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Related Experiment Video

Updated: Sep 18, 2025

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Near-Infrared Spectroscopy to Assess Covert Volitional Brain Activity in Intensive Care.

Pardis Zarifkar1, Matthew Kolisnyk2, Marwan H Othman1

  • 1Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Neurocritical Care
|June 23, 2025
PubMed
Summary

Functional near-infrared spectroscopy (fNIRS) can detect volitional brain activity in patients with disorders of consciousness (DoC). This portable method shows promise for assessing covert consciousness in intensive care units.

Keywords:
Brain injuryCognitive motor dissociationComaConsciousnessNeuromonitoringPrognostication

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Area of Science:

  • Neuroscience
  • Medical Technology
  • Clinical Neurology

Background:

  • Detecting covert consciousness in unresponsive patients is challenging.
  • Advanced neuroimaging techniques like fMRI and EEG are not always accessible.
  • Functional near-infrared spectroscopy (fNIRS) offers a portable alternative for assessing brain activity.

Purpose of the Study:

  • To assess the feasibility of using fNIRS with verbal motor commands to detect volitional brain activity in acute disorders of consciousness (DoC).
  • To evaluate fNIRS as a potential tool for identifying covert consciousness.

Main Methods:

  • fNIRS recordings and clinical assessments were performed on 50 patients with acute DoC and 20 healthy controls.
  • Data were analyzed both post hoc computationally and visually at the bedside.
  • Cortical activation was assessed in response to verbal motor commands.

Main Results:

  • fNIRS detected cortical activation in 44% of patients with DoC (16/36), compared to 96% of controls (18/19).
  • Among patients with disorders of consciousness, 62% of minimally conscious and 35% of unresponsive patients showed volitional activity.
  • Bedside visual analysis demonstrated high specificity (90%) but moderate agreement with post hoc analysis.

Conclusions:

  • fNIRS with motor commands is a feasible method for detecting volitional brain activity in acute disorders of consciousness.
  • While promising, data quality issues remain a limitation for widespread clinical application.