Detecting Awareness in the Vegetative State

University of Cambridge, Cambridge, England, United Kingdom
Science (Impact Factor: 31.48). 10/2006; 313(5792):1402. DOI: 10.1126/science.1130197
Source: PubMed

ABSTRACT We used functional magnetic resonance imaging to demonstrate preserved conscious awareness in a patient fulfilling the criteria for a diagnosis of vegetative state. When asked to imagine playing tennis or moving around her home, the patient activated predicted cortical areas in a manner indistinguishable from that of healthy volunteers.

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Available from: Melanie Boly, Dec 28, 2013
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    • "Functional magnetic resonance imaging (fMRI) studies by Owen et al. (2006) and others Boly et al. (2007), Monti et al. (2010), demonstrating detection of awareness in the unresponsive wakefulness syndrome (UWS, Laureys et al., 2010), paved the way for the development of brain–computer interfaces (BCI) as a means of communication in this patient group. In these studies, patients were asked to imagine playing tennis, or to navigate through their own apartment. "
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    ABSTRACT: Further development of an EEG based communication device for patients with disorders of consciousness (DoC) could benefit from addressing the following gaps in knowledge – first, an evaluation of different types of motor imagery; second, an evaluation of passive feet movement as a mean of an initial classifier setup; and third, rapid delivery of biased feedback. To that end we investigated whether complex and / or familiar mental imagery, passive, and attempted feet movement can be reliably detected in patients with DoC using EEG recordings, aiming to provide them with a means of communication. Six patients in a minimally conscious state (MCS) took part in this study. The patients were verbally instructed to perform different mental imagery tasks (sport, navigation), as well as attempted feet movements, to induce distinctive event-related (de)synchronization (ERD/S) patterns in the EEG. Offline classification accuracies above chance level were reached in all three tasks (i.e. attempted feet, sport, and navigation), with motor tasks yielding significant (p<0.05) results more often than navigation (sport: 10 out of 18 sessions; attempted feet: 7 out of 14 sessions; navigation: 4 out of 12 sessions). The passive feet movements, evaluated in one patient, yielded mixed results: whereas time-frequency analysis revealed task-related EEG changes over neurophysiological plausible cortical areas, the classification results were not significant enough (p<0.05) to setup an initial classifier for the detection of attempted movements. Concluding, the results presented in this study are consistent with the current state of the art in similar studies, to which we contributed by comparing different types of mental tasks, notably complex motor imagery and attempted feet movements, within patients. Furthermore, we explored new venues, such as an evaluation of passive feet movement as a mean of an initial classifier setup, and rapid delivery of biased feedback.
    Frontiers in Human Neuroscience 12/2014; 8:1009. DOI:10.3389/fnhum.2014.01009 · 2.90 Impact Factor
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    • "Recent functional neuroimaging studies based on mental imagery tasks provided evidence for awareness in patients diagnosed with UWS/VS or MCS as they presented with volitional control of brain functions detected with electroencephalography (Schnakers et al., 2008b; Cruse et al., 2011; Goldfine et al., 2011) or functional magnetic resonance imaging (Owen et al., 2006; Boly et al., 2007; Monti et al., 2010; Bardin et al., 2011). Additionally, electromyography (Bekinschtein et al., 2008) or pupil dilation (Stoll et al., 2013) monitoring can offer alternative ways to identify response to command in DOC. "
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    ABSTRACT: Detecting signs of consciousness in patients in a vegetative state/unresponsive wakefulness syndrome (UWS/VS) or minimally conscious state (MCS) is known to be very challenging. Plotkin et al. (2010) recently showed the possibility of using a breathing-controlled communication device in patients with locked in syndrome. We here aim to test a breathing-based "sniff controller" that could be used as an alternative diagnostic tool to evaluate response to command in severely brain damaged patients with chronic disorders of consciousness (DOC). Twenty-five DOC patients were included. Patients' resting breathing-amplitude was measured during a 5 min resting condition. Next, they were instructed to end the presentation of a music sequence by sniffing vigorously. An automated detection of changes in breathing amplitude (i.e., >1.5 SD of resting) ended the music and hence provided positive feedback to the patient. None of the 11 UWS/VS patients showed a sniff-based response to command. One out of 14 patients with MCS was able to willfully modulate his breathing pattern to answer the command on 16/19 trials (accuracy 84%). Interestingly, this patient failed to show any other motor response to command. We here illustrate the possible interest of using breathing-dependent response to command in the detection of residual cognition in patients with DOC after severe brain injury.
    Frontiers in Human Neuroscience 12/2014; 8:1020. DOI:10.3389/fnhum.2014.01020 · 2.90 Impact Factor
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    • "In the spatial navigation task, they were instructed to imagine walking from room to room in their house and visualize all objects they would encounter if they were in their home. The experimental procedure has been reported in previous work (Owen et al., 2006; Monti et al., 2010; Fernández-Espejo et al., 2014). For the EEG task, the procedure was similar to that reported in Cruse et al. (2012); Gibson et al. (2013). "
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    ABSTRACT: Minimal or inconsistent behavioral responses to command make it challenging to accurately diagnose the level of awareness of a patient with a Disorder of consciousness (DOC). By identifying markers of mental imagery being covertly performed to command, functional neuroimaging (fMRI), electroencephalography (EEG) has shown that some of these patients are aware despite their lack of behavioral responsiveness. We report the findings of behavioral, fMRI, and EEG approaches to detecting command-following in a group of patients with DOC. From an initial sample of 14 patients, complete data across all tasks was obtained in six cases. Behavioral evaluations were performed with the Coma Recovery Scale—Revised. Both fMRI and EEG evaluations involved the completion of previously validated mental imagery tasks—i.e., motor imagery (EEG and fMRI) and spatial navigation imagery (fMRI). One patient exhibited statistically significant evidence of motor imagery in both the fMRI and EEG tasks, despite being unable to follow commands behaviorally. Two behaviorally non-responsive patients produced appropriate activation during the spatial navigation fMRI task. However, neither of these patients successfully completed the motor imagery tasks, likely due to specific motor area damage in at least one of these cases. A further patient demonstrated command following only in the EEG motor imagery task, and two patients did not demonstrate command following in any of the behavioral, EEG, or fMRI assessments. Due to the heterogeneity of etiology and pathology in this group, DOC patients vary in terms of their suitability for some forms of neuroimaging, the preservation of specific neural structures, and the cognitive resources that may be available to them. Assessments of a range of cognitive abilities supported by spatially-distinct brain regions and indexed by multiple neural signatures are therefore required in order to accurately characterize a patient’s level of residual cognition and awareness.
    Frontiers in Human Neuroscience 11/2014; 8(November):1-9. DOI:10.3389/fnhum.2014.00950 · 2.90 Impact Factor