Bedside patient engagement monitor for rehabilitation in disorders of consciousness–demonstrative case-reports

Aim: A chronic disorder of consciousness (DOC) is a devastating condition for the patients and their families. Achieving improved communication with patients in this state is of utmost importance. Over recent years we have seen some progress in the development of rehabilitation protocols for patients with DOC by which the patient’s limited actions impact the environment (e.g. activate music) based on the principle of contingent stimulation. However, one of the major factors, which hinders further progress, is the limited overt responsiveness of the patient, which poses a severe limitation on the ability of the therapists to evaluate whether specific interventions have an impact. In this work, we harness a novel electrophysiological marker the Brain Engagement Index (BEI), which enables simple monitoring of patient’s engagement during interventions, intending to overcome this limitation. Methods: We combine the BEI marker with the contingent stimulation principle, to propose a 4-levels protocol for advancing communication with DOC patients. Results: The potential of the evolving protocol is demonstrated with 4 representative case reports. Each case report demonstrates one level of the protocol. Conclusions: The protocol seems to be both feasible and effective for better clarification of the communication abilities of DOC patients. We recommend its continued evaluation employing a more structured study.IMPLICATIONS FOR REHABILITATION We suggest a systematic method for rehabilitation of patients with disorders of consciousness It is based upon monitoring patient engagement in real-time and selecting interventions accordingly.