TY - JOUR

T1 - Cognitive Motor Dissociation

T2 - Gap Analysis and Future Directions

AU - Claassen, Jan

AU - Kondziella, Daniel

AU - Alkhachroum, Ayham

AU - Diringer, Michael

AU - Edlow, Brian L.

AU - Fins, Joseph J.

AU - Gosseries, Olivia

AU - Hannawi, Yousef

AU - Rohaut, Benjamin

AU - Schnakers, Caroline

AU - Stevens, Robert D.

AU - Thibaut, Aurore

AU - Monti, Martin

AU - the Curing Coma Campaign, and Its Contributing Collaborators

N1 - Publisher Copyright: © 2023, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

PY - 2024

Y1 - 2024

N2 - 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.

AB - 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.

KW - Acute brain injury

KW - Cognitive motor dissociation

KW - Coma

KW - Consciousness

KW - Covert consciousness

KW - Curing Coma Campaign

KW - Outcome

KW - Prognostication

KW - Vegetative state

U2 - 10.1007/s12028-023-01769-3

DO - 10.1007/s12028-023-01769-3

M3 - Journal article

C2 - 37349602

AN - SCOPUS:85163171001

VL - 40

SP - 81

EP - 98

JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

IS - 1

ER -