Background: Recent neuroimaging investigations have explored the use of mental imagery tasks as proxies for an overt motor response, in which patients are asked to imagine performing a task, such as “Imagine yourself swimming.”
Objectives: To detect covert volitional brain activity in patients with severe brain injury using pattern classification of the blood oxygenation level–dependent (BOLD) response during mental imagery and to compare these results with those of a univariate functional magnetic resonance imaging analysis.
Design: Case-control study.
Setting: Academic research.
Participants: Experiments were performed in 8 healthy control subjects and in 5 patients with severe brain injury. The patients with severe brain injury constituted a convenience sample.
Main Outcome Measures: Functional magnetic resonance imaging data were acquired as the patients were asked to follow commands or to answer questions using motor imagery as a proxy response.
Results: In the controls, the responses were accurately classified. In the patient group, the responses of 3 of 5 patients were correctly classified. The remaining 2 patients showed no significant BOLD response in a standard univariate analysis, suggesting that they did not perform the task. In addition, we showed that a classifier trained on command-following data can be used to evaluate a later communication run. This technique was used to successfully disambiguate 2 potential BOLD responses to a single question.
Conclusions: Pattern classification in functional magnetic resonance imaging is a promising technique for advancing the understanding of volitional brain responses in patients with severe brain injury and may serve as a powerful complement to traditional general linear model– based univariate analysis methods.