ArticleNeurology2023
A Focus on Subtle Signs and Motor Behavior to Unveil Awareness in Unresponsive Brain-Impaired Patients: The Importance of Being Clinical.
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Article in Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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23 citing papers in PubMed.
- Multisensory integration in peripersonal space indexes consciousness states in sleep and disorders of consciousness.Cell reports. Medicine · 2026Article
- Manual Dexterity in Patients with Disorder of Consciousness.Archives of rehabilitation research and clinical translation · 2026Article
- Hemosiderosis of lower cranial nerves: A pitfall in difficult-to-wean tracheotomized patients - A case report.SAGE open medical case reports · 2026Article
- Disorder of consciousness rather than complete Locked-In Syndrome for end stage Amyotrophic Lateral Sclerosis: a case series.Communications medicine · 2025Article
- Computer vision detects covert voluntary facial movements in unresponsive brain injury patients.Communications medicine · 2025Article
- Cortical signatures linked to behavior quantitatively track arousal levels.Proceedings of the National Academy of Sciences of the United States of America · 2025Article
- The Role of Life History Questionnaires in Defining Individualised Goals of Care for Clinical Cognitive Motor Dissociation Patients: A Pilot Study.Brain sciences · 2025Article
- Cross-frequency coupling patterns during oddball processing in disorders of consciousness: a delta-gamma predominance.Frontiers in psychology · 2025Article
- Different diseases, same circuits: lessons from rare and overlooked causes of disorders of consciousness.Brain communications · 2025Review
- Detecting cognitive motor dissociation by functional near-infrared spectroscopy.Frontiers in neurology · 2025Article
- Disorders of Consciousness, Language and Communication Following Severe Brain Injury.Psychologica Belgica · 2025Review
- Avoiding Misdiagnosis in Global Rostral Midbrain Syndrome (GRMS): Clinical Insights and Neurorehabilitation Approaches.Journal of clinical medicine · 2024Article
- Explaining recovery from coma with multimodal neuroimaging.Journal of neurology · 2024Observational
- Brain-Computer Interfaces for Communication in Patients with Disorders of Consciousness: A Gap Analysis and Scientific Roadmap.Neurocritical care · 2024Review
- Limitation of life sustaining therapy in disorders of consciousness: ethics and practice.Brain : a journal of neurology · 2024Review
- Disclosing Results of Tests for Covert Consciousness: A Framework for Ethical Translation.Neurocritical care · 2024Review
- Disorders of Consciousness Rehabilitation: Ethical Dimensions and Epistemic Dilemmas.Physical medicine and rehabilitation clinics of North America · 2024Review
- Covert consciousness.NeuroRehabilitation · 2024Article
- Clinical and ethical challenges in decision-making for patients with disorders of consciousness and locked-in syndrome from Chinese neurologists' perspectives.Therapeutic advances in neurological disorders · 2024Article
- Disambiguating Consciousness in Clinical Settings.Neurology · 2023Article
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Authors and funding
10 authors.
Karin DiserensFrom the Neurology and Acute Neurorehabilitation Unit (K.D., I.A.M., J.J., P.R.), Department of Clinical Neurosciences, and Department of Radiology (V.D., P.P.), Lausanne University Hospital and University of Lausanne; University Hospital of Old Age Psychiatry (I.A.M.), University of Bern, Switzerland; Neurology Unit (A.P.), Department of Medicine, Hôpitaux Robert Schuman, Luxembourg; Department of Neuroscience (D.F.M.), Luliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery (R.D.S.), School of Medicine, Johns Hopkins University, Baltimore, MD; Feil Family Brain and Mind Research Institute (N.D.S.), Weill Cornell Medical College, New York, NY; and Department of Neurology (N.D.S.), New York Presbyterian Hospital.
Ivo A MeyerFrom the Neurology and Acute Neurorehabilitation Unit (K.D., I.A.M., J.J., P.R.), Department of Clinical Neurosciences, and Department of Radiology (V.D., P.P.), Lausanne University Hospital and University of Lausanne; University Hospital of Old Age Psychiatry (I.A.M.), University of Bern, Switzerland; Neurology Unit (A.P.), Department of Medicine, Hôpitaux Robert Schuman, Luxembourg; Department of Neuroscience (D.F.M.), Luliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery (R.D.S.), School of Medicine, Johns Hopkins University, Baltimore, MD; Feil Family Brain and Mind Research Institute (N.D.S.), Weill Cornell Medical College, New York, NY; and Department of Neurology (N.D.S.), New York Presbyterian Hospital. meyer.ivo@gmail.com.
Jane JöhrFrom the Neurology and Acute Neurorehabilitation Unit (K.D., I.A.M., J.J., P.R.), Department of Clinical Neurosciences, and Department of Radiology (V.D., P.P.), Lausanne University Hospital and University of Lausanne; University Hospital of Old Age Psychiatry (I.A.M.), University of Bern, Switzerland; Neurology Unit (A.P.), Department of Medicine, Hôpitaux Robert Schuman, Luxembourg; Department of Neuroscience (D.F.M.), Luliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery (R.D.S.), School of Medicine, Johns Hopkins University, Baltimore, MD; Feil Family Brain and Mind Research Institute (N.D.S.), Weill Cornell Medical College, New York, NY; and Department of Neurology (N.D.S.), New York Presbyterian Hospital.ORCID 0000-0003-4280-9310
Alessandro PincherleFrom the Neurology and Acute Neurorehabilitation Unit (K.D., I.A.M., J.J., P.R.), Department of Clinical Neurosciences, and Department of Radiology (V.D., P.P.), Lausanne University Hospital and University of Lausanne; University Hospital of Old Age Psychiatry (I.A.M.), University of Bern, Switzerland; Neurology Unit (A.P.), Department of Medicine, Hôpitaux Robert Schuman, Luxembourg; Department of Neuroscience (D.F.M.), Luliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery (R.D.S.), School of Medicine, Johns Hopkins University, Baltimore, MD; Feil Family Brain and Mind Research Institute (N.D.S.), Weill Cornell Medical College, New York, NY; and Department of Neurology (N.D.S.), New York Presbyterian Hospital.
Vincent DunetFrom the Neurology and Acute Neurorehabilitation Unit (K.D., I.A.M., J.J., P.R.), Department of Clinical Neurosciences, and Department of Radiology (V.D., P.P.), Lausanne University Hospital and University of Lausanne; University Hospital of Old Age Psychiatry (I.A.M.), University of Bern, Switzerland; Neurology Unit (A.P.), Department of Medicine, Hôpitaux Robert Schuman, Luxembourg; Department of Neuroscience (D.F.M.), Luliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery (R.D.S.), School of Medicine, Johns Hopkins University, Baltimore, MD; Feil Family Brain and Mind Research Institute (N.D.S.), Weill Cornell Medical College, New York, NY; and Department of Neurology (N.D.S.), New York Presbyterian Hospital.ORCID 0000-0002-9897-4561
Polona PozegFrom the Neurology and Acute Neurorehabilitation Unit (K.D., I.A.M., J.J., P.R.), Department of Clinical Neurosciences, and Department of Radiology (V.D., P.P.), Lausanne University Hospital and University of Lausanne; University Hospital of Old Age Psychiatry (I.A.M.), University of Bern, Switzerland; Neurology Unit (A.P.), Department of Medicine, Hôpitaux Robert Schuman, Luxembourg; Department of Neuroscience (D.F.M.), Luliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery (R.D.S.), School of Medicine, Johns Hopkins University, Baltimore, MD; Feil Family Brain and Mind Research Institute (N.D.S.), Weill Cornell Medical College, New York, NY; and Department of Neurology (N.D.S.), New York Presbyterian Hospital.
Philippe RyvlinFrom the Neurology and Acute Neurorehabilitation Unit (K.D., I.A.M., J.J., P.R.), Department of Clinical Neurosciences, and Department of Radiology (V.D., P.P.), Lausanne University Hospital and University of Lausanne; University Hospital of Old Age Psychiatry (I.A.M.), University of Bern, Switzerland; Neurology Unit (A.P.), Department of Medicine, Hôpitaux Robert Schuman, Luxembourg; Department of Neuroscience (D.F.M.), Luliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery (R.D.S.), School of Medicine, Johns Hopkins University, Baltimore, MD; Feil Family Brain and Mind Research Institute (N.D.S.), Weill Cornell Medical College, New York, NY; and Department of Neurology (N.D.S.), New York Presbyterian Hospital.
Dafin F MureşanuFrom the Neurology and Acute Neurorehabilitation Unit (K.D., I.A.M., J.J., P.R.), Department of Clinical Neurosciences, and Department of Radiology (V.D., P.P.), Lausanne University Hospital and University of Lausanne; University Hospital of Old Age Psychiatry (I.A.M.), University of Bern, Switzerland; Neurology Unit (A.P.), Department of Medicine, Hôpitaux Robert Schuman, Luxembourg; Department of Neuroscience (D.F.M.), Luliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery (R.D.S.), School of Medicine, Johns Hopkins University, Baltimore, MD; Feil Family Brain and Mind Research Institute (N.D.S.), Weill Cornell Medical College, New York, NY; and Department of Neurology (N.D.S.), New York Presbyterian Hospital.
Robert D StevensFrom the Neurology and Acute Neurorehabilitation Unit (K.D., I.A.M., J.J., P.R.), Department of Clinical Neurosciences, and Department of Radiology (V.D., P.P.), Lausanne University Hospital and University of Lausanne; University Hospital of Old Age Psychiatry (I.A.M.), University of Bern, Switzerland; Neurology Unit (A.P.), Department of Medicine, Hôpitaux Robert Schuman, Luxembourg; Department of Neuroscience (D.F.M.), Luliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery (R.D.S.), School of Medicine, Johns Hopkins University, Baltimore, MD; Feil Family Brain and Mind Research Institute (N.D.S.), Weill Cornell Medical College, New York, NY; and Department of Neurology (N.D.S.), New York Presbyterian Hospital.
Nicholas D SchiffFrom the Neurology and Acute Neurorehabilitation Unit (K.D., I.A.M., J.J., P.R.), Department of Clinical Neurosciences, and Department of Radiology (V.D., P.P.), Lausanne University Hospital and University of Lausanne; University Hospital of Old Age Psychiatry (I.A.M.), University of Bern, Switzerland; Neurology Unit (A.P.), Department of Medicine, Hôpitaux Robert Schuman, Luxembourg; Department of Neuroscience (D.F.M.), Luliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery (R.D.S.), School of Medicine, Johns Hopkins University, Baltimore, MD; Feil Family Brain and Mind Research Institute (N.D.S.), Weill Cornell Medical College, New York, NY; and Department of Neurology (N.D.S.), New York Presbyterian Hospital.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Brain-injured patients in a state of cognitive motor dissociation (CMD) exhibit a lack of command following using conventional neurobehavioral examination tools but a high level of awareness and language processing when assessed using advanced imaging and electrophysiology techniques. Because of their behavioral unresponsiveness, patients with CMD may seem clinically indistinguishable from those with a true disorder of consciousness that affects awareness on a substantial level (coma, vegetative state/unresponsive wakefulness state, or minimally conscious state minus). Yet, by expanding the range of motor testing across limb, facial, and ocular motricity, we may detect subtle, purposeful movements even in the subset of patients classified as vegetative state/unresponsive wakefulness state. We propose the term of clinical CMD to describe patients showing these slight but determined motor responses and exhibiting a characteristic akinetic motor behavior as opposed to a pyramidal motor system behavior. These patients may harbor hidden cognitive capabilities and significant potential for a good long-term outcome. Indeed, we envision CMD as ranging from complete (no motor response) to partial (subtle clinical motor response) forms, falling within a spectrum of progressively better motor output in patients with considerable cognitive capabilities. In addition to providing a decisional flowchart, we present this novel approach to classification as a graphical model that illustrates the range of clinical manifestations and recovery trajectories fundamentally differentiating true disorders of consciousness from the spectrum of CMD.
Indexed as
BrainPersistent Vegetative StateAwarenessComaConsciousnessConsciousness DisordersHumansWakefulness
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