Advancing the science of consciousness: from ethics to clinical care

Abstract

Significant advances in the scientific investigation of the neurobiology of consciousness have been slow to be translated into clinical settings, limited by factors of conceptual (e.g., what is consciousness?), methodological (e.g., how to identify reliable indicators of consciousness?), and technical (e.g., how to improve sensitivity and specificity of the technological identification of consciousness?) nature. In the present paper we aim at reducing the gap between research, clinical practice, patients’ and their caregivers’ needs regarding disorders of consciousness. By implementing a multidisciplinary and multidimensional approach, the paper focuses on disorders of consciousness: it starts from the review of some of the most promising measures of consciousness from brain activity (i.e., spectral measures, measures of functional connectivity, complexity-based measures). Next the paper introduces brain responses to illusions as a new indicator of consciousness (i.e., a feature that facilitates the attribution of consciousness), and illustrates the clinical operationalization of the indicators of consciousness through the case of virtual reality. Finally, the paper analyzes a set of urgent ethical issues and describes a model for assessing and dealing with those issues, concluding by elaborating key recommendations for improving the clinical treatment of patients with disorders of consciousness through a better translation of research into clinics.

An integrative, multiscale view on consciousness theories_Eary version of paper in press in NEURON

“…The relevance of this is twofold. First, novel, theory-based empirical measures such as PCI and other complexity-related measures can be usefully applied in clinical settings, such as in helping to classify unresponsive patients with consciousness disorders into different subgroups with more nuanced distinctions and different prospects for recovery and treatment (e.g., 141,149,163 ). Second, empirical measures may help to distinguish or unify different theories.…”