New Advances in Diagnostic Tools and Rehabilitation of Disorders of Consciousness in the Acute Phase

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Background

Disorders of Consciousness (DOC) result from focal to global brain injuries. They present a crucial challenge to neurologists and neurorehabilitation specialists in terms of accuracy of diagnosis, outcome prediction, and development of an appropriate treatment plan. It is particularly challenging to properly detect conscious processing in non-communicating individuals and objectively recommend an optimal medical strategy. Diagnosing consciousness currently relies on clinical examination at the bedside. Widely used neurobehavioral rating scales are designed to detect behavioral signs of consciousness through standardized administration, and have been found to generally provide good reliability and validity. However, behavioral observations constitute indirect evidence of conscious processes, and their interpretation depends on several subjective parameters. They can also be critically constrained by patient-specific characteristics such as motor abilities, vigilance fluctuation, or aphasia.

Over the past decade, supplementary approaches using neuroimaging and electrophysiological techniques have been designed to detect conscious awareness when behavioral examination suggests absent or low-level consciousness – a phenomenon named cognitive-motor dissociation (CMD). Recent studies using these techniques have demonstrated that a significant amount of acute and chronic patients classified as DOC may present CMD; motor deficits mask patients’ ability to express language or respond purposefully to examiners at bedside. Developing a synergetic combination of such methods for use in an acute clinical setting would have a great impact on patient care. Indeed, it would help pave the way for new integrative and innovative models of early assessment and care of CMD that would have important implications for health care systems, including regarding medico-legal ethics and societal issues. However, such methods have not yet been implemented, and it is necessary to use them in combination with current ones to better understand the patient’s state, make a diagnosis, predict clinical outcomes, and choose an adequate treatment. New evidence suggests that treatment of DOC should begin during intensive care, and that it should take advantage of integrating neurosensory approaches and early verticalization, as well as mobilization supported by robotic devices. We would like to further explore these aspects in this Research Topic. Finally, the use of multidimensional analysis can open a new direction for clinical and statistical thinking, and can help further our knowledge relating to spontaneous recovery and evaluation of treatment and outcome for very heterogenous populations of DOC patients.

In this context, our Research Topic would also like to gather studies reporting results from coordinated multi-center research approaches, with the aim to compensate for a low sample number in the different study groups. This should involve the integration of information from complementary sources, to increase diagnostic accuracy of DOC in the acute stage. The results of these studies could then lead to informing on the decision-making process and prognosis to improving early therapeutic interventions.

Therefore, this Research Topic welcomes submissions of manuscripts on the following subtopics:

- Clinical, neurophysiological and neuroimaging diagnostic techniques for DOC and CMD;
- Statistical methodological approaches with multi-dimensional analysis for the diagnosis, evaluation and prediction of outcome for DOC patients;
- Treatment approaches for DOC, especially those utilizing integrated neurosensory methods and robotics;
- Interdisciplinary and individual goals of assessment of acute neurological lesions;
- Coordinated pathway organization from the acute to the post-acute phase for patients with neurological lesions;
- Multi-centric studies relating to patients with DOC, CMD and central neurological lesions.

Keywords: Disorders of consciousness, Cognitive Motor dissociation, Connectivity, Acute Neurorehabilitation, Multimodal evaluation of motor behavior and disorders of consciousness

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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