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Recovery of consciousness after traumatic brain injury (TBI) is heterogeneous and difficult to predict. Structures such as the thalamus and prefrontal cortex are thought to be important in facilitating consciousness. We sought to investigate whether the integrity of thalamo-prefrontal circuits, assessed via diffusion tensor imaging (DTI), was associated with the return of goal-directed behavior after severe TBI. We classified a cohort of severe TBI patients ( N = 25, 20 males) into Early and Late/Never outcome groups based on their ability to follow commands within 30 days post-injury. We assessed connectivity between whole thalamus, and mediodorsal thalamus (MD), to prefrontal cortex (PFC) subregions including dorsolateral PFC (dlPFC), medial PFC (mPFC), anterior cingulate (ACC), and orbitofrontal (OFC) cortices. We found that the integrity of thalamic projections to PFC subregions (L OFC, L and R ACC, and R mPFC) was significantly associated with Early command-following. This association persisted when the analysis was restricted to prefrontal-mediodorsal (MD) thalamus connectivity. In contrast, dlPFC connectivity to thalamus was not significantly associated with command-following. Using the integrity of thalamo-prefrontal connections, we created a linear regression model that demonstrated 72% accuracy in predicting command-following after a leave-one-out analysis. Together, these data support a role for thalamo-prefrontal connectivity in the return of goal-directed behavior following TBI. 

Abstract The relative significance of various geodynamic mechanisms that drive supercontinent breakup is unclear. A previous analysis of extensional stress during supercontinent breakup demonstrated the importance of the plume‐push force relative to the dragging force of subduction retreat. Here, we extend the analysis to basal traction (shear stress) and cross‐lithosphere integrations of both extensional and shear stresses, aiming to understand more clearly the relevant importance of these mechanisms in supercontinent breakup. More importantly, we evaluate the effect of preexisting orogens (mobile belts) in the lithosphere on supercontinent breakup process. Our analysis suggests that a homogeneous supercontinent has extensional stress of 20–50 MPa in its interior (<40° from the central point). When orogens are introduced, the extensional stress in the continents focuses on the top 80‐km of the lithosphere with an average magnitude of ~160 MPa, whereas at the margin of the supercontinent the extensional stress is 5–50 MPa. In both homogeneous and orogeny‐embedded cases, the subsupercontinent mantle upwellings act as the controlling factor on the normal stress field in the supercontinent interior. Compared with the extensional stress, shear stress at the bottom of the supercontinent is 1–2 order of magnitude smaller (0–5 MPa). In our two end‐member models, the breakup of a supercontinent with orogens can be achieved after the first extensional stress surge, whereas for a hypothetical supercontinent without orogens it starts with more diffused local thinning of the continental lithospheric before the breakup, suggesting that weak orogens play a critical role in the dispersal of supercontinents.