Clinical Translation in Disorders of Consciousness: New Pathways and Challenges

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Systems Neuroscience".

Deadline for manuscript submissions: closed (15 April 2026) | Viewed by 642

Special Issue Editors


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Guest Editor
Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA 91767, USA
Interests: cognitive neuropsychology; neuropsychology; clinical neuropsychology; consciousness; disorder of consciousness; brain activity; neuroimaging
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Guest Editor
1. TIRR Memorial Hermann, Houston, TX 77030, USA
2. Department of Physical Medicine & Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
Interests: brain injury; consciousness; coma; vegetative state; unresponsive wakefulness syndrome; minimally conscious state; post-traumatic confusional state; locked-in syndrome

Special Issue Information

Dear Colleagues,

Advancing the translation of neuroscience into everyday care for patients with disorders of consciousness (DoC) remains one of the field’s most pressing challenges. Recent work has underscored the importance of moving beyond single-technique investigations toward integrative, patient-centered approaches that connect mechanistic research, clinical guidelines, and implementation science. This Special Issue welcomes contributions that employ multimodal methodologies (e.g., neuroimaging, electrophysiology, neuromodulation, and digital health), leverage interdisciplinary collaborations across neuroscience, rehabilitation, psychology, and bioengineering, and adopt patient-centered frameworks such as individualized rehabilitation pathways and family-engaged care models. By featuring studies that bridge experimental and clinical domains, we aim to stimulate dialogue on how diverse methods and perspectives can collectively advance diagnosis, prognosis, and treatment in DoC. We hope this issue will serve as both a reflection of current challenges and a catalyst for future translational research in this field.

Dr. Caroline Schnakers
Dr. Katherine O'Brien
Guest Editors

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Keywords

  • disorders of consciousness
  • brain injury
  • consciousness
  • coma

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Published Papers (2 papers)

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15 pages, 1822 KB  
Article
Spasticity in Prolonged Disorders of Consciousness: A Prospective Cohort Study
by Nathalie Draulans, Cecile Utens, Danielle Driessen, Willemijn van Erp, Gerard Ribbers, Jörg Wissel and Aurore Thibaut
Brain Sci. 2026, 16(5), 524; https://doi.org/10.3390/brainsci16050524 - 14 May 2026
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Abstract
Background: Spasticity is a frequent and disabling complication in patients with prolonged disorders of consciousness (PDOC), yet its prevalence, distribution, evolution, and relationship with recovery of consciousness remain poorly characterized. The aim was to investigate the prevalence, severity, distribution, and evolution of spasticity [...] Read more.
Background: Spasticity is a frequent and disabling complication in patients with prolonged disorders of consciousness (PDOC), yet its prevalence, distribution, evolution, and relationship with recovery of consciousness remain poorly characterized. The aim was to investigate the prevalence, severity, distribution, and evolution of spasticity in PDOC patients undergoing early intensive neurorehabilitation (EIN), and to explore clinical factors associated with spasticity and its relationship with level of consciousness (LOC). Methods: This study was embedded in the nationwide prospective DOCTOR cohort and included 126 PDOC patients admitted for EIN in the Netherlands between 2019 and 2023. Spasticity was assessed at admission and discharge using the Ashworth Scale (AS) across seven bilateral muscle groups. Associations between spasticity, demographic and clinical variables, medication use, nociception, and recovery of consciousness were analyzed. Results: Spasticity was highly prevalent at EIN admission (88%) and discharge (90%), with mostly bilateral and widespread involvement. Elbow flexors, wrist flexors, hip adductors, and knee flexors were most frequently affected. Severe spasticity was present in 19% at admission and 30% at discharge. Spasticity severity correlated positively with pain scores and use of spasmolytics, but not with LOC. No association was found between spasticity at admission and recovery of consciousness. Conclusions: Spasticity is nearly ubiquitous and often progressive in PDOC, even during specialized neurorehabilitation. Its evolution appears independent of recovery of consciousness, underscoring the need to assess and manage spasticity as a distinct clinical entity. Prospective interventional studies are warranted to optimize spasticity treatment in this population. Full article
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19 pages, 2657 KB  
Systematic Review
Eye-Tracking Assessment in Patients with Disorders of Consciousness: A Systematic Review
by Anna Estraneo, Lorenza Marcello, Francesca Mancino, Alessia De Feo, Andrea Soricelli, Monica Franzese and Carlo Cavaliere
Brain Sci. 2026, 16(6), 590; https://doi.org/10.3390/brainsci16060590 (registering DOI) - 30 May 2026
Abstract
Background/Objectives: Disorders of consciousness (DOC), including vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS), present significant diagnostic challenges. Misdiagnosis rates approach 40%, often due to limitations in detecting subtle behavioural responses through clinical observation alone. Eye-tracking technology offers objective, quantitative assessment [...] Read more.
Background/Objectives: Disorders of consciousness (DOC), including vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS), present significant diagnostic challenges. Misdiagnosis rates approach 40%, often due to limitations in detecting subtle behavioural responses through clinical observation alone. Eye-tracking technology offers objective, quantitative assessment of visual behaviours that may reveal covert signs of consciousness. This systematic review aimed to evaluate the diagnostic accuracy of eye-tracking technology compared to the Coma Recovery Scale-Revised (CRS-R) for detecting visual responses and consciousness signs in patients with DOC; to examine stimulus effects; and to assess prognostic value. Methods: A systematic literature search was conducted across SciSpace, Google Scholar, PubMed, and institutional libraries following PRISMA 2020 guidelines. Eligibility criteria specified studies involving patients with prolonged DOC assessed using eye-tracking technology. Data extraction, risk of bias assessment, and GRADE certainty evaluation were conducted systematically. Results: Fifteen studies (n = 4–123 patients; published 2012–2025) were included. Eye-tracking detected visual responses in significantly more patients than clinical observation alone (46.2% vs. 18.1% in one study). Mirror stimuli demonstrated the highest detection sensitivity (97% vs. 69% for person and 57% for object). Affectively salient stimuli elicited stronger tracking responses in patients with MCS (37.3% vs. 29.9–30.6% neutral). Advanced VR-based systems achieved high diagnostic accuracy (sensitivity 100%, specificity 88.9%) with prognostic value (overt tracking predicting 62.5% command-following at one year). GRADE certainty was Low for detection rates and diagnostic discrimination, and Very Low for sensitivity, specificity, and prognostic outcomes. Conclusions: Eye-tracking provides objective, sensitive assessment of visual behaviours in patients with DOC and may reduce misdiagnosis rates, supporting a conditional recommendation for its use as a supplementary assessment tool alongside CRS-R. Methodological heterogeneity, small sample sizes, and absence of blinding limit certainty. Adequately powered, multicentre prospective studies are urgently needed. Full article
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