phenomenon · claim-type · cross-domain-transfer · mechanism · claim-relation · replication-status · limitation — grounded in the full text| phenomenon | disorders of consciousness— “Significant advances have been made in the behavioral assessment and clinical management of disorders of consciousness (DOC).” | |
| claim-type | method— “In addition, functional neuroimaging paradigms are now available to help assess consciousness levels in this challenging patient population.” | |
| method — evidence | — “The promise of such theoretically based markers is illustrated by recent findings that used a perturbational approach to assess the levels of consciousness.” | |
| transfer | from information theory / algorithmic complexity: the 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— “PCI estimates both the information content and the integration of brain activations through the computation of the normalized Lempel-Ziv complexity (Lempel & Ziv 1976) of the significant EEG spatiotemporal responses to TMS.” | transfers[0] |
| mechanism | 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— “In the case of the brain, the theory predicts that consciousness-supporting networks should present an optimal balance between functional integration and differentiation (Boly et al. 2009).” | mechanisms[0] |
| mechanism | 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— “During non–rapid eye movement sleep (NREM), under general anesthesia (e.g., midazolam), and in VS/UWS patients, TMS typically triggers a stereotypical slow wave that stays local, which indicates a breakdown of effective connectivity (Ferrarelli et al. 2010, Massimini et al. 2005, Rosanova et al. 2012).” | mechanisms[1] |
| mechanism | Preserved cortical backward (top-down) connections generate the larger long-latency evoked components seen in MCS relative to VS/UWS— “The higher amplitude of long latency components in MCS patients as compared with VS/UWS patients could be linked to preserved function in cerebral backward connections (Figure 2f ) (Boly et al. 2011).” | mechanisms[2] |
| qualifies | Ferreira (2007), Manning (2012)— “Legal precedence in several countries has established the right of the medical team to withdraw artificial nutrition and hydration from patients in VS/UWS, but not those in MCS (Ferreira 2007, Manning 2012). Opinions on these end-of-life decisions vary, however, depending not only on the diagnosis of the patient, but also on the profession… | claim_relations[0] |
| contradicts | the assumption that locked-in patients have poor quality of life— “Another ethical concern is the quality of life in chronic DOC patients. This question is difficult to address in the absence of communication with the patient. In this context, it is striking to note, however, that most LIS patients report subjective near-to-normal quality of life (Bruno et al. 2011a).” | claim_relations[1] |
| builds-on | Schnakers et al. (2009)— “Misdiagnosis of unawareness is very frequent (up to 40%) when diagnosis is based solely on clinical consensus, without use of appropriate behavioral scales (Schnakers et al. 2009). The most sensitive scale to differentiate MCS from VS/UWS is, to date, the revised version of the Coma Recovery Scale (CRS-R) (Giacino et al. 2004, Seel et al.… | claim_relations[2] |
| sense | bedside 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— “bedside assessment of consciousness is intrinsically gated by behavioral responsiveness. It is now increasingly more recognized that the absence of observed purposeful behaviors at the bedside cannot be taken as definitive proof of the absence of consciousness” | senses[0] |
| sense | the 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— “Misdiagnosis of unawareness is very frequent (up to 40%) when diagnosis is based solely on clinical consensus, without use of appropriate behavioral scales” | senses[1] |
| sense | the 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— “Thus, validation studies should be performed to ensure that the passive listening of the instruction to perform a task cannot elicit a brain activity pattern similar to the one from a voluntary response” | senses[2] |
| control | a separate experiment run on the same task — held — rules out reflexive activation as the source of the response, and so establishes the task's specificity to conscious responses— “In a separate experiment, this task was controlled for the absence of reflexive activation and, thus, for its specificity to detect only conscious responses (Naci et al. 2013).” | controls[0] |
| control | comparing active against passive conditions, and runs attending to the patient's own name against runs attending to another name — held — rules out a nonreflexive response being mistaken for command-following, and a nonspecific response being mistaken for a targeted one— “The search for a difference between active and passive conditions as well as between runs with attention to the patient’s own name and runs with attention to another name offers a control for both the presence of nonreflexive responses and for specificity.” | controls[1] |
| control | instructing subjects NOT to perform the task and recording what happens — held — rules out activation that would have occurred without any intention to comply - the response is absent when compliance is withheld— “Here again a control experiment shows no response when the subjects are instructed not to do the task.” | controls[2] |
| differs in | Ferreira (2007), Manning (2012) — 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, but also on the profession and the cultural background of the clinicians'. So the same category, on the same patient, does not determine the same decision— “Legal precedence in several countries has established the right of the medical team to withdraw artificial nutrition and hydration from patients in VS/UWS, but not those in MCS (Ferreira 2007, Manning 2012). Opinions on these end-of-life decisions vary, however, depending not only on the diagnosis of the patient, but also on the profession…— “but also on the profession and the cultural background of the clinicians” | claim_relations[0] |
| differs in | the assumption that locked-in patients have poor quality of life — 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 most LIS patients report subjective near-to-normal quality of life'. The inference drawn from outside about a state is contradicted by the only group in that state who can answer— “Another ethical concern is the quality of life in chronic DOC patients. This question is difficult to address in the absence of communication with the patient. In this context, it is striking to note, however, that most LIS patients report subjective near-to-normal quality of life (Bruno et al. 2011a).”— “most LIS patients report subjective near-to-normal quality of life” | claim_relations[1] |
| differs in | Schnakers et al. (2009) — WHICH INSTRUMENT PRODUCED THE DIAGNOSIS. The 40% figure is not a property of the patients: misdiagnosis is that frequent 'when diagnosis is based solely on clinical consensus, without use of appropriate behavioral scales', 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— “Misdiagnosis of unawareness is very frequent (up to 40%) when diagnosis is based solely on clinical consensus, without use of appropriate behavioral scales (Schnakers et al. 2009). The most sensitive scale to differentiate MCS from VS/UWS is, to date, the revised version of the Coma Recovery Scale (CRS-R) (Giacino et al. 2004, Seel et al.…— “when diagnosis is based solely on clinical consensus, without use of appropriate behavioral scales” | claim_relations[2] |
| effect direction | clinical consensus —causes→ Misdiagnosis of unawareness — increases— “Misdiagnosis of unawareness is very frequent (up to 40%) when diagnosis is based solely on clinical… | concept_edges[0] |
| holds when | clinical consensus —causes→ Misdiagnosis of unawareness — when diagnosis rests on clinical consensus alone, without | concept_edges[0] |
| outcome (stated by the tagger, no quotation) | control — held | controls[0] |
| outcome (stated by the tagger, no quotation) | control — held | controls[1] |
| outcome (stated by the tagger, no quotation) | control — held | controls[2] |
| for which use | limitation — 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] |
| for which use | limitation — any quoted misdiagnosis rate for unawareness: up to 40% applies Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[1] |
| for which use | limitation — 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 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[2] |
| for which use | limitation — 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 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[3] |
| replication | untested | |
| limitation | The assessment is gated by behaviour, so absence of response is not proof of absence of consciousness. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[0] |
| limitation | The misdiagnosis rate is given together with the assessment method that produces it. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[1] |
| limitation | A named patient group is misdiagnosed despite preserved awareness. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[2] |
| limitation | The neuroimaging paradigm's validity rests on a control study the authors say is still needed. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[3] |
finding · quantity · variable · definition · key-term — grounded in the full text| finding | Unawareness is misdiagnosed in up to 40% of cases when clinicians rely on consensus impression instead of a standardised behavioural scale. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[0] |
| finding | Only about one in five patients with disorders of consciousness produces a positive response on active command-following neuroimaging paradigms. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[1] |
| finding | A negative result on an active paradigm can never exclude that the patient retains awareness. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[2] |
| finding | The 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. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[3] |
| finding | No conventional neuroimaging technique on its own is adequate to diagnose consciousness in a brain-damaged patient. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[4] |
| finding | Preserved PET metabolism cannot serve as proof of consciousness, since metabolism can be normal or raised during epileptic seizures in which the subject is unconscious. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[5] |
| finding | In NREM sleep, midazolam anaesthesia and vegetative state, TMS triggers a stereotypical local slow wave, indicating a breakdown of effective connectivity. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[6] |
| finding | Neuroimaging and electrophysiology show consistent group differences between MCS and VS/UWS patients. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[7] |
| finding | About 20% of VS/UWS patients show an atypical brain activity pattern. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[8] |
| finding | The contents of consciousness in MCS remain inaccessible because these patients cannot give the reports on which content assessment normally depends. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[9] |
| quantity | up to 40% — rate of misdiagnosed unawareness when standardised behavioural scales are not used Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[0] |
| quantity | about 20% — share of DOC patients who respond positively to active command-following paradigms Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[1] |
| quantity | 0.31 — PCI threshold separating conscious from unconscious states Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[2] |
| quantity | 0.44 and 0.67 / 0.12 and 0.31 — observed PCI ranges in wakefulness versus in NREM sleep and anaesthesia Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[3] |
| quantity | about 20% — share of behaviourally vegetative patients showing an atypical brain activity pattern Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[4] |
| quantity | 30 s — duration of each imagery block alternated with rest in the tennis imagery fMRI paradigm Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[5] |
| quantity | 7 / 3 of 10 — authors' experience of how many bedside-diagnosed VS/UWS patients show the classical hypometabolic PET pattern versus preserved metabolism Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[6] |
| quantity | >6 — CRS-R total score on admission that acts as a favourable prognostic factor Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[7] |
| quantity | minimum 5 times — number of repeated CRS-R assessments the authors recommend before a final diagnosis Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[8] |
| definition | unresponsive wakefulness syndrome Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[0] |
| definition | minimally conscious state (MCS) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[1] |
| definition | disorders of consciousness (DOC) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[2] |
| definition | locked-in syndrome (LIS) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[3] |
| definition | active paradigm Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[4] |
| definition | passive paradigm Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[5] |
| definition | Coma Recovery Scale-Revised (CRS-R) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[6] |
| definition | default mode network (DMN) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[7] |
| definition | coma Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[8] |
| definition | perturbational complexity index (PCI) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[9] |
| definition | mismatch negativity (MMN) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[10] |
| definition | transcranial magnetic stimulation (TMS) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[11] |
| definition | positron emission tomography (PET) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[12] |
| concept | behavioral responsiveness Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[0] |
| concept | purposeful behaviors Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[1] |
| concept | Misdiagnosis of unawareness Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[2] |
| concept | clinical consensus Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[3] |
| concept | locked-in syndrome Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[4] |
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