Covert consciousness, where unresponsive patients willfully modulate brain activity to command, is gaining attention. But these assessments are fundamentally limited. What if we could just. read their minds instead? 🧵 about our paper in @GreenJournal

What's the impact of @RECOVER_program, a specialized neuroprognostication service, on provider attitudes? This survey study in @Resus_Plus suggests providers are satisfied, think it's better than the usual, and makes neurology more useful. More at #AANAM

Privileged to collaborate with this international group of experts on disorders of consciousness at a recent conference. A resulting paper, led by @MJYoung_MD in @TheLancetNeuro, outlines an ethical approach to covert consciousness assessment.

Regardless, we are excited to see where this road takes us in treating this vulnerable patient population. If you're interested in joining this collaborative effort (@RECOVER_program, @ComaRecoveryLab, and many others), check out our job posting here!:

Neural decoding as a covert consciousness assessment is not without limitations. One cannot investigate another's consciousness without eventually falling into a philosophical rabbit hole. Read a thoughtful editorial about this piece here:

If feasible, the implications are numerous: A more granular tool that identifies a spectrum of covert consciousness. A more sensitive consciousness assessment that circumvents atypical functional neuroanatomy and limited interactivity. And potentially, a brain-computer interface.

It would also allow us to evaluate consciousness not as an oversimplistic dichotomy, but as a continuous spectrum, based on the complexity of distinctions that can be decoded from the patient's brain activity.

Neural decoding for covert consciousness is, in a sense, simpler than what's been done in healthy individuals. We don't need to reconstruct entire narratives (yet). We only need a paradigm to determine if patients can make basic semantic distinctions -- i.e., extract meaning.

What if we used mind-reading to determine what minds were there in the first place? Neural decoding could solve a lot of problems. Unlike behavioral or traditional covert consciousness paradigms, it wouldn't require interaction or assumptions of functional neuroanatomy.

The narratives didn't need to be auditory. The algorithms could even decode narratives from muted movies. This is as close to mind-reading as we've ever come.

Take this brilliant study by @alex_ander and colleagues. Healthy subjects listened to narratives during an fMRI scan, then individualized algorithms decoded novel narratives with surprising accuracy.

Neural decoding works like this: You train an algorithm to associate stimuli with patterns of brain activity, then use it to "decode" a person's experience from their brain activity. The stimulus can even be a semantic concept, so you can decode not only sensation, but *meaning*.

Thus, current fMRI covert consciousness paradigms may be neither sensitive nor specific. EEG-based paradigms solve some problems, but create others. We therefore may be making errors in who we consider conscious. Enter "neural decoding".

Conversely, what if there is distortion of the brain due to a lesion, and activity occurs outside of typical motor regions? Should we not count this (and risk overlooking consciousness patients)?

Many fMRI paradigms work like this: During a scan, we present alternating periods of commands (e.g., "move your hand") and rest. If there is activity in motor regions during commands (relative to rest), we conclude covert consciousness. But should we? Does slight overlap count?

Do you have experience with fMRI analysis? Interested in consciousness and helping patients in coma? Consider applying for this position to join our @RECOVER_program team at @PennMedicine. Please reach out with ?'s and spread the word!.

RT @stephanamayer: This is cool. RECOVER. A multidisciplinary team at @PennNeurology that provides neuroprognostication for DoC pts — an….

RT @MJYoung_MD: Clinical Implementation of fMRI & EEG to Detect Cognitive Motor Dissociation: Lessons we learned in translating neurotechno….

RT @YelenaBodien: Studies show that some patients who appear unresponsive after severe brain injury can follow commands covertly, as detect….

With guidelines advising clinicians to wait longer before definitively concluding a poor prognosis after brain injury, D-WLST has become an increasingly relevant consideration. Read the paper to learn more about how to counsel families about this important option! 6/6.