{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:47:52Z","timestamp":1787960872669,"version":"build-2784847793"},"reference-count":44,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Signs of awareness after acute severe brain injury are critical for informing goals\u2010of\u2010care decisions, ranging from the continuation of aggressive life\u2010sustaining therapy to comfort\u2010focused end\u2010of\u2010life measures. However, awareness may go undetected in some critically ill patients when assessed using bedside behavioral neurological examination. Here, we use functional near\u2010infrared spectroscopy to identify covert awareness in acute brain injured patients who are unable to follow behavioral commands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective, consecutive cross\u2010sectional study of 32 critically ill patients\u00a0in a single intensive care unit (ICU). All had acute brain injuries from various causes and lacked behavioral command\u2010following on bedside examination, as determined by using the Coma Recovery Scale\u2010Revised. Using functional near\u2010infrared spectroscopy, an optical bedside neuroimaging technique, we assessed brain activity while patients were instructed to perform a mental imagery task in which a positive response was dependent upon preserved awareness. We referred to this phenomenon as covert awareness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 32 acutely brain injured patients (mean age = 63, \u00b1 12 years, 15 females), 8 (25%) were able to willfully modulate their brain activity when instructed to imagine playing a game of tennis\u2014providing evidence of covert awareness despite no observable behavioral signs that this was the case. We found no association between covert awareness and 3\u2010month functional outcomes using the Glasgow Outcome Scale\u2010Extended.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Functional near\u2010infrared spectroscopy detected preserved consciousness in 25% of patients who lacked behavioral command following\u00a0in an intensive care setting. This finding highlights the need for further research to assess the use of advanced neuroimaging techniques in the clinical assessment of critically ill patients. Such methods could ensure that goals of care decisions are based on a more accurate understanding of a patient's level of awareness. ANN NEUROL 2025;98:1201\u20131209<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ana.78070","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T21:26:52Z","timestamp":1761686812000},"page":"1201-1209","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Detecting Awareness in the Intensive Care Unit Using Functional Near\u2010Infrared Spectroscopy"],"prefix":"10.1002","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6157-601X","authenticated-orcid":false,"given":"Karnig","family":"Kazazian","sequence":"first","affiliation":[{"name":"Western Institute of Neuroscience, Western University  London ON Canada"},{"name":"Department of Physiology and Pharmacology Schulich School of Medicine and Dentistry, Western University  London ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"de Jeu","sequence":"additional","affiliation":[{"name":"Western Institute of Neuroscience, Western University  London ON Canada"},{"name":"Department of Psychology Faculty of Social Science, Western University  London ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Androu","family":"Abdalmalak","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology Schulich School of Medicine and Dentistry, Western University  London ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio L.","family":"Novi","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology Schulich School of Medicine and Dentistry, Western University  London ON Canada"},{"name":"Polytechnic School, Pontifical Catholic University of Campinas (PUC \u2013 Campinas)  Campinas 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