As many as 25% of patients with brain injury who are unresponsive to commands showed signs of cognitive motor dissociation when tested with functional magnetic resonance imaging (fMRI) or electroencephalography (EEG), according to new research. The prospective cohort study, which was conducted at six international centers, used clinical, behavioral, and task-based fMRI and EEG data from a convenience sample of 353 adults with disorders of consciousness. Only 231 patients (65%) had fMRI only or EEG only, and data for both techniques were only available in 122 patients (35%). The patients had a median age of 37.9 years, a median of 7.9 months between brain injury and assessment with the  Coma Recovery Scale–Revised (CRS-R), and 50% had brain trauma as an etiologic factor. For the 241 patients without an observable response to commands, 60 (25%) had a response to commands on task-based fMRI, EEG, or both. Eleven patients had been assessed with fMRI only, 13 using only EEG, and 36 were assessed with both techniques. Factors associated with cognitive motor dissociation include younger age, longer time since injury, and brain trauma as an etiologic factor. For the 112 patients who were diagnosed as having minimally conscious state-plus or who had emerged from the minimally conscious state, 43 (38%) had a response to commands with task-based fMRI, EEG, or both. “Although standardized behavioral evaluation remains the reference standard for detecting a response to commands at the bedside, the use of task-based fMRI and EEG can improve detection, and the use of both imaging techniques appears to be a more sensitive approach than the use of one of the techniques alone,” the researchers write.