Towards modern post-coma care based on neuroscientific evidence

BackgroundUnderstanding the mechanisms underlying human consciousness is pivotal to improve the prognostication and treatment of severely brain-injured patients. Consciousness remains an elusive concept and the identification of its neural correlates is an active subject of research, however recent neuroscientific advances have allowed scientists to better characterize disorders of consciousness. These breakthroughs question the historical nomenclature and our current management of post-comatose patients.MethodThis review examines the contribution of consciousness neurosciences to the current clinical management of severe brain injury. It investigates the major impact of consciousness disorders on healthcare systems, the scientific frameworks employed to identify their neural correlates and how evidence-based data from neuroimaging research have reshaped the landscape of post-coma care in recent years.ResultsOur increased ability to detect behavioral and neurophysiological signatures of consciousness has led to significant changes in taxonomy and clinical practice. We advocate for a multimodal framework for the management of severely brain-injured patients based on precision medicine and evidence-based decisions, integrating epidemiology, health economics and neuroethics.ConclusionsMajor progress in brain imaging and clinical assessment have opened the door to a new era of post-coma care based on standardized neuroscientific evidence. We highlight its implications in clinical applications and call for improved collaborations between researchers and clinicians to better translate findings to the bedside.     

STAGE‐TWO SECULARITY AND THE FUTURE OF THEOLOGY‐AND‐SCIENCE

Charles Taylor has recently provided an in‐depth exploration of secularity, with a central characteristic being the understanding that religious commitment is optional. This essay extends this analysis, considering the possibility that American society may be entering a second stage of secularity, one in which the possibility of religious commitment ceases to be an option at all for many. The possible implications of such a development are considered for the theology‐and‐science dialogue.     

Attentional focus effects on joint covariation in a reaching task

Adopting an external focus of attention (EF) has been found beneficial over internal focus (IF) for performing motor skills. Previous studies primarily examined focus of attention (FOA) effects on performance outcomes (such as error and accuracy), with relatively less emphasis on movement coordination. Given that human movements are kinematically and kinetically abundant (Gefland & Latash, 1998), FOA instructions may change how motor abundance is utilized by the CNS. This study applied the uncontrolled manifold analysis (UCM) to address this question in a reaching task. Healthy young adults (N = 38; 22 ± 1 yr; 7 men, 31 women) performed planar reaching movements to a target using either the dominant or nondominant arm under two different FOA instructions: EF and IF. Reaching was performed without online visual feedback and at a preferred pace. Joint angles of the clavicle-scapula, shoulder, elbow, and wrist were recorded, and their covariation for controlling dowel endpoint position was analyzed via UCM. As expected, IF led to a higher mean radial error than EF, driven by increases in aiming bias and variability. Consistent with this result, the UCM analysis showed that IF led to higher goal-relevant variance among the joints (V_ORT) compared to EF starting from the first 20% of the reach to the end. However, the goal-irrelevant variance (V_UCM)—index of joint variance that does not affect the end-effector position—did not show FOA effects. The index of stability of joint coordination with respect to endpoint position (ΔV) was also not different between the EF and IF. Consistent with the constrained action hypothesis, these results provide evidence that IF disrupted goal-relevant joint covariation starting in the early phases of the reach without affecting goal-irrelevant coordination.