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Terry Wallis showed only fleeting hints of consciousness for 19 years after he suffered a brain injury in a road accident. But then, in 2003, at age 39, he began to speak. It started with “Mom,” and then “Pepsi,” but soon he was slowly stringing sentences together and holding down his end of a conversation.

Far too often, patients like Wallis are given up for gone, left to languish in nursing homes where no one bothers with physical therapy or even to check for glimmers of regained consciousness, says Joseph Fins, a medical ethicist at Weill Cornell Medical College.

That’s at odds with a growing body of research showing that many patients with no outward signs of awareness retain some degree of consciousness. “We began to see patients who looked like they were vegetative, but they weren’t,” said Fins. “They were beginning to show responsiveness, they were sort of breaking the rules.”

In Wallis’ case, brain scans revealed evidence that his brain had rewired itself to some extent to compensate for the injury. Although such dramatic recoveries are exceedingly rare, a 2009 study by Belgian researchers found that 41 percent of hospital and rehab patients with a vegetative state diagnosis were actually minimally conscious. “It’s like a flickering light, and you’re going to miss it unless you systematically look for it,” Fins said.

At a conference last month at Duke University, researchers discussed emerging technology that could help doctors detect that flicker. In recent years, neuroscientists have developed fMRI brain scans and other methods to assess consciousness. In a few cases, this technology has enabled rudimentary communication with patients trapped inside an unresponsive body. In the future, some scientists believe, it may be possible to directly decode these patients’ thoughts.

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Awakening from anesthesia is often associated with an initial phase of delirious struggle before the full restoration of awareness and orientation to one’s surroundings. Scientists now know why this may occur: primitive consciousness emerges first. Using brain imaging techniques in healthy volunteers, a team of scientists led by Adjunct Professor Harry Scheinin, M.D. from the University of Turku, Turku, Finland in collaboration with investigators from the University of California, Irvine, USA, have now imaged the process of returning consciousness after general anesthesia. The emergence of consciousness was found to be associated with activations of deep, primitive brain structures rather than the evolutionary younger neocortex. These results may represent an important step forward in the scientific explanation of human consciousness.

The study was part of the Research Programme on Neuroscience by the Academy of Finland.

“We expected to see the outer bits of brain, the cerebral cortex (often thought to be the seat of higher human consciousness), would turn back on when consciousness was restored following anesthesia. Surprisingly, that is not what the images showed us. In fact, the central core structures of the more primitive brain structures including the thalamus and parts of the limbic system appeared to become functional first, suggesting that a foundational primitive conscious state must be restored before higher order conscious activity can occur” Scheinin said.

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During surgery, a patient awakes but is unable to move. She sees people dressed in green who talk in strange slowed-down voices. There seem to be tombstones nearby and she assumes she is at her own funeral. Slipping back into oblivion, she awakes later in her hospital bed, troubled by her frightening experiences.

These are genuine memories from a patient who regained awareness during an operation. Her experiences are clearly a distorted version of reality but crucially, none of the medical team was able to tell she was conscious.

This is because medical tests for consciousness are based on your behavior. Essentially, someone talks to you or prods you, and if you don’t respond, you’re assumed to be out cold. Consciousness, however, is not defined as a behavioral response but as a mental experience. If I were completely paralyzed, I could still be conscious and I could still experience the world, even if I was unable to communicate this to anyone else.

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