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Awareness Detection and Communication in Disorders of Consciousness

Primary Purpose

Disorder of Consciousness, Paralysis, Motor Neuron Disease

Status
Recruiting
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Motor imagery based EEG-BCI
Sponsored by
University of Ulster
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Disorder of Consciousness

Eligibility Criteria

10 Years - 80 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Study 1 - Initial assessment/screening

Inclusion Criteria:

  • Disorder of consciousness or low awareness state diagnosis ranging from unclear diagnosis in low awareness states, vegetative state and minimally conscious diagnosis. Those with locked in syndrome / completed locked in syndrome resulting from injury or disease e.g., motor neuron disease who do not have health problems that would preclude them from participating may be assessed but considered as a separate cohort to those with low awareness states.
  • acute, post-acute patients where appropriate

Exclusion Criteria:

  • Participants with brain related diseases or illnesses (e.g., progressive neurological condition or uncontrolled epilepsy) or suffer from pain (these may adversely affect the brain data produced) and are deemed to be unsuitable for the trials by clinical teams.
  • Current consumption of medications that cause excessive fatigue or adversely affect cognitive functioning
  • Where English is not the individual's first language
  • Participant with excessive uncontrollable arm or head movement or teeth grinding as EEG signal quality will be degraded significantly.

Study 2 - BCI training

Inclusion Criteria:

- Those identified in study 1 to have a level of awareness based on observed appropriate brain activations and/or those who have known awareness but are target groups for movement independent assistive devices and technologies controlled using a brain-computer interface.

Exclusion Criteria:

- Participants who have shown no active brain responses in study 1 where the difference between baseline

Sites / Locations

  • National Rehabilitation Hospital of Ireland
  • Castel Froma Neuro CareRecruiting
  • Northern Health and Social Care TrustRecruiting
  • Barnsley Hospital NHS Foundation TrustRecruiting
  • Belfast Health and Social Care TrustRecruiting
  • Frenchay Brain Injury Rehabilitation CentreRecruiting
  • NHS LothianRecruiting
  • Hull University Teaching Hospitals NHS TrustRecruiting
  • The Walton Centre NHS Foundation TrustRecruiting
  • Western Health and Social Care TrustRecruiting
  • The Huntercombe GroupRecruiting
  • Royal Hospital for Neuro-DisabilityRecruiting
  • Imperial College Healthcare NHS TrustRecruiting
  • Oxford University Hospitals NHS Foundation TrustRecruiting
  • Southern Health and Social Care TrustRecruiting
  • Sheffield Teaching Hospitals NHS Foundation TrustRecruiting
  • South Warwickshire NHS Foundation TrustRecruiting
  • Inspire Neurocare WorcesterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Motor imagery based Brain computer interfacing

Arm Description

Brief assessment of motor imagery in response to command, auditory feedback training and responding to binary yes-no closed questions through Electroencephalography based Brain-computer interfacing.

Outcomes

Primary Outcome Measures

Change in performance accuracy of BCI use pre- and post- training
The main primary outcome measure is BCI performance (e.g., accuracy in % for repeated binary choice selections using the BCI e.g., movement free control of cursor towards one of two targets using EEG-based BCI or accuracy in discriminating different brain responses associated with imagined movement of different limbs. Multiple cross validation will be performed to assess the significance of the difference between a baseline accuracy (pre cue- where accuracy in the response is expected to be around 50% (chance level)) and the peak accuracy (where the accuracy of discriminating event related brain response peaks following the cue).
Change in ability to use imagined movements to consistently communicate yes-no responses to closed questions over multiple sessions by participant with Prolonged Disorder of Consciousness
Accuracy rate when using the BCI system to provide known responses to statements will be used to build evidence to establish that participants could use the technology as an aided communication method. Examples of questions are given below. Yes Questions: Your name is David. You are 25 years old.

Secondary Outcome Measures

Diagnostic utility of BCI data provided through study completion to clinicians
The performance accuracy of the participant in producing consistent cue- induced imagined movements appropriately in timed paradigms will be assessed across sessions, to determine variability and consistency in performance accuracy. The affects of real-time feedback will be looked at, alongside differences in performance accuracy across question subcategories. Performance accuracy per question subcategory will be assessed to evaluate awareness of self versus awareness of environment and understanding of numbers and letters, and logic. Whether this information is in line with the patient's current diagnosis/CRS-R and WHIM scores will be assessed in order to further understand whether the technology can aid feedback/interpretation on assessment outcomes from consultants?
Changes in Wessex Head Injury Matrix and Coma Recovery Scale Scores due to potential therapeutic benefit of engaging in motor imagery
Is there a benefit to intentionally modulating motor cortex regions in response to a command in a timed paradigm over multiple sessions. In participants with a Prolonged Disorder of Consciousness the scores for The Wessex Head Injury Matrix and Coma-Recovery Scale Revised taken at each session will be looked at to seek out therapeutic benefit. Here therapeutic benefit is defined in terms of changes in state of arousal and awareness of self/environment. Therapeutic benefit may also be assessed via performance given as an accuracy percentage of motor imagery trials successfully completed, and how this changes over time.
Change in performance accuracy as a factor of whether feedback was presented as music or broadband noise,
Is there a significant difference in performance as a function of type of feedback participant was receiving - music clips or broadband noise.
Changes in performance accuracy as a results of time of day of research experimentation
Arousability varies with time of day - is this reflected in BCI use performance or do some patients perform more optimally at a particular time? The aim is to perform 5 sessions in the morning and 5 in the afternoon to look at the affects of time of day.

Full Information

First Posted
September 5, 2018
Last Updated
June 28, 2023
Sponsor
University of Ulster
Collaborators
National Rehabilitation Hospital, Ireland, Belfast Health and Social Care Trust, Western Health and Social Care Trust, Southern Health and Social Care Trust, Northern Health and Social Care Trust, Barnsley Hospital NHS Foundation Trust, NHS Lothian, Walton Centre NHS Foundation Trust, Hull University Teaching Hospitals NHS Trust, Imperial College Healthcare NHS Trust, Royal Hospital for Neuro-disability, South Warwickshire NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Oxford University Hospitals NHS Trust, Castel Froma Neuro Care, Inspire Neurocare, The Huntercombe Group, Active Care Group
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1. Study Identification

Unique Protocol Identification Number
NCT03827187
Brief Title
Awareness Detection and Communication in Disorders of Consciousness
Official Title
EEG Based Awareness Detection and Communication in Prolonged Disorders of Consciousness and Physical Disability
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 8, 2022 (Actual)
Primary Completion Date
August 2026 (Anticipated)
Study Completion Date
August 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Ulster
Collaborators
National Rehabilitation Hospital, Ireland, Belfast Health and Social Care Trust, Western Health and Social Care Trust, Southern Health and Social Care Trust, Northern Health and Social Care Trust, Barnsley Hospital NHS Foundation Trust, NHS Lothian, Walton Centre NHS Foundation Trust, Hull University Teaching Hospitals NHS Trust, Imperial College Healthcare NHS Trust, Royal Hospital for Neuro-disability, South Warwickshire NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Oxford University Hospitals NHS Trust, Castel Froma Neuro Care, Inspire Neurocare, The Huntercombe Group, Active Care Group

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
STUDY OVERVIEW Brain injury can result in a loss of consciousness or awareness, to varying degrees. Some injuries are mild and cause relatively minor changes in consciousness. However, in severe cases a person can be left in a state where they are "awake" but unaware, which is called unresponsive wakefulness syndrome (UWS, previously known as a vegetative state). Up to 43% of patients with a UWS diagnosis, regain some conscious awareness, and are then reclassified as minimally conscious after further assessment by clinical experts. Many of those in the minimally conscious state (MCS) and all with unresponsive wakefulness syndrome (UWS) are incapable of providing any, or consistent, overt motor responses and therefore, in some cases, existing measures of consciousness are not able to provide an accurate assessment. Furthermore, patients with locked-in syndrome (LIS), which is not a disorder of consciousness as patients are wholly aware, also, struggle to produce overt motor responses due to paralysis and anarthria, leading to long delays in accurate diagnoses using current measures to determine levels of consciousness and awareness. There is evidence that LIS patients, and a subset of patients with prolonged disorders of consciousness (DoC), can imagine movement (such as imagining lifting a heavy weight with their right arm) when given instructions presented either auditorily or visually - and the pattern of brain activity that they produce when imagining these movements, can be recorded using a method known as electroencephalography (or EEG). With these findings, the investigators have gathered evidence that EEG-based bedside detection of conscious awareness is possible using Brain- Computer Interface (BCI) technology - whereby a computer programme translates information from the users EEG-recorded patterns of activity, to computer commands that allow the user to interact via a user interface. The BCI system for the current study employs three possible imagined movement combinations for a two-class movement classification; left- vs right-arm, right-arm vs feet, and left-arm vs feet. Participants are trained, using real-time feedback on their performance, to use one of these combinations of imagined movement to respond to 'yes' or 'no' answer questions in the Q&A sessions, by imagining one movement for 'yes' and the other for 'no'. A single combination of movements is chosen for each participant at the outset, and this participant-specific combination is used throughout their sessions. The study comprises three phases. The assessment Phase I (sessions 1-2) is to determine if the patient can imagine movements and produce detectable modulation in sensorimotor rhythms and thus is responding to instructions. Phase II (sessions 3-6) involves motor-imagery (MI) -BCI training with neurofeedback to facilitate learning of brain activity modulation; Phase III (sessions 7-10) assesses patients' MI-BCI response to closed questions, categorized to assess biographical, numerical, logical, and situational awareness. The present study augments the evidence of the efficacy for EEG-based BCI technology as an objective movement-independent diagnostic tool for the assessment of, and distinction between, PDoC and LIS patients.
Detailed Description
PRINCIPLE RESEARCH QUESTIONS The project will address a number key principal research questions largely based on two phases to the study. Phase/study 1 What percentage of disorder of consciousness patients assessed provide evidence of awareness using EEG-based BCI technology? How does this differ from their clinical diagnosis/prognosis? Does the EEG-based information complement or augment the clinical assessment and diagnosis process? Do any of those participants who are diagnosed as being in a vegetative state (or MCS) show signs of awareness beyond the vegetative state based on the EEG-based detection of awareness protocol? Phase/study 2 Is it possible to train those participants who show clear signs of awareness, as indicated by significant brain activation during the initial assessment in study 1, to produce a more prominent and/or consistent response over a number of training sessions using BCI based training and feedback protocols? Can a subset of the participants use BCI technology to communicate simple responses to questions at the end of the study or is there enough evidence to suggest that with further training over a longer period that the participant may use BCI technology as an alternative or an exclusive communication channel? Does neurotechnology offer any other therapeutic benefits to patients, for example, a means of technology interaction that is movement independent and engaging brain areas otherwise not engaged? SECONDARY RESEARCH Q UESTIONS Does the technology aid feedback/interpretation on assessment outcomes from consultants? How might the experiment provide an opportunity for training others in the deployment of the technology in a clinical setting? What types of BCI methods of feedback are best auditory/visual or both, musical or broadband noise, games or applications etc?

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Disorder of Consciousness, Paralysis, Motor Neuron Disease, Stroke, Physical Disability

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Motor imagery based Brain computer interfacing
Arm Type
Experimental
Arm Description
Brief assessment of motor imagery in response to command, auditory feedback training and responding to binary yes-no closed questions through Electroencephalography based Brain-computer interfacing.
Intervention Type
Other
Intervention Name(s)
Motor imagery based EEG-BCI
Intervention Description
Information gathered in this study may be useful when considering diagnosis of prolonged disorder of consciousness and successful adoption of device could lead to assistive communication intervention with therapeutic benefits. Participants undergo quick assessment to test ability to engage in task, if successful this implies they are minimally conscious, have some awareness of self and memory intact to remember commands. During training participant undergoes multiple sessions whereby they are conducting two different imagined movements to move a sound across the azimuthal plane in a direction dictated by an auditory cue. Participant will receive auditory feedback on the position of the sound which acts as a reflection of how well the participant is engaged in the task in terms of performance and consistency across trials. The participant will move on to use the imagined movements to answer a series of biographical, situational, basic logic and numbers/letters questions.
Primary Outcome Measure Information:
Title
Change in performance accuracy of BCI use pre- and post- training
Description
The main primary outcome measure is BCI performance (e.g., accuracy in % for repeated binary choice selections using the BCI e.g., movement free control of cursor towards one of two targets using EEG-based BCI or accuracy in discriminating different brain responses associated with imagined movement of different limbs. Multiple cross validation will be performed to assess the significance of the difference between a baseline accuracy (pre cue- where accuracy in the response is expected to be around 50% (chance level)) and the peak accuracy (where the accuracy of discriminating event related brain response peaks following the cue).
Time Frame
~10 sessions of ~1.5 hours
Title
Change in ability to use imagined movements to consistently communicate yes-no responses to closed questions over multiple sessions by participant with Prolonged Disorder of Consciousness
Description
Accuracy rate when using the BCI system to provide known responses to statements will be used to build evidence to establish that participants could use the technology as an aided communication method. Examples of questions are given below. Yes Questions: Your name is David. You are 25 years old.
Time Frame
3-4 sessions of ~1.5 hours
Secondary Outcome Measure Information:
Title
Diagnostic utility of BCI data provided through study completion to clinicians
Description
The performance accuracy of the participant in producing consistent cue- induced imagined movements appropriately in timed paradigms will be assessed across sessions, to determine variability and consistency in performance accuracy. The affects of real-time feedback will be looked at, alongside differences in performance accuracy across question subcategories. Performance accuracy per question subcategory will be assessed to evaluate awareness of self versus awareness of environment and understanding of numbers and letters, and logic. Whether this information is in line with the patient's current diagnosis/CRS-R and WHIM scores will be assessed in order to further understand whether the technology can aid feedback/interpretation on assessment outcomes from consultants?
Time Frame
2 - 7 weeks. Duration of study which lasts 10 sessions of ~1.5 hours in addition to some time for analysis/reporting of results
Title
Changes in Wessex Head Injury Matrix and Coma Recovery Scale Scores due to potential therapeutic benefit of engaging in motor imagery
Description
Is there a benefit to intentionally modulating motor cortex regions in response to a command in a timed paradigm over multiple sessions. In participants with a Prolonged Disorder of Consciousness the scores for The Wessex Head Injury Matrix and Coma-Recovery Scale Revised taken at each session will be looked at to seek out therapeutic benefit. Here therapeutic benefit is defined in terms of changes in state of arousal and awareness of self/environment. Therapeutic benefit may also be assessed via performance given as an accuracy percentage of motor imagery trials successfully completed, and how this changes over time.
Time Frame
~10 sessions of ~1.5 hours
Title
Change in performance accuracy as a factor of whether feedback was presented as music or broadband noise,
Description
Is there a significant difference in performance as a function of type of feedback participant was receiving - music clips or broadband noise.
Time Frame
~10 sessions of ~1.5hours
Title
Changes in performance accuracy as a results of time of day of research experimentation
Description
Arousability varies with time of day - is this reflected in BCI use performance or do some patients perform more optimally at a particular time? The aim is to perform 5 sessions in the morning and 5 in the afternoon to look at the affects of time of day.
Time Frame
~10 sessions of ~1.5hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
10 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Study 1 - Initial assessment/screening Inclusion Criteria: Disorder of consciousness or low awareness state diagnosis ranging from unclear diagnosis in low awareness states, vegetative state and minimally conscious diagnosis. Those with locked in syndrome / completed locked in syndrome resulting from injury or disease e.g., motor neuron disease who do not have health problems that would preclude them from participating may be assessed but considered as a separate cohort to those with low awareness states. acute, post-acute patients where appropriate Exclusion Criteria: Participants with brain related diseases or illnesses (e.g., progressive neurological condition or uncontrolled epilepsy) or suffer from pain (these may adversely affect the brain data produced) and are deemed to be unsuitable for the trials by clinical teams. Current consumption of medications that cause excessive fatigue or adversely affect cognitive functioning Where English is not the individual's first language Participant with excessive uncontrollable arm or head movement or teeth grinding as EEG signal quality will be degraded significantly. Study 2 - BCI training Inclusion Criteria: - Those identified in study 1 to have a level of awareness based on observed appropriate brain activations and/or those who have known awareness but are target groups for movement independent assistive devices and technologies controlled using a brain-computer interface. Exclusion Criteria: - Participants who have shown no active brain responses in study 1 where the difference between baseline
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Damien Coyle, PhD
Phone
+44 28 7167 5170
Email
dh.coyle@ulster.ac.uk
First Name & Middle Initial & Last Name or Official Title & Degree
Naomi du Bois, PhD
Phone
+44 28 7167 5321
Email
n.du-bois@ulster.ac.uk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Damien Coyle, PhD
Organizational Affiliation
University of Ulster
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Rehabilitation Hospital of Ireland
City
Dublin
ZIP/Postal Code
A96 E2H2
Country
Ireland
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dr Valerie Twomey
Email
Valerie.Twomey@nrh.ie
Facility Name
Castel Froma Neuro Care
City
Warwick
State/Province
Warwickshire
ZIP/Postal Code
CV32 6LL
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Elizabeth Jackson
Email
elizabeth.jackson@castelfroma.org.uk
First Name & Middle Initial & Last Name & Degree
Damon Hoad
Email
Damon.Hoad@warwick.ac.uk
First Name & Middle Initial & Last Name & Degree
Damon Hoad
Facility Name
Northern Health and Social Care Trust
City
Antrim
ZIP/Postal Code
BT41 2RL
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jacqueline Pogue
Email
jacqueline.pogue@northerntrust.hscni.net
Facility Name
Barnsley Hospital NHS Foundation Trust
City
Barnsley
ZIP/Postal Code
S75 2EP
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Simon Judge, MEng
Email
simon.judge@nhs.net
Facility Name
Belfast Health and Social Care Trust
City
Belfast
ZIP/Postal Code
BT9 7AB
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sheena Caldwell, MB BCh FRCP(UK)
Email
sheena.caldwell@belfasttrust.hscni.net
Facility Name
Frenchay Brain Injury Rehabilitation Centre
City
Bristol
ZIP/Postal Code
BS16 2UU
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Suzanne Moss
Email
Suzanne.Moss@huntercombe.com
Facility Name
NHS Lothian
City
Edinburgh
ZIP/Postal Code
EH9 2HL
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dr Alasdair Fitzgerald
Email
alasdair.fitzgerald@nhslothian.scot.nhs.uk
Facility Name
Hull University Teaching Hospitals NHS Trust
City
Hull
ZIP/Postal Code
HU3 2JZ
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Abayomi Salawu, MBBS, FWACS, FRCSI, PGCME, MSc
Email
abayomi.salawu@nhs.net
Facility Name
The Walton Centre NHS Foundation Trust
City
Liverpool
ZIP/Postal Code
L9 7LJ
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ganesh Bavikatte, MBBS, MD, FRCP(London), FEBPRM
Phone
07816 078 294
Ext
+44
Email
ganesh.bavikatte@thewaltoncentre.nhs.uk
First Name & Middle Initial & Last Name & Degree
Ganesh Bavikatte, MBBS, MD, FRCP(London), FEBPRM
Facility Name
Western Health and Social Care Trust
City
Londonderry
ZIP/Postal Code
BT47 6SB
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dr Paul Johnson
Email
paul.johnson@westerntrust.hscni.net
Facility Name
The Huntercombe Group
City
London
ZIP/Postal Code
SE10 8AD
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Samantha Mcantagart
Email
samantha.mcantagart@huntercombe.com
Facility Name
Royal Hospital for Neuro-Disability
City
London
ZIP/Postal Code
SW15 3SW
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lloyd Bradley, MD
Email
lbradley@rhn.org.uk
Facility Name
Imperial College Healthcare NHS Trust
City
London
ZIP/Postal Code
W6 8RF
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dr Paul Bentley
Email
p.bentley@imperial.ac.uk
Facility Name
Oxford University Hospitals NHS Foundation Trust
City
Oxford
ZIP/Postal Code
OX3 7HE
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Emma Dodds
Email
Emma.Dodds@ouh.nhs.uk
Facility Name
Southern Health and Social Care Trust
City
Portadown
ZIP/Postal Code
BT63 5QQ
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dr Bernadette Salisbury
Email
Bernadette.Salisbury@southerntrust.hscni.ne
Facility Name
Sheffield Teaching Hospitals NHS Foundation Trust
City
Sheffield
ZIP/Postal Code
S10 2JF
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sivaraman Nair, DM, FRCP
Email
siva.nair@nhs.net
Facility Name
South Warwickshire NHS Foundation Trust
City
Warwick
ZIP/Postal Code
CV34 5BW
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dr Damon Hoad
Email
Damon.Hoad@swft.nhs.uk
Facility Name
Inspire Neurocare Worcester
City
Worcester
ZIP/Postal Code
WR2 6AS
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Harriet Miller
Email
Worcester.CL@inspireneurocare.co.uk
First Name & Middle Initial & Last Name & Degree
Damon Hoad
Email
Damon.Hoad@warwick.ac.uk
First Name & Middle Initial & Last Name & Degree
Damon Hoad

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Awareness Detection and Communication in Disorders of Consciousness

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