International study detects consciousness in unresponsive patients with severe brain injuries

Amazing stuff! Is such an unresponsive individual dead or alive? Can the individual recover (to what extent?) with critical care and intensive rehabilitation?

"When tested for “hidden consciousness,” one in four patients with severe brain injury who appeared unresponsive were able to respond to instructions covertly ...

In the study, 241 participants with severe brain injury who did not respond when given a simple instruction were assessed with functional MRI (fMRI), electroencephalography (EEG), or both tests. During these tests, participants heard instructions, such as “imagine opening and closing your hand,” followed 15-30 seconds later by “stop imagining opening and closing your hand.” The fMRI and EEG brain responses showed that 60 participants (25 percent) repeatedly followed this instruction covertly over minutes.
According to the authors of the study, patients who demonstrate this phenomenon, called cognitive motor dissociation, understand language, remember instructions, and can sustain attention, even though they appear unresponsive. For these patients, cognitive (i.e., thinking) abilities exceed, and are therefore dissociated from, motor abilities. ...
“These results bring up critical ethical, clinical, and scientific questions — such as how can we harness that unseen cognitive capacity to establish a system of communication and promote further recovery?” ...
Just knowing that somebody is cognitively aware and more capable than is immediately apparent can alter their clinical care substantially. ..."

From the abstract:

"Background

Patients with brain injury who are unresponsive to commands may perform cognitive tasks that are detected on functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). This phenomenon, known as cognitive motor dissociation, has not been systematically studied in a large cohort of persons with disorders of consciousness.

Methods

In this prospective cohort study conducted at six international centers, we collected clinical, behavioral, and task-based fMRI and EEG data from a convenience sample of 353 adults with disorders of consciousness. We assessed the response to commands on task-based fMRI or EEG in participants without an observable response to verbal commands (i.e., those with a behavioral diagnosis of coma, vegetative state, or minimally conscious state–minus) and in participants with an observable response to verbal commands. The presence or absence of an observable response to commands was assessed with the use of the Coma Recovery Scale–Revised (CRS-R).

Results

Data from fMRI only or EEG only were available for 65% of the participants, and data from both fMRI and EEG were available for 35%. The median age of the participants was 37.9 years, the median time between brain injury and assessment with the CRS-R was 7.9 months (25% of the participants were assessed with the CRS-R within 28 days after injury), and brain trauma was an etiologic factor in 50%. We detected cognitive motor dissociation in 60 of the 241 participants (25%) without an observable response to commands, of whom 11 had been assessed with the use of fMRI only, 13 with the use of EEG only, and 36 with the use of both techniques. Cognitive motor dissociation was associated with younger age, longer time since injury, and brain trauma as an etiologic factor. In contrast, responses on task-based fMRI or EEG occurred in 43 of 112 participants (38%) with an observable response to verbal commands.

Conclusions

Approximately one in four participants without an observable response to commands performed a cognitive task on fMRI or EEG as compared with one in three participants with an observable response to commands."

International study detects consciousness in unresponsive patients — Harvard Gazette "25% of participants with severe brain injury followed instructions covertly"

Cognitive Motor Dissociation in Disorders of Consciousness