Utilizing EEG to detect covert command-following in vegetative traumatic brain injury patients: A review




Leonard, Julia

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1.7 million people in the US suffer from traumatic brain injury (TBI) each year, typically resulting from car accidents, contact sports, military operations, and falls [1]. Currently, healthcare personnel rely on the Glasgow Coma Scale (GCS) and other behavioral assessments for TBI diagnosis, which are rather subjective and poor diagnostic tools [1]. Other commonplace methods include medical resonance imaging (MRI) and computed tomography (CT) scans, which lack portability and are a financial burden on patients and hospitals. Because of this, both MRI and CT lack easy repeatability. Current techniques result in 36% of TBI patients receiving a misdiagnosis, and proper diagnosis is only seen after 5 assessments over 2 weeks [2]. Diagnosis is important for outcome, as patients that show covert command-following have a better chance of survival [3]. This review will highlight current new methods for diagnosing TBI patients with little or no physical movement and response to environment. Studies utilizing methods such as electroencephalography (EEG) and P300 display how patients in varying disorders of consciousness have covert responses to commands, although behavioral assessments would diagnose them as nonresponsive. 17-20% of vegetative patients completing lacking in physical movements show brain activity response to imagery tasks [4,5]. EEG and P300 prove to be a promising tool moving forward for TBI diagnoses, as it is more portable and a fraction of the cost of MRIs, allowing for multiple assessments over time. Limitations include high heterogeneity in EEG data, which can lead to false positives and negatives, as well as P300 methods need greater control before they can be fully adopted [5,6]. Ultimately, EEG techniques show clinical applicability for TBI diagnosis, especially as the methods continue to improve.



Traumatic brain injury