[en] BACKGROUND:
Detecting signs of consciousness in patients in a vegetative state/unresponsive wakefulness syndrome (UWS/VS) or minimally conscious state (MCS) is known to be very challenging. Plotkin et al. (2010) recently showed the possibility of using a breathing-controlled communication device in patients with locked in syndrome. We here aim to test a breathing-based "sniff controller" that could be used as an alternative diagnostic tool to evaluate response to command in severely brain damaged patients with chronic disorders of consciousness (DOC).
METHODS:
Twenty-five DOC patients were included. Patients' resting breathing-amplitude was measured during a 5 min resting condition. Next, they were instructed to end the presentation of a music sequence by sniffing vigorously. An automated detection of changes in breathing amplitude (i.e., >1.5 SD of resting) ended the music and hence provided positive feedback to the patient.
RESULTS:
None of the 11 UWS/VS patients showed a sniff-based response to command. One out of 14 patients with MCS was able to willfully modulate his breathing pattern to answer the command on 16/19 trials (accuracy 84%). Interestingly, this patient failed to show any other motor response to command.
DISCUSSION:
We here illustrate the possible interest of using breathing-dependent response to command in the detection of residual cognition in patients with DOC after severe brain injury.
Lesenfants, Damien; Université de Liège - ULiège > Centre de recherches du cyclotron
Sela, Lee; The Weizmann Institute of Science > Department of Neurobiology
Noirhomme, Quentin; Brain Innovation B.V.
Ziegler, Erik ; University of Liège > Centre de recherches du cyclotron
Chatelle, Camille ; Université de Liège - ULiège > Centre de recherches du cyclotron
Plotkin, Anton; The Weizmann Institute of Science > Department of Neurobiology
Sobel, Noam; The Weizmann Institute of Science > Department of Neurobiology
Laureys, Steven ; Université de Liège - ULiège > Centre de recherches du cyclotron
Language :
English
Title :
Detection of response to command using voluntary control of breathing in disorders of consciousness
Publication date :
23 December 2014
Journal title :
Frontiers in Human Neuroscience
eISSN :
1662-5161
Publisher :
Frontiers Research Foundation, Lausanne, Switzerland
Volume :
8
Issue :
1020
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
F.R.S.-FNRS - Fonds de la Recherche Scientifique DG RDT - Commission Européenne. Direction Générale de la Recherche et de l'Innovation JSMF - James S McDonnell Foundation MSF - Mind Science Foundation French Speaking Community Concerted Research Action
Bardin, J. C., Fins, J. J., Katz, D. I., Hersh, J., Heier, L. A., Tabelow, K., et al. (2011). Dissociations between behavioural and functional magnetic resonance imaging- based evaluations of cognitive function after brain injury. Brain 134(Pt. 3), 769-782. doi: 10.1093/brain/awr005
Bekinschtein, T. A., Coleman, M. R., Niklison, J. III, Pickard, J. D., and Manes, F. (2008). Can electromyography objectively detect voluntary movement in disorders ofconsciousness? J. Neurol. Neurosurg. Psychiatry 79, 826-828. doi: 10.1136/jnnp.2007.132738
Birbaumer, N., Murguialday, A. R., and Cohen, L. (2008). Brain-computer interface in paralysis. Curr. Opin. Neurol. 21, 634-638. doi: 10.1097/WC0.0b013e328315ee2d
Boly, M., Coleman, M. R., Davis, M. H., Hampshire, A., Bor, D., Moo nen, et al. (2007). When thoughts become action: an fMRI paradigm to study volitional brain activity in non-communicative brain injured patients. Neuroimage 36, 979-992. doi: 10.1016/j.neuroimage.2007.02.047
Brumberg, J. S., Nieto-Castanon, A., Kennedy, P. R., and Guenther, F. H. (2010). Brain-computer interfaces for speech communication. Speech Commun. 52, 367-379. doi: 10.1016/j.specom.2010.01.001
Bruno, M. A, Vanhaudenhuyse, A, Thibaut, A, Moonen, G, and Laureys, S. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J. Neurol. 258, 1373-1384. doi: 10.1007/s00415-011-6114-x
Chatelle, C., Chennu, S., Noirhomme, Q., Cruse, D., Owen, A. M., and Laureys, S. Brain-computer interfacing in disorders of consciousness. Brain Inj. 26, 1510-1522. doi: 10.3109/02699052.2012.698362
Chatelle, C., Laureys, S., and Noirhomme, Q. (2014). “BCI and diagnosis,” in Brain- Computer-Interfaces in TheirEthical, Social and Cultural Contexts, ed G. Grubler and E. Hildt (Dordrecht: Springer), 39-47.
Cruse, D., Chennu, S., Chatelle, C., Bekinschtein, T. A., Fernandez-Espejo, D., Pickard, J. D., etal. (2011). Bedside detection of awareness in the vegetative state: a cohort study. Lancet 378,2088-2094. doi: 10.1016/S0140-6736(11)61224-5
Giacino, J. T., Ashwal, S., Childs, N., Cranford, R., Jennett, B., Katz, D. I., et al. (2002). The minimally conscious state: definition and diagnostic criteria. Neurology 58, 349-353. doi: 10.1212/wnl.58.3.349
Giacino, J. T., Kalmar, K., and Whyte, J. (2004). The JFK coma recovery scale- revised: measurement characteristics and diagnostic utility. Arch. Phys. Med. Rehabil. 85, 2020-2029. doi: 10.1016/j.apmr.2004.02.033
Goldfine, A. M., Victor, J. D., Conte, M. M., Bardin, J. C., and Schiff, N. D. Determination of awareness in patients with severe brain injury using EEG power spectral analysis. Clin. Neurophysiol. 122, 2157-2168. doi: 10.1016/j.clinph.2011.03.022
Hill, N. J., Lal, T. N., Schroder, M., Hinterberger, T., Wilhelm, B., Nijboer, F., et al. (2006). Classifying EEG and ECoG signals without subject training for fast BCI implementation: comparison of nonparalyzed and completely paralyzed subjects. IEEE Trans. Neural Syst. Rehabil. Eng. 14, 183-186. doi: 10.1109/tnsre.2006.875548
Laureys, S. (2005). The neural correlate of (un)awareness: lessons from the vegetative state. Trends Cogn. Sci. 9, 556-559. doi: 10.1016/j.tics.2005.10.010
Laureys, S., Celesia, G. G., Cohadon, F., Lavrijsen, J., Leon-Carrion, J., Sannita, W. G., et al. (2010). Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med. 8:68. doi: 10.1186/17417015-8-68
Lesenfants, D., Habbal, D., Lugo, Z., Lebeau, M., Horki, P., Amico, E., et al. (2014). An independent SSVEP-based brain-computer interface in locked-in syndrome. J. Neural Eng. 11:035002. doi: 10.1088/1741-2560/11/3/035002
Majerus, S., Gill-Thwaites, H., Andrews, K., and Laureys, S. (2005). Behavioral evaluation of consciousness in severe brain damage. Prog. Brain Res. 150, 397-413. doi: 10.1016/s0079-6123(05)50028-1
Monti, M. M., Vanhaudenhuyse, A., Coleman, M. R., Boly, M., Pickard, J. D., Tshibanda, L., et al. (2010). Willful modulation of brain activity in disorders of consciousness. N. Engl. J. Med. 362, 579-589. doi: 10.1056/NEJMoa0905370
Muller-Putz, G. R., Scherer, R., Brunner, C., Leeb, R., and Pfurtscheller, G. (2008). Better than random? A closer look on BCI results. IEEE Trans. Neural Syst. Rehabil. Eng. 10, 52-55.
Owen, A. M., Coleman, M. R., Boly, M., Davis, M. H., Laureys, S., and Pickard, J. D. Detecting awareness in the vegetative state. Science 313:1402. doi: 10.1126/science.1130197
Plotkin, A., Sela, L., Weissbrod, A., Kahana, R., Haviv, L., Yeshurun, Y., et al. (2010). Sniffing enables communication and environmental control for the severely disabled. Proc. Natl. Acad. Sci. USA 107, 14413-14418. doi: 10.1073/pnas.1006746107
Riganello, F., Dolce, G., and Sannita, W. G. (2012). Heart rate variability and the central autonomic network in the severe disorder of consciousness. J. Rehabil. Med. 44, 495-501. doi: 10.2340/16501977-0975
Schnakers, C., Majerus, S., Giacino, J., Vanhaudenhuyse, A., Bruno, M. A., Boly, M., et al. (2008a). A french validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Inj. 22, 786-792. doi: 10.1080/02699050802403557
Schnakers, C., Perrin, F., Schabus, M., Majerus, S., Ledoux, D., Damas, P., et al. (2008b). Voluntary brain processing in disorders of consciousness. Neurology 71, 1614-1620. doi: 10.1212/01.wnl.0000334754.15330.69
Schnakers, C., Vanhaudenhuyse, A., Giacino, J., Ventura, M., Boly, M., Majerus, S., et al. (2009). Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 9:35. doi: 10.1186/1471-2377-9-35
Shimokawa, T., Yi, S., and Tanaka, S. (2005). Nerve supply to the soft palate muscles with special reference to the distribution of the lesser palatine nerve. CleftPalate Craniofac. J. 42, 495-500. doi: 10.1597/04-142r.1
Stender, J., Gosseries, O., Bruno, M. A., Charland-Verville, V., Vanhaudenhuyse, A., Demertzi, A., et al. (2014). Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. Lancet 384, 514-522. doi:10.1016/S0140-6736(14)60042-8
Stoll, J., Chatelle, C., Carter, O., Koch, C., Laureys, S., and Einhauser, W. (2013). Pupil responses allow communication in locked-in syndrome patients. Curr. Biol. 23, R647-R648. doi: 10.1016/j.cub.2013.06.011
