Skip to main content
SpringerLink
Log in

Cognitive Motor Dissociation: Gap Analysis and Future Directions

  • Curing Coma Campaign
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

Patients with disorders of consciousness who are behaviorally unresponsive may demonstrate volitional brain responses to motor imagery or motor commands detectable on functional magnetic resonance imaging or electroencephalography. This state of cognitive motor dissociation (CMD) may have prognostic significance.

Methods

The Neurocritical Care Society’s Curing Coma Campaign identified an international group of experts who convened in a series of monthly online meetings between September 2021 and April 2023 to examine the science of CMD and identify key knowledge gaps and unmet needs.

Results

The group identified major knowledge gaps in CMD research: (1) lack of information about patient experiences and caregiver accounts of CMD, (2) limited epidemiological data on CMD, (3) uncertainty about underlying mechanisms of CMD, (4) methodological variability that limits testing of CMD as a biomarker for prognostication and treatment trials, (5) educational gaps for health care personnel about the incidence and potential prognostic relevance of CMD, and (6) challenges related to identification of patients with CMD who may be able to communicate using brain–computer interfaces.

Conclusions

To improve the management of patients with disorders of consciousness, research efforts should address these mechanistic, epidemiological, bioengineering, and educational gaps to enable large-scale implementation of CMD assessment in clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Giacino JT, Kalmar K, Whyte J. The JFK coma recovery scale-revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004;85(12):2020–9. https://doi.org/10.1016/j.apmr.2004.02.033.

    Article  PubMed  Google Scholar 

  2. Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD. Detecting awareness in the vegetative state. Science. 2006;313(5792):1402. https://doi.org/10.1126/science.1130197.

    Article  CAS  PubMed  Google Scholar 

  3. Claassen J, Doyle K, Matory A, Couch C, Burger KM, Velazquez A, Okonkwo JU, King JR, Park S, Agarwal S, Roh D, Megjhani M, Eliseyev A, Connolly ES, Rohaut B. Detection of brain activation in unresponsive patients with acute brain injury. N Engl J Med. 2019;380(26):2497–505. https://doi.org/10.1056/NEJMoa1812757.

    Article  PubMed  Google Scholar 

  4. Monti MM, Vanhaudenhuyse A, Coleman MR, Boly M, Pickard JD, Tshibanda L, Owen AM, Laureys S. Willful modulation of brain activity in disorders of consciousness. N Engl J Med. 2010;362(7):579–89. https://doi.org/10.1056/NEJMoa0905370.

    Article  CAS  PubMed  Google Scholar 

  5. Edlow BL, Chatelle C, Spencer CA, Chu CJ, Bodien YG, O’Connor KL, Hirschberg RE, Hochberg LR, Giacino JT, Rosenthal ES, Wu O. Early detection of consciousness in patients with acute severe traumatic brain injury. Brain. 2017;140(9):2399–414. https://doi.org/10.1093/brain/awx176.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schnakers C, Bauer C, Formisano R, Noé E, Llorens R, Lejeune N, Farisco M, Teixeira L, Morrissey AM, De Marco S, Veeramuthu V, Ilina K, Edlow BL, Gosseries O, Zandalasini M, De Bellis F, Thibaut A, Estraneo A. What names for covert awareness? A systematic review. Front Hum Neurosci. 2022;16:971315. https://doi.org/10.3389/fnhum.2022.971315.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Schiff ND. Cognitive motor dissociation following severe brain injuries. JAMA Neurol. 2015;72(12):1413–5. https://doi.org/10.1001/jamaneurol.2015.2899.

    Article  PubMed  Google Scholar 

  8. Egbebike J, Shen Q, Doyle K, Der-Nigoghossian CA, Panicker L, Gonzales IJ, Grobois L, Carmona JC, Vrosgou A, Kaur A, Boehme A, Velazquez A, Rohaut B, Roh D, Agarwal S, Park S, Connolly ES, Claassen J. Cognitive-motor dissociation and time to functional recovery in patients with acute brain injury in the USA: a prospective observational cohort study. Lancet Neurol. 2022;21(8):704–13. https://doi.org/10.1016/S1474-4422(22)00212-5.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Posner JB, Saper CB, Schiff ND, Claassen J. Plum and Posner’s: diagnosis and treatment of Stupor and Coma. 5th ed. New York: Oxford University Press; 2019.

    Book  Google Scholar 

  10. Dahl R. William and Mary. In: Kiss Kiss by Roald Dahl. Knopf Inc.; 1960

  11. Kondziella D. Roald Dahl and the complete locked-in syndrome: “Cold dead body, living brain.” J Neurol Sci. 2017;15(379):276–8. https://doi.org/10.1016/j.jns.2017.06.033.

    Article  Google Scholar 

  12. Decety J. The neurophysiological basis of motor imagery. Behav Brain Res. 1996;77(1–2):45–52. https://doi.org/10.1016/0166-4328(95)00225-1.

    Article  CAS  PubMed  Google Scholar 

  13. Jeannerod M. Neural simulation of action: a unifying mechanism for motor cognition. Neuroimage. 2001;14(1 Pt 2):S103–9. https://doi.org/10.1006/nimg.2001.0832.

    Article  CAS  PubMed  Google Scholar 

  14. Jackson PL, Decety J. Motor cognition: a new paradigm to study self-other interactions. Curr Opin Neurobiol. 2004;14(2):259–63. https://doi.org/10.1016/j.conb.2004.01.020.

    Article  CAS  PubMed  Google Scholar 

  15. Cruse D, Chennu S, Chatelle C, Bekinschtein TA, Fernández-Espejo D, Pickard JD, Laureys S, Owen AM. Bedside detection of awareness in the vegetative state: a cohort study. Lancet. 2011;378(9809):2088–94. https://doi.org/10.1016/S0140-6736(11)61224-5.

    Article  PubMed  Google Scholar 

  16. Curley WH, Forgacs PB, Voss HU, Conte MM, Schiff ND. Characterization of EEG signals revealing covert cognition in the injured brain. Brain. 2018;141(5):1404–21. https://doi.org/10.1093/brain/awy070.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fins JJ, Schiff ND. Shades of gray: new insights on the vegetative state. Hastings Cent Rep. 2006;36:8–8. https://doi.org/10.1353/HCR.2006.0094.

    Article  PubMed  Google Scholar 

  18. Thibaut A, Panda R, Annen J, Sanz LRD, Naccache L, Martial C, Chatelle C, Aubinet C, Bonin EAC, Barra A, Briand MM, Cecconi B, Wannez S, Stender J, Laureys S, Gosseries O. Preservation of brain activity in unresponsive patients identifies MCS Star. Ann Neurol. 2021;90(1):89–100. https://doi.org/10.1002/ana.26095.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Gosseries O, Zasler ND, Laureys S. Recent advances in disorders of consciousness: focus on the diagnosis. Brain Inj. 2014;28(9):1141–50. https://doi.org/10.3109/02699052.2014.920522.

    Article  PubMed  Google Scholar 

  20. Giacino JT, Schnakers C, Rodriguez-Moreno D, Kalmar K, Schiff N, Hirsch J. Behavioral assessment in patients with disorders of consciousness: gold standard or fool’s gold? Prog Brain Res. 2009;177:33–48. https://doi.org/10.1016/S0079-6123(09)17704-X.

    Article  PubMed  Google Scholar 

  21. Bruno MA, Vanhaudenhuyse A, Thibaut A, Moonen G, Laureys S. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol. 2011;258(7):1373–84. https://doi.org/10.1007/s00415-011-6114-x.

    Article  PubMed  Google Scholar 

  22. Edlow BL, Claassen J, Schiff ND, Greer DM. Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies. Nat Rev Neurol. 2021;17(3):135–56. https://doi.org/10.1038/s41582-020-00428-x.

    Article  PubMed  Google Scholar 

  23. Monti MM, Schnakers C. Flowchart for implementing advanced imaging and electrophysiology in patients with disorders of consciousness: to fMRI or not to fMRI? Neurology. 2022;98(11):452–9. https://doi.org/10.1212/WNL.0000000000200038.

    Article  PubMed  Google Scholar 

  24. Kondziella D, Friberg CK, Frokjaer VG, Fabricius M, Møller K. Preserved consciousness in vegetative and minimal conscious states: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2016;87(5):485–92. https://doi.org/10.1136/jnnp-2015-310958.

    Article  PubMed  Google Scholar 

  25. Fins JJ, Bernat JL. Ethical, palliative, and policy considerations in disorders of consciousness. Arch Phys Med Rehabil. 2018;99(9):1927–31. https://doi.org/10.1016/j.apmr.2018.07.003.

    Article  PubMed  Google Scholar 

  26. Fins JJ, Wright MS, Bagenstos SR. Disorders of consciousness and disability law. Mayo Clin Proc. 2020;95(8):1732–9. https://doi.org/10.1016/j.mayocp.2020.02.008.

    Article  PubMed  Google Scholar 

  27. Young MJ, Bodien YG, Giacino JT, Fins JJ, Truog RD, Hochberg LR, Edlow BL. The neuroethics of disorders of consciousness: a brief history of evolving ideas. Brain. 2021;144(11):3291–310. https://doi.org/10.1093/brain/awab290.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fins JJ. Disorders of consciousness, past, present, and future. Camb Q Healthc Ethics. 2019;28(4):603–15. https://doi.org/10.1017/S0963180119000719.

    Article  PubMed  Google Scholar 

  29. Giacino JT, Katz DI, Schiff ND, Whyte J, Ashman EJ, Ashwal S, Barbano R, Hammond FM, Laureys S, Ling GSF, Nakase-Richardson R, Seel RT, Yablon S, Getchius TSD, Gronseth GS, Armstrong MJ. Practice guideline update recommendations summary: disorders of consciousness: report of the guideline development, dissemination, and implementation subcommittee of the American academy of neurology; the American congress of rehabilitation medicine; and the national institute on disability, independent living, and rehabilitation research. Neurology. 2018;91(10):450–60. https://doi.org/10.1212/WNL.0000000000005926.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kondziella D, Bender A, Diserens K, et al. European academy of neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol. 2020;27:741–56. https://doi.org/10.1111/ENE.14151.

    Article  CAS  PubMed  Google Scholar 

  31. Lutkenhoff ES, Monti MM. Brain responsiveness after severe brain injury: revolutions and controversies. In: Brain function and responsiveness in disorders of consciousness. Springer; 2016. p. 81–92.

    Chapter  Google Scholar 

  32. Schnakers C, Hirsch M, Noé E, Llorens R, Lejeune N, Veeramuthu V, De Marco S, Demertzi A, Duclos C, Morrissey AM, Chatelle C, Estraneo A. Covert cognition in disorders of consciousness: a meta-analysis. Brain Sci. 2020;10(12):930. https://doi.org/10.3390/brainsci10120930.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Stender J, Gosseries O, Bruno MA, Charland-Verville V, Vanhaudenhuyse A, Demertzi A, Chatelle C, Thonnard M, Thibaut A, Heine L, Soddu A, Boly M, Schnakers C, Gjedde A, Laureys S. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. Lancet. 2014;384(9942):514–22. https://doi.org/10.1016/S0140-6736(14)60042-8.

    Article  PubMed  Google Scholar 

  34. Fernández-Espejo D, Rossit S, Owen AM. A Thalamocortical mechanism for the absence of overt motor behavior in covertly aware patients. JAMA Neurol. 2015;72(12):1442–50. https://doi.org/10.1001/jamaneurol.2015.2614.

    Article  PubMed  Google Scholar 

  35. Luppi AI, Craig MM, Coppola P, Peattie ARD, Finoia P, Williams GB, Allanson J, Pickard JD, Menon DK, Stamatakis EA. Preserved fractal character of structural brain networks is associated with covert consciousness after severe brain injury. Neuroimage Clin. 2021;30:102682. https://doi.org/10.1016/j.nicl.2021.102682.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Haar S, Donchin O. A revised computational neuroanatomy for motor control. J Cogn Neurosci. 2020;32(10):1823–36. https://doi.org/10.1162/jocn_a_01602.

    Article  PubMed  Google Scholar 

  37. Shadmehr R, Krakauer JW. A computational neuroanatomy for motor control. Exp Brain Res. 2008;185(3):359–81. https://doi.org/10.1007/s00221-008-1280-5.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Vanhaudenhuyse A, Noirhomme Q, Tshibanda LJ, Bruno MA, Boveroux P, Schnakers C, Soddu A, Perlbarg V, Ledoux D, Brichant JF, Moonen G, Maquet P, Greicius MD, Laureys S, Boly M. Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients. Brain. 2010;133(Pt 1):161–71. https://doi.org/10.1093/brain/awp313.

    Article  PubMed  Google Scholar 

  39. Threlkeld ZD, Bodien YG, Rosenthal ES, Giacino JT, Nieto-Castanon A, Wu O, Whitfield-Gabrieli S, Edlow BL. Functional networks reemerge during recovery of consciousness after acute severe traumatic brain injury. Cortex. 2018;106:299–308. https://doi.org/10.1016/j.cortex.2018.05.004.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Amiri M, Fisher PM, Raimondo F, Sidaros A, Cacic Hribljan M, Othman MH, Zibrandtsen I, Albrechtsen SS, Bergdal O, Hansen AE, Hassager C, Højgaard JLS, Jakobsen EW, Jensen HR, Møller J, Nersesjan V, Nikolic M, Olsen MH, Sigurdsson ST, Sitt JD, Sølling C, Welling KL, Willumsen LM, Hauerberg J, Larsen VA, Fabricius M, Knudsen GM, Kjaergaard J, Møller K, Kondziella D. Multimodal prediction of residual consciousness in the intensive care unit: the CONNECT-ME study. Brain. 2023;146(1):50–64. https://doi.org/10.1093/brain/awac335.

    Article  PubMed  Google Scholar 

  41. Demertzi A, Antonopoulos G, Heine L, Voss HU, Crone JS, de Los AC, Bahri MA, Di Perri C, Vanhaudenhuyse A, Charland-Verville V, Kronbichler M, Trinka E, Phillips C, Gomez F, Tshibanda L, Soddu A, Schiff ND, Whitfield-Gabrieli S, Laureys S. Intrinsic functional connectivity differentiates minimally conscious from unresponsive patients. Brain. 2015;138(Pt 9):2619–31. https://doi.org/10.1093/brain/awv169.

    Article  PubMed  Google Scholar 

  42. Bodien YG, Threlkeld ZD, Edlow BL. Default mode network dynamics in covert consciousness. Cortex. 2019;119:571–4. https://doi.org/10.1016/j.cortex.2019.01.014.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Curley WH, Bodien YG, Zhou DW, Conte MM, Foulkes AS, Giacino JT, Victor JD, Schiff ND, Edlow BL. Electrophysiological correlates of thalamocortical function in acute severe traumatic brain injury. Cortex. 2022;152:136–52. https://doi.org/10.1016/j.cortex.2022.04.007.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Engemann DA, Raimondo F, King JR, Rohaut B, Louppe G, Faugeras F, Annen J, Cassol H, Gosseries O, Fernandez-Slezak D, Laureys S, Naccache L, Dehaene S, Sitt JD. Robust EEG-based cross-site and cross-protocol classification of states of consciousness. Brain. 2018;141(11):3179–92. https://doi.org/10.1093/brain/awy251.

    Article  PubMed  Google Scholar 

  45. Sitt JD, King JR, El Karoui I, Rohaut B, Faugeras F, Gramfort A, Cohen L, Sigman M, Dehaene S, Naccache L. Large scale screening of neural signatures of consciousness in patients in a vegetative or minimally conscious state. Brain. 2014;137(Pt 8):2258–70. https://doi.org/10.1093/brain/awu141.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Chennu S, Annen J, Wannez S, Thibaut A, Chatelle C, Cassol H, Martens G, Schnakers C, Gosseries O, Menon D, Laureys S. Brain networks predict metabolism, diagnosis and prognosis at the bedside in disorders of consciousness. Brain. 2017;140(8):2120–32. https://doi.org/10.1093/brain/awx163.

    Article  PubMed  Google Scholar 

  47. Forgacs PB, Frey HP, Velazquez A, Thompson S, Brodie D, Moitra V, Rabani L, Park S, Agarwal S, Falo MC, Schiff ND, Claassen J. Dynamic regimes of neocortical activity linked to corticothalamic integrity correlate with outcomes in acute anoxic brain injury after cardiac arrest. Ann Clin Transl Neurol. 2017;4(2):119–29. https://doi.org/10.1002/acn3.385.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Alkhachroum A, Eliseyev A, Der-Nigoghossian CA, Rubinos C, Kromm JA, Mathews E, Bauerschmidt A, Doyle K, Velasquez A, Egbebike JA, Calderon AR, Roh DJ, Park S, Agarwal S, Connolly ES, Claassen J. EEG to detect early recovery of consciousness in amantadine-treated acute brain injury patients. J Neurol Neurosurg Psychiatry. 2020;91(6):675–6. https://doi.org/10.1136/jnnp-2019-322645.

    Article  PubMed  Google Scholar 

  49. Forgacs PB, Conte MM, Fridman EA, Voss HU, Victor JD, Schiff ND. Preservation of electroencephalographic organization in patients with impaired consciousness and imaging-based evidence of command-following. Ann Neurol. 2014;76(6):869–79. https://doi.org/10.1002/ana.24283.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Casarotto S, Comanducci A, Rosanova M, Sarasso S, Fecchio M, Napolitani M, Pigorini A, Casali A, Trimarchi PD, Boly M, Gosseries O, Bodart O, Curto F, Landi C, Mariotti M, Devalle G, Laureys S, Tononi G, Massimini M. Stratification of unresponsive patients by an independently validated index of brain complexity. Ann Neurol. 2016;80(5):718–29. https://doi.org/10.1002/ana.24779.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Sinitsyn DO, Poydasheva AG, Bakulin IS, Legostaeva LA, Iazeva EG, Sergeev DV, Sergeeva AN, Kremneva EI, Morozova SN, Lagoda DY, Casarotto S, Comanducci A, Ryabinkina YV, Suponeva NA, Piradov MA. Detecting the potential for consciousness in unresponsive patients using the perturbational complexity index. Brain Sci. 2020;10(12):917. https://doi.org/10.3390/brainsci10120917.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kondziella D, Menon DK, Helbok R, Naccache L, Othman MH, Rass V, Rohaut B, Diringer MN, Stevens RD; contributing collaborators of the Curing Coma Campaign. A precision medicine framework for classifying patients with disorders of consciousness: advanced classification of consciousness endotypes (ACCESS). Neurocrit Care. 2021;35(1):27–36. https://doi.org/10.1007/s12028-021-01246-9

  53. Bekinschtein TA, Dehaene S, Rohaut B, Tadel F, Cohen L, Naccache L. Neural signature of the conscious processing of auditory regularities. Proc Natl Acad Sci USA. 2009;106(5):1672–7. https://doi.org/10.1073/pnas.0809667106.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Morlet D, Mattout J, Fischer C, Luauté J, Dailler F, Ruby P, André-Obadia N. Infraclinical detection of voluntary attention in coma and post-coma patients using electrophysiology. Clin Neurophysiol. 2023;145:151–61. https://doi.org/10.1016/j.clinph.2022.09.019.

    Article  PubMed  Google Scholar 

  55. Monti MM, Rosenberg M, Finoia P, Kamau E, Pickard JD, Owen AM. Thalamo-frontal connectivity mediates top-down cognitive functions in disorders of consciousness. Neurology. 2015;84(2):167–73. https://doi.org/10.1212/WNL.0000000000001123.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Schnakers C, Giacino JT, Løvstad M, Habbal D, Boly M, Di H, Majerus S, Laureys S. Preserved covert cognition in noncommunicative patients with severe brain injury? Neurorehabil Neural Repair. 2015;29(4):308–17. https://doi.org/10.1177/1545968314547767.

    Article  PubMed  Google Scholar 

  57. Weiler M, Casseb RF, de Campos BM, Crone JS, Lutkenhoff ES, Vespa PM, Monti MM. EpiBioS4Rx study group. Evaluating denoising strategies in resting-state functional magnetic resonance in traumatic brain injury (EpiBioS4Rx). Hum Brain Mapp. 2022;43(15):4640–9. https://doi.org/10.1002/hbm.25979.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Goldfine AM, Victor JD, Conte MM, Bardin JC, Schiff ND. Determination of awareness in patients with severe brain injury using EEG power spectral analysis. Clin Neurophysiol. 2011;122(11):2157–68. https://doi.org/10.1016/j.clinph.2011.03.022.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Stoll J, Chatelle C, Carter O, Koch C, Laureys S, Einhäuser W. Pupil responses allow communication in locked-in syndrome patients. Curr Biol. 2013;23(15):R647–8. https://doi.org/10.1016/j.cub.2013.06.011.

    Article  CAS  PubMed  Google Scholar 

  60. Sattin D, Bruzzone MG, Ferraro S, Nigri A, Leonardi M, Guido D. Coma research center, fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy. Olfactory discrimination in disorders of consciousness: A new sniff protocol. Brain Behav. 2019;9(8):e01273. https://doi.org/10.1002/brb3.1273.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Nigri A, Ferraro S, Bruzzone MG, Nava S, D’Incerti L, Bertolino N, Sattin D, Leonardi M, Lundström JN. CRC—coma research centre members. Central olfactory processing in patients with disorders of consciousness. Eur J Neurol. 2016;23(3):605–12. https://doi.org/10.1111/ene.12907.

    Article  CAS  PubMed  Google Scholar 

  62. Arzi A, Rozenkrantz L, Gorodisky L, Rozenkrantz D, Holtzman Y, Ravia A, Bekinschtein TA, Galperin T, Krimchansky BZ, Cohen G, Oksamitni A, Aidinoff E, Sacher Y, Sobel N. Olfactory sniffing signals consciousness in unresponsive patients with brain injuries. Nature. 2020;581(7809):428–33. https://doi.org/10.1038/s41586-020-2245-5.

    Article  CAS  PubMed  Google Scholar 

  63. Pan J, Xie Q, Qin P, Chen Y, He Y, Huang H, Wang F, Ni X, Cichocki A, Yu R, Li Y. Prognosis for patients with cognitive motor dissociation identified by brain-computer interface. Brain. 2020;143(4):1177–89. https://doi.org/10.1093/brain/awaa026.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Eliseyev A, Gonzales IJ, Le A, Doyle K, Egbebike J, Velazquez A, Agarwal S, Roh D, Park S, Connolly ES, Claassen J. Development of a brain-computer interface for patients in the critical care setting. PLoS One. 2021;16(1):e0245540. https://doi.org/10.1371/journal.pone.0245540.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Chatelle C, Spencer CA, Cash SS, Hochberg LR, Edlow BL. Feasibility of an EEG-based brain-computer interface in the intensive care unit. Clin Neurophysiol. 2018;129(8):1519–25. https://doi.org/10.1016/j.clinph.2018.04.747.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Lee MH, Smyser CD, Shimony JS. Resting-state fMRI: a review of methods and clinical applications. AJNR Am J Neuroradiol. 2013;34(10):1866–72. https://doi.org/10.3174/ajnr.A3263.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Hannawi Y, Lindquist MA, Caffo BS, Sair HI, Stevens RD. Resting brain activity in disorders of consciousness: a systematic review and meta-analysis. Neurology. 2015;84(12):1272–80. https://doi.org/10.1212/WNL.0000000000001404.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Sair HI, Hannawi Y, Li S, Kornbluth J, Demertzi A, Di Perri C, Chabanne R, Jean B, Benali H, Perlbarg V, Pekar J, Luyt CE, Galanaud D, Velly L, Puybasset L, Laureys S, Caffo B, Stevens RD. Neuroimaging for Coma Emergence and Recovery (NICER) Consortium. Early functional connectome integrity and 1-year recovery in comatose survivors of cardiac arrest. Radiology. 2018;287(1):247–55. https://doi.org/10.1148/radiol.2017162161.

    Article  PubMed  Google Scholar 

  69. Claassen J, Velazquez A, Meyers E, Witsch J, Falo MC, Park S, Agarwal S, Michael Schmidt J, Schiff ND, Sitt JD, Naccache L, Sander Connolly E, Frey HP. Bedside quantitative electroencephalography improves assessment of consciousness in comatose subarachnoid hemorrhage patients. Ann Neurol. 2016;80(4):541–53. https://doi.org/10.1002/ana.24752.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Chennu S, Finoia P, Kamau E, Allanson J, Williams GB, Monti MM, Noreika V, Arnatkeviciute A, Canales-Johnson A, Olivares F, Cabezas-Soto D, Menon DK, Pickard JD, Owen AM, Bekinschtein TA. Spectral signatures of reorganised brain networks in disorders of consciousness. PLoS Comput Biol. 2014;10(10):e1003887. https://doi.org/10.1371/journal.pcbi.1003887.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Helbok R, Rass V, Beghi E, Bodien YG, Citerio G, Giacino JT, Kondziella D, Mayer SA, Menon D, Sharshar T, Stevens RD, Ulmer H, Venkatasubba Rao CP, Vespa P, McNett M, Frontera J; Curing Coma Campaign and its contributing members. The Curing Coma Campaign international survey on coma epidemiology, evaluation, and therapy (COME TOGETHER). Neurocrit Care. 2022;37(1):47–59. https://doi.org/10.1007/s12028-021-01425-8

  72. Schnakers C. Update on diagnosis in disorders of consciousness. Expert Rev Neurother. 2020;20(10):997–1004. https://doi.org/10.1080/14737175.2020.1796641.

    Article  CAS  PubMed  Google Scholar 

  73. Zhang B, Huang K, Karri J, O’Brien K, DiTommaso C, Li S. Many faces of the hidden souls: medical and neurological complications and comorbidities in disorders of consciousness. Brain Sci. 2021;11(5):608. https://doi.org/10.3390/brainsci11050608.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Thibaut FA, Chatelle C, Wannez S, Deltombe T, Stender J, Schnakers C, Laureys S, Gosseries O. Spasticity in disorders of consciousness: a behavioral study. Eur J Phys Rehabil Med. 2015;51(4):389–97.

    CAS  PubMed  Google Scholar 

  75. Winters B, Kuluris B, Pathmanaban R, Vanderwalt H, Thibaut A, Schnakers C. Changes of spasticity across time in prolonged disorders of consciousness: a retrospective study. Brain Sci. 2022;12(2):295. https://doi.org/10.3390/brainsci12020295.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Pincherle A, Jöhr J, Chatelle C, Pignat JM, Du Pasquier R, Ryvlin P, Oddo M, Diserens K. Motor behavior unmasks residual cognition in disorders of consciousness. Ann Neurol. 2019;85(3):443–7. https://doi.org/10.1002/ana.25417.

    Article  PubMed  Google Scholar 

  77. Pignat JM, Mauron E, Jöhr J, Gilart de Keranflech C, Van De Ville D, Preti MG, Meskaldji DE, Hömberg V, Laureys S, Draganski B, Frackowiak R, Diserens K. Outcome prediction of consciousness disorders in the acute stage based on a complementary motor behavioural tool. PLoS One. 2016;11(6):0156882. https://doi.org/10.1371/journal.pone.0156882.

    Article  CAS  Google Scholar 

  78. Mat B, Sanz LRD, Arzi A, Boly M, Laureys S, Gosseries O. New behavioral signs of consciousness in patients with severe brain injuries. Semin Neurol. 2022;42(3):259–72. https://doi.org/10.1055/a-1883-0861.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Hermann B, Salah AB, Perlbarg V, Valente M, Pyatigorskaya N, Habert MO, Raimondo F, Stender J, Galanaud D, Kas A, Puybasset L, Perez P, Sitt JD, Rohaut B, Naccache L. Habituation of auditory startle reflex is a new sign of minimally conscious state. Brain. 2020;143(7):2154–72. https://doi.org/10.1093/brain/awaa159.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Hermann B, Goudard G, Courcoux K, Valente M, Labat S, Despois L, Bourmaleau J, Richard-Gilis L, Faugeras F, Demeret S, Sitt JD, Naccache L, Rohaut B. Pitié-Salpétrière hospital Neuro-ICU. Wisdom of the caregivers: pooling individual subjective reports to diagnose states of consciousness in brain-injured patients, a monocentric prospective study. BMJ Open. 2019;9(2):e026211. https://doi.org/10.1136/bmjopen-2018-026211.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Comanducci A, Boly M, Claassen J, De Lucia M, Gibson RM, Juan E, Laureys S, Naccache L, Owen AM, Rosanova M, Rossetti AO, Schnakers C, Sitt JD, Schiff ND, Massimini M. Clinical and advanced neurophysiology in the prognostic and diagnostic evaluation of disorders of consciousness: review of an IFCN-endorsed expert group. Clin Neurophysiol. 2020;131(11):2736–65. https://doi.org/10.1016/j.clinph.2020.07.015.

    Article  CAS  PubMed  Google Scholar 

  82. Klein KE, Rasmussen PA, Winners SL, Frontera JA. Teleneurocritical care and telestroke. Crit Care Clin. 2015;31(2):197–224. https://doi.org/10.1016/j.ccc.2014.12.002.

    Article  PubMed  Google Scholar 

  83. Peretti A, Amenta F, Tayebati SK, Nittari G, Mahdi SS. Telerehabilitation: review of the state-of-the-art and areas of application. JMIR Rehabil Assist Technol. 2017;4(2):e7. https://doi.org/10.2196/rehab.7511.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Soun JE, Chow DS, Nagamine M, Takhtawala RS, Filippi CG, Yu W, Chang PD. Artificial intelligence and acute stroke imaging. AJNR Am J Neuroradiol. 2021;42(1):2–11. https://doi.org/10.3174/ajnr.A6883.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Grinnon ST, Miller K, Marler JR, Lu Y, Stout A, Odenkirchen J, Kunitz S. National institute of neurological disorders and stroke common data element project—approach and methods. Clin Trials. 2012;9(3):322–9. https://doi.org/10.1177/1740774512438980.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Provencio JJ, Hemphill JC, Claassen J, Edlow BL, Helbok R, Vespa PM, Diringer MN, Polizzotto L, Shutter L, Suarez JI, Stevens RD, Hanley DF, Akbari Y, Bleck TP, Boly M, Foreman B, Giacino JT, Hartings JA, Human T, Kondziella D, Ling GSF, Mayer SA, McNett M, Menon DK, Meyfroidt G, Monti MM, Park S, Pouratian N, Puybasset L, Rohaut B, Rosenthal ES, Schiff ND, Sharshar T, Wagner A, Whyte J, Olson DM. Neurocritical care society Curing Coma Campaign. The Curing Coma Campaign: framing initial scientific challenges-proceedings of the first Curing Coma Campaign scientific advisory council meeting. Neurocrit Care. 2020;33(1):1–12. https://doi.org/10.1007/s12028-020-01028-9.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Estraneo A, Moretta P, Loreto V, Lanzillo B, Santoro L, Trojano L. Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state. Neurology. 2010;75(3):239–45. https://doi.org/10.1212/WNL.0b013e3181e8e8cc.

    Article  CAS  PubMed  Google Scholar 

  88. Estraneo A, Fiorenza S, Magliacano A, Formisano R, Mattia D, Grippo A, Romoli AM, Angelakis E, Cassol H, Thibaut A, Gosseries O, Lamberti G, Noé E, Bagnato S, Edlow BL, Chatelle C, Lejeune N, Veeramuthu V, Bartolo M, Toppi J, Zasler N, Schnakers C, Trojano L. IBIA DoC-SIG. Multicenter prospective study on predictors of short-term outcome in disorders of consciousness. Neurology. 2020;95(11):e1488–99. https://doi.org/10.1212/WNL.0000000000010254.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Estraneo A, Moretta P, Loreto V, Lanzillo B, Cozzolino A, Saltalamacchia A, Lullo F, Santoro L, Trojano L. Predictors of recovery of responsiveness in prolonged anoxic vegetative state. Neurology. 2013;80(5):464–70. https://doi.org/10.1212/WNL.0b013e31827f0f31.

    Article  PubMed  Google Scholar 

  90. Faugeras F, Rohaut B, Valente M, Sitt J, Demeret S, Bolgert F, Weiss N, Grinea A, Marois C, Quirins M, Demertzi A, Raimondo F, Galanaud D, Habert MO, Engemann D, Puybasset L, Naccache L. Survival and consciousness recovery are better in the minimally conscious state than in the vegetative state. Brain Inj. 2018;32(1):72–7. https://doi.org/10.1080/02699052.2017.1364421.

    Article  PubMed  Google Scholar 

  91. Nakase-Richardson R, Whyte J, Giacino JT, Pavawalla S, Barnett SD, Yablon SA, Sherer M, Kalmar K, Hammond FM, Greenwald B, Horn LJ, Seel R, McCarthy M, Tran J, Walker WC. Longitudinal outcome of patients with disordered consciousness in the NIDRR TBI model systems programs. J Neurotrauma. 2012;29(1):59–65. https://doi.org/10.1089/neu.2011.1829.

    Article  PubMed  Google Scholar 

  92. McCrea MA, Giacino JT, Barber J, Temkin NR, Nelson LD, Levin HS, Dikmen S, Stein M, Bodien YG, Boase K, Taylor SR, Vassar M, Mukherjee P, Robertson C, Diaz-Arrastia R, Okonkwo DO, Markowitz AJ, Manley GT; TRACK-TBI Investigators; Adeoye O, Badjatia N, Bullock MR, Chesnut R, Corrigan JD, Crawford K, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson AR, Foreman B, Gardner R, Gaudette E, Goldman D, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Jain S, Keene CD, Korley FK, Kramer J, Kreitzer N, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, Merchant R, Ngwenya LB, Noel F, Nolan A, Palacios E, Perl D, Puccio A, Rabinowitz M, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Sherer M, Toga A, Valadka A, Wang K, Yue JK, Yuh E, Zafonte R. Functional outcomes over the first year after moderate to severe traumatic brain injury in the prospective, longitudinal TRACK-TBI study. JAMA Neurol. 2021;78(8):982–992. https://doi.org/10.1001/jamaneurol.2021.2043

  93. Hammond FM, Giacino JT, Nakase Richardson R, Sherer M, Zafonte RD, Whyte J, Arciniegas DB, Tang X. Disorders of consciousness due to traumatic brain injury: functional status ten years post-injury. J Neurotrauma. 2019;36(7):1136–46. https://doi.org/10.1089/neu.2018.5954.

    Article  PubMed  Google Scholar 

  94. Thibaut A, Schiff N, Giacino J, Laureys S, Gosseries O. Therapeutic interventions in patients with prolonged disorders of consciousness. Lancet Neurol. 2019;18(6):600–14. https://doi.org/10.1016/S1474-4422(19)30031-6.

    Article  PubMed  Google Scholar 

  95. Edlow BL, Sanz LRD, Polizzotto L, Pouratian N, Rolston JD, Snider SB, Thibaut A, Stevens RD, Gosseries O; Curing Coma Campaign and its contributing members. Therapies to restore consciousness in patients with severe brain injuries: a gap analysis and future directions. Neurocrit Care. 2021;35(Suppl 1):68–85. https://doi.org/10.1007/s12028-021-01227-y

  96. Schnakers C, Monti MM. Disorders of consciousness after severe brain injury: therapeutic options. Curr Opin Neurol. 2017;30(6):573–9. https://doi.org/10.1097/WCO.0000000000000495.

    Article  PubMed  Google Scholar 

  97. Sokoliuk R, Degano G, Banellis L, Melloni L, Hayton T, Sturman S, Veenith T, Yakoub KM, Belli A, Noppeney U, Cruse D. Covert speech comprehension predicts recovery from acute unresponsive states. Ann Neurol. 2021;89(4):646–56. https://doi.org/10.1002/ana.25995.

    Article  PubMed  Google Scholar 

  98. Thibaut A, Chatelle C, Vanhaudenhuyse A, Martens G, Cassol H, Martial C, Carrière M, Barra A, Laureys S, Gosseries O. Transcranial direct current stimulation unveils covert consciousness. Brain Stimul. 2018;11(3):642–4. https://doi.org/10.1016/j.brs.2018.02.002.

    Article  PubMed  Google Scholar 

  99. Baude M, Nielsen JB, Gracies JM. The neurophysiology of deforming spastic paresis: a revised taxonomy. Ann Phys Rehabil Med. 2019;62(6):426–30. https://doi.org/10.1016/j.rehab.2018.10.004.

    Article  PubMed  Google Scholar 

  100. Zhang B, Karri J, O’Brien K, DiTommaso C, Kothari S, Li S. Spasticity management in persons with disorders of consciousness. PMR. 2021;13(7):657–65. https://doi.org/10.1002/pmrj.12458.

    Article  Google Scholar 

  101. Owen AM. Into the gray zone: a neuroscientist explores the border between life and death. Guardian Faber Publishing, 2017

  102. Monti MM. Ethics, neuroimaging and disorders of consciousness: what is the question. AJOB Neurosci. 2013;4:1–2. https://doi.org/10.1080/21507740.2013.836337.

    Article  Google Scholar 

  103. Peterson A, Naci L, Weijer C, et al. Assessing decision-making capacity in the behaviorally nonresponsive patient with residual covert awareness. AJOB Neurosci. 2013;4:3–14. https://doi.org/10.1080/21507740.2013.821189.

    Article  Google Scholar 

  104. Laureys S, Pellas F, Van Eeckhout P, Ghorbel S, Schnakers C, Perrin F, Berré J, Faymonville ME, Pantke KH, Damas F, Lamy M, Moonen G, Goldman S. The locked-in syndrome: what is it like to be conscious but paralyzed and voiceless? Prog Brain Res. 2005;150:495–511. https://doi.org/10.1016/S0079-6123(05)50034-7.

    Article  PubMed  Google Scholar 

  105. Bruno MA, Bernheim JL, Ledoux D, Pellas F, Demertzi A, Laureys S. A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority. BMJ Open. 2011;1(1):e000039. https://doi.org/10.1136/bmjopen-2010-000039.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Rousseau MC, Baumstarck K, Alessandrini M, Blandin V, Billette de Villemeur T, Auquier P. Quality of life in patients with locked-in syndrome: evolution over a 6-year period. Orphanet J Rare Dis. 2015;10:88. https://doi.org/10.1186/s13023-015-0304-z.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Lugo Z, Pellas F, Blandin V, Laureys S, Gosseries O. Assessment of needs, psychological impact and quality of life in families of patients with locked-in syndrome. Brain Inj. 2017;31(12):1590–6. https://doi.org/10.1080/02699052.2017.1347277.

    Article  PubMed  Google Scholar 

  108. Thengone DJ, Voss HU, Fridman EA, Schiff ND. Local changes in network structure contribute to late communication recovery after severe brain injury. Sci Transl Med. 2016;8(368):368re5. https://doi.org/10.1126/scitranslmed.aaf6113.

    Article  PubMed  Google Scholar 

  109. Claassen J, Edlow BL. Covert consciousness. Sci Am. 2022;327(5):60–5.

    Google Scholar 

  110. Fins JJ. Rights come to mind: brain injury, ethics and the struggle for consciousness. New York: Cambridge University Press; 2015.

    Book  Google Scholar 

  111. Rohaut B, Eliseyev A, Claassen J. Uncovering consciousness in unresponsive ICU patients: technical, medical and ethical considerations. Crit Care. 2019;23(1):78. https://doi.org/10.1186/s13054-019-2370-4.

    Article  PubMed  PubMed Central  Google Scholar 

  112. Drane JF. Competency to give an informed consent. A model for making clinical assessments. JAMA. 1984;252(7):925–7.

    Article  CAS  PubMed  Google Scholar 

  113. Vansteensel MJ, Pels EGM, Bleichner MG, Branco MP, Denison T, Freudenburg ZV, Gosselaar P, Leinders S, Ottens TH, Van Den Boom MA, Van Rijen PC, Aarnoutse EJ, Ramsey NF. Fully implanted brain-computer interface in a locked-in patient with ALS. N Engl J Med. 2016;375(21):2060–6. https://doi.org/10.1056/NEJMoa1608085.

    Article  PubMed  PubMed Central  Google Scholar 

  114. Moses DA, Metzger SL, Liu JR, Anumanchipalli GK, Makin JG, Sun PF, Chartier J, Dougherty ME, Liu PM, Abrams GM, Tu-Chan A, Ganguly K, Chang EF. Neuroprosthesis for decoding speech in a paralyzed person with anarthria. N Engl J Med. 2021;385(3):217–27. https://doi.org/10.1056/NEJMoa2027540.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Fins JJ. Neuroethics and disorders of consciousness: a pragmatic approach to neuro-palliative care. In: Laureys S, Osseries O, Tononi G, editors. The neurology of consciousness, cognitive neuroscience and neuropathology. 2nd ed. Amsterdam: Elsevier; 2015. p. 241–55.

    Google Scholar 

  116. Fins JJ. The unintended consequences of Chile’s neurorights constitutional reform: moving beyond negative rights to capabilities. Neuroethics. 2022;15:1–11. https://doi.org/10.1007/S12152-022-09504-Z/METRICS.

    Article  Google Scholar 

  117. Charlton JI. Nothing about us without us : disability oppression and empowerment. University of California Press; 1998

  118. Ashwal S, Cranford R, Bernat JL. The multi-society task force on PVS. Medical aspects of the persistent vegetative state. N Engl J Med. 1994;330:1499–508.

    Article  Google Scholar 

  119. Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, Zasler ND. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002;58(3):349–53. https://doi.org/10.1212/wnl.58.3.349.

    Article  PubMed  Google Scholar 

  120. Thibaut A, Bodien YG, Laureys S, Giacino JT. Minimally conscious state “plus”: diagnostic criteria and relation to functional recovery. J Neurol. 2020;267(5):1245–54. https://doi.org/10.1007/s00415-019-09628-y.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to express our gratitude to Nicholas D. Schiff for careful reading and providing insightful comments and critiques.

Funding

Funding sources included NINDS (R01NS106014, R03NS112760, R21NS128326) and James S. McDonnell Foundation (JC); Novo Nordisk Foundation (NNF21OC0067769), Lundbeck Foundation (R349-2020-658), and Offerfonden (19-610-00060, 21-610-00119) (DK); NIH BRAIN Initiative (RF1MH12378-01) (JJF); Miami CTSI NCATS (KL2 UL1TR002736), NINDS (K23NS126577, R21NS128326) (AA); Belgian National Funds for Scientific Research (FRS-FNRS), University and University Hospital of Liege, Fund Léon Fredericq, Fund Generet, King Baudouin Foundation, DOCMA project (EU-H2020-MSCA–RISE–778234), AstraZeneca Foundation, European Union’s Horizon 2020 Framework Programme for Research and Innovation (No. 945539 Human Brain Project SGA3), Mind Science Foundation and the European Commission, F.R.S-FNRS (OG, AT); NINDS, NIH Director’s Office, James S. McDonnell Foundation (BLE); NIH (R33AG071744), JHU Discovery, The Institute for Data Intensive Engineering and Science JHU (RDS); NIGMS (MM); none for BR, CS, and YH.

Author information

Authors and Affiliations

  1. Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY, 10032, USA

    Jan Claassen

  2. Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    Daniel Kondziella

  3. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Daniel Kondziella

  4. University of Miami, Miami, FL, USA

    Ayham Alkhachroum

  5. Department of Neurology, Washington University, St. Louis, MO, USA

    Michael Diringer

  6. Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Brian L. Edlow

  7. Division of Medical Ethics, Department of Medicine, Weill Cornell Medical College, NewYork Presbyterian Hospital, New York, NY, 10032, USA

    Joseph J. Fins

  8. Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium

    Olivia Gosseries & Aurore Thibaut

  9. Centre du Cerveau, University Hospital of Liege, Liege, Belgium

    Olivia Gosseries & Aurore Thibaut

  10. Division of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, The Ohio State University, Columbus, OH, USA

    Yousef Hannawi

  11. Sorbonne Université, Assistance Publique–Hôpitaux de Paris (AP-HP) - Pitié Salpêtrière, Paris, France

    Benjamin Rohaut

  12. Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA

    Caroline Schnakers

  13. Department of Anesthesiology and Critical Care Medicine, Neurology, and Radiology, School of Medicine, Secondary Appointment in Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA

    Robert D. Stevens

  14. Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA

    Martin Monti

Authors
  1. Jan Claassen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Kondziella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ayham Alkhachroum
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Diringer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brian L. Edlow
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph J. Fins
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Olivia Gosseries
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yousef Hannawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Benjamin Rohaut
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Caroline Schnakers
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Robert D. Stevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Aurore Thibaut
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Martin Monti
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the Curing Coma Campaign, and Its Contributing Collaborators

Contributions

JC: manuscript development, revisions of manuscripts, and development and finalization of figures. DK: manuscript development, revisions of manuscripts, and development and finalization of figures. AA: manuscript development, revisions of manuscripts, and development and finalization of figures. MD: manuscript development, revisions of manuscripts, and development and finalization of figures. BLE: manuscript development, revisions of manuscripts, and development and finalization of figures. JJF: manuscript development, revisions of manuscripts, and development and finalization of figures. OG: manuscript development, revisions of manuscripts, and development and finalization of figures. YH: manuscript development, revisions of manuscripts, and development and finalization of figures. BR: manuscript development, revisions of manuscripts, and development and finalization of figures. CS: manuscript development, revisions of manuscripts, and development and finalization of figures. RDS: manuscript development, revisions of manuscripts, and development and finalization of figures. AT: manuscript development, revisions of manuscripts, and development and finalization of figures. MM: manuscript development, revisions of manuscripts, and development and finalization of figures.

Corresponding author

Correspondence to Jan Claassen.

Ethics declarations

Conflicts of Interest

Minority shareholder in iCE Neurosystems (JC); book royalties (Cambridge University Press, Oxford University Press) (JJF); consulting fees for Ceribell, PIPRA, and BSecur, payment for expert testimony (RDS); Editor in Chief NCC (MD).

Ethical Approval/Informed Consent

The authors confirm compliance with ethical approval and informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Claassen, J., Kondziella, D., Alkhachroum, A. et al. Cognitive Motor Dissociation: Gap Analysis and Future Directions. Neurocrit Care 40, 81–98 (2024). https://doi.org/10.1007/s12028-023-01769-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-023-01769-3

Keywords

Search

Navigation