Data were collected from a cohort of 169 individuals scanned in four clinical expert centers in Belgium [Department of Radiology, Centre Hospitalier Universitaire (CHU), Liège; n = 87], France (Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris; n = 43), United States (Citigroup Biomedical Imaging Center, Weill Cornell Medical College, New York; n = 28), and Canada (Centre for Functional and Metabolic Mapping, Western’s Robarts Research Institute, London, Ontario; n = 11). The cohort included 47 healthy controls and 122 patients suffering from disorders of consciousness leading to a vegetative state/UWS or in a MCS. Patients in UWS open their eyes but never exhibit nonreflex voluntary movements, indicating preserved awareness (39). Patients in MCS show more complex behaviors potentially declarative of awareness, such as visual pursuit, orientation to pain, or nonsystematic command following but who, nevertheless, remain unable to communicate their thoughts and feelings (40).

Inclusion criteria for patients were brain damage at least 7 days after the acute brain insult and behavioral diagnosis of the MCS or UWS performed with the Coma Recovery Scale–Revised (CRS-R) (41). The CRS-R evaluates 23 arranged items organized on subscales for auditory, visual, motor, oromotor, communication, and arousal function. Each item assesses the presence or absence of specific physical signs, which represent the integrity of brain function as generalized, localized, or cognitively mediated responsiveness. Patients were excluded when there was contraindication for MRI (e.g., the presence of ferromagnetic aneurysm clips and pacemakers). In addition, 10 patients (6 from Paris, 3 from Liège, and 1 from New York; 8 in MCS and 2 in UWS) were discarded because the signal extracted from the selected ROIs was partially missing during the recordings, resulting in the final cohort of 112 patients (table S1). Inclusion criteria for healthy controls were >18 years old and free of psychiatric and neurological history. The study was approved by the Ethics Committee of the Medical School of the University of Liège, the Ethics Committee of the Pitié-Salpêtrière Hospital, the Institutional Review Board at Weill Cornell Medical College, and the Western University Research Ethics Board. Informed consent to participate in the study was obtained directly from healthy control participants and the legal surrogates of the patients.

The cohort was divided into three datasets. Dataset 1 (n = 125) was used for the main analysis, with the aim of identifying the dynamic coordination patterns. It included 47 healthy controls and 78 patients, all scanned under an anesthesia-free resting-state condition [Liège: 21 healthy controls (8 females; mean age, 45 ± 17 years), 40 patients (23 in MCS, 17 in UWS, 11 females; mean age, 47 ± 18 years; 12 traumatic, 28 nontraumatic of which 17 anoxic, 10 patients assessed under acute condition, i.e., <30 days after insult); Paris: 15 healthy controls (9 females; mean age, 41 ± 13 years), 22 patients (9 in MCS, 13 in UWS, 9 females; mean age, 45 ± 17 years; 5 traumatic, 19 nontraumatic of which 12 anoxic, 3 patients assessed in acute setting, i.e., <30 days after insult); New York: 11 healthy controls (3 females; mean age, 32 ± 11 years), 16 patients (10 in MCS, 6 in UWS, 8 females; mean age, 44 ± 14 years; 8 traumatic, 8 nontraumatic of which 4 anoxic, all patients assessed chronic setting, i.e., >30 days after insult)]. Dataset 2 (n = 11) included patients with cognitive-motor dissociation (20), i.e., lacking overt conscious behavior yet evidenced using functional neuroimaging (Ut+), and patients who did not perform the imagery task and hence were considered in UWS (Ut−). This dataset was used to test the hypothesis that the complex coordination pattern would be more frequent in the Ut+ patients, whereas the low coordination pattern would be more frequent in patients in UWS who could not perform the task (Ut−) [London, Ontario: 5 Ut+, 6 Ut−; seven females; mean age, 36 ± 15 years; two traumatic, nine nontraumatic of which eight anoxic, all patients assessed in chronic setting, i.e., >30 days after insult)]. Dataset 3 (n = 23) included patients scanned under propofol anesthesia and was used to test the hypothesis that complex coordination would disappear as an effect of overall cerebral depression due to the administered anesthetic [Liège: 3 emergence from MCS, 14 in MCS, 6 in UWS; 6 females; mean age, 37 ± 14 years; 16 traumatic, 7 nontraumatic of which 3 anoxic, 21 patients assessed in chronic setting, i.e., >30 days after insult)]. Details on patients’ demographics and clinical characteristics are summarized in table S1.

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