Article

The reestablishment of communication is one of the main goals for patients with
disorders of consciousness (DOC). It is now established that many DOC patients
retain the ability to process stimuli of varying complexity even in the absence
of behavioural response. Motor impairment, fatigue, attention disorders might
contribute to the difficulty of communication in this population. Brain-computer
interfaces (BCI) might be helpful in restoring some communication ability in
these patients. After a definition of the different disorders of consciousness
that might benefit from BCI, brain markers able to detect cognitive processes and
awareness in the absence of behavioural manifestation are described. Can these
markers be willfully modulated and used to restore communication in DOC patients?
In order to answer this question, three paradigmatic articles using either
functional imaging or electrophysiology are critically analysed with regard to
clinical applications. It appears that the use of fMRI is limited from a clinical
point of view, whereas the EEG seems more feasible with possible BCI applications
at the patient's bedside. However, at this stage, several limitations are pointed
out: the lack of awareness in itself, the lack of sensitivity of the technique,
atypical pattern of brain activity in brain damaged patients. The challenge is
now to select the best candidates, to improve the efficiency, portability and
cost of these techniques. Although this innovative technology may concern a
minority of DOC patients, it might offer the possibility to restore or improve
communication to heavily disabled patients and meanwhile detect a signature of
awareness.
CI - Copyright (c) 2015 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS