• Emilia Fló, Daniel Fraiman, and Jacobo Diego Sitt.
• Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Paris, France. emilia.flo.rama@gmail.com.
• Bmc Med. 2025 Feb 6; 23 (1): 6868.

BackgroundIn this study, we evaluated the potential of a network approach to electromyography and electroencephalography recordings to detect covert command-following in healthy participants. The motivation underlying this study was the development of a diagnostic tool that can be applied in common clinical settings to detect awareness in patients that are unable to convey explicit motor or verbal responses, such as patients that suffer from disorders of consciousness (DoC).MethodsWe examined the brain and muscle response during movement and imagined movement of simple motor tasks, as well as during resting state. Brain-muscle networks were obtained using non-negative matrix factorization (NMF) of the coherence spectra for all the channel pairs. For the 15/38 participants who showed motor imagery, as indexed by common spatial filters and linear discriminant analysis, we contrasted the configuration of the networks during imagined movement and resting state at the group level, and subject-level classifiers were implemented using as features the weights of the NMF together with trial-wise power modulations and heart response to classify resting state from motor imagery.ResultsKinesthetic motor imagery produced decreases in the mu-beta band compared to resting state, and a small correlation was found between mu-beta power and the kinesthetic imagery scores of the Movement Imagery Questionnaire-Revised Second version. The full-feature classifiers successfully distinguished between motor imagery and resting state for all participants, and brain-muscle functional networks did not contribute to the overall classification. Nevertheless, heart activity and cortical power were crucial to detect when a participant was mentally rehearsing a movement.ConclusionsOur work highlights the importance of combining EEG and peripheral measurements to detect command-following, which could be important for improving the detection of covert responses consistent with volition in unresponsive patients.© 2025. The Author(s).

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