Conceptual dilemmas in evaluating individuals with severely impaired consciousness

States of severely impaired consciousness (SIC) are characterized by cognit ive and motor limitations. This case report describes a 45-year-old female with impaired consciousness who began to 'walk'. She initially presented to the hospital unresponsive and was subsequently diagnosed with metabolic en cephalopathy due to severe hypoglycaemia. Traditional indices of consciousn ess indicated a low level of responsiveness; however, during physical thera py, she displayed reciprocal walking movements when lifted to a standing po sition by two therapists. Despite her ability to walk increased distances d uring and after neurorehabilitation, she was unable to consistently demonst rate responses indicative of higher levels of consciousness. This case illu strates the challenge of rating patients with limited behavioural repertoir e using established measures of impaired consciousness.