Challenge Workshop
October 15-19, 2026
Apply here
Director: Christof Koch
Tiny Blue Dot Foundation & Allen Institute, Seattle, USA
Co-Director: Michael J. Young
Massachusetts General Hospital & Harvard Medical School, Boston, USA
Faculty:
Lionel Naccache, Paris Brain Institute, France
Nicholas Schiff, Weill Cornell Medicine, New York, USA
Jan Claassen, Columbia University Irving Medical Center, New York, USA
Benedetta Cecconi, University of Wisconsin – Madison, USA
Caroline Schnakers, Casa Colina, Hospital and Centers for Healthcare, USA
Christof Koch, Tiny Blue Dot Foundation & Allen Institute, Seattle, USA
Michael J. Young, Massachusetts General Hospital & Harvard Medical School, Boston, USA
Over the past decade, it has become clear that a significant number of behaviourally unresponsive patients with disorders of consciousness (DoC) are covertly conscious, as shown by complex and/or voluntary cortical response patterns. The realisation that behaviourally unresponsive patients are not necessarily unconscious changes the way brain-injured and critically ill patients must be assessed and treated, and how families are counselled. This Challenge Workshop will focus on the latest advances in detecting and managing covert consciousness in both ICU and sub-acute settings, supporting functional recovery through pharmacological or neurotechnological interventions, restoring communication via brain-machine interfaces, and navigating ethical implications, such as communication with families and loved ones, implications for withdrawal of life-sustaining therapy (WLST), and controlled donation after circulatory death. The primary audience includes neurologists, intensivists, neuroscientists, allied health professionals, ethicists, and technologists.
Caroline Schnakers
Naming the Unseen: challenges, consensus and ongoing debates
Accurate diagnosis of disorders of consciousness (DoC) remains challenging, as up to 40% of patients are misclassified when relying solely on behaviors. Neuroimaging and electrophysiology have revealed that a subset of individuals diagnosed as behaviorally unresponsive show volitional neural modulation. First demonstrated in 2006 using task-based fMRI, this finding has since been replicated, with recent studies suggesting that such a clinical entity might be present in up to 25% of patients with DoC. However, terminology remains fragmented—over 25 labels exist, including covert awareness (CA), covert consciousness (CA), cognitive-motor dissociation (CMD), and non-behavioral minimally conscious state (MCS*)—hindering communication and comparability across studies. A recent Delphi consensus proposes Covert Awareness as the preferred umbrella term, though its definition and related taxonomy still need refinement. Standardized diagnostic approaches through harmonized task-based EEG/fMRI paradigms, well-defined terminology and taxonomy, and improved interpretation frameworks are now essential. Unified terminology and validated assessment pathways will enhance recognition, research, and care for patients.
Jan Claassen
Covert consciousness in the ICU
Up to one in four patients with severe acute brain injury admitted to an intensive care unit retains cognitive abilities that are not detected by clinical examination. This state, known as covert consciousness, can be rapidly identified at the bedside and may be linked to better long-term outcomes. Incorporating covert consciousness into clinical practice could potentially transform critical care and the management of patients with severe brain injuries.
Emerging technological approaches aim to democratise access to Cognitive Motor Dissociation (CMD) testing, which is currently limited to a few academic centres. CMD testing faces clear limitations, such as reliance on comprehension of verbal commands. This poses a problem for aphasic patients, as diagnosis cannot be easily established in behaviourally unresponsive brain-injured patients. CMD may help identify patients who are more responsive to therapeutic interventions like physical therapy or medication trials. Additionally, brain-computer interfaces are being developed that may provide opportunities to reconnect with patients exhibiting covert consciousness.
Christof Koch
When communication fails – detecting consciousness under difficult conditions
Humans not only act in the world but also experience it, such as the delectable taste of Nutella or the sharp sting of an infected tooth. I will discuss the relationship between consciousness and overt or covert responses, how these can be dissociated, progress achieved over the past decades in locating the footprints of conscious experiences, and in distinguishing the true neural substrate of consciousness from its correlates and enabling factors. Finally, I will introduce the clinical setting in which these scholarly-scientific questions and experiments encounter the bedrock of existential concerns – determining whether behaviorally unresponsive patients are conscious.
Michael J. Young
Translating covert consciousness testing into clinical care
Scientific advances in covert consciousness assessment have outpaced clinical practice. Clinicians face pervasive barriers to accessing testing infrastructure, unsettled norms for when and how to test, how to communicate results, and attendant uncertainty about what evidence of covert consciousness (or lack thereof) obligates us to do for an individual patient. Drawing on recent experiences translating covert consciousness testing into clinical care, alongside semi-structured interviews with families, recovered patients, clinicians, and researchers, I examine opportunities, dilemmas, and desiderata opened by new visibility into the minds of critically ill or injured individuals, including implications for neurorecovery, end-of-life care, clinical trial design, and public communication.