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Updated: Mar 13, 2026
Assessment and Communication for People with Disorders of Consciousness
Published on: August 1, 2017
Electromyographic decoding of response to command in disorders of consciousness
Damien Lesenfants1, Dina Habbal2, Camille Chatelle2
1From the School of Engineering and Institute for Brain Science (D.L.), Brown University, Providence, RI; Coma Science Group (D.H., S.L.), GIGA-Research, CHU University Hospital of Liège, Belgium; Laboratory for NeuroImaging of Coma and Consciousness (C.C.), Massachusetts General Hospital, Boston; Department of Neurosurgery (C.S.), UCLA, Los Angeles, CA; and Brain Innovation B.V. and Maastricht University (Q.N.), the Netherlands. damien_lesenfants@brown.edu.
Objective:
To propose a new methodology based on single-trial analysis for detecting residual response to command with EMG in patients with disorders of consciousness (DOC), overcoming the issue of trial dependency and decreasing the influence of a patient's fluctuation of vigilance or arousal over time on diagnostic accuracy.
Methods:
Forty-five patients with DOC (18 with vegetative/unresponsive wakefulness syndrome [VS/UWS], 22 in a minimally conscious state [MCS], 3 who emerged from MCS [EMCS], and 2 with locked-in syndrome [LIS]) and 20 healthy controls were included in the study. Patients were randomly instructed to either move their left or right hand or listen to a control command ("It is a sunny day") while EMG activity was recorded on both arms.
Results:
Differential EMG activity was detected in all MCS cases displaying reproducible response to command at bedside on multiple assessments, even though only 6 of the 14 individuals presented a behavioral response to command on the day of the EMG assessment. An EMG response was also detected in all EMCS and LIS patients, and 2 MCS patients showing nonreflexive movements without command following at the bedside. None of the VS/UWS presented a response to command with this method.
Conclusions:
This method allowed us to reliably distinguish between different levels of consciousness and could potentially help decrease diagnostic errors in patients with motor impairment but presenting residual motor activity.
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