02630nas a2200289 4500008004100000022001400041245009200055210006900147260001300216300001200229490000700241520171500248100001701963700002201980700001902002700001902021700001802040700002102058700001702079700002302096700001902119700002002138700002402158700001702182700002002199856012102219 2022 eng d a2163-040200aCognitive-Motor Dissociation Following Pediatric Brain Injury: What About the Children?0 aCognitiveMotor Dissociation Following Pediatric Brain Injury Wha c2022 Jun a248-2570 v123 a

BACKGROUND AND OBJECTIVES: Following severe brain injury, up to 16% of adults showing no clinical signs of cognitive function nonetheless have preserved cognitive capacities detectable via neuroimaging and neurophysiology; this has been designated cognitive-motor dissociation (CMD). Pediatric medicine lacks both practice guidelines for identifying covert cognition and epidemiologic data regarding CMD prevalence.

METHODS: We applied a diverse battery of neuroimaging and neurophysiologic tests to evaluate 2 adolescents (aged 15 and 18 years) who had shown no clinical evidence of preserved cognitive function following brain injury at age 9 and 13 years, respectively. Clinical evaluations were consistent with minimally conscious state (minus) and vegetative state, respectively.

RESULTS: Both participants' EEG, and 1 participant's fMRI, provided evidence that they could understand commands and make consistent voluntary decisions to follow them. Both participants' EEG demonstrated larger-than-expected responses to auditory stimuli and intact semantic processing of words in context.

DISCUSSION: These converging lines of evidence lead us to conclude that both participants had preserved cognitive function dissociated from their motor output. Throughout the 5+ years since injury, communication attempts and therapy had remained uninformed by such objective evidence of their cognitive abilities. Proper diagnosis of CMD is an ethical imperative. Children with covert cognition reflect a vulnerable and isolated population; the methods outlined here provide a first step in identifying such persons to advance efforts to alleviate their condition.

1 aKim, Nayoung1 aO'Sullivan, James1 aOlafson, Emily1 aCaliendo, Eric1 aNowak, Sophie1 aVoss, Henning, U1 aLowder, Ryan1 aWatson, William, D1 aIvanidze, Jana1 aFins, Joseph, J1 aSchiff, Nicholas, D1 aHill, Jeremy1 aShah, Sudhin, A uhttps://www.neurotechcenter.org/publications/2022/cognitive-motor-dissociation-following-pediatric-brain-injury-what02884nas a2200217 4500008004100000022001400041245008200055210006900137260001200206300001200218490000700230520217300237100001702410700002002427700001902447700001802466700002402484700002002508700001702528856012102545 2022 eng d a2163-040200aObjective Neurophysiologic Markers of Cognition After Pediatric Brain Injury.0 aObjective Neurophysiologic Markers of Cognition After Pediatric  c10/2022 a352-3640 v123 a

BACKGROUND AND OBJECTIVES: Following brain injury, clinical assessments of residual and emerging cognitive function are difficult and fraught with errors. In adults, recent American Academy of Neurology (AAN) practice guidelines recommend objective neuroimaging and neurophysiologic measures to support diagnosis. Equivalent measures are lacking in pediatrics-an especially great challenge due to the combined heterogeneity of both brain injury and pediatric development. Therefore, we aim to establish quantitative, clinically practicable measures of cognitive function following pediatric brain injury.

METHODS: Participants with and without brain injury were aged 8-18 years, clinically classified according to cognitive recovery state: N = 8 in disorders of consciousness (DoC), N = 7 in confusional state, N = 19 cognitively impaired, and N = 13 typically developing uninjured controls. We prospectively measured electroencephalographic markers of sensory processing and attention in an auditory oddball paradigm, and of covert movement attempts in a command-following paradigm.

RESULTS: In 3 participants with DoC, EEG markers of active attempted command following revealed cognitive function that clinical assessment had failed to detect. These same 3 individuals could also be distinguished from the rest of their group by 2 event-related potentials that correlate with sensory processing and orienting attention in the oddball paradigm. Considered across the whole participant group, magnitudes of these 2 ERP markers significantly increased as cognitive recovery progressed (ANOVA: each < 0.001); viewed jointly, the 2 ERP markers cleanly delineated the 4 cognitive states.

DISCUSSION: Despite heterogeneity of brain injuries and brain development, our objective EEG markers reflected cognitive recovery independent of motor function. Two of these markers required no active participation. Together, they allowed us to identify 3 individuals who meet the criteria for cognitive-motor dissociation. To diagnose, prognose, and track cognitive recovery accurately, such markers should be used in pediatrics.

1 aKim, Nayoung1 aWatson, William1 aCaliendo, Eric1 aNowak, Sophie1 aSchiff, Nicholas, D1 aShah, Sudhin, A1 aHill, Jeremy uhttps://www.neurotechcenter.org/publications/2022/objective-neurophysiologic-markers-cognition-after-pediatric-brain