Complete absence of behavioral evidence
for self or environmental awareness
- There
is preserved capacity for spontaneous or stimulus–induced arousal,
evidenced by sleep–wake cycles i.e. patients are awake, but have no
awareness. This means that the patients appear awake. They have normal
heart beat and breathing, and do not require advanced life support to
preserve life and cannot produce a purposeful, co–coordinated, voluntary
response in a sustained manner, although they may have primitive reflexive
responses to light, sound, touch or pain.
- Patients
cannot understand, communicate, speak, or have emotions and unaware of
self and environment and have no interaction with voluntarily control
passing of urine or stools. They sleep and awaken. As the centers in the
brain controlling the heart and breathing are intact, there is no threat
to life, and patients can survive for many years with expert nursing care.
- The
following behaviors may be seen in the vegetative state:
- Sleep–wake
cycles with eyes closed, then opened. Patient breathes on her own;
Spontaneous blinking and roving eye movements; Produce sounds but no
words; Visual pursuit following an object with her eyes; Grimacing to
pain; changing facial expression; Yawning; chewing jaw movements;
swallowing of own spit; no purposeful limb movements; arching of back;
reflex withdrawal from painful stimuli; brief movements of head or eyes
toward sound or movement without apparent localization or fixation;
startled reaction on a loud sound.
Almost all of these features consistent
with the diagnosis of permanent vegetative state were present during the
medical examination of Aruna Shaunbag; behavior suggestive of a minimally
conscious not vegetative state observed during the examination.
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