@article {4489, title = {Brain-Computer Interfaces for Communication in Patients with Disorders of Consciousness: A Gap Analysis and Scientific Roadmap.}, journal = {Neurocrit Care}, year = {2024}, month = {2024 Jan 29}, abstract = {

BACKGROUND: We developed a gap analysis that examines the role of brain-computer interfaces (BCI) in patients with disorders of consciousness (DoC), focusing on their assessment, establishment of communication, and engagement with their environment.

METHODS: The Curing Coma Campaign convened a Coma Science work group that included 16 clinicians and neuroscientists with expertise in DoC. The work group met online biweekly and performed a gap analysis of the primary question.

RESULTS: We outline a roadmap for assessing BCI readiness in patients with DoC and for advancing the use of BCI devices in patients with DoC. Additionally, we discuss preliminary studies that inform development of BCI solutions for communication and assessment of readiness for use of BCIs in DoC study participants. Special emphasis is placed on the challenges posed by the complex pathophysiologies caused by heterogeneous brain injuries and their impact on neuronal signaling. The differences between one-way and two-way communication are specifically considered. Possible implanted and noninvasive BCI solutions for acute and chronic DoC in adult and pediatric populations are also addressed.

CONCLUSIONS: We identify clinical and technical gaps hindering the use of BCI in patients with DoC in each of these contexts and provide a roadmap for research aimed at improving communication for adults and children with DoC, spanning the clinical spectrum from intensive care unit to chronic care.

}, issn = {1556-0961}, doi = {10.1007/s12028-023-01924-w}, author = {Schiff, Nicholas D and Diringer, Michael and Diserens, Karin and Edlow, Brian L and Gosseries, Olivia and Hill, N Jeremy and Hochberg, Leigh R and Ismail, Fatima Y and Meyer, Ivo A and Mikell, Charles B and Mofakham, Sima and Molteni, Erika and Polizzotto, Leonard and Shah, Sudhin A and Stevens, Robert D and Thengone, Daniel} } @article {4461, title = {Comparisons of electrophysiological markers of impaired executive attention after traumatic brain injury and in healthy aging.}, journal = {Neuroimage}, volume = {274}, year = {2023}, month = {07/2023}, pages = {120126}, abstract = {

Executive attention impairments are a persistent and debilitating consequence of traumatic brain injury (TBI). To make headway towards treating and predicting outcomes following heterogeneous TBI, cognitive impairment specific pathophysiology first needs to be characterized. In a prospective observational study, we measured EEG during the attention network test aimed at detecting alerting, orienting, executive attention and processing speed. The sample (N~=~110) of subjects aged 18-86 included those with and without traumatic brain injury: n~=~27, complicated mild TBI; n~=~5, moderate TBI; n~=~10, severe TBI; n~=~63, non-brain-injured controls. Subjects with TBI had impairments in processing speed and executive attention. Electrophysiological markers of executive attention processing in the midline frontal regions reveal that, as a group, those with TBI and elderly non-brain-injured controls have reduced responses. We also note that those with TBI and elderly controls have responses that are similar for both low and high-demand trials. In subjects with moderate-severe TBI, reductions in frontal cortical activation and performance profiles are both similar to that of controls who are \~{}4 to 7 years older. Our specific observations of frontal response reductions in subjects with TBI and in older adults is consistent with the suggested role of the anterior forebrain mesocircuit as underlying cognitive impairments. Our results provide novel correlative data linking specific pathophysiological mechanisms underlying domain-specific cognitive deficits following TBI and with normal aging. Collectively, our findings provide biomarkers that may serve to track therapeutic interventions and guide development of targeted therapeutics following brain injuries.

}, keywords = {Aged, Aging, Biomarkers, Brain Injuries, Brain Injuries, Traumatic, Executive Function, Healthy Aging, Humans, Neuropsychological Tests}, issn = {1095-9572}, doi = {10.1016/j.neuroimage.2023.120126}, author = {Kim, Nayoung and Jamison, Keith and Jaywant, Abhishek and Garetti, Jacob and Blunt, Emily and RoyChoudhury, Arindam and Butler, Tracy and Dams-O{\textquoteright}Connor, Kristen and Khedr, Shahenda and Chen, Chun-Cheng and Shetty, Teena and Winchell, Robert and Hill, N Jeremy and Schiff, Nicholas D and Kuceyeski, Amy and Shah, Sudhin A} } @article {4493, title = {Cognitive-Motor Dissociation Following Pediatric Brain Injury: What About the Children?}, journal = {Neurol Clin Pract}, volume = {12}, year = {2022}, month = {2022 Jun}, pages = {248-257}, abstract = {

BACKGROUND AND OBJECTIVES: Following severe brain injury, up to 16\% of adults showing no clinical signs of cognitive function nonetheless have preserved cognitive capacities detectable via neuroimaging and neurophysiology; this has been designated cognitive-motor dissociation (CMD). Pediatric medicine lacks both practice guidelines for identifying covert cognition and epidemiologic data regarding CMD prevalence.

METHODS: We applied a diverse battery of neuroimaging and neurophysiologic tests to evaluate 2 adolescents (aged 15 and 18 years) who had shown no clinical evidence of preserved cognitive function following brain injury at age 9 and 13 years, respectively. Clinical evaluations were consistent with minimally conscious state (minus) and vegetative state, respectively.

RESULTS: Both participants{\textquoteright} EEG, and 1 participant{\textquoteright}s fMRI, provided evidence that they could understand commands and make consistent voluntary decisions to follow them. Both participants{\textquoteright} EEG demonstrated larger-than-expected responses to auditory stimuli and intact semantic processing of words in context.

DISCUSSION: These converging lines of evidence lead us to conclude that both participants had preserved cognitive function dissociated from their motor output. Throughout the 5+ years since injury, communication attempts and therapy had remained uninformed by such objective evidence of their cognitive abilities. Proper diagnosis of CMD is an ethical imperative. Children with covert cognition reflect a vulnerable and isolated population; the methods outlined here provide a first step in identifying such persons to advance efforts to alleviate their condition.

}, issn = {2163-0402}, doi = {10.1212/CPJ.0000000000001169}, author = {Kim, Nayoung and O{\textquoteright}Sullivan, James and Olafson, Emily and Caliendo, Eric and Nowak, Sophie and Voss, Henning U and Lowder, Ryan and Watson, William D and Ivanidze, Jana and Fins, Joseph J and Schiff, Nicholas D and Hill, N Jeremy and Shah, Sudhin A} } @article {4452, title = {Objective Neurophysiologic Markers of Cognition After Pediatric Brain Injury.}, journal = {Neurol Clin Pract}, volume = {12}, year = {2022}, month = {10/2022}, pages = {352-364}, abstract = {

BACKGROUND AND OBJECTIVES: Following brain injury, clinical assessments of residual and emerging cognitive function are difficult and fraught with errors. In adults, recent American Academy of Neurology (AAN) practice guidelines recommend objective neuroimaging and neurophysiologic measures to support diagnosis. Equivalent measures are lacking in pediatrics-an especially great challenge due to the combined heterogeneity of both brain injury and pediatric development. Therefore, we aim to establish quantitative, clinically practicable measures of cognitive function following pediatric brain injury.

METHODS: Participants with and without brain injury were aged 8-18 years, clinically classified according to cognitive recovery state: N = 8 in disorders of consciousness (DoC), N = 7 in confusional state, N = 19 cognitively impaired, and N = 13 typically developing uninjured controls. We prospectively measured electroencephalographic markers of sensory processing and attention in an auditory oddball paradigm, and of covert movement attempts in a command-following paradigm.

RESULTS: In 3 participants with DoC, EEG markers of active attempted command following revealed cognitive function that clinical assessment had failed to detect. These same 3 individuals could also be distinguished from the rest of their group by 2 event-related potentials that correlate with sensory processing and orienting attention in the oddball paradigm. Considered across the whole participant group, magnitudes of these 2 ERP markers significantly increased as cognitive recovery progressed (ANOVA: each < 0.001); viewed jointly, the 2 ERP markers cleanly delineated the 4 cognitive states.

DISCUSSION: Despite heterogeneity of brain injuries and brain development, our objective EEG markers reflected cognitive recovery independent of motor function. Two of these markers required no active participation. Together, they allowed us to identify 3 individuals who meet the criteria for cognitive-motor dissociation. To diagnose, prognose, and track cognitive recovery accurately, such markers should be used in pediatrics.

}, issn = {2163-0402}, doi = {10.1212/CPJ.0000000000200066}, author = {Kim, Nayoung and Watson, William and Caliendo, Eric and Nowak, Sophie and Schiff, Nicholas D and Shah, Sudhin A and Hill, N Jeremy} }