I interviewed over 100 formerly unconscious patients. regardless of cause, they reported and increase in consciousness when moved. During some of the time, they appeared to be unconscious externally but could hear, understand and emotionally respond to what was being said but couldn't move. Trying to find a physiological explanation.
Sorry, I didn't get it the first time. The physiological explanation is that they weren't unconscious but areactive. This touches a big issue in clinical neurology as we usually evaluate motor reactions to some stimuli, instructions, pain, etc. We put less weight on the experience of the patient as it is more difficult or impossible to evaluate. Still, I believe that the underlying physiology depends on the time course and there may not a single mechanism involved.
The patient's varied a lot in the length of time they were perceived to be unconscious. The patients who became alert when moved had no awareness before being moved. The movement 'woke' them temporarily so to speak. The other question relates to patients who could hear and understand but could not respond physically even though they tried. There is a definite gap between what clinically looks like unconsciousness and what the patient's are experiencing.
If they were unconscious, they were not aware and if they were not aware then how would you be possible to interview them, for the experience would differ if recorded in full consciousness. If they were moved then it must have been post operation, that is when the anaesthetic effect is fading or rather the cells are trying to come back to normal. I would not restrict myself to neural cells as in my opinion the effect is throughout the body in case of general anaesthesia and localized in case of local anaesthesia but effects each and every cell. Movement would result in triggering a mild sense of awareness which could trigger of the senses to some extent. There sure is a mix of mechanisms that get triggered during revival which may be at a cellular level and may hold an answer to the cognitive state observed.
I guess, neural correlates for these happenings could be understood from a few combined aspects of 'Narcolepsy' (where patients even though appear to be physically unconscious or asleep, they are aware of their surroundings), and 'Sleep Paralysis' (where one is unable to move or speak while remaining aware and conscious of one's surroundings). If one look for neural regions in the brain responsible for these two disorders, one may get some clue as to what may possibly create the phenomena you observed.
From a neuro stand point that is a good recommendation but from a consciousness stand point these patients might have been in a state of recovery which is why the cognitive states appeared more active. Consciousness can be reduced by science only to a certain limit beyond which it becomes purely subjective or rather phenomenal. If we address these characteristic from this perspective there is high possibility of this state being non physical or non local which maybe difficult to prove. Consciousness in the unbound form can perform much better than in the bound form, for every experience is subjective.
These patients were unconscious from physiological issues not post op anesthesia. Post cardiac arrest, diabetic coma, strokes, head trauma. I agree that interviewing them after recovering from the unconscious episode depends on their memories of the events. I suspect movement stimulates the proprioceptors which can impact the RAS maybe leading to temporary alertness. I'll look into the sleep paralysis research for an explanation of the inability to move while being alert. Great suggestion.
Maybe this work about empathy can give you some answers. interesting is your researh
J. Shashi Kiran Redd,
Followed up on the 'sleep paralysis'. Great suggestion. Many of the unconscious patients also reported hearing, understanding when going into unconsciousness during a cardiac arrest and similar situations. The mechanisms of muscle atonia at the beginning of sleep and awakening seem consistent. Thank you so much. On my mind for many years to at least get a lead for what happens.
Having experienced something that assembles the description of sleep paralysis several times in the past (spontaneously), I think it is that different parts of brain do different jobs in the body, often in different combination. It warrants more research to understand what is going on in peoples brains during these periods, which regions are active (making people aware of the reality) and the activity of which is being inhibited (unable to initiate movement). My experience included funny sensations in my cheeks, like if they were inflated (like when you want to fill a balloon) and feeling like being pulled out of my body via feet. I was conscious, aware of being awake, I could see the ceiling with half opened eyes, but I could not move despite I wanted. Heavy sensation on my chest was sometimes there as well. That usually happened when taking a nap in the afternoon and when laying on my back. My blood pressure has always been rather low, not sure whether this could have some connection to the episodes.
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