00:09:49,000 That's really good. 164 00:09:49,000 --> 00:09:51,560 So the planned operation, the 165 00:09:51,560 --> 00:09:55,360 cranioplasty, is where we put a custom-made implant, 166 00:09:55,360 --> 00:09:59,040 which would reconstruct the original contour of the bone. 167 00:09:59,040 --> 00:10:03,760 And as a result, the brain would then expand into that space, 168 00:10:03,760 --> 00:10:06,560 and then move over to the left-hand 169 00:10:06,560 --> 00:10:10,280 side and take away that tension on the brain. 170 00:10:10,280 --> 00:10:13,840 And it's that untensioning of the brain that we believe leads to 171 00:10:13,840 --> 00:10:15,960 improvements in blood supply 172 00:10:15,960 --> 00:10:18,040 and, as a result, improve function. 173 00:10:18,040 --> 00:10:20,560 It's a beautiful day. 174 00:10:20,560 --> 00:10:23,360 I think in Richard's case, he evidently 175 00:10:23,360 --> 00:10:26,480 had such an indrawn defect on that 176 00:10:26,480 --> 00:10:28,880 left-hand side that I felt if we 177 00:10:28,880 --> 00:10:31,360 could normalise that, that would actually 178 00:10:31,360 --> 00:10:33,680 lead to an improvement overall, 179 00:10:33,680 --> 00:10:35,160 so that was the working position. 180 00:10:36,360 --> 00:10:37,840 We were told it could be months 181 00:10:37,840 --> 00:10:40,240 before Richard could have the operation, 182 00:10:40,240 --> 00:10:42,960 so the next important stage was for him to start therapy, 183 00:10:42,960 --> 00:10:44,480 and he was transferred to the 184 00:10:44,480 --> 00:10:46,800 Royal Hospital for Neuro-disability in Putney. 185 00:10:50,880 --> 00:10:53,240 All right, Richard. Off we go. 186 00:10:53,240 --> 00:10:56,920 The plan was for him to start intensive physio, hydrotherapy, 187 00:10:56,920 --> 00:11:00,760 occupational, and speech and language therapy. 188 00:11:00,760 --> 00:11:03,280 OK, so, Richard, what we're going to start off today... 189 00:11:03,280 --> 00:11:06,880 Richard had to wear a custom made helmet whenever he was moved out of 190 00:11:06,880 --> 00:11:10,680 the wheelchair so that it protected the exposed left side of his brain. 191 00:11:13,760 --> 00:11:16,160 Have you got your balance, Richard? Can I let go? 192 00:11:17,400 --> 00:11:19,000 Go on. 193 00:11:19,000 --> 00:11:21,280 Hold it, hold it. 194 00:11:21,280 --> 00:11:25,320 One doctor had told me that a sign of a good recovery is if you can sit 195 00:11:25,320 --> 00:11:27,520 up on your own after four months, 196 00:11:27,520 --> 00:11:30,800 but this was nine months later and Richard still couldn't do it. 197 00:11:31,960 --> 00:11:33,760 Ooh, up, up, up, up, up. 198 00:11:33,760 --> 00:11:36,480 Richard, use those tummy muscles. That's it. 199 00:11:36,480 --> 00:11:39,520 Push those feet down into the ground. Good, OK. 200 00:11:39,520 --> 00:11:41,960 So, Richard, what colour is this? 201 00:11:43,920 --> 00:11:47,000 OK. So what I want you to do is to take this, Richard, 202 00:11:47,000 --> 00:11:50,280 and I want you to put it in the ring that's the same colour. 203 00:11:50,280 --> 00:11:51,960 So you need to look at the ring... 204 00:11:51,960 --> 00:11:54,360 So, is there any rings there, Richard? 205 00:11:54,360 --> 00:11:55,920 No. OK. 206 00:11:55,920 --> 00:11:59,760 It was now also becoming clear that he was having huge problems with 207 00:11:59,760 --> 00:12:02,760 understanding concepts such as shape and colour. 208 00:12:02,760 --> 00:12:04,520 So, is that in a ring, Richard? 209 00:12:09,080 --> 00:12:10,760 Go on. 210 00:12:10,760 --> 00:12:12,840 Reach it. Well done. 211 00:12:12,840 --> 00:12:15,440 Whoa, that was great. And again. Very good. 212 00:12:16,920 --> 00:12:19,120 Good. Lovely. 213 00:12:32,800 --> 00:12:35,000 Now, Richard, what you want, basically, 214 00:12:35,000 --> 00:12:36,720 it's just a trim up, is it? 215 00:12:36,720 --> 00:12:39,040 Just going to wipe your chin. Despite everything, 216 00:12:39,040 --> 00:12:40,680 there were moments of normality. 217 00:12:40,680 --> 00:12:42,360 So, darling, just think, 218 00:12:42,360 --> 00:12:45,800 this time next week you'll have had your plate fitted. 219 00:12:45,800 --> 00:12:49,040 And when we heard that Richard was about to have his operation, he went 220 00:12:49,040 --> 00:12:51,200 and had his first haircut in eight months. 221 00:12:51,200 --> 00:12:52,680 That's such good news. 222 00:12:52,680 --> 00:12:54,480 It's fantastic, isn't it? 223 00:12:54,480 --> 00:12:56,040 Yeah. 224 00:12:56,040 --> 00:12:58,680 I bet you're looking forward to that, aren't you, Richard? Eh? 225 00:13:00,160 --> 00:13:02,200 It'll be fine, darling. 226 00:13:02,200 --> 00:13:04,200 Mr Bentley does it all the time. 227 00:13:07,920 --> 00:13:09,400 Pretty good. Are you happy? 228 00:13:11,360 --> 00:13:12,720 All done, darling. 229 00:13:23,560 --> 00:13:26,480 I was under no illusions that this was a very major operation. 230 00:13:27,960 --> 00:13:30,080 Mr Bentley, the surgeon, 231 00:13:30,080 --> 00:13:31,720 had been very clear that the procedure 232 00:13:31,720 --> 00:13:33,520 coupled with Richard's multiple 233 00:13:33,520 --> 00:13:36,120 health problems made him a very high-risk patient. 234 00:13:37,560 --> 00:13:40,760 So, in terms of the risk of the procedure, 235 00:13:40,760 --> 00:13:43,480 in Richard's case he was already on 236 00:13:43,480 --> 00:13:46,280 blood thinning medication prior to his 237 00:13:46,280 --> 00:13:48,160 original incident, 238 00:13:48,160 --> 00:13:50,240 and he had an irregular heartbeat, 239 00:13:50,240 --> 00:13:52,680 and his heart was a little bit enlarged 240 00:13:52,680 --> 00:13:55,160 and wasn't pumping as well as it could have done, 241 00:13:55,160 --> 00:13:57,640 which predisposed him to a stroke. 242 00:14:01,160 --> 00:14:05,800 So, this is a plate, like one Richard had inserted. 243 00:14:05,800 --> 00:14:10,840 It's been made on a model made from the information from the CT scan. 244 00:14:11,000 --> 00:14:13,840 It would have been accessed via the original scar. 245 00:14:15,240 --> 00:14:20,440 We would have then gently dissected the scalp off the underlying brain. 246 00:14:20,960 --> 00:14:23,640 We would have exposed the defect. 247 00:14:23,640 --> 00:14:25,720 And then the plate would have been 248 00:14:25,720 --> 00:14:30,600 placed and secured through these small holes with screws. 249 00:14:30,600 --> 00:14:35,120 It's important to note that the plate has got perforations in it. 250 00:14:35,120 --> 00:14:39,280 And that's to prevent any blood 251 00:14:39,280 --> 00:14:43,800 building up underneath the plate and on the surface of the brain. 252 00:14:43,800 --> 00:14:47,120 And then the scalp is closed - he has a head bandage. 253 00:14:47,120 --> 00:14:49,720 And in Richard's case the drains 254 00:14:49,720 --> 00:14:52,760 would have come out two days after the 255 00:14:52,760 --> 00:14:55,200 operation and we would have restarted him 256 00:14:55,200 --> 00:14:57,560 on his blood thinning medication at that stage. 257 00:15:03,080 --> 00:15:07,720 Six days after Richard's operation, his daughters, Katie, Bridie, 258 00:15:07,720 --> 00:15:10,000 and Lucy, arrive from New Zealand. 259 00:15:11,200 --> 00:15:14,040 Lucy had brought her seven-month-old baby, Noah, 260 00:15:14,040 --> 00:15:17,560 who'd been born just a couple of weeks after Richard's stroke. 261 00:15:17,560 --> 00:15:20,400 Just... Sweetie, small mouthfuls. 262 00:15:23,920 --> 00:15:26,440 So, you've got to suck it up, Dad. 263 00:15:26,440 --> 00:15:29,320 Suck it up. That's what you always told us. 264 00:15:29,320 --> 00:15:31,560 LAUGHTER 265 00:15:37,480 --> 00:15:39,040 Oh, don't be silly. 266 00:15:40,520 --> 00:15:42,720 Isn't he beautiful, Dad? 267 00:15:46,280 --> 00:15:48,240 Do you want some more? 268 00:15:48,240 --> 00:15:50,200 No, thank you. Yes, please. 269 00:15:51,400 --> 00:15:53,360 Go on, go on, go on. 270 00:15:53,360 --> 00:15:55,920 Come on, darling. You can do it, you can do it. 271 00:15:55,920 --> 00:15:57,760 Look at you. 272 00:15:57,760 --> 00:15:59,360 Wow. 273 00:15:59,360 --> 00:16:02,000 Come on. You can do it, sweetie. Come on, come on, come on, sweetie. 274 00:16:02,000 --> 00:16:05,000 Stand to attention. You can do it, you can do it. 275 00:16:05,000 --> 00:16:07,840 You can do it. 276 00:16:09,400 --> 00:16:12,560 It sometimes seemed to be really tortuous for him, 277 00:16:12,560 --> 00:16:15,000 but I knew if he was going to get better 278 00:16:15,000 --> 00:16:17,000 it was going to be really hard work. 279 00:16:17,000 --> 00:16:18,960 They've got you. 280 00:16:18,960 --> 00:16:21,680 There was a significant improvement on day one. 281 00:16:22,920 --> 00:16:26,160 So, he was able to move his leg, his right leg, 282 00:16:26,160 --> 00:16:29,080 which he was unable to do before the operation, 283 00:16:29,080 --> 00:16:32,200 and he looked bright and well orientated. 284 00:16:32,200 --> 00:16:33,960 Two more seconds. Up tall. Come on. 285 00:16:35,120 --> 00:16:39,560 Stand up. Come on. You're doing really well, darling. 286 00:16:39,560 --> 00:16:41,480 He's wanting to sit down. OK. 287 00:16:43,440 --> 00:16:45,880 We haven't seen a big change in the hand, 288 00:16:45,880 --> 00:16:48,480 but I've seen a change in your leg, more spontaneous movement, 289 00:16:48,480 --> 00:16:50,120 which is good. 290 00:16:50,120 --> 00:16:52,400 Very good, darling. 291 00:16:52,400 --> 00:16:54,200 Is he just showing...? Did it just move? 292 00:16:54,200 --> 00:16:56,240 Yeah. His hand? Look at it. Are you filming this? 293 00:16:56,240 --> 00:16:57,440 Yes. 294 00:16:59,280 --> 00:17:02,280 Sweetie, are you moving your fingers for us? 295 00:17:02,280 --> 00:17:04,560 Richard, move your... 296 00:17:04,560 --> 00:17:06,600 The moment Richard moved his finger 297 00:17:06,600 --> 00:17:08,880 for the first time was extraordinary. 298 00:17:08,880 --> 00:17:12,400 Because it came out of nowhere, really. Nobody was expecting it, 299 00:17:12,400 --> 00:17:15,280 and suddenly his finger moved and we saw it. 300 00:17:15,280 --> 00:17:17,160 And it just, for me, 301 00:17:17,160 --> 00:17:22,120 was also a spark of hope that something had reconnected, 302 00:17:22,120 --> 00:17:25,040 something was improving that was completely unexpected. 303 00:17:26,120 --> 00:17:29,360 Especially when you're around, he's much more compliant. 304 00:17:29,360 --> 00:17:32,560 He's managing to hold his sitting balance on his own, 305 00:17:32,560 --> 00:17:36,200 he's able to stand up with the rotor stand and the stand hoist. 306 00:17:36,200 --> 00:17:38,480 Today, movement in his hand. 307 00:17:38,480 --> 00:17:40,480 Cool bananas, darling. 308 00:17:40,480 --> 00:17:41,640 Hello. 309 00:17:42,960 --> 00:17:45,360 Are you showing you can turn your head both ways? 310 00:17:50,320 --> 00:17:51,960 Several weeks later, 311 00:17:51,960 --> 00:17:55,080 Richard went back to see Mr Bentley to have his staples removed. 312 00:17:57,360 --> 00:17:59,360 OK, now, Richard, I'm just going to... 313 00:17:59,360 --> 00:18:01,160 Yeah, you tuck that, Richard. 314 00:18:01,160 --> 00:18:03,280 You did say he was a high-risk patient. 315 00:18:03,280 --> 00:18:05,960 He was a high-risk patient from his heart function, 316 00:18:05,960 --> 00:18:08,920 from his bleeding tendencies, 317 00:18:08,920 --> 00:18:10,560 from all sorts of reasons. 318 00:18:10,560 --> 00:18:12,920 And a big shift in the brain, too. 319 00:18:12,920 --> 00:18:15,320 So, as I said, 320 00:18:15,320 --> 00:18:18,880 not many people would have taken Richard on, I'll be honest. 321 00:18:18,880 --> 00:18:20,880 Erm, and... 322 00:18:21,960 --> 00:18:25,800 I... You know, you don't want to make people worse. 323 00:18:27,200 --> 00:18:30,720 As a doctor, that's your first 324 00:18:30,720 --> 00:18:33,080 pledge to the patients. First, do no harm. 325 00:18:34,720 --> 00:18:37,000 But on the other hand, you know, 326 00:18:37,000 --> 00:18:39,000 if there's a chance of improving things, 327 00:18:39,000 --> 00:18:41,240 then obviously we would like to. 328 00:18:41,240 --> 00:18:43,880 There is lots of evidence that suggests 329 00:18:43,880 --> 00:18:46,160 those patients do better after 330 00:18:46,160 --> 00:18:48,440 what they feel is the reconstruction. 331 00:18:48,440 --> 00:18:50,360 They feel more self, more whole, 332 00:18:50,360 --> 00:18:52,120 and their quality of life scores, if 333 00:18:52,120 --> 00:18:54,360 you compare that after the operation, 334 00:18:54,360 --> 00:18:57,640 compared to before, actually do show improvements. 335 00:18:57,640 --> 00:18:59,920 I mean, I don't know whether it's too optimistic 336 00:18:59,920 --> 00:19:01,720 to think he might be able to walk. 337 00:19:01,720 --> 00:19:03,960 I think, you know, 338 00:19:03,960 --> 00:19:06,640 who am I to say? 339 00:19:06,640 --> 00:19:08,400 If we can save people's lives, 340 00:19:08,400 --> 00:19:10,880 as we do in a major trauma centre like this, 341 00:19:10,880 --> 00:19:13,040 that's only half the story. 342 00:19:13,040 --> 00:19:17,200 And that sort of mind and body reconstruction, if you like, 343 00:19:17,200 --> 00:19:21,080 actually makes for a more complete patient overall. 344 00:19:21,080 --> 00:19:22,840 They're far more engaged, 345 00:19:22,840 --> 00:19:24,520 they're far more open to their physio 346 00:19:24,520 --> 00:19:26,560 and their rehabilitation and their 347 00:19:26,560 --> 00:19:28,800 quality of life is enhanced as a result. 348 00:19:28,800 --> 00:19:32,840 So, what I would say on a practical level with this now, just leave this 349 00:19:32,840 --> 00:19:35,920 for the next three days, and then you can wash the hair. 350 00:19:35,920 --> 00:19:38,200 How do you feel, sweetie? 351 00:19:38,200 --> 00:19:40,320 There you are. Do you want your staples? 352 00:19:40,320 --> 00:19:41,560 Do you want to count them? 353 00:19:48,320 --> 00:19:50,720 It was almost a year since Richard's stroke, 354 00:19:50,720 --> 00:19:53,880 and although there were small signs of improvement, 355 00:19:53,880 --> 00:19:56,160 I was told that he had plateaued and probably 356 00:19:56,160 --> 00:19:58,240 wouldn't get any better. 357 00:19:58,240 --> 00:20:01,080 I refused to accept that this was the end of his recovery. 358 00:20:02,720 --> 00:20:05,360 Then, a year to the day of his stroke, 359 00:20:05,360 --> 00:20:08,200 he was transferred to another NHS-funded 360 00:20:08,200 --> 00:20:10,400 neuro rehabilitation unit in Kent. 361 00:20:18,160 --> 00:20:23,240 The Raphael Hospital is run by director Dr Gerhard Florschutz. 362 00:20:23,240 --> 00:20:27,200 We set Raphael Medical Centre up as an acute neuro rehab unit, 363 00:20:27,200 --> 00:20:29,920 but at the same time we realised 364 00:20:29,920 --> 00:20:32,360 that you cannot just deal with the acute 365 00:20:32,360 --> 00:20:34,800 phase of a rehabilitation programme, 366 00:20:34,800 --> 00:20:37,200 but there is a continuum of care that is required. 367 00:20:38,480 --> 00:20:43,720 And our task is to develop a pathway to enable people to go back into 368 00:20:45,000 --> 00:20:46,800 the community to live a normal life. 369 00:20:55,520 --> 00:20:59,760 When we first assessed Richard, his speech was non-existent. 370 00:20:59,760 --> 00:21:03,040 He had a right-sided weakness. 371 00:21:03,040 --> 00:21:06,280 In particular, he couldn't stand up on his legs on his own. 372 00:21:09,120 --> 00:21:11,880 He had no movement on his right arm. 373 00:21:11,880 --> 00:21:17,040 Can you touch left ear and then touch right ear? 374 00:21:19,120 --> 00:21:21,080 Left ear. Where's your ear? 375 00:21:22,720 --> 00:21:25,160 No, that's your shoulder. 376 00:21:25,160 --> 00:21:27,600 Cognitively, he was very impaired. 377 00:21:27,600 --> 00:21:31,080 So he was quite a complex individual. 378 00:21:31,080 --> 00:21:34,360 But behind that, one could 379 00:21:34,360 --> 00:21:36,640 see there was something there. 380 00:21:36,640 --> 00:21:39,560 There was a, sort of, certain spark in Richard. 381 00:21:39,560 --> 00:21:41,240 And I think that is... 382 00:21:41,240 --> 00:21:44,600 If you can connect to that, then I think the work actually can begin. 383 00:21:44,600 --> 00:21:46,280 There's your right shoulder. 384 00:21:48,640 --> 00:21:50,880 Your left shoulder. 385 00:21:50,880 --> 00:21:53,000 Your right shoulder. 386 00:21:53,000 --> 00:21:54,360 Your left shoulder. 387 00:21:57,280 --> 00:22:00,840 With the right leg. I want you to push with the right leg. 388 00:22:00,840 --> 00:22:02,560 Just the right leg. 389 00:22:02,560 --> 00:22:04,360 Use, use... The right leg. 390 00:22:04,360 --> 00:22:06,160 Push. 391 00:22:06,160 --> 00:22:08,400 No, I feel only the left. Push hard. 392 00:22:08,400 --> 00:22:10,720 Push hard. And then, of course, 393 00:22:10,720 --> 00:22:13,360 he was able to go into the hydrotherapy pool. 394 00:22:13,360 --> 00:22:15,760 Push it. Is that the best you can do? 395 00:22:15,760 --> 00:22:18,360 Push it, push it. Show him you're strong. 396 00:22:18,360 --> 00:22:20,440 And I think in Richard's case, that 397 00:22:20,440 --> 00:22:23,440 was probably the most beneficial because he 398 00:22:23,440 --> 00:22:25,720 could begin moving without the 399 00:22:25,720 --> 00:22:29,000 forces of gravity to prevent that from happening. 400 00:22:29,000 --> 00:22:31,000 Richard, don't rush! 401 00:22:31,000 --> 00:22:33,840 Richard, slow down! Slowly, slowly, sweetie. 402 00:22:33,840 --> 00:22:36,560 That really is the basic principle of hydrotherapy. 403 00:22:36,560 --> 00:22:38,920 The weightlessness that you experience, 404 00:22:38,920 --> 00:22:41,960 the float holds you up in the water, you're in this warm, 405 00:22:41,960 --> 00:22:45,600 supporting environment, and then you become... 406 00:22:45,600 --> 00:22:47,480 You are able to achieve movement 407 00:22:47,480 --> 00:22:50,080 that you haven't been able to do before. 408 00:22:50,080 --> 00:22:51,520 And that is really the starting 409 00:22:51,520 --> 00:22:54,320 point of reconnecting with your whole self. 410 00:22:54,320 --> 00:22:57,600 One, two, three, four. 411 00:22:57,600 --> 00:23:01,640 I knew Richard could be pushed to his physical and emotional limits 412 00:23:01,640 --> 00:23:03,320 because he'd been there before. 413 00:23:04,800 --> 00:23:06,120 18... 414 00:23:07,320 --> 00:23:09,360 ..19... 415 00:23:09,360 --> 00:23:12,200 ..20... 416 00:23:12,200 --> 00:23:13,440 ..21... 417 00:23:13,440 --> 00:23:15,560 He was, after all, a seasoned soldier. 418 00:23:18,040 --> 00:23:22,400 Richard had volunteered in 1992 to serve with the United Nations. 419 00:23:22,400 --> 00:23:24,640 He was sent to the Bosnian capital, Sarajevo... 420 00:23:28,040 --> 00:23:29,880 ..where he suddenly found himself in 421 00:23:29,880 --> 00:23:32,360 the heart of a vicious, raging conflict. 422 00:23:32,360 --> 00:23:36,000 Snipers corner Sarajevo, as dangerous today as it has ever been. 423 00:23:36,000 --> 00:23:39,000 People taking a back road to work were open to sniper fire... 424 00:23:40,080 --> 00:23:44,280 He was an unarmed peacekeeper in a place where everyone was a target. 425 00:23:49,200 --> 00:23:52,000 Every day, he faced machine guns, sniper attacks 426 00:23:52,000 --> 00:23:54,080 and mortars, as he crossed the front 427 00:23:54,080 --> 00:23:57,680 lines to try and negotiate an end to the killing. 428 00:23:57,680 --> 00:24:00,680 I know that there are people breaking the ceasefire, 429 00:24:00,680 --> 00:24:05,600 but it is a very fine line of who starts it first. 430 00:24:07,680 --> 00:24:10,280 People have been analysing the information 431 00:24:10,280 --> 00:24:12,240 that we gathered from last 432 00:24:12,240 --> 00:24:16,000 night, the firing last night, and when I get back to PDT, 433 00:24:16,000 --> 00:24:19,240 I expect to... I'll know who started firing last night. 434 00:24:26,480 --> 00:24:27,920 Give me your hands. 435 00:24:33,800 --> 00:24:37,120 It was amazing to see Richard's progress in the hydrotherapy pool. 436 00:24:38,720 --> 00:24:40,760 Sweetie, you've improved so much. 437 00:24:40,760 --> 00:24:42,520 Look at him! He's walking. 438 00:24:47,680 --> 00:24:51,320 Six, seven, 439 00:24:51,320 --> 00:24:54,520 eight, nine... 440 00:24:54,520 --> 00:24:58,200 ..16, 17, 441 00:24:58,200 --> 00:25:01,520 18, 19... 442 00:25:01,520 --> 00:25:04,960 The clinic's philosophy of consistent and regular therapy 443 00:25:04,960 --> 00:25:07,320 seemed to be having a really positive effect. 444 00:25:07,320 --> 00:25:08,840 ..24, 25... 445 00:25:10,080 --> 00:25:11,680 ..26. 446 00:25:11,680 --> 00:25:16,040 First of all, the biggest difference is we work, therapy is seven days a 447 00:25:16,040 --> 00:25:19,360 week. I can never understand how you can run a rehab, 448 00:25:19,360 --> 00:25:21,560 particularly an acute rehab unit, 449 00:25:21,560 --> 00:25:25,240 and stop Friday afternoon and then begin again from Monday morning. 450 00:25:25,240 --> 00:25:27,120 You lose two and a half days, 451 00:25:27,120 --> 00:25:29,720 and it takes you two days to get back what you have lost. 452 00:25:29,720 --> 00:25:31,680 So, we start at seven days a week. 453 00:25:31,680 --> 00:25:35,720 OK, ready, steady, and up. 454 00:25:35,720 --> 00:25:37,760 Up you go. 455 00:25:37,760 --> 00:25:40,160 OK. Well done. 456 00:25:40,160 --> 00:25:42,160 Well done. 457 00:25:42,160 --> 00:25:43,200 OK? 458 00:25:44,560 --> 00:25:45,800 Look at me, darling. 459 00:25:46,960 --> 00:25:48,840 Richard? 460 00:25:48,840 --> 00:25:50,560 Look at me. Walk towards me. 461 00:25:51,560 --> 00:25:53,400 Come on. 462 00:25:53,400 --> 00:25:55,760 The process of relearning to walk, 463 00:25:55,760 --> 00:25:58,480 it's often in a certain way a mechanical problem 464 00:25:58,480 --> 00:26:01,400 that the therapist moves your leg to begin with. 465 00:26:01,400 --> 00:26:04,680 You get the connection with your brain again 466 00:26:04,680 --> 00:26:07,720 that programmes how to make 467 00:26:07,720 --> 00:26:10,560 a proper, controlled movement in space. 468 00:26:12,520 --> 00:26:15,440 Well done. 469 00:26:15,440 --> 00:26:17,880 Darling, don't look out of the window, 470 00:26:17,880 --> 00:26:19,560 just concentrate on what you're doing. 471 00:26:19,560 --> 00:26:22,360 Shift the weight, shift the weight, shift the weight. 472 00:26:22,360 --> 00:26:24,360 Shift the weight. Shift, shift, shift. 473 00:26:30,040 --> 00:26:31,600 Well done. That was good. 474 00:26:33,320 --> 00:26:37,000 That's really good. You're doing it, darling! You're walking. 475 00:26:37,000 --> 00:26:38,960 You're walking, darling. 476 00:26:38,960 --> 00:26:41,440 That's brilliant! Look at you go. 477 00:26:41,440 --> 00:26:43,840 Look at you go, sweetie! 478 00:26:43,840 --> 00:26:45,560 Good. That was really good. 479 00:26:45,560 --> 00:26:47,880 Really good step. One more time. 480 00:26:47,880 --> 00:26:52,200 Really good step. The next step was gradually 481 00:26:52,200 --> 00:26:55,280 to be able to regain his balance 482 00:26:55,280 --> 00:26:58,760 and, once he achieves that, the ability to take the first step. 483 00:27:01,600 --> 00:27:03,400 But in between, of course, 484 00:27:03,400 --> 00:27:06,440 there's a lot of work to be done in terms of movement of the legs, 485 00:27:06,440 --> 00:27:09,480 movement of the arm, movement of the whole body, 486 00:27:09,480 --> 00:27:11,880 the awareness of his physicality. 487 00:27:13,720 --> 00:27:17,280 Even though Richard still needed an enormous amount of help, 488 00:27:17,280 --> 00:27:19,640 there were signs that maybe he was going 489 00:27:19,640 --> 00:27:21,760 to be able to walk, and walk on his own. 490 00:27:23,280 --> 00:27:27,680 And I could see that, you know, he was coming back as a person too. 491 00:27:31,040 --> 00:27:36,120 Because he was starting to be able to be in control of his life, 492 00:27:36,120 --> 00:27:40,560 even though it was happening at a very tiny, tiny snail's pace. 493 00:27:40,560 --> 00:27:42,280 He was coming back. 494 00:27:42,280 --> 00:27:44,600 Richard was becoming reconnected to himself. 495 00:27:52,360 --> 00:27:55,360 As a break from the intensive daily routine, 496 00:27:55,360 --> 00:27:57,080 I took him to a centre that 497 00:27:57,080 --> 00:27:59,440 specialises in treating veterans with trauma. 498 00:28:04,320 --> 00:28:06,440 The unique element of the therapy 499 00:28:06,440 --> 00:28:09,000 this place offers is contact with horses. 500 00:28:11,440 --> 00:28:14,040 And as soon as the horse moved towards Richard, 501 00:28:14,040 --> 00:28:15,680 his response was immediate. 502 00:28:16,880 --> 00:28:19,200 Hello. 503 00:28:19,200 --> 00:28:22,800 Hello. I know, I know. 504 00:28:25,640 --> 00:28:28,520 It was amazing to hear him talk so clearly 505 00:28:28,520 --> 00:28:30,440 and spontaneously to the horse. 506 00:28:31,720 --> 00:28:33,400 I know. 507 00:28:33,400 --> 00:28:35,160 Hello. 508 00:28:39,240 --> 00:28:41,120 Hello. 509 00:28:42,280 --> 00:28:44,520 Hello. 510 00:28:44,520 --> 00:28:47,440 And it was the first time I'd really seen him do something like that 511 00:28:47,440 --> 00:28:48,800 since he'd been ill. 512 00:28:58,280 --> 00:29:00,600 As Richard's recovery progressed, 513 00:29:00,600 --> 00:29:04,760 he also started to do exercises for his mind as well as his body. 514 00:29:06,480 --> 00:29:11,760 The traditional therapies very much work on the physical body. 515 00:29:11,920 --> 00:29:14,600 The creative therapies does much 516 00:29:14,600 --> 00:29:18,280 more work on what I call the soul dimension of man, 517 00:29:18,280 --> 00:29:21,120 the feeling and the thinking level. 518 00:29:21,120 --> 00:29:24,440 And I think that is the most important thing. 519 00:29:24,440 --> 00:29:27,400 To have a recovery in a proper, holistic way, 520 00:29:27,400 --> 00:29:30,040 you cannot just deal with the physical disabilities, 521 00:29:30,040 --> 00:29:32,880 but there's more to the human being than just a physical disability. 522 00:29:32,880 --> 00:29:35,240 And that is what we're trying to encompass here. 523 00:29:35,240 --> 00:29:40,040 HE PLAYS MUSICAL SCALE 524 00:29:44,320 --> 00:29:46,080 The stroke had also affected 525 00:29:46,080 --> 00:29:48,920 Richard's ability to see things on his right side. 526 00:29:53,600 --> 00:29:58,640 Visual neglect is the connection between the eyes and the brain 527 00:29:58,640 --> 00:30:00,640 is disturbed. 528 00:30:00,640 --> 00:30:03,120 The eyesight is usually intact, but 529 00:30:03,120 --> 00:30:07,000 the processing in the brain has been damaged. 530 00:30:07,000 --> 00:30:09,240 Well, in Richard's particular case, 531 00:30:09,240 --> 00:30:13,560 he was not able to see one side of his vision. 532 00:30:13,560 --> 00:30:18,200 What we wanted to do is to re-establish the connection between 533 00:30:18,200 --> 00:30:21,840 his neglected side and the pathway in the brain. 534 00:30:21,840 --> 00:30:25,320 And we worked on that mainly with the art therapy. 535 00:30:25,320 --> 00:30:27,320 We have special exercises that 536 00:30:27,320 --> 00:30:30,240 gradually enable the individual to become 537 00:30:30,240 --> 00:30:33,120 more and more aware of his neglected side. 538 00:30:33,120 --> 00:30:35,960 And I think in Richard's case, it worked very well. 539 00:30:46,400 --> 00:30:48,400 Darling, that's fantastic. 540 00:30:53,520 --> 00:30:56,560 With Richard's physical recovery gathering pace, 541 00:30:56,560 --> 00:30:58,240 the team could now look at 542 00:30:58,240 --> 00:31:00,200 other ways to promote his development... 543 00:31:02,280 --> 00:31:04,560 ..and suggested an electric wheelchair. 544 00:31:07,240 --> 00:31:09,200 With some people, you would not 545 00:31:09,200 --> 00:31:11,400 recommend an electric wheelchair because 546 00:31:11,400 --> 00:31:13,040 they will never walk again. 547 00:31:13,040 --> 00:31:15,120 In Richard's case, it's quite different. 548 00:31:15,120 --> 00:31:17,320 With his army background, 549 00:31:17,320 --> 00:31:19,120 and his determination and motivation, 550 00:31:19,120 --> 00:31:21,080 he wants to work, he wants to walk, 551 00:31:21,080 --> 00:31:22,800 he wants to be independent. 552 00:31:22,800 --> 00:31:25,440 And the wheelchair enabled him to make that step, 553 00:31:25,440 --> 00:31:27,920 to make the first step in independence, 554 00:31:27,920 --> 00:31:31,200 but not neglecting in the long-term the ability to walk. 555 00:31:31,200 --> 00:31:32,920 So in his case, it was quite 556 00:31:32,920 --> 00:31:35,160 appropriate to have an electric wheelchair. 557 00:31:38,000 --> 00:31:39,640 Do a whole circle. 558 00:31:39,640 --> 00:31:41,960 Do a whole circle, sweetie. 559 00:31:41,960 --> 00:31:43,680 Ta-da! 560 00:31:46,880 --> 00:31:48,920 All the way, all the way! 561 00:31:48,920 --> 00:31:51,240 Yeah! 562 00:31:51,240 --> 00:31:52,800 Ta-da! 563 00:31:58,240 --> 00:32:00,080 For the first time, he had the 564 00:32:00,080 --> 00:32:02,600 freedom to go wherever he wanted to without 565 00:32:02,600 --> 00:32:05,520 the enormous effort he had to put in to walk. 566 00:32:05,520 --> 00:32:07,480 OK, should we go round? 567 00:32:07,480 --> 00:32:10,440 With this freedom, his gung-ho personality returned. 568 00:32:10,440 --> 00:32:12,520 Beep-beep-beep... 569 00:32:12,520 --> 00:32:14,240 SHE GASPS 570 00:32:14,240 --> 00:32:18,440 Careful! God, you're trying to freak me out! 571 00:32:18,440 --> 00:32:21,560 Go on, then. Just, sweetie, don't have an accident. 572 00:32:23,320 --> 00:32:27,560 Richard had been at Raphael for a year. He'd made huge progress, 573 00:32:27,560 --> 00:32:30,080 and now he wanted to come home. 574 00:32:40,760 --> 00:32:42,920 OK? 575 00:32:46,440 --> 00:32:48,280 OK, off you go. 576 00:32:48,280 --> 00:32:52,320 Two years and one day after his stroke, he returned home for good. 577 00:33:01,080 --> 00:33:04,120 It was an incredible moment to see him walk through the front door... 578 00:33:05,920 --> 00:33:09,200 ..and to be home once again. 579 00:33:09,200 --> 00:33:11,240 You're in. 580 00:33:11,240 --> 00:33:14,600 Come and sit down, darling. You walked home. 581 00:33:14,600 --> 00:33:17,680 It was something that I wasn't even sure would ever be possible. 582 00:33:17,680 --> 00:33:22,080 Before you sit down... Leave the chair there, please, darling. 583 00:33:22,080 --> 00:33:24,200 Hang on, hang on, move your hand, hang on. 584 00:33:24,200 --> 00:33:25,440 There. 585 00:33:29,320 --> 00:33:32,880 Having Richard back home, of course, was fantastic. 586 00:33:32,880 --> 00:33:36,840 But it was also hugely daunting because 587 00:33:36,840 --> 00:33:40,920 here was somebody who was 100% dependent on me. 588 00:33:40,920 --> 00:33:43,680 So it was a lot to take on board, 589 00:33:43,680 --> 00:33:46,160 and a very steep learning curve. 590 00:33:46,160 --> 00:33:48,160 Well done. 591 00:33:48,160 --> 00:33:50,360 Right. Welcome home. 592 00:33:52,280 --> 00:33:55,720 Things couldn't have been more different than from when we'd met. 593 00:33:55,720 --> 00:33:57,360 You're amazing. 594 00:34:02,440 --> 00:34:05,520 The aircraft came in with a tight turn, a short landing, 595 00:34:05,520 --> 00:34:08,160 and as fast a turnaround as possible. 596 00:34:08,160 --> 00:34:11,960 In July 1992, I'd flown in to Sarajevo. 597 00:34:11,960 --> 00:34:14,600 Can I have somebody to help? 598 00:34:14,600 --> 00:34:17,560 I'd gone to make a film about my sister, Vanessa, 599 00:34:17,560 --> 00:34:19,480 who was a doctor in the British Army. 600 00:34:20,680 --> 00:34:23,760 They've had analgesia. And... 601 00:34:23,760 --> 00:34:25,800 EXPLOSION 602 00:34:25,800 --> 00:34:27,800 Here we go. They've had some analgesia, 603 00:34:27,800 --> 00:34:29,480 we put some iodine in the wounds, 604 00:34:29,480 --> 00:34:32,080 they've got a drip set up and going, so they're getting fluids. 605 00:34:32,080 --> 00:34:33,720 We're keeping them stable and we 606 00:34:33,720 --> 00:34:35,680 want to get them out as soon as possible. 607 00:34:37,160 --> 00:34:39,640 It was through Vanessa that I met Richard. 608 00:34:45,920 --> 00:34:50,320 Richard was a peacekeeper in former Yugoslavia for almost a year. 609 00:34:50,320 --> 00:34:52,960 He saw the horrors of the civil war first-hand. 610 00:34:52,960 --> 00:34:55,680 SHE CRIES 611 00:35:00,320 --> 00:35:03,160 They could destroy the whole city if they want to. 612 00:35:03,160 --> 00:35:05,120 They have enough firepower out there 613 00:35:05,120 --> 00:35:07,200 to flatten this place ten times over. 614 00:35:10,720 --> 00:35:12,320 His time in Sarajevo led to 615 00:35:12,320 --> 00:35:15,080 post-traumatic stress disorder that would 616 00:35:15,080 --> 00:35:18,160 leave his physical and psychological health in tatters. 617 00:35:22,520 --> 00:35:25,280 It was 13 years before I'd see Richard again. 618 00:35:27,240 --> 00:35:30,720 I decided to contact him after the sudden death of my sister, Vanessa. 619 00:35:33,040 --> 00:35:35,280 He moved from New Zealand to London, 620 00:35:35,280 --> 00:35:37,080 and we were married six months later. 621 00:35:39,080 --> 00:35:42,600 My wedding day was the happiest day of my life. 622 00:35:42,600 --> 00:35:47,840 Richard looked amazing in his scarlet mess dress with his medals. 623 00:35:48,080 --> 00:35:51,880 And we got married at Saint Bride's, the journalist church, 624 00:35:51,880 --> 00:35:53,840 surrounded by friends. 625 00:35:53,840 --> 00:35:57,320 And it was a wonderful day. 626 00:36:03,480 --> 00:36:05,480 Sweetie, think about your shoulder. 627 00:36:05,480 --> 00:36:07,960 Move your shoulder forward. 628 00:36:07,960 --> 00:36:09,600 You can do it. 629 00:36:09,600 --> 00:36:12,320 Two weeks after coming home from Raphael, 630 00:36:12,320 --> 00:36:15,440 Richard suddenly started moving his right arm. 631 00:36:15,440 --> 00:36:17,840 That's it. 632 00:36:17,840 --> 00:36:19,560 Something as simple as pushing a 633 00:36:19,560 --> 00:36:21,600 ball into a cup was a real challenge, 634 00:36:21,600 --> 00:36:23,720 but it soon became part of his daily routine. 635 00:36:37,840 --> 00:36:41,080 For seven months, our lives revolved around therapy, 636 00:36:41,080 --> 00:36:42,960 with Richard making steady progress. 637 00:36:44,120 --> 00:36:45,800 Then he was selected to go on an 638 00:36:45,800 --> 00:36:48,000 intensive three-week programme at the 639 00:36:48,000 --> 00:36:51,000 National Hospital for Neurology and Neurosurgery in London. 640 00:36:53,280 --> 00:36:55,600 It's run by Professor Nick Ward. 641 00:36:58,560 --> 00:37:00,560 So when we saw Richard in clinic, 642 00:37:00,560 --> 00:37:02,200 what we saw was somebody who had 643 00:37:02,200 --> 00:37:05,440 some function in his arm and his hand, but he wasn't using it. 644 00:37:05,440 --> 00:37:07,680 He was still very dependent for help 645 00:37:07,680 --> 00:37:10,080 in day-to-day activities, in washing 646 00:37:10,080 --> 00:37:12,560 and dressing, and feeding himself. 647 00:37:12,560 --> 00:37:16,600 And our view was that, given what he had in his arm and his hand, 648 00:37:16,600 --> 00:37:18,520 that we could show him how to use it. 649 00:37:23,960 --> 00:37:26,600 So, to do something like cutting up a banana, 650 00:37:26,600 --> 00:37:29,320 or use a knife and fork to cut up a steak, for example, 651 00:37:29,320 --> 00:37:32,600 you need reasonable control of your limbs and your fingers. 652 00:37:32,600 --> 00:37:34,520 You need good sensation, 653 00:37:34,520 --> 00:37:37,200 so you need to be able to feel what's going on. 654 00:37:37,200 --> 00:37:39,200 But beyond that, you also need a 655 00:37:39,200 --> 00:37:41,920 concept of what a knife and fork is, and 656 00:37:41,920 --> 00:37:45,440 how you might use them together in order to achieve that task. 657 00:37:45,440 --> 00:37:47,600 So we call that planning. 658 00:37:47,600 --> 00:37:50,560 And Richard did have some problems with planning, 659 00:37:50,560 --> 00:37:53,040 so how you put all of those ideas together 660 00:37:53,040 --> 00:37:55,440 in order to execute the task. 661 00:37:55,440 --> 00:37:59,280 Sweetie, it's good for me to see how much you can do, 662 00:37:59,280 --> 00:38:01,560 because you can actually do a lot. 663 00:38:01,560 --> 00:38:03,360 Yeah, so what? 664 00:38:03,360 --> 00:38:08,560 Yeah, so when we get home, I'm going be getting you to start pulling 665 00:38:08,600 --> 00:38:11,480 your weight. Yeah. 666 00:38:11,480 --> 00:38:13,320 So, Richard's deficits in 667 00:38:13,320 --> 00:38:15,520 movement were not just about weakness. 668 00:38:15,520 --> 00:38:18,160 He did have some weakness, he did have sensory loss, 669 00:38:18,160 --> 00:38:20,320 but he did have problems with planning, 670 00:38:20,320 --> 00:38:21,840 and that's likely to be a 671 00:38:21,840 --> 00:38:25,280 consequence of where the damage was in his brain. 672 00:38:25,280 --> 00:38:27,760 Pick up phone and dial 999. 673 00:38:27,760 --> 00:38:28,960 Right. 674 00:38:30,840 --> 00:38:32,840 Yeah, each hand. It doesn't matter. 675 00:38:35,080 --> 00:38:37,040 And then dial. No, with that one. 676 00:38:37,040 --> 00:38:38,280 Dial. 677 00:38:39,720 --> 00:38:42,360 What Richard benefited from was 678 00:38:42,360 --> 00:38:45,440 what we call hand-over-hand assistance, 679 00:38:45,440 --> 00:38:47,640 so where I would place my hand over 680 00:38:47,640 --> 00:38:50,680 his to help guide the movement in the 681 00:38:50,680 --> 00:38:54,720 right plane of direction using the right force, and I would grade that. 682 00:38:54,720 --> 00:38:57,960 As the weeks went on, he needed less and less help. 683 00:38:59,600 --> 00:39:01,000 Good. Lovely. 684 00:39:03,480 --> 00:39:06,320 So, initially Richard needed 685 00:39:06,320 --> 00:39:10,400 prompting to attempt to pick up the pencil. 686 00:39:10,400 --> 00:39:15,080 And once he was able to reach and grasp the pencil, he had difficulty 687 00:39:15,080 --> 00:39:18,120 manipulating the pencil within his hand 688 00:39:18,120 --> 00:39:21,720 and also orientating the pencil to the paper. 689 00:39:21,720 --> 00:39:23,760 Shall we turn it around, so it's...? 690 00:39:23,760 --> 00:39:24,880 There we go. 691 00:39:25,920 --> 00:39:28,840 Then draw a line across it. 692 00:39:28,840 --> 00:39:30,040 Good. 693 00:39:35,640 --> 00:39:36,840 Lovely. 694 00:39:38,160 --> 00:39:40,840 That's OK. Just the one. 695 00:39:47,760 --> 00:39:51,080 LAWN MOWER STARTS 696 00:39:53,040 --> 00:39:54,440 Get in there! 697 00:39:54,440 --> 00:39:56,280 Go on! 698 00:39:56,280 --> 00:39:59,800 His ability to use the arm in day to day tasks dramatically improved. 699 00:40:03,520 --> 00:40:06,240 Richard always had a passion for gardening, 700 00:40:06,240 --> 00:40:09,120 and now that he was able to move around more independently, 701 00:40:09,120 --> 00:40:11,320 he really threw himself back into it. 702 00:40:13,080 --> 00:40:14,600 But, for me, there was a difficult 703 00:40:14,600 --> 00:40:17,040 balance and tension between encouraging 704 00:40:17,040 --> 00:40:21,480 him to do more, but also to hold him back so he didn't overdo things. 705 00:40:21,480 --> 00:40:23,320 Sweetie, don't you think you've done enough? 706 00:40:23,320 --> 00:40:25,280 What? Don't you think you've done enough? 707 00:40:25,280 --> 00:40:27,080 Get out of here. 708 00:40:27,080 --> 00:40:28,880 Go away. 709 00:40:28,880 --> 00:40:31,760 I had to learn to step back and let him take risks, 710 00:40:31,760 --> 00:40:33,480 whatever the outcome might be. 711 00:40:34,680 --> 00:40:38,280 When we've talked to people who've been through the programme, 712 00:40:38,280 --> 00:40:40,480 they do describe it as intensive. 713 00:40:40,480 --> 00:40:42,360 They call it a boot camp. 714 00:40:42,360 --> 00:40:44,440 It's fatiguing, 715 00:40:44,440 --> 00:40:47,480 but actually there's something exhilarating about that, 716 00:40:47,480 --> 00:40:50,360 being given the opportunity to work that hard 717 00:40:50,360 --> 00:40:53,000 is something that I think people really value. 718 00:40:59,440 --> 00:41:02,080 Six months after the upper limb programme, 719 00:41:02,080 --> 00:41:05,960 Richard was making such remarkable progress that he was now able to use 720 00:41:05,960 --> 00:41:08,880 his right hand to copy a daily writing exercise. 721 00:41:20,360 --> 00:41:22,360 One. That's much better. 722 00:41:22,360 --> 00:41:24,760 That's much better. Two. 723 00:41:24,760 --> 00:41:27,040 Five of these. Six. 724 00:41:27,040 --> 00:41:29,080 Very good. Seven. 725 00:41:29,080 --> 00:41:30,560 Very good. 726 00:41:30,560 --> 00:41:31,800 Eight. 727 00:41:34,000 --> 00:41:37,240 Physically, Richard was now pretty independent, 728 00:41:37,240 --> 00:41:39,240 and so when we went for his final assessment 729 00:41:39,240 --> 00:41:41,120 at the upper limb programme, 730 00:41:41,120 --> 00:41:43,320 he was able to walk in on his own unaided. 731 00:41:44,560 --> 00:41:49,440 What's important about the programme is demonstrating change, 732 00:41:49,440 --> 00:41:52,720 so providing evidence that we make a difference. 733 00:41:52,720 --> 00:41:56,320 Because what's important is not just the ability to change after an 734 00:41:56,320 --> 00:41:58,400 intensive three-week programme, 735 00:41:58,400 --> 00:42:02,200 but actually what's absolutely key is that those gains are maintained. 736 00:42:05,080 --> 00:42:06,920 To your ear. 737 00:42:06,920 --> 00:42:08,720 There aren't any other programmes 738 00:42:08,720 --> 00:42:10,720 that work with people this intensively... 739 00:42:12,400 --> 00:42:16,840 ..that delivers high dose, high intensity rehabilitation, 740 00:42:16,840 --> 00:42:18,840 specifically for the upper limb. 741 00:42:21,920 --> 00:42:25,200 So our responsibility at a place like Queen's Square 742 00:42:25,200 --> 00:42:27,000 is to show what's possible. 743 00:42:27,000 --> 00:42:28,600 Lovely. 744 00:42:28,600 --> 00:42:30,880 And part of that is measuring what we do, 745 00:42:30,880 --> 00:42:33,320 so we have outcome scores at admission, 746 00:42:33,320 --> 00:42:35,960 at discharge, six weeks, and six months. 747 00:42:35,960 --> 00:42:39,800 And if we can show that there are measurable and meaningful changes in 748 00:42:39,800 --> 00:42:44,280 a higher proportion of people that come through that programme, then 749 00:42:44,280 --> 00:42:49,160 our hope is that this will change the way rehabilitation is delivered. 750 00:42:51,000 --> 00:42:55,280 Richard's recovery had gone far beyond everyone's expectations. 751 00:42:55,280 --> 00:42:59,040 So much so that he could now even climb a flight of stairs. 752 00:43:00,520 --> 00:43:01,960 Slowly, Richard. 753 00:43:05,640 --> 00:43:07,240 Great. 754 00:43:07,240 --> 00:43:09,840 So the scores, though... I mean, the scores have improved a lot. 755 00:43:09,840 --> 00:43:11,680 Yeah. 756 00:43:11,680 --> 00:43:16,320 The action research arm test was 26 out of 57 when you came in. 757 00:43:16,320 --> 00:43:18,320 It's now 48 now out of 57. Yeah. 758 00:43:18,320 --> 00:43:20,320 Wow. So that's an improvement... 759 00:43:20,320 --> 00:43:22,640 Amazing. ..of 22 points. 760 00:43:22,640 --> 00:43:26,240 It is emotional. There's something about just giving people some hope. 761 00:43:26,240 --> 00:43:29,160 Hope that we think is realistic, you know? 762 00:43:29,160 --> 00:43:31,800 Reopening those doors, which is... 763 00:43:31,800 --> 00:43:33,880 Yeah, it is quite emotional. 764 00:43:35,040 --> 00:43:37,720 But look at it. That's... That's really improved, hasn't it? 765 00:43:37,720 --> 00:43:40,880 That's incredible. Great progress. You're a star. Yeah. 766 00:43:47,640 --> 00:43:49,600 You have to use two hands, sweetie. 767 00:43:54,120 --> 00:43:56,960 Despite all the improvements that Richard had made, 768 00:43:56,960 --> 00:43:58,640 we lived in virtual silence. 769 00:43:59,640 --> 00:44:02,960 He was very good at communicating without using words, 770 00:44:02,960 --> 00:44:05,080 but we weren't able to have a conversation. 771 00:44:06,360 --> 00:44:09,160 Tell me how you are. How are you feeling? 772 00:44:09,160 --> 00:44:14,440 HE APPROXIMATES RESPONSE 773 00:44:23,480 --> 00:44:27,640 If he was going to be able to talk and understand language again, 774 00:44:27,640 --> 00:44:29,480 he'd need intensive therapy. 775 00:44:29,480 --> 00:44:32,720 I feel like a paper-based low technology... 776 00:44:32,720 --> 00:44:36,520 After finding a source of funding, Richard was able to start weekly 777 00:44:36,520 --> 00:44:40,000 speech and language sessions with Liz Williamson and her assistant, 778 00:44:40,000 --> 00:44:42,280 Laura. 779 00:44:42,280 --> 00:44:45,040 Fruit. Grapes, 780 00:44:45,040 --> 00:44:47,320 or teddy? What do you do with fruit? 781 00:44:47,320 --> 00:44:48,440 Do you... 782 00:44:50,440 --> 00:44:52,760 ..eat it? Yeah. 783 00:44:52,760 --> 00:44:56,280 Yeah? So, which one of these would you eat - grapes or teddy? 784 00:44:56,280 --> 00:44:58,720 He presented as 785 00:44:58,720 --> 00:45:01,720 severely impaired, in terms of his 786 00:45:01,720 --> 00:45:05,240 ability to understand the spoken word. 787 00:45:05,240 --> 00:45:06,240 So, which one of these... 788 00:45:08,600 --> 00:45:12,960 ..goes with toothbrush? Cheese, toothpaste, 789 00:45:12,960 --> 00:45:14,240 or globe? 790 00:45:16,080 --> 00:45:17,640 Cheese? 791 00:45:17,640 --> 00:45:21,080 And it's just a little bit like filing away books in a library. 792 00:45:22,320 --> 00:45:27,560 Because Richard's working library was completely thrown up in the air. 793 00:45:30,240 --> 00:45:35,480 And he, or we, needed to re-categorise, slot in place, 794 00:45:36,520 --> 00:45:38,400 all of those words. 795 00:45:38,400 --> 00:45:41,560 How about engine? 796 00:45:43,240 --> 00:45:45,280 Which one of these has an engine? 797 00:45:45,280 --> 00:45:48,320 One of those two. You're right. It is one of those two. 798 00:45:48,320 --> 00:45:52,440 So, we worked on this level for many months, actually. 799 00:45:52,440 --> 00:45:55,480 And he started to show some real improvements. 800 00:45:55,480 --> 00:45:58,120 Which one of those two things has an engine to power it? 801 00:46:00,880 --> 00:46:03,520 Yeah, a car. Well done, Richard. 802 00:46:03,520 --> 00:46:05,760 The last word is locker. 803 00:46:07,240 --> 00:46:10,000 Very good. You need a key to open your locker, don't you? 804 00:46:10,000 --> 00:46:11,640 Fabulous. Well done. 805 00:46:21,240 --> 00:46:25,400 Sometimes Richard's new-found confidence went a bit too far. 806 00:46:25,400 --> 00:46:27,680 Darling, have you fallen over? 807 00:46:27,680 --> 00:46:30,440 Oh, sweetie. 808 00:46:30,440 --> 00:46:32,200 I'm OK. I'm OK. 809 00:46:32,200 --> 00:46:33,160 Darling... 810 00:46:34,240 --> 00:46:36,000 Oh, sweetie. 811 00:46:36,000 --> 00:46:37,440 I just... I'm fine. 812 00:46:42,360 --> 00:46:44,320 Thank you, darling. 813 00:46:44,320 --> 00:46:46,600 Oh, good stuff. 814 00:46:46,600 --> 00:46:49,200 Thank you. Because the thing is you could break your leg, darling. 815 00:46:49,200 --> 00:46:51,080 I'm OK. 816 00:46:51,080 --> 00:46:53,680 I know you're OK now, but you might not be. 817 00:46:53,680 --> 00:46:55,880 I am. You all right, sweetie? 818 00:46:55,880 --> 00:46:57,360 Yeah. You all right? 819 00:47:05,200 --> 00:47:07,160 Richard always loved driving, 820 00:47:07,160 --> 00:47:08,960 so as a treat I arranged a day out 821 00:47:08,960 --> 00:47:11,360 at Brands Hatch to have a go on their 822 00:47:11,360 --> 00:47:12,560 driving simulator. 823 00:47:16,240 --> 00:47:18,120 This wasn't just for fun. 824 00:47:18,120 --> 00:47:21,160 I'd also arranged to meet Professor Mike Merzenich, 825 00:47:21,160 --> 00:47:24,160 one of the world's leading neuroscientists. 826 00:47:24,160 --> 00:47:26,240 He'd agreed to assess Richard 827 00:47:26,240 --> 00:47:28,040 and offer some advice on how we 828 00:47:28,040 --> 00:47:30,520 could push Richard's recovery even further. 829 00:47:32,720 --> 00:47:35,080 Nice to meet you again. Nice to see you. 830 00:47:35,080 --> 00:47:36,360 And you. 831 00:47:38,440 --> 00:47:40,400 Great, thank you. 832 00:47:40,400 --> 00:47:42,240 Have a go at getting in. 833 00:47:42,240 --> 00:47:43,880 OK. Yeah? Just be careful. 834 00:47:43,880 --> 00:47:46,320 Put that leg first. 835 00:47:46,320 --> 00:47:48,520 People that have left sided brain injuries 836 00:47:48,520 --> 00:47:50,320 usually have problems expressed 837 00:47:50,320 --> 00:47:52,600 on the right side of the action, you could say. 838 00:47:52,600 --> 00:47:54,280 Both in movement control, 839 00:47:54,280 --> 00:47:56,120 and if they have any problems with vision, 840 00:47:56,120 --> 00:47:59,360 it'll relate to the right side as opposed to the left side. 841 00:47:59,360 --> 00:48:03,080 So a driving simulator is a pretty good environment to determine... 842 00:48:03,080 --> 00:48:07,840 To show whether or not he has strongly asymmetric control. 843 00:48:07,840 --> 00:48:11,120 It's going to show us whether or not he sees things adequately across the 844 00:48:11,120 --> 00:48:14,440 field of vision. It's going to show us pretty clearly whether he can 845 00:48:14,440 --> 00:48:16,720 control his actions across the horizon. 846 00:48:16,720 --> 00:48:18,440 So it's a good, simple way to get an 847 00:48:18,440 --> 00:48:20,760 overall read of how he's doing in his 848 00:48:20,760 --> 00:48:24,560 action control as he's drinking in information from vision. 849 00:48:24,560 --> 00:48:27,640 That's good. 850 00:48:29,400 --> 00:48:32,400 After a bit of a shaky start, Richard was amazing. 851 00:48:32,400 --> 00:48:34,440 He could do it. Follow the road out. 852 00:48:36,280 --> 00:48:39,920 Yeah, you're not on the... Not on the track yet. 853 00:48:39,920 --> 00:48:42,000 It looks like a proper racetrack. 854 00:48:42,000 --> 00:48:44,520 That's good. That's good. 855 00:48:44,520 --> 00:48:48,680 Getting the hang of it now. Well, that's good. He's managing the 856 00:48:48,680 --> 00:48:51,280 lateral peripheral vision pretty well there. 857 00:48:52,800 --> 00:48:54,160 Good. 858 00:48:56,520 --> 00:49:00,680 He has a really excellent control in this complex visual flow field. 859 00:49:00,680 --> 00:49:02,880 Things are coming at him very rapidly. 860 00:49:02,880 --> 00:49:06,320 He's making judgments about how to change his control, 861 00:49:06,320 --> 00:49:08,320 and this is pretty impressive. 862 00:49:08,320 --> 00:49:09,880 He's come a long way. 863 00:49:13,560 --> 00:49:15,520 Before he made the wrong turn on that bit. 864 00:49:15,520 --> 00:49:17,120 Now he's made the correction. 865 00:49:18,480 --> 00:49:20,240 It was great to see him driving. 866 00:49:20,240 --> 00:49:23,600 He was a very good driver once and I think he really enjoyed himself. 867 00:49:23,600 --> 00:49:25,440 How well do you think you did? 868 00:49:25,440 --> 00:49:27,040 Do you think you did a good job? 869 00:49:27,040 --> 00:49:29,840 Well, it was very hard, but I thought it was very good. 870 00:49:29,840 --> 00:49:31,520 Overall, you did a good job. 871 00:49:31,520 --> 00:49:33,160 Oh, very good. Yeah. 872 00:49:35,040 --> 00:49:38,440 It's all about continuing to drive your brain in a continually more 873 00:49:38,440 --> 00:49:41,640 positive direction. He can go a lot farther still. 874 00:49:41,640 --> 00:49:44,040 He's gone a long distance, 875 00:49:44,040 --> 00:49:48,800 but the whole idea is to see life as a progression of getting better and 876 00:49:48,800 --> 00:49:51,040 better in life, as long as you can. 877 00:49:51,040 --> 00:49:53,680 And he has a lot farther that he can go. 878 00:49:53,680 --> 00:49:55,960 And you're prepared to work hard, aren't you? Yes, I do. 879 00:49:55,960 --> 00:49:58,560 Yeah. You're good at that. You're very good at that, sweetie. 880 00:50:00,400 --> 00:50:03,200 After his meeting with Professor Merzenich, 881 00:50:03,200 --> 00:50:07,080 Richard's daily routine now included a new set of exercises and games 882 00:50:07,080 --> 00:50:08,880 designed to stimulate his brain. 883 00:50:10,000 --> 00:50:11,600 No, that's good. That's good. 884 00:50:11,600 --> 00:50:14,000 No! Yes. 885 00:50:14,000 --> 00:50:16,960 Although he didn't enjoy them as much as driving. 886 00:50:16,960 --> 00:50:19,880 Let me show you. Let me show you. Let me show you. 887 00:50:19,880 --> 00:50:22,320 You're showing wrong. No, no, no, look. 888 00:50:22,320 --> 00:50:24,520 I mean, sweetie, if it was easy, there would be no 889 00:50:24,520 --> 00:50:25,960 point doing it, would there? 890 00:50:32,600 --> 00:50:34,240 Less effort. 891 00:50:34,240 --> 00:50:37,160 After all the hard work, Richard's now able to enjoy doing some of 892 00:50:37,160 --> 00:50:39,560 the things that he used to do. 893 00:50:39,560 --> 00:50:42,440 That's it. Pop that thumb back on... 894 00:50:42,440 --> 00:50:44,320 That's brilliant from there. 895 00:50:45,600 --> 00:50:47,760 That's more like it. Now we've got it. 896 00:50:47,760 --> 00:50:50,360 Now we're getting the hang of it. 897 00:50:50,360 --> 00:50:52,200 One more go. Yeah. 898 00:50:56,840 --> 00:50:58,520 I think it's very clear, 899 00:50:58,520 --> 00:51:00,960 having seen what Richard's like now, 900 00:51:00,960 --> 00:51:02,760 that the extent of recovery that 901 00:51:02,760 --> 00:51:06,800 he's had has exceeded what I would have expected or possibly predicted, 902 00:51:06,800 --> 00:51:09,440 and that, you know, makes me feel great. 903 00:51:09,440 --> 00:51:12,280 You know, I think all the staff who were involved in Richard's care, 904 00:51:12,280 --> 00:51:14,200 it really justifies what they did, 905 00:51:14,200 --> 00:51:15,960 and it's the sort of thing that 906 00:51:15,960 --> 00:51:18,080 makes them come back into work each day. 907 00:51:18,080 --> 00:51:21,440 So, I think our increasing awareness of how much potential recovery there 908 00:51:21,440 --> 00:51:24,480 is in the adult brain, which is something that's relatively new... 909 00:51:24,480 --> 00:51:27,480 We've always been taught the adult brain, once damaged, can't recover. 910 00:51:27,480 --> 00:51:29,400 We know that's not the case now. 911 00:51:29,400 --> 00:51:33,000 It means that the onus on us is now not just to save life, but to try 912 00:51:33,000 --> 00:51:35,720 and preserve as much brain as possible 913 00:51:35,720 --> 00:51:38,880 so that the patient has the potential for maximal recovery. 914 00:51:38,880 --> 00:51:40,560 As we say in neurosurgery, 915 00:51:40,560 --> 00:51:43,520 we're taught that the brain doesn't get better in a bucket. 916 00:51:43,520 --> 00:51:45,320 If you remove that bit of brain, 917 00:51:45,320 --> 00:51:47,960 whatever you do, it can never recover. 918 00:51:47,960 --> 00:51:50,280 You want me to switch the lights off? 919 00:51:50,280 --> 00:51:53,240 That's because we're filming. We're filming. 920 00:51:53,240 --> 00:51:56,200 Sorry. 921 00:51:57,800 --> 00:52:01,440 I want you to pick up all of the blocks that aren't blue. 922 00:52:04,520 --> 00:52:07,240 When we first began to appreciate the brain was plastic, 923 00:52:07,240 --> 00:52:09,240 continuously changing itself, 924 00:52:09,240 --> 00:52:13,280 and that we could conceivably control it for human benefit, 925 00:52:13,280 --> 00:52:15,480 I thought that this would sweep 926 00:52:15,480 --> 00:52:18,120 across medicine and science like a flash. 927 00:52:18,120 --> 00:52:20,000 Good job. 928 00:52:20,000 --> 00:52:24,640 But still, it's a hard-won fight to drive this into medicine. 929 00:52:24,640 --> 00:52:27,480 Now that you're doing so well, we have to make it harder. 930 00:52:27,480 --> 00:52:31,040 OK. OK? The coin goes somewhere. 931 00:52:31,040 --> 00:52:33,560 We can apply plasticity to help 932 00:52:33,560 --> 00:52:36,960 people who struggle be in a better position. 933 00:52:36,960 --> 00:52:38,440 Perfect. 934 00:52:38,440 --> 00:52:42,680 Perfect. But it's a resource that's valuable to every human being. 935 00:52:42,680 --> 00:52:45,120 And they should understand they have this potential, 936 00:52:45,120 --> 00:52:47,840 they have this power to drive their brain into a stronger, 937 00:52:47,840 --> 00:52:49,720 better position. 938 00:52:49,720 --> 00:52:51,520 We should all take that to heart. 939 00:52:51,520 --> 00:52:54,040 We should all live life to the advantage of this 940 00:52:54,040 --> 00:52:55,480 and take advantage of it, 941 00:52:55,480 --> 00:52:57,280 to have a better and stronger life. 942 00:53:08,040 --> 00:53:10,320 18 months after Richard left Raphael, 943 00:53:10,320 --> 00:53:13,360 he returned to show them how much progress he'd made. 944 00:53:18,440 --> 00:53:21,080 That's great. It's a great change, great change. 945 00:53:21,080 --> 00:53:22,640 That's really good. 946 00:53:22,640 --> 00:53:24,320 Really good. Thank you. 947 00:53:24,320 --> 00:53:26,320 Looking at his journey over time, 948 00:53:26,320 --> 00:53:30,200 I mean, every time you see him he has done another step. 949 00:53:30,200 --> 00:53:33,880 Of course he will improve. And I think one must never give up. 950 00:53:33,880 --> 00:53:37,720 Rehabilitation is a lifelong process. 951 00:53:37,720 --> 00:53:40,600 And the human being has this wonderful ability 952 00:53:40,600 --> 00:53:42,920 to regenerate in a real sense. 953 00:53:45,240 --> 00:53:48,200 It's like on the parade ground, isn't it? 954 00:53:48,200 --> 00:53:50,400 Look at that. 955 00:53:50,400 --> 00:53:54,200 And I think one never can underestimate the importance of 956 00:53:54,200 --> 00:53:57,280 relatives, particularly close relatives, 957 00:53:57,280 --> 00:53:59,680 as part of the treatment process. 958 00:53:59,680 --> 00:54:04,760 The point is that relatives can be part of the therapy team in the most 959 00:54:04,760 --> 00:54:08,000 important way, and that can be only beneficial. 960 00:54:08,000 --> 00:54:09,840 Let's demonstrate. Great, yeah. 961 00:54:09,840 --> 00:54:11,440 Left, right... 962 00:54:11,440 --> 00:54:13,080 You know, it's an exciting moment 963 00:54:13,080 --> 00:54:15,440 for all of us to see how he continues making his 964 00:54:15,440 --> 00:54:18,920 recovery. And I think that always we have to remember, 965 00:54:18,920 --> 00:54:21,240 never write any individual off. 966 00:54:21,240 --> 00:54:24,880 Everyone has the possibility to make progress. 967 00:54:24,880 --> 00:54:26,880 Good to see you. 968 00:54:26,880 --> 00:54:28,320 Thank you very much. 969 00:54:28,320 --> 00:54:31,200 I hope it all goes well. And keep in touch, yeah? 970 00:54:31,200 --> 00:54:33,760 That would be great. So good to see you. 971 00:54:33,760 --> 00:54:35,640 Thank you very much. 972 00:54:35,640 --> 00:54:39,160 If you see a patient coming in in a vegetative state, 973 00:54:39,160 --> 00:54:42,320 and see them actually walking out of the front door, 974 00:54:42,320 --> 00:54:44,240 that is what our work is about, 975 00:54:44,240 --> 00:54:48,080 and that is the most uplifting experience you can have. 976 00:54:52,960 --> 00:54:55,800 This is coming out as well. 977 00:54:55,800 --> 00:54:57,040 See? 978 00:54:57,040 --> 00:54:58,560 Mm-hm. 979 00:54:58,560 --> 00:55:00,320 Got another one here. 980 00:55:00,320 --> 00:55:01,960 Need to take this one out. 981 00:55:03,680 --> 00:55:05,320 There, see? 982 00:55:05,320 --> 00:55:06,680 That one right there. 983 00:55:36,480 --> 00:55:41,400 MILITARY MARCH PLAYS 984 00:55:44,080 --> 00:55:47,920 30 years of service in the New Zealand Army 985 00:55:47,920 --> 00:55:49,160 and three wars. 986 00:55:55,280 --> 00:55:58,000 I did things that other people weren't prepared to do. 987 00:56:06,200 --> 00:56:07,840 I took extreme risks... 988 00:56:10,880 --> 00:56:12,280 ..in an extreme situation. 989 00:56:15,520 --> 00:56:17,040 But life goes on. 990 00:56:27,880 --> 00:56:31,640 For the first time in years, Richard wanted to be part of the annual 991 00:56:31,640 --> 00:56:34,840 ceremony that had meant so much to him throughout his army career. 992 00:56:37,000 --> 00:56:39,120 Anzac Day, the national day of 993 00:56:39,120 --> 00:56:43,000 remembrance for Australia and New Zealand. 994 00:56:43,000 --> 00:56:47,680 They shall not grow old as we that are left grow old. 995 00:56:49,400 --> 00:56:53,120 Age shall not weary them, nor the years condemn. 996 00:56:54,640 --> 00:56:59,160 At the going down of the sun and in the morning, 997 00:56:59,160 --> 00:57:01,240 we will remember them. 998 00:57:03,120 --> 00:57:07,040 MUSIC PLAYS: The Last Post 999 00:57:26,000 --> 00:57:27,920 Richard used to say to me, 1000 00:57:27,920 --> 00:57:31,120 "Fi, I'd walk over a mile of broken glass for you." 1001 00:57:31,120 --> 00:57:35,200 And the past four years have been my chance to do the same thing for him. 1002 00:57:35,200 --> 00:57:37,840 It's been an honour and a privilege to look after him, 1003 00:57:37,840 --> 00:57:41,000 and it's probably the most rewarding thing that I've ever done. 1004 00:57:54,800 --> 00:57:56,520 You're fantastic. Yeah. 1005 00:57:56,520 --> 00:57:58,320 Yes. I know. 1006 00:57:58,320 --> 00:57:59,880 Awesome. I know. 1007 00:58:01,600 --> 00:58:03,800 Well done, darling. You're brilliant. 1008 00:58:03,800 --> 00:58:05,080 I know. 1009 00:58:10,120 --> 00:58:11,600 Well, going to go round. 1010 00:58:11,600 --> 00:58:12,800 Yeah?