In a discovery that could change our understanding of consciousness and patient care, researchers have found that as many as one in four patients deemed unresponsive after brain injuries may actually be aware of their surroundings.
There have been a number of recorded cases where someone appears to be in a coma following some type of head injury or cardiac arrest, Dr. Ted L. Rothstein, a neurologist in Washington D.C. affiliated with George Washington University Hospital and not with the study, told The Epoch Times. "But if you whisper, think of playing tennis, or think of your mother telling you such and such, certain parts of the brain might light up with functional MRI," he said. "And that would indicate that these people are really in a minimally conscious state, not totally comatose."
In light of the recent findings, Claassen and his team urge health care practitioners to develop effective communication methods with these patients. "We have an obligation to try to reach out to these patients and build communication bridges with them," he added.
The implications extend beyond moral responsibility. The presence of cognitive motor dissociation may significantly influence a patient's prognosis.
The need for increased accessibility is crucial -- especially given the potential for misdiagnosis in patients whose language comprehension may be impaired, according to Classen. This limitation could lead to false negatives when identifying individuals with CMD.
The findings demonstrate how advanced tools like fMRI and continuous electroencephalography (cEEG) monitoring, a technique to monitor brain activity over an extended period, can be used to identify more patients capable of responding to verbal commands compared to traditional bedside clinical exams, Dangayach noted. This development has promising implications for neuroprognostication, the prediction of recovery from severe brain injury, she said.
"It tells us that we can't rely on our bedside clinical examination alone when in doubt about a severe brain injury patient's ability to regain consciousness," she said. "We must make an effort to determine which patients might have CMD if we have access to advanced imaging tools like fMRI and monitoring tools like cEEG to improve detection of CMD."
Dangayach said she found it "eye-opening" that even in this study, only 61 percent of eligible patients underwent fMRI testing, 74 percent had cEEG testing, and only 30 percent received both. "Despite that, CMD was detected in 25 percent of patients. I wonder if 100 percent of these patients had undergone advanced testing, would the detection of CMD be even higher?" she said.
Also, coma patients' conditions tend to fluctuate, emphasizing the importance of repeated testing to improve accuracy in detecting consciousness and determining prognosis, she noted.
As the medical community's understanding of cognitive motor dissociation evolves, it will need to address not only the symptoms and implications but also potential recovery pathways for those previously considered unresponsive. The emerging research could change neurocritical care and the lives of patients and their families facing the uncertainties of brain injuries.