Disorders of Consciousness Rehabilitation

Young, Michael J.

doi:10.1016/j.pmr.2023.06.016

Cited by 4 publications

(1 citation statement)

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“…Historically, clinical evaluation of unresponsive patients following brain injury has relied principally on serial behavioral examination to search for emerging signs of consciousness (i.e. capacity for subjective experience) and track recovery ( Aparicio and Christos 2023 , Young 2023 ). Patients who did not exhibit signs of wakefulness or awareness were dubbed comatose, and patients with wakefulness but without awareness dubbed vegetative ( PVS Multisociety Task Force 1994 ).…”

Section: Introduction: From Behavior To Brain Activity For Probing Co...mentioning

confidence: 99%

Covert cortical processing: a diagnosis in search of a definition

Young,

Fecchio,

Bodien

et al. 2024

Neuroscience of Consciousness

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Historically, clinical evaluation of unresponsive patients following brain injury has relied principally on serial behavioral examination to search for emerging signs of consciousness and track recovery. Advances in neuroimaging and electrophysiologic techniques now enable clinicians to peer into residual brain functions even in the absence of overt behavioral signs. These advances have expanded clinicians’ ability to sub-stratify behaviorally unresponsive and seemingly unaware patients following brain injury by querying and classifying covert brain activity made evident through active or passive neuroimaging or electrophysiologic techniques, including functional MRI, electroencephalography (EEG), transcranial magnetic stimulation-EEG, and positron emission tomography. Clinical research has thus reciprocally influenced clinical practice, giving rise to new diagnostic categories including cognitive-motor dissociation (i.e. ‘covert consciousness’) and covert cortical processing (CCP). While covert consciousness has received extensive attention and study, CCP is relatively less understood. We describe that CCP is an emerging and clinically relevant state of consciousness marked by the presence of intact association cortex responses to environmental stimuli in the absence of behavioral evidence of stimulus processing. CCP is not a monotonic state but rather encapsulates a spectrum of possible association cortex responses from rudimentary to complex and to a range of possible stimuli. In constructing a roadmap for this evolving field, we emphasize that efforts to inform clinicians, philosophers, and researchers of this condition are crucial. Along with strategies to sensitize diagnostic criteria and disorders of consciousness nosology to these vital discoveries, democratizing access to the resources necessary for clinical identification of CCP is an emerging clinical and ethical imperative.

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Section: Introduction: From Behavior To Brain Activity For Probing Co...mentioning

confidence: 99%