Abstract
Visual fixation is an item in the visual function subscale of the Coma Recovery Scale-Revised (CRS-R). Sometimes clinicians using the behavioral scales find it difficult to detect because of the motor impairment in patients with disorders of consciousness (DOCs). Brain-computer interface (BCI) can be used to improve clinical assessment because it directly detects the brain response to an external stimulus in the absence of behavioral expression. In this study, we designed a BCI system to assist the visual fixation assessment of DOC patients. The results from 15 patients indicated that three showed visual fixation in both CRS-R and BCI assessments and one did not show such behavior in the CRS-R assessment but achieved significant online accuracy in the BCI assessment. The results revealed that electroencephalography-based BCI can detect the brain response for visual fixation. Therefore, the proposed BCI may provide a promising method for assisting behavioral assessment using the CRS-R.
Highlights
Patients with severe brain injury may suffer from disorders of consciousness (DOCs), including coma, vegetative state (VS), and minimally conscious state (MCS)
The results revealed that electroencephalography-based Braincomputer interface (BCI) can detect the brain response for visual fixation
In the Coma Recovery Scale-Revised (CRS-R) assessment, a visual subscale score of 2 means that visual fixation behavior was detected by the clinician
Summary
Patients with severe brain injury may suffer from disorders of consciousness (DOCs), including coma, vegetative state (VS), and minimally conscious state (MCS). Accurate assessment of the status of DOC patients is important for monitoring the effects of treatment and the rehabilitation process. The proposed behavioral scales for DOC patients include the Coma Recovery Scale-revised (CRS-R), the Glasgow Coma Scale, the Full Outline of Unresponsiveness, the Wessex Head Injury Matrix, and the Sensory Modalities Assessment and Rehabilitation Technique. The CRS-R provides a more fine-grained assessment and has demonstrated significant sensitivity in differentiating MCS from VS patients [1]. Each subscale consists of several items that are critical for identifying subtle behavioral markers of recovery of consciousness, and there are a total of 23 hierarchicallyarranged items. The visual subscale includes five items: visual startle, visual fixation, visual pursuit, object localization, and object recognition, corresponding to scores of 1, 2, 3, 4, and 5, respectively [2,3,4]
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