AUTHOR=Charland-Verville Vanessa , Lesenfants Damien , Sela Lee , Noirhomme Quentin , Ziegler Erik , Chatelle Camille , Plotkin Anton , Sobel Noam , Laureys Steven TITLE=Detection of response to command using voluntary control of breathing in disorders of consciousness JOURNAL=Frontiers in Human Neuroscience VOLUME=8 YEAR=2014 URL=https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2014.01020 DOI=10.3389/fnhum.2014.01020 ISSN=1662-5161 ABSTRACT=

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.