The objective of project A (Clinical) is to apply new technology toward obtaining a continous functional neurologic assessment of afferent and efferent pathways of the comatose patient utilizing non-invasive methods. These techniques will be employed to test the hypothesis that under pathologic conditions the response of the CNS to rapid stimulation will provide a sensitive measure of synaptic impairment to accomplish this aim, we will employ sensory and non-invasive magnetic motor stimulation to determine the sensitivity and specificity of the NS response to pseudorandom stimulation trains in head injured patients. Data obtained from a proposed laboratory study using animals (Part B) will assist us in developing strategies for application of magnetic stimulation of motor pathways in head injured patients. A second cond objective is to apply novel methods employing artificial intelligence techniques to automatically grade the evoked response. This will extend our development of fully automated methods for acquiring, processing, grading and displaying the results of these measures continously in an ICU setting. The information derived from these measures can then be used as diagnostic tools, available in real time, to provide a non-invasive measure of functional CNS integrity for optimizing therapeutic management of the severely head injured, comatose patient.
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