Measuring consciousness in severely damaged brains

Gosseries, Di, Laureys, Boly · Annual Review of Neuroscience · 2014 · neuroscience · 10.1146/annurev-neuro-062012-170339 · record gosseries2014-measuring-consciousness-in-severel
tag layer · index · concepts · authors · עברית
Where this record's text came from. faceted 2026-08 by reading the locally held text (html); every evidence string verified as an exact substring of that text before merging. IMPORTANT: the retrieved file is an ORBi repository landing page, not the article. Below the ARTICLE TEXT line there is only the record metadata, the publisher's abstract, and the full bibliography. Every facet here is therefore drawn from the six abstract sentences; no methods, results or discussion text exists in the file to quote. limitations is empty because the abstract states only field-level gaps ('Further research on the contents of consciousness in DOC is also needed.'), which is a call for future work rather than a stated limit of this paper. Claim relations is empty because the file relates the paper to no named prior work — it contains a reference list only, which is off-limits for quoting. Claim type was set to 'method' because the abstract's contribution shape is about how to assess consciousness (behavioural scales, neuroimaging paradigms, perturbational markers); a case could be made for 'critique' given the argument that neuroimaging markers without theory are insufficient. 2026-08-13, 2026-08-14 and 2026-08-15 schema-0.3 passes: every quote verified as an exact substring of the staged text and anchored at merge time; concept terms verified present; every edge endpoint an existing node. Update, 18 September 2026: the full article has since been staged (2026-08-21, 53,389 characters) and this record's quotes now come from it - all 67 are in it and anchored, as deep as character 50,798; the passage above describes the landing page it was first read from.
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Tags on this paper

Every tag the record carries, each linking to every other paper in the corpus that carries it. A tag appears here whether or not its words occur in the article — the spans below are only the ones a sentence in this paper licenses. Of the 5 concept tags on this paper, all 5 are grounded in a quoted sentence.
behavioral responsiveness purposeful behaviors Misdiagnosis of unawareness clinical consensus locked-in syndrome Consciousness arises from a system's capacity to integrate information, so that networks supporting it must strike an optimal balance between functional integration and differentiation Loss of consciousness occurs through a breakdown of cortical effective connectivity, so that a local perturbation can no longer propagate as a widespread differentiated causal interaction Preserved cortical backward (top-down) connections generate the larger long-latency evoked components seen in MCS relative to VS/UWS unresponsive wakefulness syndrome minimally conscious state (MCS) disorders of consciousness (DOC) locked-in syndrome (LIS) active paradigm passive paradigm Coma Recovery Scale-Revised (CRS-R) default mode network (DMN) coma perturbational complexity index (PCI) mismatch negativity (MMN) transcranial magnetic stimulation (TMS) positron emission tomography (PET) review

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relation to other workclaim_relationshow this paper stands to another: agrees, contradicts, extends, qualifies
claim typeclaim_typethe shape of the claim: existence, mechanism, method, critique, prediction, null
concept edgeconcept_edgesan asserted relation between two concepts, with the sentence asserting it
conceptconceptsan idea the paper works with, quoted where the paper uses it
content tagcontent_tagsa finding, definition, quantity, statistic or variable named in the paper
controlcontrolsan experiment run to eliminate a rival explanation
limitationlimitationswhat the paper says its evidence cannot support
mechanismmechanismshow the reported effect is said to come about
methodmethodhow the paper produced its evidence
phenomenonphenomenonthe effect or regularity under study
sensesensesa distinct use of a term, quoted where the paper fixes it
transfertransfersa method or concept carried in from another field

The paper

The full text is not reproduced here. This article is not cleared for redistribution, so the page carries the tag layer only. Its evidence sentences are withheld; the grounding status remains with each tag, and the article itself is at https://doi.org/10.1146/annurev-neuro-062012-170339. The reading view exists for the papers whose licence permits it.

Every tag on this page

claim_relations 3 · claim_type 1 · concept_edges 1 · concepts 5 · content_tags 32 · controls 3 · limitations 4 · mechanisms 3 · method 1 · phenomenon 1 · senses 3 · transfers 1

Relations on this page carry a quotation for the claim. Where a relation was separately evidenced — and so tested against the vocabulary for its type — the row says so; none of 1 relation here carry that mark. The rest are the tagger’s reading of the sentence quoted beside them.

facettagfieldconf.whose words
claim_typemethod
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claim_typethe paper's words
phenomenondisorders of consciousness
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phenomenonthe paper's words
methodreview
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also in: review
methodthe paper's words
mechanismsmechanisms
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mechanisms[0]the tagger's words
mechanismsmechanisms
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mechanisms[1]the tagger's words
mechanismsmechanisms
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mechanisms[2]the tagger's words
limitationsThe assessment is gated by behaviour, so absence of response is not proof of absence of consciousness.
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what this limits: any bedside diagnosis of unawareness: the authors state the assessment is intrinsically gated by behavioral responsiveness and that absence of observed purposeful behaviors cannot be taken as definitive proof of the absence of consciousness
limitations[0]1.0the tagger's words
limitationsThe misdiagnosis rate is given together with the assessment method that produces it.
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what this limits: any quoted misdiagnosis rate for unawareness: up to 40% applies
limitations[1]1.0the tagger's words
limitationsA named patient group is misdiagnosed despite preserved awareness.
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what this limits: any diagnosis of a disorder of consciousness: locked-in syndrome patients can be misdiagnosed as DOC despite preserved awareness, because of complete paralysis of voluntary muscles except vertical eye movements
limitations[2]1.0the tagger's words
limitationsThe neuroimaging paradigm's validity rests on a control study the authors say is still needed.
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what this limits: any use of an active-task neuroimaging paradigm as evidence of willful response: the authors state validation studies should be performed to ensure passive listening cannot elicit a similar brain activity pattern
limitations[3]1.0the tagger's words
transfersthe normalized Lempel-Ziv complexity measure, originally defined for finite symbol sequences, is computed on TMS-evoked EEG spatiotemporal response maps to yield the perturbational complexity index
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transfers[0]the tagger's words
controlsa separate experiment run on the same task
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eliminates: reflexive activation as the source of the response, and so establishes the task's specificity to conscious responses · outcome (stated by the tagger, no quotation): held
controls[0]0.9the tagger's words
controlscomparing active against passive conditions, and runs attending to the patient's own name against runs attending to another name
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eliminates: a nonreflexive response being mistaken for command-following, and a nonspecific response being mistaken for a targeted one · outcome (stated by the tagger, no quotation): held
controls[1]0.9the tagger's words
controlsinstructing subjects NOT to perform the task and recording what happens
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eliminates: activation that would have occurred without any intention to comply - the response is absent when compliance is withheld · outcome (stated by the tagger, no quotation): held
controls[2]0.95the tagger's words
conceptsbehavioral responsiveness
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concepts[0]the paper's words
conceptspurposeful behaviors
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concepts[1]the paper's words
conceptsMisdiagnosis of unawareness
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concepts[2]the paper's words
conceptsclinical consensus
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concepts[3]the paper's words
conceptslocked-in syndrome
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concepts[4]the paper's words
sensesbedside consciousness - WHAT THE PATIENT CAN SHOW, NOT WHAT THEY HAVE: the assessment is intrinsically gated by behavioral responsiveness, and the same reading is returned by a patient who is unconscious and by one who is conscious and unable to demonstrate it, which the review states cannot be treated as proof either way
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senses[0]1.0the tagger's words
sensesthe 40% misdiagnosis rate - CONDITIONAL ON THE INSTRUMENT: it applies to diagnosis based solely on clinical consensus without appropriate behavioral scales, so the number measures a practice rather than a difficulty, and the practice is nameable and fixable
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senses[1]1.0the tagger's words
sensesthe active-task paradigm - VALID ONLY IF A CONTROL HOLDS THAT HAS NOT BEEN RUN: its status as evidence of willful response depends on passive listening not producing a similar pattern, and the authors say validation studies should be performed to establish that
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senses[2]1.0the tagger's words
claim_relationsqualifies → Ferreira (2007), Manning (2012)
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differs in: WHO IS APPLYING THE CATEGORY. The law is stated as turning on the label - 'the right of the medical team to withdraw artificial nutrition and hydration from patients in VS/UWS, but not those in MCS' - and then: 'Opinions on these end-of-life decisions vary, however, depending not only on the diagnosis of the patient, Quotation withheld'. So the same category, on the same patient, does not determine the same decision
claim_relations[0]0.95the tagger's words
claim_relationscontradicts → the assumption that locked-in patients have poor quality of life
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differs in: WHO IS ASKED. The quality-of-life question 'is difficult to address in the absence of communication with the patient' - and where communication IS possible the answer inverts: 'it is striking to note, however, that Quotation withheld'. The inference drawn from outside about a state is contradicted by the only group in that state who can answer
claim_relations[1]0.9the tagger's words
claim_relationsbuilds-on → Schnakers et al. (2009)
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differs in: WHICH INSTRUMENT PRODUCED THE DIAGNOSIS. The 40% figure is not a property of the patients: misdiagnosis is that frequent 'Quotation withheld', and the review names the scale that does better in the next sentence. Quoted without its condition, the number describes the population rather than the procedure
claim_relations[2]0.95the tagger's words
concept_edgesclinical consensus —causes→ Misdiagnosis of unawareness
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holds when: when diagnosis rests on clinical consensus alone, without · direction on the measure: increases · strength of the relation: 1
concept_edges[0]the tagger's words
content_tagsUnawareness is misdiagnosed in up to 40% of cases when clinicians rely on consensus impression instead of a standardised behavioural scale.
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content_tags.findings[0]the tagger's words
content_tagsOnly about one in five patients with disorders of consciousness produces a positive response on active command-following neuroimaging paradigms.
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content_tags.findings[1]the tagger's words
content_tagsA negative result on an active paradigm can never exclude that the patient retains awareness.
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content_tags.findings[2]the tagger's words
content_tagsThe perturbational complexity index separates conscious from unconscious states across subjects and conditions, staying above 0.31 in wakefulness, MCS, EMCS, LIS and REM sleep and below 0.31 in NREM sleep, vegetative state and anaesthesia.
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content_tags.findings[3]the tagger's words
content_tagsNo conventional neuroimaging technique on its own is adequate to diagnose consciousness in a brain-damaged patient.
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content_tags.findings[4]the tagger's words
content_tagsPreserved PET metabolism cannot serve as proof of consciousness, since metabolism can be normal or raised during epileptic seizures in which the subject is unconscious.
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content_tags.findings[5]the tagger's words
content_tagsIn NREM sleep, midazolam anaesthesia and vegetative state, TMS triggers a stereotypical local slow wave, indicating a breakdown of effective connectivity.
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content_tags.findings[6]the tagger's words
content_tagsNeuroimaging and electrophysiology show consistent group differences between MCS and VS/UWS patients.
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content_tags.findings[7]the tagger's words
content_tagsAbout 20% of VS/UWS patients show an atypical brain activity pattern.
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content_tags.findings[8]the tagger's words
content_tagsThe contents of consciousness in MCS remain inaccessible because these patients cannot give the reports on which content assessment normally depends.
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content_tags.findings[9]the tagger's words
content_tagsunresponsive wakefulness syndrome
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content_tags.definitions[0]the tagger's words
content_tagsminimally conscious state (MCS)
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content_tags.definitions[1]the tagger's words
content_tagsdisorders of consciousness (DOC)
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content_tags.definitions[2]the tagger's words
content_tagslocked-in syndrome (LIS)
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content_tags.definitions[3]the tagger's words
content_tagsactive paradigm
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content_tags.definitions[4]the tagger's words
content_tagspassive paradigm
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content_tags.definitions[5]the tagger's words
content_tagsComa Recovery Scale-Revised (CRS-R)
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content_tags.definitions[6]the tagger's words
content_tagsdefault mode network (DMN)
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content_tags.definitions[7]the tagger's words
content_tagscoma
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also in: coma
content_tags.definitions[8]the tagger's words
content_tagsperturbational complexity index (PCI)
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content_tags.definitions[9]the tagger's words
content_tagsmismatch negativity (MMN)
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content_tags.definitions[10]the tagger's words
content_tagstranscranial magnetic stimulation (TMS)
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content_tags.definitions[11]the tagger's words
content_tagspositron emission tomography (PET)
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content_tags.definitions[12]the tagger's words
content_tagsup to 40% — rate of misdiagnosed unawareness when standardised behavioural scales are not used
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content_tags.quantities[0]the tagger's words
content_tagsabout 20% — share of DOC patients who respond positively to active command-following paradigms
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content_tags.quantities[1]the tagger's words
content_tags0.31 — PCI threshold separating conscious from unconscious states
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content_tags.quantities[2]the tagger's words
content_tags0.44 and 0.67 / 0.12 and 0.31 — observed PCI ranges in wakefulness versus in NREM sleep and anaesthesia
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content_tags.quantities[3]the tagger's words
content_tagsabout 20% — share of behaviourally vegetative patients showing an atypical brain activity pattern
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content_tags.quantities[4]the tagger's words
content_tags30 s — duration of each imagery block alternated with rest in the tennis imagery fMRI paradigm
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content_tags.quantities[5]the tagger's words
content_tags7 / 3 of 10 — authors' experience of how many bedside-diagnosed VS/UWS patients show the classical hypometabolic PET pattern versus preserved metabolism
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content_tags.quantities[6]the tagger's words
content_tags>6 — CRS-R total score on admission that acts as a favourable prognostic factor
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content_tags.quantities[7]the tagger's words
content_tagsminimum 5 times — number of repeated CRS-R assessments the authors recommend before a final diagnosis
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content_tags.quantities[8]the tagger's words

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