Detecting Residual Awareness in Patients With Prolonged Disorders of Consciousness: An fNIRS Study

Li, Meng; Yang, Yi; Zhang, Yujin; Gao, Yuhang; Jing, Rixing; Dang, Yuanyuan; Chen, Xueling; He, Jianghong; Si, Juanning

doi:10.3389/fneur.2021.618055

Cited by 12 publications

(12 citation statements)

References 28 publications

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“…4 and 5 ), indicating that the MCS patients exhibited hemodynamic responses that were highly similar to those of people without brain impairments. 22 , 26 Regional brain activation is associated with local increases in cerebral blood supply that exceed the corresponding metabolic demand. The result of this would be that increases in HbO and HbT measurements accompanied by a decrease in HbR measurement can be expected to be recorded in target brain areas using fNIRS system.…”

Section: Discussionmentioning

confidence: 99%

“… 9 Inspired by the promising results proposed by Owen et al, several studies have been conducted to use MI tasks for detection of residual consciousness in patients with DOC 17 , 19 , 25 – 27 in the past few years. Our previous pilot study 22 was also based on the tennis-playing MI paradigm. To further confirm the findings of our previous study and to investigate the spatiotemporal characteristics between UWS and MCS groups, the improved experimental paradigm was conducted in the current study.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, the differences in hemodynamics between patients with MCS and UWS and the underlying mechanisms that cause them to differ still need to be elucidated. In our previous study, 22 fNIRS was used to detect residual awareness in DOC patients during a MI task. A support vector machine was used to classify the yes-or-no responses.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of residual cognition in patients with disorders of consciousness based on functional near-infrared spectroscopy

Yang

et al. 2023

Neurophoton.

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. Significance Accurate evaluation of consciousness in patients with prolonged disorders of consciousness (DOC) is critical for designing therapeutic plans, determining rehabilitative services, and predicting prognosis. Effective ways for detecting consciousness in patients with DOC are still needed. Aim Evaluation of the residual awareness in patients with DOC and investigation of the spatiotemporal differences in the hemodynamic responses between the minimally conscious state (MCS) and the unresponsive wakefulness syndrome (UWS) groups using active command-driven motor imagery (MI) tasks. Approach In this study, functional near-infrared spectroscopy (fNIRS) was used to measure the changes of hemodynamic responses in 19 patients with DOC (9 MCS and 10 UWS) using active command-driven MI tasks. The characteristics of the hemodynamic responses were extracted to compare the differences between the MCS and UWS groups. Moreover, the correlations between the hemodynamic responses and the clinical behavioral evaluations were also studied. Results The results showed significant differences in the spatiotemporal distribution of the hemodynamic responses between the MCS and UWS groups. For the patients with MCS, significant increases in task-evoked hemodynamic responses occurred during the “YES” questions of the command-driven MI tasks. Importantly, these changes were significantly correlated with their coma-recovery scale-revised (CRS-R) scores. However, for the patients with UWS, no significant changes of the hemodynamic responses were found. Additionally, the results did not show any statistical correlation between the hemodynamic responses and their CRS-R scores. Conclusions The fNIRS-based command-driven MI tasks can be used as a promising tool for detecting residual awareness in patients with DOC. We hope that the findings and the active paradigm used in this study will provide useful insights into the diagnosis, therapy, and prognosis of this challenging patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Evaluation of residual cognition in patients with disorders of consciousness based on functional near-infrared spectroscopy

Yang

et al. 2023

Neurophoton.

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“…Such residual command-following ability was also reported using functional near-infrared spectroscopy, a neuroimaging technique estimating local hemodynamic response variations using near-infrared light. [44][45][46] Note that other electrophysiological measures may be used, such as electromyography 47 or automated pupillometry. 48 These techniques, however, need to be further investigated to support their validity in the assessment of DoC patients.…”

Section: Neuroimaging and Electrophysiological Measuresmentioning

confidence: 99%

Language Assessment in Patients with Disorders of Consciousness

2022

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The assessment of residual language abilities in patients with disorders of consciousness (DoC) after severe brain injury is particularly challenging due to their limited behavioral repertoire. Moreover, associated language impairment such as receptive aphasia may lead to an underestimation of actual consciousness levels. In this review, we examine past research on the assessment of residual language processing in DoC patients, and we discuss currently available tools for identifying language-specific abilities and their prognostic value. We first highlight the need for validated and sensitive bedside behavioral assessment tools for residual language abilities in DoC patients. As regards neuroimaging and electrophysiological methods, the tasks involving higher level linguistic commands appear to be the most informative about level of consciousness and have the best prognostic value. Neuroimaging methods should be combined with the most appropriate behavioral tools in multimodal assessment protocols to assess receptive language abilities in DoC patients in the most complete and sensitive manner.

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“…Functional near-infrared spectroscopy (fNIRS) is a promising, strictly non-invasive bed-side tool which could assist the identification of covert consciousness by detecting biomarkers of cerebral activity in response to external stimuli (Kempny et al, 2016, Molteni et al, 2013. On this purpose, some feasibility studies already proposed experimental paradigms with auditory presented mental-arithmetic tasks (Kurz et al, 2018) or motor imagery tasks (Kempny et al, 2016, Li et al, 2021.All these studies examined the relative changes of hemoglobin oxygenation during the tasks. Studying the relative changes of oxygenated (O2Hb) and deoxygenated (HHb) hemoglobin in a time-course analysis is one of the most common approaches to fNIRS data analysis.…”

Section: Introductionmentioning

confidence: 99%