Abstract
One of the first clinical signs differentiating the minimally conscious state from the vegetative state is the presence of smooth pursuit eye movements occurring in direct response to moving salient stimuli. Glasgow Coma Scale (GCS) is one of the most commonly used diagnostic tools for acute phase assessment of the level of consciousness, together with a neurological examination. These classic measures are limited to qualitative neurological examination without more quantitative measures provided from e.g., tasks with tracking position of the gaze. Among this and other limitations, it is prone to a relatively high rate of misdiagnosis. Here, we developed an interface for gaze tracking to enhance the assessment of consciousness in 10 patients with acquired brain injuries. According to the acute phase GCS assessment, nine of them were considered unaware and below the minimally conscious state. Chronic neurological examination confirmed six of them below the minimally conscious state. Our new Human Computer Interface (HCI) revealed that six patients were conscious enough to complete at least one of the gaze tracking tasks. Among these six patients, one was originally diagnosed as remaining in a vegetative state and one in coma. The patient diagnosed as remaining in a chronic vegetative state scored six GCS points acutely. Following assessment with our HCI the patient was re-diagnosed with a possible locked-in syndrome. Our HCI method provides a new complementary tool for clinical assessment of patients suffering from disorders of consciousness.
Highlights
Glasgow Coma Scale (GCS) is the most commonly used method for assessing consciousness level in the acute phase after acquired brain injuries
The acute phase GCS assessment results have been presented in the paper to provide the information on initial state of patients
We found that 6 out of 10 patients expressed conscious task performance in at least one of the five Human Computer Interface (HCI) tasks (Table 4; pvalues for statistically significant results in bold)
Summary
Glasgow Coma Scale (GCS) is the most commonly used method for assessing consciousness level in the acute phase after acquired brain injuries. This acute phase assessment is typically followed by repeated neurological examination in the chronic phase. Several shortcomings of the acute phase GCS and chronic neurological examinations have been reported for the last two decades [3,4,5,6]. One of the main drawbacks is that the eye movements are not being tracked in the these assessments. The presence of smooth pursuit eye movements in response to a moving or salient
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