The EyeCon system for communication in patients with a disorder of consciousness: Initial case-based demonstrations of a differentiated positive response

Over the last decades, we have learned that many patients, who are clinically suspected to be unconscious, demonstrate high level brain processing when assessed with functional brain imaging modalities. However, these insights had not been translated into a systematic rehabilitation protocol, which can advance patients with suspected disorders of consciousness (DOC) toward effective communication. There are rehabilitation protocols for DOC with certain efficacy, such as contingent stimulation. However, therapists often lack feedback regarding intervention efficacy, and whether they should adhere to a current intervention or switch to another one. Tools such as fMRI and multichannel EEG may provide valuable feedback, but are too cumbersome for routine use during rehabilitation. We suggest it might be possible to utilize mobile EEG + EMG for useful feedback. The EyeCon system combines this feedback with protocols of contingent stimulation in order to offer a tool for the rehabilitation of communication in DOC patients. In this paper, we suggest only the potential feasibility of the first stage of this feedback reliant rehabilitation - establishment of a differentiated positive response. We do this by case-based multiple baseline demonstrations of typical challenges encountered in the rehabilitation process, and the use of EyeCon to assess possible interventions to address these challenges.