Figure 14.

Toward precision assessment of emerging consciousness following severe brain injury. While behavior-based approaches to characterizing consciousness currently predominate in clinical settings, they are by definition insensitive to covert signs of preserved brain function which may carry diagnostic and prognostic significance. Advanced neurotechnologies now permit more precise assessment of patients’ conditions beyond overt behaviors, giving rise to new diagnostic categories including CCP in patients who might otherwise be considered to unresponsive based on behavioral testing alone. Results of different modalities, including task-based fMRI/EEG/PET; resting-state fMRI/EEG/PET; stimulus-based fMRI/EEG/PET; TMS-EEG perturbational complexity index (PCI), where available, could be integrated into a multimodal approach to advance precision assessment of emerging consciousness following severe brain injury. A radar chart such as displayed here may be used to unify, display, and communicate multivariate results of diagnostic tests to surrogates and clinical teams. The outer limit of the radar represents the most positive potential result for each diagnostic modality along a continuum of possible findings from negative (inner limit of radar) to positive (outer limit of radar). Response levels are modality-specific and positioning on the radar does not imply inter-modality equivalence with respect to the level of consciousness implied at each ring level across modalities. EEG = electroencephalography; fMRI = functional magnetic resonance imaging; PET = positron emission tomography; TMS-EEG = transcranial magnetic stimulation paired with EEG