02626nas a2200289 4500008004100000022001400041245009200055210006900147260001300216300001200229490000700241520171500248100001701963700002201980700001902002700001902021700001802040700002102058700001702079700002302096700001902119700002002138700002402158700001702182700002002199856011702219 2022 eng d a2163-040200aCognitive-Motor Dissociation Following Pediatric Brain Injury: What About the Children?0 aCognitiveMotor Dissociation Following Pediatric Brain Injury Wha c2022 Jun a248-2570 v123 a

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' EEG, and 1 participant's fMRI, provided evidence that they could understand commands and make consistent voluntary decisions to follow them. Both participants' 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.

1 aKim, Nayoung1 aO'Sullivan, James1 aOlafson, Emily1 aCaliendo, Eric1 aNowak, Sophie1 aVoss, Henning, U1 aLowder, Ryan1 aWatson, William, D1 aIvanidze, Jana1 aFins, Joseph, J1 aSchiff, Nicholas, D1 aHill, Jeremy1 aShah, Sudhin, A uhttps://neurotechcenter.org/publications/2022/cognitive-motor-dissociation-following-pediatric-brain-injury-what