{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T19:38:26Z","timestamp":1771529906315,"version":"3.50.1"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":324,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Identifying wilful brain activity in patients with disorders of consciousness is critical, as some patients fail to exhibit behavioural signs of consciousness at the bedside but respond to active tasks via neuroimaging or electrophysiological measures. Standardized terminology for this subgroup is absent while it is essential for advancing research and clinical care. The objective of this study was to determine the level of consensus among a large group of international experts on terminology and definitions for this clinical entity, as described by terms such as covert awareness, cognitive motor dissociation, functional locked-in syndrome, and non-behavioural minimally conscious state. A Delphi study was conducted using REDCap to evaluate expert agreement on terminology and definitions. The study was conducted among international experts, primarily from Europe\/UK, the USA and other regions. Ninety-six experts participated. Among these, 75 (78%) completed both rounds. Participants were predominantly clinical scientists (71%) working in rehabilitation settings (63%). A Delphi method was followed. Consensus on terminology and related definitions was defined as a median score of 5, an interquartile range \u22641 and \u226575% agreement (scores of 4 or 5). Within two rounds, consensus was achieved for over two-thirds of the statements. The term \u2018Covert Awareness\u2019 and its associated definition were identified as the preferred terminology by an international expert panel. We recommend the use of \u2018Covert Awareness\u2019 since our large group of international experts consistently agreed on such preferred term for this subgroup of patients with disorders of consciousness. This consensus (&amp;gt;75% agreement) establishes a foundation both for future research and clinical standardization. The findings have implications for improving diagnostic accuracy and advancing understanding of covert awareness, although further study is needed to refine and apply the agreed-upon definition in clinical practice.<\/jats:p>","DOI":"10.1093\/braincomms\/fcaf462","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T13:36:11Z","timestamp":1763645771000},"source":"Crossref","is-referenced-by-count":1,"title":["Consensus on covert awareness: a Delphi study"],"prefix":"10.1093","volume":"7","author":[{"given":"Caroline","family":"Schnakers","sequence":"first","affiliation":[{"name":"Casa Colina Hospital and Centers for Healthcare Research Institute, , Pomona, CA 91767 ,","place":["USA"]}]},{"given":"Berno","family":"Overbeek","sequence":"additional","affiliation":[{"name":"Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation , Nijmegen, 6525 GA ,","place":["The Netherlands"]},{"name":"Department of Rehabilitation, Azora , Terborg, 7061 AP ,","place":["The Netherlands"]}]},{"given":"Niko","family":"Fullmer","sequence":"additional","affiliation":[{"name":"Casa Colina Hospital and Centers for Healthcare Research Institute, , Pomona, CA 91767 ,","place":["USA"]}]},{"given":"Liliana","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Center for Translational Health and Medical Biotechnology Research (TBIO)\/Health Research Network (RISE-Health), Polytechnic Institute of Porto, School of Health , 4200-465 Porto ,","place":["Portugal"]}]},{"given":"Matteo","family":"Zandalasini","sequence":"additional","affiliation":[{"name":"Dipartimento di Medicina Riabilitativa, Azienda USL di Piacenza, Unit\u00e0 Spinale, Neuroriabilitazione e Medicina Riabilitativa Intensiva , 29121 Piacenza ,","place":["Italy"]}]},{"given":"Kseniia","family":"Yatsko","sequence":"additional","affiliation":[{"name":"Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University , 119991 Moscow ,","place":["Russia"]}]},{"given":"Ann-Marie","family":"Morrissey","sequence":"additional","affiliation":[{"name":"School of Allied Health, Health Research Institute, Ageing Research Centre, University of Limerick , Limerick, V94T9PX ,","place":["Ireland"]}]},{"given":"Nathan","family":"Zasler","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University , Richmond, VA 23284 ,","place":["USA"]}]},{"given":"Anna","family":"Estraneo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Don Gnocchi Foundation IRCCS , 50143 Florence ,","place":["Italy"]}]}],"member":"286","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"issue":"10","key":"2025120211462581100_fcaf462-B1","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1080\/14737175.2020.1796641","article-title":"Update on diagnosis in disorders of consciousness","volume":"20","author":"Schnakers","year":"2020","journal-title":"Expert Rev Neurother"},{"issue":"5792","key":"2025120211462581100_fcaf462-B2","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1126\/science.1130197","article-title":"Detecting awareness in the vegetative state","volume":"313","author":"Owen","year":"2006","journal-title":"Science"},{"issue":"7","key":"2025120211462581100_fcaf462-B3","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1056\/NEJMoa0905370","article-title":"Willful modulation of brain activity in disorders of consciousness","volume":"362","author":"Monti","year":"2010","journal-title":"N Engl J Med"},{"issue":"5","key":"2025120211462581100_fcaf462-B4","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1136\/jnnp-2015-310958","article-title":"Preserved consciousness in vegetative and minimal conscious states: Systematic review and meta-analysis","volume":"87","author":"Kondziella","year":"2016","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"12","key":"2025120211462581100_fcaf462-B5","doi-asserted-by":"crossref","first-page":"930","DOI":"10.3390\/brainsci10120930","article-title":"Covert cognition in disorders of consciousness: A meta-analysis","volume":"10","author":"Schnakers","year":"2020","journal-title":"Brain Sci"},{"issue":"7","key":"2025120211462581100_fcaf462-B6","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1056\/NEJMoa2400645","article-title":"Cognitive motor dissociation in disorders of consciousness","volume":"391","author":"Bodien","year":"2024","journal-title":"N Engl J Med"},{"issue":"10","key":"2025120211462581100_fcaf462-B7","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1212\/WNL.0000000000005928","article-title":"Comprehensive systematic review update summary: Disorders of consciousness: Report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research","volume":"91","author":"Giacino","year":"2018","journal-title":"Neurology"},{"issue":"5","key":"2025120211462581100_fcaf462-B8","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1111\/ene.14151","article-title":"European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness","volume":"27","author":"Kondziella","year":"2020","journal-title":"Eur J Neurol"},{"key":"2025120211462581100_fcaf462-B9","doi-asserted-by":"crossref","first-page":"971315","DOI":"10.3389\/fnhum.2022.971315","article-title":"What names for covert awareness? 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