Cognitive Motor Dissociation: Gap Analysis and Future Directions

Jan Claassen, Daniel Kondziella, Ayham Alkhachroum, Michael Diringer, Brian L. Edlow, Joseph J. Fins, Olivia Gosseries, Yousef Hannawi, Benjamin Rohaut, Caroline Schnakers, Robert D. Stevens, Aurore Thibaut, Martin Monti

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background: Patients with disorders of consciousness who are behaviorally unresponsive may demonstrate volitional brain responses to motor imagery or motor commands detectable on functional magnetic resonance imaging or electroencephalography. This state of cognitive motor dissociation (CMD) may have prognostic significance. Methods: The Neurocritical Care Society’s Curing Coma Campaign identified an international group of experts who convened in a series of monthly online meetings between September 2021 and April 2023 to examine the science of CMD and identify key knowledge gaps and unmet needs. Results: The group identified major knowledge gaps in CMD research: (1) lack of information about patient experiences and caregiver accounts of CMD, (2) limited epidemiological data on CMD, (3) uncertainty about underlying mechanisms of CMD, (4) methodological variability that limits testing of CMD as a biomarker for prognostication and treatment trials, (5) educational gaps for health care personnel about the incidence and potential prognostic relevance of CMD, and (6) challenges related to identification of patients with CMD who may be able to communicate using brain–computer interfaces. Conclusions: To improve the management of patients with disorders of consciousness, research efforts should address these mechanistic, epidemiological, bioengineering, and educational gaps to enable large-scale implementation of CMD assessment in clinical practice.

Original languageEnglish
Pages (from-to)81-98
Number of pages18
JournalNeurocritical Care
Volume40
Issue number1
DOIs
StatePublished - Feb 2024

Keywords

  • Acute brain injury
  • Cognitive motor dissociation
  • Coma
  • Consciousness
  • Covert consciousness
  • Curing Coma Campaign
  • Outcome
  • Prognostication
  • Vegetative state

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