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

Disorders of consciousness (DoC) result from focal to global brain injuries and continue to pose one of the most demanding challenges in acute neurology and neurorehabilitation, in terms of diagnostic accuracy, outcome prediction and the design of an appropriate treatment plan. Detecting conscious or cognitive processing in an unresponsive patient, and translating that judgement into a defensible medical strategy, remains difficult for reasons that have not disappeared since Volume I. Behavioral phenotyping still rests on clinical examination at the bedside, with standardized neurobehavioral rating scales detecting behavioral signs of consciousness with improved reliability and validity compared to clinical consensus alone. However, behavior is only indirect evidence of conscious or cognitive processes, its interpretation depends on subjective parameters, and it can be critically constrained by knowledge gaps and patient-specific confounders such as motor impairment, fluctuating vigilance, aphasia, sensory deficits, sedation and analgesia, etc. In the acute setting these constraints are at their most severe, and misdiagnosis carries immediate consequences for goals-of-care discussions. Structured clinical behavioral evaluation remains the cornerstone of diagnosis and the necessary foundation for further assessment, but it is expressly recommended that it should not be used on its own: repeated standardized examinations (based on scales enriched by observation of spontaneous motor behavior/motor pattern, and identification of subtle signs of covert consciousness) should be complemented by electrophysiological and neuroimaging investigations within a multimodal assessment framework, as recommended by American and European guidelines. This recommendation, however, remains challenging to implement in practice. Access to task-based EEG, functional MRI, PET, transcranial magnetic stimulation with EEG, or bedside optical neuroimaging varies enormously between countries, between institutions within the same country, and between acute and post-acute settings. Expertise in administering and interpreting these techniques is unequally distributed, protocols are not harmonized, and the resulting inconsistencies limit both the comparability of published results and the equity of care received by individual patients.Over the past five years, the phenomenon that motivated Volume I – cognitive-motor dissociation, the presence of covert command-following detectable by neuroimaging or electrophysiology in patients who show no behavioral response – has moved from a research finding to a quantified, reproducible clinical phenomenon. Large multicentre cohorts indicate that roughly one in four behaviorally unresponsive patients demonstrates covert responses, that this can be identified in the intensive care unit within days of injury, and that its detection carries prognostic weight for the recovery of both consciousness and functional independence. The terminology used to describe these patients has also begun to converge, and the field is increasingly explicit that unresponsiveness must not be equated with unconsciousness. Structured identification and mitigation of confounders before and during assessment, together with careful behavioral phenotyping, therefore, remain the most widely transferable ways of raising diagnostic quality where advanced tools are unavailable, with referral or tele-expertise networks serving as an important complement.In parallel, a substantial body of consensus work – most visibly the successive Common Data Elements publications covering behavioral phenotyping, electrophysiology, neuroimaging, biospecimens, outcomes and pediatric populations – has set out contemporary challenges, agreed on common terminology, and defined shared axes for data collection and reporting. These efforts directly address the small, heterogeneous and non-comparable samples that have long constrained the field.Therefore, this Research Topic Volume II welcomes submissions of manuscripts that consolidate these advances, and that confront what remains unresolved in the acute management of unresponsive and DoC patients, including:- clinical assessment, neurophysiological and neuroimaging diagnostic techniques (i.e. bedside-deployable detection of covert consciousness; management of knowledge gaps and assessment confounders, cognitive bias mitigation strategies, etc.),- methods to improve the assessment and treatment of pain and suffering, including behavioral and autonomic nervous system approaches,- novel treatment approaches and early rehabilitation techniques, especially those utilizing integrated neurosensory methods, neuromodulation, and robotics,- as a counterbalance to the technological focus of the items above, submissions reporting low-tech advances for the care and treatment, including personalized environment and stimuli,- prognostic model validation with multi-dimensional analysis for the diagnosis, evaluation and prediction of outcome,- the organizational dimensions of care, especially coordinated pathways from intensive care to post-acute rehabilitation, interdisciplinary aspects, and individual goals of assessment,- early prognostication based on individual goals assessment (for instance based on CIF classification), and consider the heterogeneity of characteristics of the patients and their context factors,- the roles of proxies in care: information sharing, personalized stimuli interviews, project-of-life pathways, support of families, and community-based and inclusive approaches,- ethical and equity dimensions of care, including the ethical challenges of neuroprognostication and the management of advance directives and of uncertainty,Volume I can be found here: https://www.frontiersin.org/research-topics/13881/new-advances-in-diagnostic-tools-and-rehabilitation-of-disorders-of-consciousness-in-the-acute-phase Topic editors: Karin Diserens, Jane Jöhr Source: https://www.frontiersin.org/research-topics/83864/new-advances-in-diagnostic-tools-and-rehabilitation-of-disorders-of-consciousness-in-the-acute-phase---volume-ii