Schiff Nicholas D, Diringer Michael, Diserens Karin, Edlow Brian L, Gosseries Olivia, Hill N Jeremy, Hochberg Leigh R, Ismail Fatima Y, Meyer Ivo A, Mikell Charles B, Mofakham Sima, Molteni Erika, Polizzotto Leonard, Shah Sudhin A, Stevens Robert D, Thengone Daniel
Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA.
Departments of Neurology and Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA.
Neurocrit Care. 2024 Aug;41(1):129-145. doi: 10.1007/s12028-023-01924-w. Epub 2024 Jan 29.
We developed a gap analysis that examines the role of brain-computer interfaces (BCI) in patients with disorders of consciousness (DoC), focusing on their assessment, establishment of communication, and engagement with their environment.
The Curing Coma Campaign convened a Coma Science work group that included 16 clinicians and neuroscientists with expertise in DoC. The work group met online biweekly and performed a gap analysis of the primary question.
We outline a roadmap for assessing BCI readiness in patients with DoC and for advancing the use of BCI devices in patients with DoC. Additionally, we discuss preliminary studies that inform development of BCI solutions for communication and assessment of readiness for use of BCIs in DoC study participants. Special emphasis is placed on the challenges posed by the complex pathophysiologies caused by heterogeneous brain injuries and their impact on neuronal signaling. The differences between one-way and two-way communication are specifically considered. Possible implanted and noninvasive BCI solutions for acute and chronic DoC in adult and pediatric populations are also addressed.
We identify clinical and technical gaps hindering the use of BCI in patients with DoC in each of these contexts and provide a roadmap for research aimed at improving communication for adults and children with DoC, spanning the clinical spectrum from intensive care unit to chronic care.
我们开展了一项差距分析，以研究脑机接口（BCI）在意识障碍（DoC）患者中的作用，重点关注其评估、沟通建立以及与环境的互动。
“治愈昏迷运动”召集了一个昏迷科学工作组，其中包括16名在意识障碍方面具有专业知识的临床医生和神经科学家。该工作组每两周进行一次线上会议，并对主要问题进行差距分析。
我们概述了一条路线图，用于评估意识障碍患者对脑机接口的准备情况以及推进脑机接口设备在意识障碍患者中的应用。此外，我们讨论了一些初步研究，这些研究为开发用于沟通的脑机接口解决方案以及评估意识障碍研究参与者使用脑机接口的准备情况提供了参考。特别强调了由异质性脑损伤引起的复杂病理生理学所带来的挑战及其对神经元信号传导的影响。具体考虑了单向和双向沟通之间的差异。还讨论了针对成人和儿童急性及慢性意识障碍的可能的植入式和非侵入式脑机接口解决方案。
我们确定了在上述每种情况下阻碍脑机接口在意识障碍患者中应用的临床和技术差距，并提供了一项研究路线图，旨在改善意识障碍成人和儿童的沟通，涵盖从重症监护病房到长期护理的整个临床范围。
