PONE-D-19-26389

Recovery in cognitive motor dissociation after severe brain injury: A cohort study

PLOS ONE

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Reviewer #1: Partly

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: This study addresses important questions regarding prognosis for recovery in patients with severe brain injuries. Specifically, differentiating between patients with potential for recovery from what is otherwise diagnosed as unresponsive wakefulness syndrome is important in terms of both treatment planning and resource management. the article adequately reviews the literature on available diagnostic tools and provides further evidence of construct validity for the motor behavior tool in use with this population. The outcome measurements are standard measures frequently used in rehabilitation settings and were an appropriate choice. I have a few suggestions to consider to improve clarity and address reader's potential questions.

1. It would be helpful to have more information about what is meant by the use of video recordings as described in the method section. Is it the case that measurements were taken via video recording and if so were the assessments being administered at the time of the recording, or was this but together ad hoc afterwards? if the latter, some discussion should be made in the limitation section regarding nonstandardized procedure.

2. it is unclear whether results may be effected by variability in the trajectory of recovery for the non-traumatic brain injury group, given that this group is comprised of ischemic, anoxic, toxic, and tumor-related brain injuries. it may be better to limit analyses instead to TBI versus hemorrhagic patients. alternatively, the potential for different effects in these subgroups should be analyzed, more clearly stated, and/or considered in the conclusion section.

Reviewer #2: This paper provides an initial assessment of the Motor Behavior Tool to distinguish the proposed cognitive motor dissociation patient from DOC patients. If validated, this will have a significant impact on threatment of those patients identified with CMD.

The Motor Behaivor tool is proposed as a method for detecting residual cognition not detected by the CRS-R. This paper documents enhanced functional and cognitive outcomes during early intensive rehabilitation for patient’s presenting with the proposed diagnosis of cognitive motor dissociation. The study demonstrates that CMD patient’s have significantly better functional outcomes than DOC patients. They also found that CMD patients’ recovery was not significantly different than non-DOC patients.

The paper is well written and the raw data is presented in table format. They present a compelling case for CMD.

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Reviewer #1: No

Reviewer #2: No

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Recovery in cognitive motor dissociation after severe brain injury: A cohort study

PONE-D-19-26389R1

Dear Dr. Jöhr,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Jose A. Muñoz-Moreno, Ph.D.

Academic Editor

PLOS ONE