A study published in the New England Journal of Medicine found that people thought to be unconscious may be awake and aware, experiencing a “hidden consciousness” undetected by doctors.
Researchers discovered that people said to be in a coma, persistent vegetative state (PVS), or a minimally conscious state can still be aware of their surroundings and may be able to mentally respond to commands. Researchers monitored patients’ brain activity through functional magnetic resonance imaging (fMRI) or electroencephalography (EEG). Though patients could not move or respond to external stimuli, they were given instructions such as, “imagine opening and closing your hand,” while being monitored.
The results revealed that approximately 25% of patients were aware and cognitively capable of performing the task — meaning the problem was one of physical function, not mental awareness. This condition is called cognitive motor dissociation.
“Some patients with severe brain injury do not appear to be processing their external world,” Yelena Bodien, lead author of the study, said. “However, when they are assessed with advanced techniques such as task-based fMRI and EEG, we can detect brain activity that suggests otherwise. These results bring up critical ethical, clinical, and scientific questions – such as how can we harness that unseen cognitive capacity to establish a system of communication and promote further recovery?”
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Similar results have been found in previous studies, including in France, where researchers were able to restore brain function in a man who had spent 15 years in a vegetative state. Yet people like Terri Schiavo, Vincent Lambert, and Margo Naranjo have either been killed or are at risk of being killed, because they were deemed to be brain-dead or in a vegetative state. If Schiavo and Lambert were aware, as some of their loved ones believe, they knew what was going to happen to them and suffered through each moment of their slow, agonizing deaths by starvation and dehydration. This research has confirmed that sometimes, all a person may need is more specific care to improve.
“Families have told us that once a positive test result revealing cognitive motor dissociation is shared with the patients’ clinical team, it can change the way that the team interacts with their loved one,” Bodien said. “Suddenly, the team is paying more attention to subtle behavioral signs that could be under volitional control, or speaking to the patient, or playing music in the room. On the other hand, failing to detect cognitive motor dissociation can have serious consequences, including premature withdrawal of life support, missed signs of awareness, and lack of access to intensive rehabilitation.”
