Soviet Psychology

ISSN: 0038-5751 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/mrpo19

The Quantitative Assessment of Levels of

Wakefulness

A. R. Luria

To cite this article: A. R. Luria (1973) The Quantitative Assessment of Levels of Wakefulness,
Soviet Psychology, 12:1, 73-84

To link to this article: http://dx.doi.org/10.2753/RPO1061-0405120173

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 Zhurnal nevropatologii i psikhiatrii imeni
I
S. S. Korsakova, 1972, -
72(11), 1604-1609

A. R. Luria

THE QUANTITATIVE ASSESSMENT

O F LEVELS O F WAKEFULNESS

In the last quarter of the 19th and the first half of the 20th
centuries, a great deal of attention was focused on the struc-
tural organization of the brain and localization of functions in
the cerebral cortex; the notable successes that were achieved
in this a r e a led to more precise notions of the systemic local-
ization of higher cortical processes and to the creation of
neuropsychology (1). However, since the early 1950s physiolo-
gists and neurologists have begun to concentrate on a new, un-
charted area - analysis of the function of the brain stem and
formations of the medial areas of the cerebral hemispheres.
Moruzzi & Magoun's study, which described the reticular
formations of the brain stem and visual thalamus, was pub-
lished in 1949; their report was followed by articles, by Jasper,
Lindsley, and others, that pinpointed the function of the ascend-
ing and descending reticular activating systems. Finally, there
was a whole research program devoted to an analysis of the
paleocortical components of the limbic system and their role
in the organization of drives, memory processes, and the

A. R. Luria is associated with the Department of Psychology,

Moscow University.

73
74 SOVIET PSYCHOLOGY

general activity of the organism (2, 3).

This overlapping of different fields of interest was accom-
panied by a shift in the problems of research: investigators who
previously had been engaged in analyzing the structure of
gnosis, praxis, and speech (by studying the disturbances in
these functions that occurred in local lesions of the convexital
areas of the cortex) now began to examine the nonspecific func-
tions of the brain - the processes of waking, levels of con-
sciousness, and general levels of activation.
Clinical studies of lesions of these regions of the brain began
to center not s o much on changes in gnosis, praxis, and speech
(observations had shown that these processes may remain rel-
atively intact even in patients with severe lesions of the brain
stem and limbic area) as on the nonspecific changes in mental
activity - that i s , those not associated with any one particular
sensory modality: disturbances in the waking state, processes
of arousal, types of sleep, and so on. Through a careful de-
scription of disorders of memory and consciousness resulting
from damage to the deep-lying a r e a s of the brain and limbic
system, researchers were able to distinguish new syndromes
which were of great value for the topical diagnosis of diseases
of these areas of the brain and which linked neurology with the
problems of psychiatry.
Reduction of cortical tone, oneiroid states, general memory
defects, and changes in consciousness thus became central
problems of neurology. The need to study changes in these
states w a s felt more urgently than ever before, since it w a s
thought that they could throw objective light on both the dynam-
i c s of the illness and the effect of drugs used in treating it.
A study of the varied symptoms of disorders of wakefulness
became a most important clinical task. However, a strictly s c i -
entific approach to this problem first demanded the develop-
ment of objective research methods that would provide a pre-
cise description of the changes in wakefulness a s well as quan-
titative assessment of the various levels of wakefulness.
It w a s the physiologists who first developed these objective
approaches to the analysis of wakefulness and to the study of
FALL 1973 75

the basic symptoms of these lesions. Among their contributions

were numerous techniques for physiological research on pro-
c e s s e s of activation and the orienting reflex and study of 'Yast"
and "slow" sleep in relation to different brain states.
Their discoveries also included a number of special psycho-
physiological techniques for objectively determining states of
consciousness and wakefulness.
Pavlov's classic research showed that the transition from
wakefulness to sleep inevitably involved characteristic changes
in neural processes, and that this transition was accompanied
by a succession of alternating inhibitory, or "phasic," cortical
states.
It is an established fact that the activity of the waking cortex
is subject to the physiological law that Pavlov called the ' l a w
of strength": strong, or significant, stimuli elicit strong r e -
sponses, and weak, or insignificant, stimuli elicit weak re-
sponses; stimuli of the inhibitory type lead to depression of
cerebral activity. The operation of the law of neurodynamics
ensures clear, selective functioning of the cerebral cortex.
When cortical tone is reduced and a transition to inhibitory
("phasic") states occurs, the picture changes considerably. In
the first of these phases (the "equalizing phase"), strong (sig-
nificant) and weak (insignificant) stimuli begin to elicit the same
type of response. A s the "phasic" state intensifies, weak, or in-
significant, stimuli can even give r i s e to stronger responses
than strong, o r significant, stimuli (the ''paradoxical phase");
finally, at an even deeper stage of this process, strong, or sig-
nificant, stimuli cease to elicit any response whatever (in other
words, they lead to inhibition of cortical activity), and positive
responses continue to occur in response to weak, o r insignifi-
cant, stimuli (the "ultraparadoxical phase").
All these dynamic changes in cerebral activity cannot but
give r i s e to distinct disorders in the selectivity of mental pro-
cesses.
In the normal (optimal) state of the cortex, important (signif -
icant) stimuli easily become dominant, and weak (insignificant)
stimuli a r e forced into the background; and the course of
 SOVIET PSYCHOLOGY

conscious processes assumes an organized character. However,

as the cortex passes into the "phasic" state and cortical tone is
reduced, this selective functioning of mental processes is in-
evitably disturbed. Important (significant) stimuli are reduced
to the same level of importance as weak (insignificant) stimuli,
and they lose their dominant character; they cease to act as
determinant factors, and the train of thought no longer gives
the appearance of organization; well-ordered associations di -
rected toward a particular goal give way to incidental, un-
controlled associations; haphazard images begin to rise to the
surface of consciousness, and the organized flow of conscious-
ness is disrupted.
One has only to follow the change in the train of thought in the
presleep state, with i t s uncontrolled flow of random associations
and images, to be convinced of the profound shifts in the organi-
zation and selectivity of mental processes that accompany this
transition from wakefulness to sleep.
Perhaps the most distinct changes in these states occur in
speech, which normally is marked by particular selectivity. It
is precisely here that we can see most graphically how the spe-
cific, selective character of word meanings begins to be dis-
rupted. Incidental and insignificant associations that are elic-
ited by a word, but that a r e normally ignored, begin to assume
the same importance as significant, dominant, semantic asso-
ciations; and as a result, the train of thought loses all sem-
blance of organization.
James Joyce, Marcel Proust, and other authors have of
course given us some highly persuasive examples of this phe-
nomenon. However, we shall restrict ourselves here to a single
illustration of this state: an excerpt from a classic description
of an oneiroid train of thought offered by Leo Tolstoy in W - ar
and Peace:
.
. . On the top of this knoll was a white patch which
Rostov could not account for. W a s it a clearing in the
woods, or the remains of snow, o r white houses? . . .
. -
"It must be snow, that patch . . a patch une tgche,"
he thought. "There now, it's no t k h e . . . Na-tash-a, my
-
FALL 1973 77

.. ..
sister, black eyes. Na-tash-a . Na-tash-a . take my
. ..
sabretache . Na-tash-a . .. sabretache . . . sabre
them ... .
Whom? The hussars . . Ah, the hussars with
moustaches. Along the Tversky boulevard rode the hussar
with the moustaches, and I was thinking about him . .. The
great thing is not to forget the important thing I w a s think-
ing of. Yes, Na-tash-a, sabretache . . . oh, yes, yes.
That's it." [Book One, P a r t 3, Chapter 13, War and
Peace, Rosemary Edmonds, trans., Penguin Books, 1957.1
It is easy to see how random images and phonetic associations
that under ordinary circumstances are forced out of conscious -
ness begin to surface uncontrollably, disrupting the organized
flow of associations and replacing the normal, fixed goal of
thought with a diffuse oneiroid process that has lost its former
selectivity. The diffuse flow of verbal and imaginal associations
that characterizes the inhibitory, "phasic" cortical state clearly
distinguishes the dreamlike state of the cortex from i t s normal,
waking state.
Might not this fact serve as the starting point for evaluating
the level of reduction of cortical tone, for providing an objective
description of the operating potentialities of the cortex, and, in
the final analysis, for quantitatively assessing wakefulness -
the all-important step in solving the clinical tasks that now
face us ? 1

Waking consciousness is characterized by the predominance

of the system of semantic associations evoked by a word, while
phonetic associations, which play no significant role whatever,
remain incidental and a r e inhibited. Thus (to use the example
from Tolstoy) pyatno [spot or patch] might in.the waking state
evoke the associations chernila [ink], gryaz [dirt], or kostyum
[suit], but it would never give rise to the association &he -
"Na-tashka" [a play on the affectionate form for "Natasha" and
on the Russian word tashka (sabretache)]. And the word tupit
[to dull] might be associated with the words nozh [knife] or
lezvie [blade], but it would scarcely evoke the phonetic asso-
ciation nas-tupit [as two words, "to dull us"; as one word, "to
tread upon"], The word - osen [autumn] easily arouses the system
78 SOVIET PSYCHOLOGY

of semantic associations: - zima [winter], let0 [summer], or

dozhd [rain], urozhay [harvest]; but in thewaking state one
would hardly hit upon the phonetic association - osen [autumn]-
- -
sin [dark blue (noun)] siniy [dark blue (adjective)]. Yet, in a
sleepy state, when cortical tone is reduced, such phonetic asso-
ciations are quite common.
Thus the semantic structure of the word and the associations
concealed behind it change as a function of the level of wakeful-
ness, The determination of that structure might serve a s a
method for quantitatively assessing the various waking states.
Indeed, psychophysiology does have a rather promising ob -
jective method for studying the semantic structure of the word
or the "semantic fields" evoked by the word. The problem has,
in fact, been the focus of an entire research program (4, 5).
The results of this work can also be applied to the question be-
ing examined in the present report.
Research has established that any new stimulus (for in-
stance, a word) elicits an orienting response reflected in
the contraction of the blood vessels of the hand and the
dilatation of the blood vessels of the head, the appearance
of the galvanic skin response, alpha-rhythm depression
on the EEG, and so on. If the stimulus (the word) is re-
peated many times, habituation to the stimulus occurs,
and the orienting response disappears. This phenomenon
served as the point of departure for our experiments.
Each subject was given a series of words; each word w a s
pronounced at intervals of 15-30 sec. After a certain
number of words had been presented, the subject became
habituated to the list, and signs of an orienting reflex to
the remaining words disappeared. This point marked the
beginning of the actual experiment.
The subject was instructed to press a button with his
right hand every time he heard a particular test word
(for example, koshka [cat]). At the same time, changes
in the size of the arteries of the left hand and in the tem-
poral artery were recorded on a plethysmograph. In a
normal subject the test word koshka [cat] evoked not only
FALL 1973

the motor reaction of the right hand but also well-defined

autonomic signs of an orienting reflex, whereas other,
neutral words elicited no such response.
The following questions arose: Would these same signs
of the orienting reflex occur when words were presented
that resembled the test word in meaning or sound ? And
if so, what would be the structure of the "semantic field"
that elicited these same responses?
To answer these questions, the experimenter gave the
subject three groups of words in random order: (a) words
similar in meaning to the test word (kot [tomcat],mysh
[mouse], sobaka [dog]); (b) words souring similar to the
test word (kroshka [crumb], kruzhka [mug], kryshka [lid]);
(c) completely neutral words. The subject was tested to
see which words evoked the appropriate involuntary re-
sponse s .
In another version of these experiments, the test word
(for example, skripka [violin]) w a s accompanied by a pain-
ful stimulus that gave rise to a specific pain response
(contraction of the blood vessels of the head and hands).
The subject was then presented with the same three groups
of words: words similar in meaning (gitara [guitar],
balalayka, struna [string], and so on), words similar in
sound (skrepka [paperclip], and so on), and neutral words.
The experimenter observed which words evoked the spe-
cific pain response (contraction of the blood vessels of
the hands and head), which words elicited the nonspecific
orienting response (contraction of the blood vessels of
the hands and dilatation of the blood vessels of the head),
and which words gave rise to no response at all.
The results obtained by this method enabled the experi-
menter to determine the "semantic fields" surrounding
the various test words for each subject. The resulting
data fit into a clear picture.
In the normal subject (with the cortex in the waking state),
words similar in meaning to the test word (kot [tomcat],
kotyonok [kitten], mysh [mouse], sobaka [dog])donot elicit a
80 SOVIET PSYCHOLOGY

1 2 3 4

11

Fig. 1. Vascular responses in a normal child of 11-12 years

to words similar in meaning to the test word. Neutral words
and words similar in sound to the test word (okoshko [window],
kroshka [crumb], kryshka [lid]) elicit no response. Vascular
reactions occur in response to words similar in sound to the
test word (korova [cow], sobaka [dog], zhivotnoe [animal]).
1. derevo [tree]; 2. okoshko [window]; 3. korova [cow]; 4. steklo
[glass]; 5. yabloko [apple]; 6. zhivotnoe [animal]; 7. kroshka
[crumb]; 8. nozhik [knife]; 9. -
noga [foot]; 10. kryshka [lid];
11. sobaka [dog].

voluntary motor response, as was the case with the test word
(koshka [cat]). They do, however, lead to a distinct orienting
response; and the closer in meaning the word is to the test
word, the more pronounced is this orienting response. Words
that a r e similar in sound to the test word (kroshka [crumb],
kruzhka [mug], kryshka [lid], okoshko [window]) do not evoke
an orienting response; nor does an orienting reaction occur in
response to neutral words (Fig. 1).
Subjects in whom the cortex i s in' a pathological state present
a different picture.
Using the method just described, we conducted an investiga-
tion with a group of mentally retarded children between the ages
of 9 and 15. The children, who were attending a special remedial
FALL 1973 81

4 5

6 7 8

Fig. 2. Vascular responses in a mentally retarded child to

words similar in sound to the test word. Vascular reactions
occur in response both to words semantically related and to
.
words phoneticallv related to the test word. 1. lozhka rsDoon1:
2. - -[duck]; 4. krovat [bed]; podushka [pillow];
L .I*

sen0 [hay]; 3. utka

6. sobaka [dog]; 7 . kirpich [brick]; 8. kroshka [crumb].

school, suffered from oligophrenia of varying degrees of se-

verity: the relatively mild form (debility) and the severe form
(imbecility).
Children with the milder form of oligophrenia (in the debility
stage) generally displayed a marked disturbance in the selective
system of semantic associations surrounding a particular word.
Presented with the test word koshka [cat] (to which these chil-
dren had given the correct motor response, accompanied by
autonomic signs of an orienting reflex), they displayed the same
autonomic signs of the orienting reflex both to words similar
to the test word in meaning (kot [tomcat] , kotyonok [kitten],
-
mysh [mouse]) and to wordssimilar to the test word in sound
(kroshka [crumb], kruzhka [mug], kryshka [lid]). The chil-
dren never displayed a voluntary motor response to these
words (as they had to the test word), but their autonomic responses
showed that the word's semantic and phonetic associations were
of equal significance for them and, consequently, that their "se-
mantic fieldsl'were characterized by a loss of selectivity (Fig. 2).
The same experiment with children suffering from more
82 SOVIET PSYCHOLOGY

1 2

Fig. 3. Vascular responses to words in an imbecile. Re-

sponses are elicited mainly by words similar in sound to the
test word. 1. kroshka [crumb]; 2. chashka [cup]; 3. kruzhka
[mug]; 4. okoshko [window]; 5 . kotyonok [kitten].

severe pathology of the cortical processes (imbeciles) pre -

sented an even clearer picture.
For children in this group, words similar in meaning to the
test word elicited no response at all and had the same effect as
neutral words. Words similar in sound to the test word
(kroshka [crumb], kruzhka [mug], kryshka [lid]), on the other
hand, produced the same autonomic signs of an orienting re-
flex as did the test word itself (Fig. 3).
These facts show that a pathological cortical state is accom-
panied by profound changes in the system of word associations
and that the method used in our experiments makes possible an
objective assessment of the degree of functional pathology of
the cortical processes.
Further studies have also established that the system of as-
sociations surrounding a word is not stable but can change as
a function of cortical strain and the degree of wakefulness of
the cortex. For example, when the experiment with subjects
suffering from relatively mild oligophrenia (debility) w a s con-
ducted when the children were not fatigued (for instance, during
the first lesson in the morning), autonomic signs of an orienting
reflex occurred mainly as a response to words similar in mean-
ing to the test word (kot [tomcat], kotyonok [kitten], mysh
[mouse], -sobaka [dog])whereas words similar in sound to the
FALL 1973 a3

Fig. 4. The effect of fatigue on the system of semantic as-

sociations in an oligophrenic. The semantic system gives way
to primitive phonetic associations: (a) before lessons; (b) after
lessons. 1. krovat [bed]; 2. sobaka [dog]; 3. - sen0 [hay];
4. kryshka [lid]; 5. nitka [thread]; 6. kroshka [crumb]; 7. -
stol
[table]; 8 . sobaka [dog].

test word (kryshka [lid], kroshka [crumb], kruzhka [mug]) did

not evoke these responses. Conversely, when the experiment
was conducted under conditions of exhaustion (after five hours
of classes), things were quite different: words similar in mean-
ing to the test word elicited no response, but autonomic signs
of an orienting reflex occurred in response to words similar
in sound (Fig. 4).
These data show that the reduction of cortical tone that r e -
sults from fatigue produces a distinct change in the system of
selective associations surrounding a word and that, conse-
quently, the method described here can aid in detecting not only
stable pathology but also variable states of the cortex.
The techniques we have described here make it possible to
objectify the state of neurodynamics and to establish the degree
to which differentiated selective systems of associations have
been retained.
W e have seen that this system of selective associations is
altered under conditions of cortical pathology and that the
84 SOVIET PSYCHOLOGY

associations surrounding a word lose their normal selective

character. We have also established that these systems of as-
sociations vary in different cortical states and, in particular,
that they can vary considerably under the influence of stress,
exhaustion, and so on.
A s yet we have no data that would indicate how the systems
of semantic associations change in severe brain lesions that
disrupt the normal activity of the reticular formation and lead
to a reduction of cortical tone, Nor do we have data that would
characterize the change undergone by the systems of semantic
associations under the influence of drugs capable of raising
cortical tone and normalizing i t s functioning.
Nevertheless, we are convinced that with the aid of the meth-
ods described above it will be possible to measure levels of
cortical wakefulness and obtain data for the objective assess-
ment of disturbances of cortical activity and the changes pro-
duced by various drugs.

References

1. Luria, A. R. Vysshie korkovye funktsii cheloveka. Mos-

cow, 1969.
2. Moruzzi, J., & Magoun, W. Brain-stem reticular forma-
tion. Electroenceph. Clin. Neurophysiol., 1949,-l, 455.
3. Lindsley, D. B. In Handbook of physiology. Section 1.
Washington, D.C., 1960. Vol. 3, p. 1559.
4. Luria, A. R., & Vinogradova, 0. S. Brit. J. Psychol.,
1959, 50, 89.
5. Luria, A. R.,& Vinogradova, 0. S. In Semanticheskaya
struktura slova. Moscow, 1971. P. 27.