Assessing receptive aphasia in post-comatose patients: validation of the Brief Evaluation of Receptive Aphasia (BERA) - 25/03/26

Doi : 10.1016/j.rehab.2026.102121

Charlène Aubinet ^1,^2,^3,^⁎ , Amandine Regnier ^1,^2,⁴, Anaïs Gillet ^1,², Pauline Fritz ^1,², Nicolas Lejeune ^1,^2,⁵, Haroun Jedidi ⁶, Didier Ledoux ^1,⁷, Steve Majerus ^3,^{^{#
Both authors contributed equally}}, Olivia Gosseries ^1,^2,^{^{#
Both authors contributed equally}}

¹ Coma Science Group, GIGA-Consciousness, GIGA Institute, University of Liège, Avenue de l’Hôpital 1, 4000 Liège, Belgium

² NeuroRehab & Consciousness Clinic, Neurology Department, University Hospital of Liège, Avenue de l’Hôpital 1, 4000 Liège, Belgium

³ Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora, Place des Orateurs 3 (B33), 4000 Liège, Belgium

⁴ Physical Medicine and Rehabilitation Department, University Hospital of Liège, Rue Champ des Alouettes 30, 4557 Tinlot, Belgium

⁵ William Lennox Neurological Rehabilitation Center, All. de Clerlande 6, 1340 Ottignies-Louvain-la-Neuve, Belgium

⁶ Neurological Rehabilitation, Valdor Hospital (ISoSL), Rue Basse-Wez 145, 4020 Liège, Belgium

⁷ Intensive Care Unit, University Hospital of Liège, Avenue de l’Hôpital 1, 4000 Liège, Belgium

^⁎ Corresponding author: C. AUBINET, CHU de Liège, GIGA Institute (B34, +1), Avenue de l’Hôpital 1, 4000 Liège, Belgium, Telephone number: +32 4 284 36 12 CHU de Liège GIGA Institute (B34, +1), Avenue de l’Hôpital 1 Liège 4000 Belgium

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Abstract

Receptive aphasia can mask residual consciousness in patients recovering from severe acquired brain injury (sABI), leading to diagnostic inaccuracies. The Brief Evaluation of Receptive Aphasia (BERA) is a fast, gaze-based bedside tool designed to assess phonological, semantic, and morphosyntactic comprehension. This cross sectional study provides the first validation of the BERA in 46 post-comatose adults who completed the Simplified Evaluation of Consciousness Disorders (SECONDs) and four repeated BERA assessments. The BERA demonstrated excellent psychometric properties, including high intra- and inter-rater reliability (ICC = 0.890-0.997), strong internal consistency (ICC = 0.904), and strong correlations with SECONDs indices (ρ = 0.693-0.823). BERA scores significantly differed across diagnostic groups, increasing from minimal consciousness to emergence. The BERA reliably detects residual receptive language, minimizes motor demands, and helps distinguish language comprehension deficits from impaired consciousness, thereby improving diagnostic accuracy after coma.

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Keywords : Disorders of consciousness, coma, diagnosis, aphasia, rehabilitation