Today News From Pakistan

BRUSSELS – Helped by a therapist, Rom Houben's outstretched finger tapped with surprising speed on a computer touchscreen, spelling out how he felt "alone, lonely, frustrated" in the 23 years he was trapped inside a paralyzed body.

After a doctor found he was wrongly diagnosed as being in a vegetative state, and worked out a way for him to communicate, Houben said he now feels reborn.

"And just like with a baby, it happens with a lot of stumbling," the 46-year-old Belgian wrote, tapping out the words in Dutch for Associated Press Television News on Tuesday as an aide guided his hand.

A leading bioethicist, however, expressed skepticism that Houben was really communicating, saying the responses seem unnatural for someone with such a profound injury and an inability to communicate for decades.

Injured in a car crash in 1983 when he was 20, Houbon was diagnosed as being in a vegetative state, though doctors now believe he was conscious the whole time.

An expert using a specialized type of brain scan that was not available in the 1980s says he finally realized Houben was suffering from a form of "locked-in syndrome," in which people are unable to speak or move but can think and reason, and provided him with the equipment to communicate.

Now, assisted by a speech therapist who moved his finger letter-by-letter along a touch-screen keyboard, Houben says years of being unable to move or express himself left him feeling "alone, lonely, frustrated, but also blessed with my family."

"It was especially frustrating when my family needed me," wrote Houben, who says he heard his father died during that time, but was unable to show any emotion. "I could not share in their sorrow. We could not give each other support."

"Just imagine. You hear, see, feel and think but no one can see that. You undergo things. You cannot participate in life," he wrote.

The therapist, Linda Wouters, told APTN that she can feel Houben guiding her hand with gentle pressure from his fingers, and that she feels him objecting when she moves his hand toward an incorrect letter.

Despite the occasional typo, the responses seemed fluid and conversational Tuesday. Suffering from a cold, he opened the interview by typing out, with the help of his therapist: "You catch me at a bad moment, I have looked better."

Dr. Steven Laureys of Belgium's Coma Science Group, whose testing uncovered Houben's misdiagnosis three years ago, says he has discovered some degree of consciousness using state-of-the-art equipment like PET scans on other patients and looks at about 50 cases from around the world a year.

But none are as extreme as that of Houben, who was fully conscious inside a paralyzed body. Many center on the fine distinction between a vegetative state and minimal consciousness.

Arthur Caplan, a bioethics professor at the University of Pennsylvania who has had no direct contact with Houben or personal knowledge of the case, said he is skeptical of Houben's ability to communicate after seeing video of his hand being moved along the keyboard.

"That's called 'facilitated communication,'" Caplan said. "That is Ouija board stuff. It's been discredited time and time again. When people look at it, it's usually the person doing the pointing who's doing the messages, not the person they claim they are helping."

Houben's mother, Fina, told the AP her son has been communicating for three years and she believes no one is guiding him.

"At first he had to push with his foot on a sort of computer mouse which only had a yes-no side," she said in a telephone interview. "Slowly he got better and developed through a language computer and now communicates with this speech therapist holding his hand."

Dr. James Bernat of Dartmouth Medical School said he could not comment on the facts of Houben's case specifically. However, he called Laureys "a very rigorous scientist and physician ... one of the world's leaders" in the field of brain imaging in people with consciousness disorders.

Houben's mother said her son has become so proficient at punching sentences that he has even started writing a book. He has also written an article titled "Hidden wealth ... the force of silence" for the in-house magazine at the 't Weyerke institute in eastern Belgian where he is being treated.

Asked Tuesday how he felt when his consciousness was discovered, Houben tapped out rapidly with the help of his aide: "I especially felt relief. Finally...able to show that I was indeed there."

Laureys said he is now re-examining dozens of other cases. In a recent study, 40 percent of the patients diagnosed as being in a vegetative state were in fact minimally conscious.

American experts acknowledged a vegetative state diagnosis can often be wrong. But in most cases, they said, it involves a patient who is minimally conscious, whose muted and intermittent signs of awareness might be overlooked, rather than a patient like Houben, who is fully conscious but paralyzed.

Experts blamed the difficulty of diagnosis, insufficient training of doctors and a lack of follow-up to look for subtle signs that a once-vegetative patient has actually improved.

"Many people recover over time," said Dr. Joseph J. Fins of the Weill Cornell Medical College. "It's very easy for the label that is affixed at one point to sort of become eternalized, and so no one questions the diagnosis."

_____

Associated Press Medical Writer Marilynn Marchione and Science Writer Malcolm Ritter contributed to this report.

COLUMBIA, S.C. – A cool-headed legal debate has replaced the once-passionate calls to oust Gov. Mark Sanford that began after his tearful summertime admission that he disappeared from the state to pursue an extramarital affair in Argentina.

A panel on Tuesday began debating whether his failure to inform his staff of his whereabouts and put anyone in charge rise to the high standard of impeachment, usually reserved for officeholders who break the law.

Two proponents of a measure to remove Sanford likened his five-day absence to a soldier leaving his post. But others on a seven-member legislative panel questioned whether the two-term Republican's actions rose to a high enough level to warrant removal.

"To speak about dereliction of duty, absence without leave, abandoning one's post are terms that ordinarily are reserved for those who are in uniform and who are not civilian citizens of our state and nation," said Rep. Walt McLeod, D-Prosperity. "It may constitute something. But it doesn't constitute dereliction of duty because those are military terms."

Sanford returned in June to confess to an affair that shattered his marriage and dimmed a once-bright political future. He told reporters in Charleston on Tuesday that it's obvious he wanted to keep an affair secret.

"Yes, I had a moral failing. I was gone for five days. I failed my marriage on a number of fronts. I mean, we've been through all of that. I don't know how many times one apologizes for that," he said. "How many times do we want to say the obvious? The nature of having an affair is you want to hide it."

Later investigations found the governor may have violated state ethics laws for travel and campaign finances, and he faces 37 civil charges that he used his office to personally benefit himself. Those charges weren't discussed Tuesday, but they'll be added to the panel's debate at later hearings.

Sanford has brushed aside repeated calls to step down before his tenure ends in January 2011, and his lawyers say they'll answer the ethics questions at separate hearings on them in January.

The four Republicans and one Democrat who co-sponsored the impeachment measure contend Sanford neglected his office and was wrong to mislead staffers into thinking he was hiking the Appalachian Trail when he left the country.

Their measure says in part that Sanford's "conduct under these circumstances has brought extreme dishonor and shame to the Office of the Governor of South Carolina and to the reputation of the State of South Carolina."

The committee will meet at least three more times before deciding whether to forward the measure to the House Judiciary Committee. On Tuesday, lawmakers said they would add the ethics charges to their deliberations, greatly broadening the issues they'll deal with in the next two weeks.

The resolution's chief sponsor said Sanford evaded his security detail when he left the state and should have told the lieutenant governor he was leaving.

"He left his post, he left his state. He left his country without notifying anyone in authority," said state Rep. Greg Delleney, R-Chester. "He was AWOL as commander in chief of the organized and unorganized militia of this state."

The governor's lawyer said in a later statement that those don't constitute "a serious crime or serious misconduct in office that has corrupted the system of government in South Carolina."

"This standard is intentionally high," attorney Ross Garber said in a statement Tuesday. "The Governor's temporary absence from the state in June does not meet this high standard."

Delleney conceded Sanford hadn't committed a serious crime but said lawmakers decide what the threshold is for "serious misconduct," the second element allowed for impeachment.

"Impeachment is a political process. It is not a legal process," he said.

Eight U.S. governors have been removed by impeachment, and the only two removed in the last 80 years each faced criminal charges. Standards for impeachment vary by state.

Arizona's Evan Mecham was driven from office in 1988 after he was convicted of trying to thwart an investigation into a death threat allegedly made by an aide. Earlier this year, Rod Blagojevich of Illinois was removed after federal authorities accused him of trying to sell the Senate seat vacated when Barack Obama was elected president.

The ethics probe of Sanford followed a series of Associated Press investigations that showed the governor had for years used state airplanes for political and personal trips, flown in pricey commercial airline seats despite a low-cost travel requirement and failed to disclose trips on planes owned by friends and donors. The State newspaper in Columbia also questioned whether Sanford properly reimbursed himself from his campaign cash.

If the impeachment measure passes the Judiciary Committee with a majority vote from its 25 members, it would head to the House floor in January for debate. A two-thirds vote in favor would result in Sanford's suspension.

The Senate, acting as jury, then would decide whether Sanford would be removed from office, which would also require a two-thirds vote.

___

Associated Press Writer Meg Kinnard contributed to this report.