Prognosis for patients with cognitive motor dissociation identified by brain-computer interface

Abstract

Cognitive motor dissociation describes a subset of patients with disorders of consciousness who show neuroimaging evidence of consciousness but no detectable command-following behaviours. Although essential for family counselling, decision-making, and the design of rehabilitation programmes, the prognosis for patients with cognitive motor dissociation remains under-investigated. The current study included 78 patients with disorders of consciousness who showed no detectable command-following behaviours. These patients included 45 patients with unresponsive wakefulness syndrome and 33 patients in a minimally conscious state, as diagnosed using the Coma Recovery Scale-Revised. Each patient underwent an EEG-based brain-computer interface experiment, in which he or she was instructed to perform an item-selection task (i.e. select a photograph or a number from two candidates). Patients who achieved statistically significant brain-computer interface accuracies were identified as cognitive motor dissociation. Two evaluations using the Coma Recovery Scale-Revised, one before the experiment and the other 3 months later, were carried out to measure the patients’ behavioural improvements. Among the 78 patients with disorders of consciousness, our results showed that within the unresponsive wakefulness syndrome patient group, 15 of 18 patients with cognitive motor dissociation (83.33%) regained consciousness, while only five of the other 27 unresponsive wakefulness syndrome patients without significant brain-computer interface accuracies (18.52%) regained consciousness. Furthermore, within the minimally conscious state patient group, 14 of 16 patients with cognitive motor dissociation (87.5%) showed improvements in their Coma Recovery Scale-Revised scores, whereas only four of the other 17 minimally conscious state patients without significant brain-computer interface accuracies (23.53%) had improved Coma Recovery Scale-Revised scores. Our results suggest that patients with cognitive motor dissociation have a better outcome than other patients. Our findings extend current knowledge of the prognosis for patients with cognitive motor dissociation and have important implications for brain-computer interface-based clinical diagnosis and prognosis for patients with disorders of consciousness.

Higher-order sensorimotor circuit of the brain’s global network supports human consciousness

“…In the previous literatures, using motor imagery tasks, task-related activation in SMA can be used to identify CMD patients (Owen et al, 2006). However, the difficulty of such tasks and the cooperation of patients could lead to false negatives in the detection of CMD (Pan et al, 2020). Although the brain computer interface (BCI) provides another way to detect the CMD patients by adopting face detection (Pan et al, 2020), the current results may provide a much easier way to identify the CMD patients by using resting-state fMRI dataset without including any active tasks.…”

Subject inefficiency phenomenon of motor imagery brain-computer interface: Influence factors and potential solutions

“…The greatest advantage of BCI is that it can realize direct communication between the brain and the external world without using the brain's normal output pathways, e.g., the peripheral nervous system and muscle tissue. Thus, it has important application value in communication, motor assistance, neural rehabilitation, and clinical diagnosis [4][5][6][7].…”

Development of a brain-computer interface for patients in the critical care setting

“…The online calibration of the model, which allows immediate feedback to the patient constituted the principal factor for this success as this feedback enables the patient to rapidly develop a control strategy. Next we are planning to integrate this BCI supported feedback for detection of CMD, building on a recently published approach [ 21 ].…”