Conscious processing of narrative stimuli synchronizes heart rate between individuals

Interpersonal Physiological Synchrony During Dyadic Joint Action Is Increased by Task Novelty and Reduced by Social Anxiety

Interpersonal physiological synchrony refers to the temporal coordination of autonomic states during social encounters. Previous studies indicate that physiological synchrony may arise during nonverbal interactions. Nevertheless, the role played by contextual and individual factors in determining its emergence is understudied. In this work, we examined heart rate synchrony during a cooperative joint action task, exploring how task constraints, novelty, and behavioral synchrony influence physiological alignment. To achieve this, we periodically modulated task demands by alternating between peer-to-peer and leader-follower dynamics, as well as between complementary and imitative movements, and their combinations. Additionally, we assessed the role of individual differences by examining the impact of dyad members' Social Anxiety and Perspective Taking levels. We further investigated how task demands and personal traits shape the perceived quality of social interactions and subject-level heart rate variability. Our findings revealed a significant increase in physiological synchrony and a decrease in perceived interaction quality when participants switched to a novel task version (i.e., during switch blocks) compared to task repetition. Task switching was also associated with increased heart rate variability. Notably, Social Anxiety negatively predicted physiological synchrony, suggesting that more socially anxious dyads were less likely to achieve physiological alignment. However, no relationship was observed between physiological synchrony and task performance. Overall, our results suggest that physiological synchrony intensifies when dyads navigate the challenge of learning a novel task together, and that both contextual and individual aspects contribute to its emergence.

Physiological team dynamics explored: physiological synchrony in medical simulation training

INTRODUCTION

For researchers and medical simulation trainers, measuring team dynamics is vital for providing targeted feedback that can lead to improved patient outcomes. It is also valuable for research, such as investigating which dynamics benefit team performance. Traditional assessment methods, such as questionnaires and observations, are often subjective and static, lacking the ability to capture team dynamics. To address these shortcomings, this study explores the use of physiological synchrony (PS) measured through electrocardiogram (ECG) data to evaluate team dynamics automated and in high-resolution.

METHODS

A multicentre observational field study was conducted involving 214 medical first responders during mixed reality (MR) mass casualty training sessions. Participants were equipped with electrocardiogram (ECG) sensors and MR gear. The study measured dyadic PS using heart rate (HR), root mean square of successive differences (RMSSD), and standard deviation of NN intervals (SDNN). Data were collected at high frequency and analysed using dynamic time warping (dtw) to assess fluctuations in PS.

RESULTS

Findings indicate that PS varies significantly by task nature, with higher synchrony during cooperative tasks compared to baseline. Different ECG metrics offered unique insights into team dynamics. Proximity and scenario conditions influenced PS, with closer teamwork leading to higher PS. Smaller sampling intervals (e.g. 5 s) provided a detailed view of PS fluctuations over time.

DISCUSSION

The results demonstrate the potential of PS as an indicator of team performance and cohesion. High-resolution monitoring provides detailed insights into team dynamics, offering high-resolution feedback that traditional methods cannot provide. The integration of physiological measures into training programmes can enhance team performance by providing objective, high-resolution data.

CONCLUSION

This study shows that PS, measured by ECG data, is sensitive to medical team activities, offering insights into team dynamics. Different ECG metrics highlight various aspects of team performance, and high-resolution monitoring captures detailed dynamics. Further research is needed to validate these findings across diverse scenarios. This approach could improve training methodologies, resulting in better-prepared medical teams and improved patient care outcomes.

Where Are They Now: The Narratives of Children Who Lost a Parent on 9/11

There is a paucity of literature examining the experiences of children who lost a parent on 9/11. The primarily quantitative research has not allowed for a deeper understanding of how children who lost a parent on 9/11 make meaning of their experiences, especially in the context of a national tragedy. This study investigates how eight children who were between the ages of 5 and 12 when they lost a parent on 9/11 developed a personal narrative about this loss in the context of the collective narrative about 9/11. Using narrative inquiry, cases demonstrated patterns of narrative development about grief, tragedy, and collective themes of American exceptionalism, patriotism, triumph, and resiliency. These cases highlight de-personalized narratives of grief, tension between the grand narrative provided to them and their personal story of loss, and distance between the reality of their loss and the collective meaning-making of the tragedy. This study extends Bronfenbrenner's (1977) ecological systems theory by highlighting how a lack of bidirectionality between larger social and cultural systems and the individual negatively impacts personal experiences of grief and loss.

Trace: A research media player measuring real-time audience engagement

Measuring attention and engagement is essential for understanding a wide range of psychological phenomena. Advances in technology have made it possible to measure real-time attention to naturalistic stimuli, providing ecologically valid insight into temporal dynamics. We developed a research protocol called Trace, which records anonymous facial landmarks, expressions, and patterns of movement associated with engagement in screen-based media. Trace runs in a standard internet browser and resembles a contemporary media player. It is embedded in the open-source package PsychoJS (the JavaScript sister library of PsychoPy) hosted via Pavlovia, and can be integrated with a wide range of behavioral research methods. Developed over multiple iterations and tested with over 200 participants in three studies, including the official broadcast of a major theatre production, Trace is a powerful, user-friendly protocol allowing behavioral researchers to capture audience attention and engagement in screen-based media as part of authentic, ecologically valid audience experiences.

Audio-visual concert performances synchronize audience's heart rates

People enjoy engaging with music. Live music concerts provide an excellent option to investigate real-world music experiences, and at the same time, use neurophysiological synchrony to assess dynamic engagement. In the current study, we assessed engagement in a live concert setting using synchrony of cardiorespiratory measures, comparing inter-subject, stimulus-response, correlation, and phase coherence. As engagement might be enhanced in a concert setting by seeing musicians perform, we presented audiences with audio-only (AO) and audio-visual (AV) piano performances. Only correlation synchrony measures were above chance level. In comparing time-averaged synchrony across conditions, AV performances evoked a higher inter-subject correlation of heart rate (ISC-HR). However, synchrony averaged across music pieces did not correspond to self-reported engagement. On the other hand, time-resolved analyses show that synchronized deceleration-acceleration heart rate (HR) patterns, typical of an "orienting response" (an index of directed attention), occurred within music pieces at salient events of section boundaries. That is, seeing musicians perform heightened audience engagement at structurally important moments in Western classical music. Overall, we could show that multisensory information shapes dynamic engagement. By comparing different synchrony measures, we further highlight the advantages of time series analysis, specifically ISC-HR, as a robust measure of holistic musical listening experiences in naturalistic concert settings.

Playing Kioku Reduces Loneliness in Older Adults: A Pilot Study

Introduction: Playing together increases social connectedness, and it may be a tool to reduce loneliness. Research into the mental health benefits of board games is underdeveloped. Objectives: The study aims to examine the effects of the Kioku board game on well-being outcomes. The Kioku board game was developed in order to enable small group interactions with a focus on encouraging participants to create stories through mutual attention and interaction. We hypothesized that following a weekly intervention for 12 weeks, players would report a decrease in loneliness and an increase in well-being, compared with nonplayers. Methods: During the summer of 2022, participants in groups of 4-5 players, chose a cube word and narrated a story. A sample of 151 older adults (Mean age = 75.05 ± 6.46 years) recruited from seven community activity centers in Israel was assigned by block randomization to an intervention (n = 72) or a control group (n = 79), awaiting 4-6 weeks for future participation. Loneliness (UCLA loneliness scale) and well-being (World Health Organization 5-item scale) were evaluated at baseline and at 12 weeks. Results: A two-way repeated measures analysis of covariance (ANCOVA) (Group × Time) controlling for age, country of origin, and marital status revealed significant interaction effects for loneliness [F(1, 146) = 178.04, n2 = 0.549, P < 0.001] and well-being [F(1, 146) = 69.14, n2 = 0.321, P < 0.001]. Loneliness decreased in the intervention group (mean difference: 0.62 points, P < 0.001), and increased in the control group (mean difference: 0.18 points, P = 0.001). Well-being increased in the intervention group (mean difference: 0.79 points, P < 0.001) and decreased in the control group (mean difference: 0.20 points, P < 0.001). Conclusions: Our findings support the effectiveness of the Kioku board game intervention for decreasing loneliness and promoting well-being in older adults, who might still be coping with the effects of the COVID-19 pandemic.

Narrative predicts cardiac synchrony in audiences

Audio-visual media possesses a remarkable ability to synchronise audiences' neural, behavioural, and physiological responses. This synchronisation is considered to reflect some dimension of collective attention or engagement with the stimulus. But what is it about these stimuli that drives such strong engagement? There are several properties of media stimuli which may lead to synchronous audience response: from low-level audio-visual features, to the story itself. Here, we present a study which separates low-level features from narrative by presenting participants with the same content but in separate modalities. In this way, the presentations shared no low-level features, but participants experienced the same narrative. We show that synchrony in participants' heart rate can be driven by the narrative information alone. We computed both visual and auditory perceptual saliency for the content and found that narrative was approximately 10 times as predictive of heart rate as low-level saliency, but that low-level audio-visual saliency has a small additive effect towards heart rate. Further, heart rate synchrony was related to a separate cohorts' continuous ratings of immersion, and that synchrony is likely to be higher at moments of increased narrative importance. Our findings demonstrate that high-level narrative dominates in the alignment of physiology across viewers.

Using Wearables to Study Biopsychosocial Dynamics in Couples Who Cope With a Chronic Health Condition: Ambulatory Assessment Study

BACKGROUND

Technology has become an integral part of our everyday life, and its use to manage and study health is no exception. Romantic partners play a critical role in managing chronic health conditions as they tend to be a primary source of support.

OBJECTIVE

This study tests the feasibility of using commercial wearables to monitor couples' unique way of communicating and supporting each other and documents the physiological correlates of interpersonal dynamics (ie, heart rate linkage).

METHODS

We analyzed 617 audio recordings of 5-minute duration (384 with concurrent heart rate data) and 527 brief self-reports collected from 11 couples in which 1 partner had type II diabetes during the course of their typical daily lives. Audio data were coded by trained raters for social support. The extent to which heart rate fluctuations were linked among couples was quantified using cross-correlations. Random-intercept multilevel models explored whether cross-correlations might differ by social contexts and exchanges.

RESULTS

Sixty percent of audio recordings captured speech between partners and partners reported personal contact with each other in 75% of self-reports. Based on the coding, social support was found in 6% of recordings, whereas at least 1 partner self-reported social support about half the time (53%). Couples, on average, showed small to moderate interconnections in their heart rate fluctuations (r=0.04-0.22). Couples also varied in the extent to which there was lagged linkage, that is, meaning that changes in one partner's heart rate tended to precede changes in the other partner's heart rate. Exploratory analyses showed that heart rate linkage was stronger (1) in rater-coded partner conversations (vs moments of no rater-coded partner conversations: rdiff=0.13; P=.03), (2) when partners self-reported interpersonal contact (vs moments of no self-reported interpersonal contact: rdiff=0.20; P<.001), and (3) when partners self-reported social support exchanges (vs moments of no self-reported social support exchange: rdiff=0.15; P=.004).

CONCLUSIONS

Our study provides initial evidence for the utility of using wearables to collect biopsychosocial data in couples managing a chronic health condition in daily life. Specifically, heart rate linkage might play a role in fostering chronic disease management as a couple. Insights from collecting such data could inform future technology interventions to promote healthy lifestyle engagement and adaptive chronic disease management.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/13685.

Reliability for music-induced heart rate synchronization

Common inputs synchronize various biological systems, including human physical and cognitive processes. This mechanism potentially explains collective human emotions in theater as unintentional behavioral synchronization. However, the inter-subject correlation of physiological signals among individuals is small. Based on findings on the common-input synchronization of nonlinear systems, we hypothesized that individual differences in perceptual and cognitive systems reduce the reliability of physiological responses to aesthetic stimuli and, thus, disturb synchronization. We tested this by comparing the inter- and intra-subject Pearson's correlation coefficients and nonlinear phase synchronization, calculated using instantaneous heart rate data measured while appreciating music. The results demonstrated that inter-subject correlations were consistently lower than intra-subject correlations, regardless of participants' music preferences and daily moods. Further, music-induced heart rate synchronization depends on the reliability of physiological responses to musical pieces rather than mood or motivation. This study lays the foundation for future empirical research on collective emotions in theater.

A practical guide to EEG hyperscanning in joint action research: from motivation to implementation

Developments in cognitive neuroscience have led to the emergence of hyperscanning, the simultaneous measurement of brain activity from multiple people. Hyperscanning is useful for investigating social cognition, including joint action, because of its ability to capture neural processes that occur within and between people as they coordinate actions toward a shared goal. Here, we provide a practical guide for researchers considering using hyperscanning to study joint action and seeking to avoid frequently raised concerns from hyperscanning skeptics. We focus specifically on Electroencephalography (EEG) hyperscanning, which is widely available and optimally suited for capturing fine-grained temporal dynamics of action coordination. Our guidelines cover questions that are likely to arise when planning a hyperscanning project, ranging from whether hyperscanning is appropriate for answering one's research questions to considerations for study design, dependent variable selection, data analysis and visualization. By following clear guidelines that facilitate careful consideration of the theoretical implications of research design choices and other methodological decisions, joint action researchers can mitigate interpretability issues and maximize the benefits of hyperscanning paradigms.

Bidirectional brain-body interactions during natural story listening

Narratives can synchronize neural and physiological signals between individuals, but the relationship between these signals, and the underlying mechanism, is unclear. We hypothesized a top-down effect of cognition on arousal and predicted that auditory narratives will drive not only brain signals but also peripheral physiological signals. We find that auditory narratives entrained gaze variation, saccade initiation, pupil size, and heart rate. This is consistent with a top-down effect of cognition on autonomic function. We also hypothesized a bottom-up effect, whereby autonomic physiology affects arousal. Controlled breathing affected pupil size, and heart rate was entrained by controlled saccades. Additionally, fluctuations in heart rate preceded fluctuations of pupil size and brain signals. Gaze variation, pupil size, and heart rate were all associated with anterior-central brain signals. Together, these results suggest bidirectional causal effects between peripheral autonomic function and central brain circuits involved in the control of arousal.

Aberrant brain-heart coupling is associated with the severity of post cardiac arrest brain injury

OBJECTIVE

To investigate autonomic nervous system activity measured by brain-heart interactions in comatose patients after cardiac arrest in relation to the severity and prognosis of hypoxic-ischemic brain injury.

METHODS

Strength and complexity of bidirectional interactions between EEG frequency bands (delta, theta, and alpha) and ECG heart rate variability frequency bands (low frequency, LF and high frequency, HF) were computed using a synthetic data generation model. Primary outcome was the severity of brain injury, assessed by (i) standardized qualitative EEG classification, (ii) somatosensory evoked potentials (N20), and (iii) neuron-specific enolase levels. Secondary outcome was the 3-month neurological status, assessed by the Cerebral Performance Category score [good (1-2) vs. poor outcome (3-4-5)].

RESULTS

Between January 2007 and July 2021, 181 patients were admitted to ICU for a resuscitated cardiac arrest. Poor neurological outcome was observed in 134 patients (74%). Qualitative EEG patterns suggesting high severity were associated with decreased LF/HF. Severity of EEG changes were proportional to higher absolute values of brain-to-heart coupling strength (p < 0.02 for all brain-to-heart frequencies) and lower values of alpha-to-HF complexity (p = 0.049). Brain-to-heart coupling strength was significantly higher in patients with bilateral absent N20 and correlated with neuron-specific enolase levels at Day 3. This aberrant brain-to-heart coupling (increased strength and decreased complexity) was also associated with 3-month poor neurological outcome.

INTERPRETATION

Our results suggest that autonomic dysfunctions may well represent hypoxic-ischemic brain injury post cardiac arrest pathophysiology. These results open avenues for integrative monitoring of autonomic functioning in critical care patients.

Interpersonal eye-tracking reveals the dynamics of interacting minds

The human eye is a rich source of information about where, when, and how we attend. Our gaze paths indicate where and what captures our attention, while changes in pupil size can signal surprise, revealing our expectations. Similarly, the pattern of our blinks suggests levels of alertness and when our attention shifts between external engagement and internal thought. During interactions with others, these cues reveal how we coordinate and share our mental states. To leverage these insights effectively, we need accurate, timely methods to observe these cues as they naturally unfold. Advances in eye-tracking technology now enable real-time observation of these cues, shedding light on mutual cognitive processes that foster shared understanding, collaborative thought, and social connection. This brief review highlights these advances and the new opportunities they present for future research.

Cardio-audio synchronization elicits neural and cardiac surprise responses in human wakefulness and sleep

The human brain can encode auditory regularities with fixed sound-to-sound intervals and with sound onsets locked to cardiac inputs. Here, we investigated auditory and cardio-audio regularity encoding during sleep, when bodily and environmental stimulus processing may be altered. Using electroencephalography and electrocardiography in healthy volunteers (N = 26) during wakefulness and sleep, we measured the response to unexpected sound omissions within three regularity conditions: synchronous, where sound and heartbeat are temporally coupled, isochronous, with fixed sound-to-sound intervals, and a control condition without regularity. Cardio-audio regularity encoding manifested as a heartbeat deceleration upon omissions across vigilance states. The synchronous and isochronous sequences induced a modulation of the omission-evoked neural response in wakefulness and N2 sleep, the former accompanied by background oscillatory activity reorganization. The violation of cardio-audio and auditory regularity elicits cardiac and neural responses across vigilance states, laying the ground for similar investigations in altered consciousness states such as coma and anaesthesia.

The interacting partner as the immediate environment: Personality, interpersonal dynamics, and bodily synchronization

OBJECTIVE

In social interactions, humans tend to naturally synchronize their body movements. We investigated interpersonal synchronization in conversations and examined its relationship with personality differences and post-interaction appraisals.

METHOD

In a 15-minute semi-structured conversation, 56 previously-unfamiliar dyads introduced themselves, followed by self-disclosing and argumentative conversations. Their bodily movements were video-recorded in a standardized room (112 young adults, aged 18-33, mean = 20.54, SD = 2.74; 58% Dutch, 31% German, 11% other). Interpersonal bodily synchronization was estimated as (a) synchronization strength using Windowed Lagged Cross-Correlations and (b) Dynamic Organization (Determinism/Entropy/Laminarity/Mean Line) using Cross-Recurrence Quantification Analysis. Bodily synchronization was associated with differences in Agreeableness and Extraversion (IPIP-NEO-120) and post-conversational appraisals (affect/closeness/enjoyment) in mixed-effect models.

RESULTS

Agreeable participants exhibited higher complexity in bodily synchronization dynamics (higher Entropy) than disagreeable individuals, who also reported more negative affect afterward. Interpersonal synchronization was stronger among extroverts than among introverts and extroverts appraised conversations as more positive and enjoyable. Bodily synchronization strength and dynamic organization were related to the type of conversation (self-disclosing/argumentative).

CONCLUSIONS

Interpersonal dynamics were intimately connected to differences in Agreeableness and Extraversion, varied across situations, and these parameters affected how pleasant, close, and enjoyable each conversation felt.

Searching for the Metaverse: Neuroscience of Physical and Digital Communities

What distinguishes real-world communities from their online counterparts? Social and cognitive neuroscience research on social networks and collective intentionality will be used in the article to answer this question. Physical communities are born in places. And places engage "we-mode" neurobiological and cognitive processes as behavioral synchrony, shared attention, deliberate attunement, interbrain synchronization, and so on, which create coherent social networks of very different individuals who are supported by a "wisdom of crowd." Digital technologies remove physical boundaries, giving people more freedom to choose their activities and groups. At the same time, however, the lack of physical co-presence of community members significantly reduces their possibility of activating "we-mode" cognitive processes and social motivation. Because of this, unlike physical communities that allow interaction between people from varied origins and stories, digital communities are always made up of people who have the same interests and knowledge (communities of practice). This new situation disrupts the "wisdom of crowd," making the community more radical and less accurate (polarization effect), allowing influential users to wield disproportionate influence over the group's beliefs, and producing inequalities in the distribution of social capital. However, a new emergent technology-the Metaverse-has the potential to reverse this trend. Several studies have revealed that virtual and augmented reality-the major technologies underlying the Metaverse-can engage the same neurobiological and cognitive "we-mode" processes as real-world environments. If the many flaws in this technology are fixed, it might encourage people to engage in more meaningful and constructive interactions in online communities.

Do we all synch alike? Brain-body-environment interactions in ASD

Autism Spectrum Disorder (ASD) is characterized by rigidity of routines and restricted interests, and atypical social communication and interaction. Recent evidence for altered synchronization of neuro-oscillatory brain activity with regularities in the environment and of altered peripheral nervous system function in ASD present promising novel directions for studying pathophysiology and its relationship to ASD clinical phenotype. Human cognition and action are significantly influenced by physiological rhythmic processes that are generated by both the central nervous system (CNS) and the autonomic nervous system (ANS). Normally, perception occurs in a dynamic context, where brain oscillations and autonomic signals synchronize with external events to optimally receive temporally predictable rhythmic information, leading to improved performance. The recent findings on the time-sensitive coupling between the brain and the periphery in effective perception and successful social interactions in typically developed highlight studying the interactions within the brain-body-environment triad as a critical direction in the study of ASD. Here we offer a novel perspective of autism as a case where the temporal dynamics of brain-body-environment coupling is impaired. We present evidence from the literature to support the idea that in autism the nervous system fails to operate in an adaptive manner to synchronize with temporally predictable events in the environment to optimize perception and behavior. This framework could potentially lead to novel biomarkers of hallmark deficits in ASD such as cognitive rigidity and altered social interaction.

Psychophysiological reactions during the trauma-film paradigm and their predictive value for intrusions

Background: Adequate adaptation of the autonomic nervous system (ANS) is crucial in potentially life-threatening situations. The defence cascade provides a descriptive model of progressing dominant physiological reactions in such situations, including cardiovascular parameters and body mobility. The empirical evidence for this model is scarce, and the influence of physiological reactions in this model for predicting trauma-induced intrusions is unresolved.Objectives: Using a trauma-film paradigm, we aimed to test physiological reactions to a highly stressful film as an analogue to a traumatic event along the defence cascade model. We also aimed to examine the predictive power of physiological activity for subsequent intrusive symptoms.Method: Forty-seven healthy female participants watched a stressful and a neutral film in randomized order. Heart rate (HR), heart rate variability (HRV), and body sway were measured. Participants tracked frequency, distress, and quality of subsequent intrusions in a diary for 7 consecutive days.Results: For the stressful film, we observed an initial decrease in HR, followed by an increase, before the HR stabilized at a high level, which was not found during the neutral film. No differences in HRV were observed between the two films. Body sway and trembling frequency were heightened during the stressful film. Neither HR nor HRV predicted subsequent intrusions, whereas perceived distress during the stressful film did.Conclusions: Our results suggest that the physiological trauma-analogue response is characterized by an orientation response and subsequent hyperarousal, reaching a high physiological plateau. In contrast to the assumptions of the defence cascade model, the hyperarousal was not followed by downregulation. Potential explanations are discussed. For trauma-associated intrusions in the subsequent week, psychological distress during the film seems to be more important than physiological distress. Understanding the interaction between physiological and psychological responses during threat informs the study of ANS imbalances in mental disorders such as post-traumatic stress disorder.

Examining the consistency of continuous affect annotations and psychophysiological measures in response to emotional videos

Despite the growing necessity of understanding the dynamics of emotion by naturalistic stimuli, averaging time-locked responses seems insufficient to capture emotional experiences that change over time. Intersubject correlation (ISC) has been implemented to examine dynamic emotional experiences by quantifying the consistency of responses across individuals. While previous research has shown that enhanced psychophysiological ISC can capture dynamic emotional experiences in response to long-lasting videos that evoke dimensional emotions, it is not yet fully understood how psychophysiological consistency varies during videos that elicit distinct emotions, such as fear. In this study, we re-analyzed publicly available data consisting of continuous affect annotations and psychophysiological signals, namely heart rate (HR), electrodermal activity (EDA), electromyographic signals from zygomaticus major (EMG-z), and corrugator supercilii (EMG-c), in response to categorical emotional videos, namely amusing, boring, relaxing, and fearful. Results showed an overall increase in ISC in multiple measures during fearful videos, indicating that emotional experiences during fearful videos were reliably consistent across participants. The effect of amusing and boring videos on ISC revealed varying results depending on the measurements. In particular, larger ISC in valence rating, EDA, and EMG-z was found for amusing than boring videos, whereas larger ISC in HR and EMG-c was observed for boring than amusing movies. Lastly, decreased ISC for relaxing videos was observed across multiple measurements, showing inconsistent emotional experiences during relaxing videos. This study builds on previous research on physiological consistency during emotional experiences by examining how the consistency of continuous affect annotations and psychophysiological measures differs in response to videos that elicit distinct emotions.

Conscious processing of global and local auditory irregularities causes differentiated heartbeat-evoked responses

Recent research suggests that brain-heart interactions are associated with perceptual and self-consciousness. In this line, the neural responses to visceral inputs have been hypothesized to play a leading role in shaping our subjective experience. This study aims to investigate whether the contextual processing of auditory irregularities modulates both direct neuronal responses to the auditory stimuli (ERPs) and the neural responses to heartbeats, as measured with heartbeat-evoked responses (HERs). HERs were computed in patients with disorders of consciousness, diagnosed with a minimally conscious state or unresponsive wakefulness syndrome. We tested whether HERs reflect conscious auditory perception, which can potentially provide additional information for the consciousness diagnosis. EEG recordings were taken during the local-global paradigm, which evaluates the capacity of a patient to detect the appearance of auditory irregularities at local (short-term) and global (long-term) levels. The results show that local and global effects produce distinct ERPs and HERs, which can help distinguish between the minimally conscious state and unresponsive wakefulness syndrome patients. Furthermore, we found that ERP and HER responses were not correlated suggesting that independent neuronal mechanisms are behind them. These findings suggest that HER modulations in response to auditory irregularities, especially local irregularities, may be used as a novel neural marker of consciousness and may aid in the bedside diagnosis of disorders of consciousness with a more cost-effective option than neuroimaging methods.

Exploring objective measures for assessing team performance in healthcare: an interview study

Introduction

Effective teamwork plays a critical role in achieving high-performance outcomes in healthcare. Consequently, conducting a comprehensive assessment of team performance is essential for providing meaningful feedback during team trainings and enabling comparisons in scientific studies. However, traditional methods like self-reports or behavior observations have limitations such as susceptibility to bias or being resource consuming. To overcome these limitations and gain a more comprehensive understanding of team processes and performance, the assessment of objective measures, such as physiological parameters, can be valuable. These objective measures can complement traditional methods and provide a more holistic view of team performance. The aim of this study was to explore the potential of the use of objective measures for evaluating team performance for research and training purposes. For this, experts in the field of research and medical simulation training were interviewed to gather their opinions, ideas, and concerns regarding this novel approach.

Methods

A total of 34 medical and research experts participated in this exploratory qualitative study, engaging in semi-structured interviews. During the interview, experts were asked for (a) their opinion on measuring team performance with objective measures, (b) their ideas concerning potential objective measures suitable for measuring team performance of healthcare teams, and (c) their concerns regarding the use of objective measures for evaluating team performance. During data analysis responses were categorized per question.

Results

The findings from the 34 interviews revealed a predominantly positive reception of the idea of utilizing objective measures for evaluating team performance. However, the experts reported limited experience in actively incorporating objective measures into their training and research. Nevertheless, they identified various potential objective measures, including acoustical, visual, physiological, and endocrinological measures and a time layer. Concerns were raised regarding feasibility, complexity, cost, and privacy issues associated with the use of objective measures.

Discussion

The study highlights the opportunities and challenges associated with employing objective measures to assess healthcare team performance. It particularly emphasizes the concerns expressed by medical simulation experts and team researchers, providing valuable insights for developers, trainers, researchers, and healthcare professionals involved in the design, planning or utilization of objective measures in team training or research.

The Synergy Zone: Connecting the Mind, Brain, and Heart for the Ideal Classroom Learning Environment

This paper proposes a new perspective on implementing neuroeducation in the classroom. The pandemic exacerbated the mental health issues of faculty and students, creating a mental health crisis that impairs learning. It is important to get our students back in "the zone", both cognitively and emotionally, by creating an ideal learning environment for capturing our students and keeping them-the Synergy Zone. Research that examines the classroom environment often focuses on the foreground-instructors' organizational and instructional aspects and content. However, the emotional climate of the classroom affects student well-being. This emotional climate would ideally exhibit the brain states of engagement, attention, connection, and enjoyment by addressing the mind, brain, and heart. This ideal learning environment would be achieved by combining proposed practices derived from three areas of research: flow theory, brain synchronization, and positive emotion with heart engagement. Each of these enhances the desired brain states in a way that the whole is greater than the sum of the individual parts. I call this the Synergy Zone. A limitation of this proposed model is that implementation of some aspects may be challenging, and professional development resources might be needed. This essay presenting this perspective provides the relevant scientific research and the educational implications of implementation.

It does not need two: Assessing physiological linkage from videos across the valence dimension

The phenomenon of physiological linkage describes similar fluctuations of two individuals' physiology, for example, the cardiac inter-beat interval (IBI). Physiological linkage is a well-documented occurrence in research settings of interacting dyads but the literature on non-interacting dyads, that is, someone watching a video of another person, is sparse. The current study investigated whether physiological linkage, based on IBI, occurs from watching videos where strangers report about personal (neutral, positive, negative non-traumatic, and negative traumatic) experiences. Videos were produced with six individuals and then presented to observers (N = 26). Time-frequency-domain cross-wavelet analyses supplemented by threshold-free cluster enhancement (TFCE; to account for multiple testing) showed significant physiological linkage between the IBI of observers and persons in the videos for 16 out of the 21 tested videos. Although significant physiological linkage also emerged for neutral videos and positive, negative valence videos led to such associations more reliably. This study shows that physiological linkage can be investigated in highly controlled conditions based on video stimuli paving the path for experimental manipulation in future research. Furthermore, due to the provision of information on time and frequency, the use of cross-wavelet analysis is encouraged to learn more about factors modulating physiological linkage. The current study presents the next step toward identifying psychophysiological causal and modulating factors of physiological linkage.

Physiological synchrony and shared flow state in Javanese gamelan: positively associated while improvising, but not for traditional performance

The experience of shared flow refers to the optimal balance between challenge and ability for a given task, resulting from interpersonal action in a group situation. The performance of Javanese gamelan is an ideal setting to investigate shared flow, due to the requirement that all performers on varying instrumental parts work harmoniously, allowing for shared flow and its native equivalent, ngeli. To minimise the disruption of flow, while still measuring it continuously, one way to assess a person's state is by measuring physiological responses of the sympathetic (i.e., fight-or-flight) system, namely heart rate and skin conductance. Flow has been related to physiological signatures, and shared actions in music-making have been related to synchronised physiology. However, to our knowledge, no study yet has directly investigated the links between shared physiology and shared flow. Therefore, this study aimed to assess the associations between flow states, physiological synchrony, and Javanese gamelan playing. Subsequently, we tested for differences between advanced and beginner groups playing traditional gamelan pieces and improvising. Firstly, a factor analysis revealed a two-factor solution of Awareness and Absorption for self-reported shared flow. Next, using inter-subject correlation to assess synchrony and circular shuffling to infer significance, we found a greater proportion of significance in traditional playing compared to improvised playing for the experienced group, and the opposite for the beginner group. Lastly, linear mixed models revealed largely positive associations between synchronised physiology and shared flow during improvised playing, and negative associations during traditional playing, regardless of experience levels. This study demonstrates methodological possibilities for the quantitative study of shared flow in music-making contexts, and potential differences in shared flow experience in improvised and traditional, or prescribed, playing.

Multidimensional assessment of heartbeat-evoked responses in disorders of consciousness

Because consciousness does not necessarily translate into overt behaviour, detecting residual consciousness in noncommunicating patients remains a challenge. Bedside diagnostic methods based on EEG are promising and cost-effective alternatives to detect residual consciousness. Recent evidence showed that the cortical activations triggered by each heartbeat, namely, heartbeat-evoked responses (HERs), can detect through machine learning the presence of minimal consciousness and distinguish between overt and covert minimal consciousness. In this study, we explore different markers to characterize HERs to investigate whether different dimensions of the neural responses to heartbeats provide complementary information that is not typically found under standard event-related potential analyses. We evaluated HERs and EEG average non-locked to heartbeats in six types of participants: healthy state, locked-in syndrome, minimally conscious state, vegetative state/unresponsive wakefulness syndrome, comatose and brain-dead patients. We computed a series of markers from HERs that can generally separate the unconscious from the conscious. Our findings indicate that HER variance and HER frontal segregation tend to be higher in the presence of consciousness. These indices, when combined with heart rate variability, have the potential to enhance the differentiation between different levels of awareness. We propose that a multidimensional evaluation of brain-heart interactions could be included in a battery of tests to characterize disorders of consciousness. Our results may motivate further exploration of markers in brain-heart communication for the detection of consciousness at the bedside. The development of diagnostic methods based on brain-heart interactions may be translated into more feasible methods for clinical practice.

Physiological synchrony in electrodermal activity predicts decreased vigilant attention induced by sleep deprivation

Introduction

When multiple individuals are presented with narrative movie or audio clips, their electrodermal activity (EDA) and heart rate show significant similarities. Higher levels of such inter-subject physiological synchrony are related with higher levels of attention toward the narrative, as for instance expressed by more correctly answered questions about the narrative. We here investigate whether physiological synchrony in EDA and heart rate during watching of movie clips predicts performance on a subsequent vigilant attention task among participants exposed to a night of total sleep deprivation.

Methods

We recorded EDA and heart rate of 54 participants during a night of total sleep deprivation. Every hour from 22:00 to 07:00 participants watched a 10-min movie clip during which we computed inter-subject physiological synchrony. Afterwards, they answered questions about the movie and performed the psychomotor vigilance task (PVT) to capture attentional performance.

Results

We replicated findings that inter-subject correlations in EDA and heart rate predicted the number of correct answers on questions about the movie clips. Furthermore, we found that inter-subject correlations in EDA, but not in heart rate, predicted PVT performance. Individuals' mean EDA and heart rate also predicted their PVT performance. For EDA, inter-subject correlations explained more variance of PVT performance than individuals' mean EDA.

Discussion

Together, these findings confirm the association between physiological synchrony and attention. Physiological synchrony in EDA does not only capture the attentional processing during the time that it is determined, but also proves valuable for capturing more general changes in the attentional state of monitored individuals.

Measuring real-time cognitive engagement in remote audiences

Responses to arts and entertainment media offer a valuable window into human behaviour. Many individuals worldwide spend the vast majority of their leisure time engaging with video content at home. However, there are few ways to study engagement and attention in this natural home viewing context. We used motion-tracking of the head via a web-camera to measure real-time cognitive engagement in 132 individuals while they watched 30 min of streamed theatre content at home. Head movement was negatively associated with engagement across a constellation of measures. Individuals who moved less reported feeling more engaged and immersed, evaluated the performance as more engaging, and were more likely to express interest in watching further. Our results demonstrate the value of in-home remote motion tracking as a low-cost, scalable metric of cognitive engagement, which can be used to collect audience behaviour data in a natural setting.

Audience immersion: validating attentional and physiological measures against self-report

When an audience member becomes immersed, their attention shifts towards the media and story, and they allocate cognitive resources to represent events and characters. Here, we investigate whether it is possible to measure immersion using continuous behavioural and physiological measures. Using television and film clips, we validated dual-task reaction times, heart rate, and skin conductance against self-reported narrative engagement. We find that reaction times to a secondary task were strongly positively correlated with self-reported immersion: slower reaction times were indicative of greater immersion, particularly emotional engagement. Synchrony in heart rate across participants was associated with self-reported attentional and emotional engagement with the story, although we found no such relationship with skin conductance. These results establish both dual-task reaction times and heart rate as candidate measures for the real-time, continuous, assessment of audience immersion.

Robustness of Physiological Synchrony in Wearable Electrodermal Activity and Heart Rate as a Measure of Attentional Engagement to Movie Clips

Individuals that pay attention to narrative stimuli show synchronized heart rate (HR) and electrodermal activity (EDA) responses. The degree to which this physiological synchrony occurs is related to attentional engagement. Factors that can influence attention, such as instructions, salience of the narrative stimulus and characteristics of the individual, affect physiological synchrony. The demonstrability of synchrony depends on the amount of data used in the analysis. We investigated how demonstrability of physiological synchrony varies with varying group size and stimulus duration. Thirty participants watched six 10 min movie clips while their HR and EDA were monitored using wearable sensors (Movisens EdaMove 4 and Wahoo Tickr, respectively). We calculated inter-subject correlations as a measure of synchrony. Group size and stimulus duration were varied by using data from subsets of the participants and movie clips in the analysis. We found that for HR, higher synchrony correlated significantly with the number of answers correct for questions about the movie, confirming that physiological synchrony is associated with attention. For both HR and EDA, with increasing amounts of data used, the percentage of participants with significant synchrony increased. Importantly, we found that it did not matter how the amount of data was increased. Increasing the group size or increasing the stimulus duration led to the same results. Initial comparisons with results from other studies suggest that our results do not only apply to our specific set of stimuli and participants. All in all, the current work can act as a guideline for future research, indicating the amount of data minimally needed for robust analysis of synchrony based on inter-subject correlations.

Machine learning in biosignals processing for mental health: A narrative review

Machine Learning (ML) offers unique and powerful tools for mental health practitioners to improve evidence-based psychological interventions and diagnoses. Indeed, by detecting and analyzing different biosignals, it is possible to differentiate between typical and atypical functioning and to achieve a high level of personalization across all phases of mental health care. This narrative review is aimed at presenting a comprehensive overview of how ML algorithms can be used to infer the psychological states from biosignals. After that, key examples of how they can be used in mental health clinical activity and research are illustrated. A description of the biosignals typically used to infer cognitive and emotional correlates (e.g., EEG and ECG), will be provided, alongside their application in Diagnostic Precision Medicine, Affective Computing, and brain-computer Interfaces. The contents will then focus on challenges and research questions related to ML applied to mental health and biosignals analysis, pointing out the advantages and possible drawbacks connected to the widespread application of AI in the medical/mental health fields. The integration of mental health research and ML data science will facilitate the transition to personalized and effective medicine, and, to do so, it is important that researchers from psychological/ medical disciplines/health care professionals and data scientists all share a common background and vision of the current research.

Neural event segmentation of continuous experience in human infants

How infants experience the world is fundamental to understanding their cognition and development. A key principle of adult experience is that, despite receiving continuous sensory input, we perceive this input as discrete events. Here we investigate such event segmentation in infants and how it differs from adults. Research on event cognition in infants often uses simplified tasks in which (adult) experimenters help solve the segmentation problem for infants by defining event boundaries or presenting discrete actions/vignettes. This presupposes which events are experienced by infants and leaves open questions about the principles governing infant segmentation. We take a different, data-driven approach by studying infant event segmentation of continuous input. We collected whole-brain functional MRI (fMRI) data from awake infants (and adults, for comparison) watching a cartoon and used a hidden Markov model to identify event states in the brain. We quantified the existence, timescale, and organization of multiple-event representations across brain regions. The adult brain exhibited a known hierarchical gradient of event timescales, from shorter events in early visual regions to longer events in later visual and associative regions. In contrast, the infant brain represented only longer events, even in early visual regions, with no timescale hierarchy. The boundaries defining these infant events only partially overlapped with boundaries defined from adult brain activity and behavioral judgments. These findings suggest that events are organized differently in infants, with longer timescales and more stable neural patterns, even in sensory regions. This may indicate greater temporal integration and reduced temporal precision during dynamic, naturalistic perception.

Individual variation in the neurophysiological representation of negative emotions in virtual reality is shaped by sociability

Negative emotions play a dominant role in daily human life, and mentalizing and empathy are also basic sociability in social life. However, little is known regards the neurophysiological pattern of negative experiences in immersive environments and how people with different sociabilities respond to the negative emotional stimuli at behavioral and neural levels. The present study investigated the neurophysiological representation of negative affective experiences and whether such variations are associated with one's sociability. To address this question, we examined four types of negative emotions that frequently occurred in real life: angry, anxious, fearful, and helpless. We combined naturalistic neuroimaging under virtual reality, multimodal neurophysiological recording, and behavioral measures. Inter-subject representational similarity analysis was conducted to capture the individual differences in the neurophysiological representations of negative emotional experiences. The behavioral and neurophysiological indices revealed that although the emotion ratings were uniquely different, a similar electroencephalography response pattern across these negative emotions was found over the parieto-occipital electrodes. Furthermore, the neurophysiological representations indeed reflected interpersonal variations regarding mentalizing and empathic abilities. Our findings yielded a common pattern of neurophysiological responses toward different negative affective experiences in VR. Moreover, the current results indicate the potential of taking a sociability perspective for understanding the interpersonal variations in the neurophysiological representation of emotion.

Brain-heart interactions in the neurobiology of consciousness

Recent experimental evidence on patients with disorders of consciousness revealed that observing brain-heart interactions helps to detect residual consciousness, even in patients with absence of behavioral signs of consciousness. Those findings support hypotheses suggesting that visceral activity is involved in the neurobiology of consciousness, and sum to the existing evidence in healthy participants in which the neural responses to heartbeats reveal perceptual and self-consciousness. More evidence obtained through mathematical modeling of physiological dynamics revealed that emotion processing is prompted by an initial modulation from ascending vagal inputs to the brain, followed by sustained bidirectional brain-heart interactions. Those findings support long-lasting hypotheses on the causal role of bodily activity in emotions, feelings, and potentially consciousness. In this paper, the theoretical landscape on the potential role of heartbeats in cognition and consciousness is reviewed, as well as the experimental evidence supporting these hypotheses. I advocate for methodological developments on the estimation of brain-heart interactions to uncover the role of cardiac inputs in the origin, levels, and contents of consciousness. The ongoing evidence depicts interactions further than the cortical responses evoked by each heartbeat, suggesting the potential presence of non-linear, complex, and bidirectional communication between brain and heartbeat dynamics. Further developments on methodologies to analyze brain-heart interactions may contribute to a better understanding of the physiological dynamics involved in homeostatic-allostatic control, cognitive functions, and consciousness.

Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Biobehavioural Synchrony in Musculoskeletal Care

Touch is recognised as crucial for survival, fostering cooperative communication, accelerating recovery, reducing hospital stays, and promoting overall wellness and the therapeutic alliance. In this hypothesis and theory paper, we present an entwined model that combines touch for alignment and active inference to explain how the brain develops "priors" necessary for the health care provider to engage with the patient effectively. We appeal to active inference to explain the empirically integrative neurophysiological and behavioural mechanisms that underwrite synchronous relationships through touch. Specifically, we offer a formal framework for understanding - and explaining - the role of therapeutic touch and hands-on care in developing a therapeutic alliance and synchrony between health care providers and their patients in musculoskeletal care. We first review the crucial importance of therapeutic touch and its clinical role in facilitating the formation of a solid therapeutic alliance and in regulating allostasis. We then consider how touch is used clinically - to promote cooperative communication, demonstrate empathy, overcome uncertainty, and infer the mental states of others - through the lens of active inference. We conclude that touch plays a crucial role in achieving successful clinical outcomes and adapting previous priors to create intertwined beliefs. The ensuing framework may help healthcare providers in the field of musculoskeletal care to use hands-on care to strengthen the therapeutic alliance, minimise prediction errors (a.k.a., free energy), and thereby promote recovery from physical and psychological impairments.

Ear-EEG Measures of Auditory Attention to Continuous Speech

Auditory attention is an important cognitive function used to separate relevant from irrelevant auditory information. However, most findings on attentional selection have been obtained in highly controlled laboratory settings using bulky recording setups and unnaturalistic stimuli. Recent advances in electroencephalography (EEG) facilitate the measurement of brain activity outside the laboratory, and around-the-ear sensors such as the cEEGrid promise unobtrusive acquisition. In parallel, methods such as speech envelope tracking, intersubject correlations and spectral entropy measures emerged which allow us to study attentional effects in the neural processing of natural, continuous auditory scenes. In the current study, we investigated whether these three attentional measures can be reliably obtained when using around-the-ear EEG. To this end, we analyzed the cEEGrid data of 36 participants who attended to one of two simultaneously presented speech streams. Speech envelope tracking results confirmed a reliable identification of the attended speaker from cEEGrid data. The accuracies in identifying the attended speaker increased when fitting the classification model to the individual. Artifact correction of the cEEGrid data with artifact subspace reconstruction did not increase the classification accuracy. Intersubject correlations were higher for those participants attending to the same speech stream than for those attending to different speech streams, replicating previously obtained results with high-density cap-EEG. We also found that spectral entropy decreased over time, possibly reflecting the decrease in the listener's level of attention. Overall, these results support the idea of using ear-EEG measurements to unobtrusively monitor auditory attention to continuous speech. This knowledge may help to develop assistive devices that support listeners separating relevant from irrelevant information in complex auditory environments.

Resonance as a Design Strategy for AI and Social Robots

Resonance, a powerful and pervasive phenomenon, appears to play a major role in human interactions. This article investigates the relationship between the physical mechanism of resonance and the human experience of resonance, and considers possibilities for enhancing the experience of resonance within human-robot interactions. We first introduce resonance as a widespread cultural and scientific metaphor. Then, we review the nature of "sympathetic resonance" as a physical mechanism. Following this introduction, the remainder of the article is organized in two parts. In part one, we review the role of resonance (including synchronization and rhythmic entrainment) in human cognition and social interactions. Then, in part two, we review resonance-related phenomena in robotics and artificial intelligence (AI). These two reviews serve as ground for the introduction of a design strategy and combinatorial design space for shaping resonant interactions with robots and AI. We conclude by posing hypotheses and research questions for future empirical studies and discuss a range of ethical and aesthetic issues associated with resonance in human-robot interactions.

Cognitive processing of a common stimulus synchronizes brains, hearts, and eyes

Neural, physiological, and behavioral signals synchronize between human subjects in a variety of settings. Multiple hypotheses have been proposed to explain this interpersonal synchrony, but there is no clarity under which conditions it arises, for which signals, or whether there is a common underlying mechanism. We hypothesized that cognitive processing of a shared stimulus is the source of synchrony between subjects, measured here as intersubject correlation (ISC). To test this, we presented informative videos to participants in an attentive and distracted condition and subsequently measured information recall. ISC was observed for electro-encephalography, gaze position, pupil size, and heart rate, but not respiration and head movements. The strength of correlation was co-modulated in the different signals, changed with attentional state, and predicted subsequent recall of information presented in the videos. There was robust within-subject coupling between brain, heart, and eyes, but not respiration or head movements. The results suggest that ISC is the result of effective cognitive processing, and thus emerges only for those signals that exhibit a robust brain-body connection. While physiological and behavioral fluctuations may be driven by multiple features of the stimulus, correlation with other individuals is co-modulated by the level of attentional engagement with the stimulus.

Collective Rhythm as an Emergent Property During Human Social Coordination

The literature on social interactions has shown that participants coordinate not only at the behavioral but also at the physiological and neural levels, and that this coordination gives a temporal structure to the individual and social dynamics. However, it has not been fully explored whether such temporal patterns emerge during interpersonal coordination beyond dyads, whether this phenomenon arises from complex cognitive mechanisms or from relatively simple rules of behavior, or which are the sociocultural processes that underlie this phenomenon. We review the evidence for the existence of group-level rhythmic patterns that result from social interactions and argue that the complexity of group dynamics can lead to temporal regularities that cannot be predicted from the individual periodicities: an emergent collective rhythm. Moreover, we use this interpretation of the literature to discuss how taking into account the sociocultural niche in which individuals develop can help explain the seemingly divergent results that have been reported on the social influences and consequences of interpersonal coordination. We make recommendations on further research to test these arguments and their relationship to the feeling of belonging and assimilation experienced during group dynamics.

Unsupervised Clustering of Individuals Sharing Selective Attentional Focus Using Physiological Synchrony

Research on brain signals as indicators of a certain attentional state is moving from laboratory environments to everyday settings. Uncovering the attentional focus of individuals in such settings is challenging because there is usually limited information about real-world events, as well as a lack of data from the real-world context at hand that is correctly labeled with respect to individuals' attentional state. In most approaches, such data is needed to train attention monitoring models. We here investigate whether unsupervised clustering can be combined with physiological synchrony in the electroencephalogram (EEG), electrodermal activity (EDA), and heart rate to automatically identify groups of individuals sharing attentional focus without using knowledge of the sensory stimuli or attentional focus of any of the individuals. We used data from an experiment in which 26 participants listened to an audiobook interspersed with emotional sounds and beeps. Thirteen participants were instructed to focus on the narrative of the audiobook and 13 participants were instructed to focus on the interspersed emotional sounds and beeps. We used a broad range of commonly applied dimensionality reduction ordination techniques-further referred to as mappings-in combination with unsupervised clustering algorithms to identify the two groups of individuals sharing attentional focus based on physiological synchrony. Analyses were performed using the three modalities EEG, EDA, and heart rate separately, and using all possible combinations of these modalities. The best unimodal results were obtained when applying clustering algorithms on physiological synchrony data in EEG, yielding a maximum clustering accuracy of 85%. Even though the use of EDA or heart rate by itself did not lead to accuracies significantly higher than chance level, combining EEG with these measures in a multimodal approach generally resulted in higher classification accuracies than when using only EEG. Additionally, classification results of multimodal data were found to be more consistent across algorithms than unimodal data, making algorithm choice less important. Our finding that unsupervised classification into attentional groups is possible is important to support studies on attentional engagement in everyday settings.

Toward a coherent structuration of disorders of consciousness expertise at a country scale: A proposal for France

Probing consciousness and cognitive abilities in non-communicating patients is one of the most challenging diagnostic issues. A fast growing medical and scientific literature explores the various facets of this challenge, often coined under the generic expression of 'Disorders of Consciousness' (DoC). Crucially, a set of independent converging results demonstrated both (1) the diagnostic and prognostic importance of this expertise, and (2) the need to combine behavioural measures with brain structure and activity data to improve diagnostic and prognostication accuracy as well as potential therapeutic intervention. Thus, probing consciousness in DoC patients appears as a crucial activity rich of human, medical, economic and ethical consequences, but this activity needs to be organized in order to offer this expertise to each concerned patient. More precisely, diagnosis of consciousness differs in difficulty across patients: while a minimal set of data can be sufficient to reach a confident result, some patients need a higher level of expertise that relies on additional behavioural and brain activity and brain structure measures. In order to enable this service on a systematic mode, we present two complementary proposals in the present article. First, we sketch a structuration of DoC expertise at a country-scale, namely France. More precisely, we suggest that a 2-tiers network composed of local (Tier-1) and regional (Tier-2) centers backed by distant electronic databases and algorithmic centers could optimally enable the systematic implementation of DoC expertise in France. Second, we propose to create a national common register of DoC patients in order to better monitor this activity, to improve its performance on the basis of nation-wide collected evidence, and to promote rational decision-making.