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Murovec N, Heilinger A, Xu R, Ortner R, Spataro R, La Bella V, Miao Y, Jin J, Chatelle C, Laureys S, Allison BZ, Guger C. Effects of a Vibro-Tactile P300 Based Brain-Computer Interface on the Coma Recovery Scale-Revised in Patients With Disorders of Consciousness. Front Neurosci 2020; 14:294. [PMID: 32327970 PMCID: PMC7161577 DOI: 10.3389/fnins.2020.00294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 03/13/2020] [Indexed: 11/22/2022] Open
Abstract
Persons diagnosed with disorders of consciousness (DOC) typically suffer from motor and cognitive disabilities. Recent research has shown that non-invasive brain-computer interface (BCI) technology could help assess these patients' cognitive functions and command following abilities. 20 DOC patients participated in the study and performed 10 vibro-tactile P300 BCI sessions over 10 days with 8-12 runs each day. Vibrotactile tactors were placed on the each patient's left and right wrists and one foot. Patients were instructed, via earbuds, to concentrate and silently count vibrotactile pulses on either their left or right wrist that presented a target stimulus and to ignore the others. Changes of the BCI classification accuracy were investigated over the 10 days. In addition, the Coma Recovery Scale-Revised (CRS-R) score was measured before and after the 10 vibro-tactile P300 sessions. In the first run, 10 patients had a classification accuracy above chance level (>12.5%). In the best run, every patient reached an accuracy ≥60%. The grand average accuracy in the first session for all patients was 40%. In the best session, the grand average accuracy was 88% and the median accuracy across all sessions was 21%. The CRS-R scores compared before and after 10 VT3 sessions for all 20 patients, are showing significant improvement (p = 0.024). Twelve of the twenty patients showed an improvement of 1 to 7 points in the CRS-R score after the VT3 BCI sessions (mean: 2.6). Six patients did not show a change of the CRS-R and two patients showed a decline in the score by 1 point. Every patient achieved at least 60% accuracy at least once, which indicates successful command following. This shows the importance of repeated measures when DOC patients are assessed. The improvement of the CRS-R score after the 10 VT3 sessions is an important issue for future experiments to test the possible therapeutic applications of vibro-tactile and related BCIs with a larger patient group.
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Affiliation(s)
- Nensi Murovec
- g. tec Medical Engineering GmbH, Schiedlberg, Austria
- Guger Technologies OG, Graz, Austria
| | | | - Ren Xu
- Guger Technologies OG, Graz, Austria
| | - Rupert Ortner
- g. tec Medical Engineering Spain S.L., Barcelona, Spain
| | - Rossella Spataro
- g. tec Medical Engineering GmbH, Schiedlberg, Austria
- IRCCS Centro Neurolesi Bonino Pulejo, Palermo, Italy
| | - Vincenzo La Bella
- ALS Clinical Research Center, Bi.N.D., University of Palermo, Palermo, Italy
| | - Yangyang Miao
- Department of Automation, East China University of Science and Technology, Shanghai, China
| | - Jing Jin
- Department of Automation, East China University of Science and Technology, Shanghai, China
| | - Camille Chatelle
- GIGA Consciousness, Coma Science Group, University of Liège, Liège, Belgium
| | - Steven Laureys
- GIGA Consciousness, Coma Science Group, University of Liège, Liège, Belgium
- French Association of Locked-in Syndrome (ALIS), Paris, France
| | - Brendan Z. Allison
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, United States
| | - Christoph Guger
- g. tec Medical Engineering GmbH, Schiedlberg, Austria
- Guger Technologies OG, Graz, Austria
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Olivetti Belardinelli M, Buonocunto F, D'Amico F, Navarro J, Lanzilotti C, Ferlisi G, Denitto F. Technology-aided programs for post-coma patients emerged from or in a minimally conscious state. Front Hum Neurosci 2014; 8:931. [PMID: 25538593 PMCID: PMC4257021 DOI: 10.3389/fnhum.2014.00931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/31/2014] [Indexed: 11/17/2022] Open
Abstract
Post-coma persons in a minimally conscious state (MCS) or emerged/emerging from such state (E-MCS), who are affected by extensive motor impairment and lack of speech, may develop an active role and interact with their environment with the help of technology-aided intervention programs. Although a number of studies have been conducted in this area during the last few years, new evidence about the efficacy of those programs is warranted. These three studies were an effort in that direction. Study I assessed a technology-aided program to enable six MCS participants to access preferred environmental stimulation independently. Studies II and III assessed technology-aided programs to enable six E-MCS participants to make choices. In Study II, three of those participants were led to choose among leisure and social stimuli, and caregiver interventions automatically presented to them. In Study III, the remaining three participants were led to choose (a) among general stimulus/intervention options (e.g., songs, video-recordings of family members, and caregiver interventions); and then (b) among variants of those options. The results of all three studies were largely positive with substantial increases of independent stimulation access for the participants of Study I and independent choice behavior for the participants of Studies II and III. The results were analyzed in relation to previous data and in terms of their implications for daily contexts working with MCS and E-MCS persons affected by multiple disabilities.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari Bari, Italy
| | - Nirbhay N Singh
- Medical College of Georgia, Georgia Regents University Augusta, GA, USA
| | - Mark F O'Reilly
- Department of Special Education, University of Texas at Austin Austin, TX, USA
| | - Jeff Sigafoos
- Department of Educational Psychology, Victoria University of Wellington Wellington, New Zealand
| | | | | | - Fiora D'Amico
- S. Raffaele Rehabilitation and Care Centers Ceglie and Alberobello, Italy
| | - Jorge Navarro
- S. Raffaele Rehabilitation and Care Centers Ceglie and Alberobello, Italy
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Liberati G, Hünefeldt T, Olivetti Belardinelli M. Questioning the dichotomy between vegetative state and minimally conscious state: a review of the statistical evidence. Front Hum Neurosci 2014; 8:865. [PMID: 25404905 PMCID: PMC4217390 DOI: 10.3389/fnhum.2014.00865] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/07/2014] [Indexed: 01/24/2023] Open
Abstract
Given the enormous consequences that the diagnosis of vegetative state (VS) vs. minimally conscious state (MCS) may have for the treatment of patients with disorders of consciousness, it is particularly important to empirically legitimate the distinction between these two discrete levels of consciousness. Therefore, the aim of this contribution is to review all the articles reporting statistical evidence concerning the performance of patients in VS vs. patients in MCS, on behavioral or neurophysiological measures. Twenty-three articles matched these inclusion criteria, and comprised behavioral, electroencephalographic (EEG), positron emission tomography (PET) and magnetic resonance imaging (MRI) measures. The analysis of these articles yielded 47 different statistical findings. More than half of these findings (n = 24) did not reveal any statistically significant difference between VS and MCS. Overall, there was no combination of variables that allowed reliably discriminating between VS and MCS. This pattern of results casts doubt on the empirical validity of the distinction between VS and MCS.
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Affiliation(s)
- Giulia Liberati
- Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
| | - Thomas Hünefeldt
- ECONA - Interuniversity Centre for Research on Cognitive Processing in Natural and Artificial Systems, "Sapienza" University of Rome Rome, Italy ; Department of Philosophy, Catholic University of Eichstätt-Ingolstadt Eichstätt, Germany
| | - Marta Olivetti Belardinelli
- ECONA - Interuniversity Centre for Research on Cognitive Processing in Natural and Artificial Systems, "Sapienza" University of Rome Rome, Italy ; Department of Psychology, Sapienza, University of Rome Rome, Italy
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Pan J, Xie Q, He Y, Wang F, Di H, Laureys S, Yu R, Li Y. Detecting awareness in patients with disorders of consciousness using a hybrid brain-computer interface. J Neural Eng 2014; 11:056007. [PMID: 25082743 DOI: 10.1088/1741-2560/11/5/056007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The bedside detection of potential awareness in patients with disorders of consciousness (DOC) currently relies only on behavioral observations and tests; however, the misdiagnosis rates in this patient group are historically relatively high. In this study, we proposed a visual hybrid brain-computer interface (BCI) combining P300 and steady-state evoked potential (SSVEP) responses to detect awareness in severely brain injured patients. APPROACH Four healthy subjects, seven DOC patients who were in a vegetative state (VS, n = 4) or minimally conscious state (MCS, n = 3), and one locked-in syndrome (LIS) patient attempted a command-following experiment. In each experimental trial, two photos were presented to each patient; one was the patient's own photo, and the other photo was unfamiliar. The patients were instructed to focus on their own or the unfamiliar photos. The BCI system determined which photo the patient focused on with both P300 and SSVEP detections. MAIN RESULTS Four healthy subjects, one of the 4 VS, one of the 3 MCS, and the LIS patient were able to selectively attend to their own or the unfamiliar photos (classification accuracy, 66-100%). Two additional patients (one VS and one MCS) failed to attend the unfamiliar photo (50-52%) but achieved significant accuracies for their own photo (64-68%). All other patients failed to show any significant response to commands (46-55%). SIGNIFICANCE Through the hybrid BCI system, command following was detected in four healthy subjects, two of 7 DOC patients, and one LIS patient. We suggest that the hybrid BCI system could be used as a supportive bedside tool to detect awareness in patients with DOC.
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Affiliation(s)
- Jiahui Pan
- Center for Brain Computer Interfaces and Brain Information Processing, South China University of Technology, Guangzhou 510640, People's Republic of China
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Sulzer J, Haller S, Scharnowski F, Weiskopf N, Birbaumer N, Blefari M, Bruehl A, Cohen L, deCharms R, Gassert R, Goebel R, Herwig U, LaConte S, Linden D, Luft A, Seifritz E, Sitaram R. Real-time fMRI neurofeedback: progress and challenges. Neuroimage 2013; 76:386-99. [PMID: 23541800 PMCID: PMC4878436 DOI: 10.1016/j.neuroimage.2013.03.033] [Citation(s) in RCA: 292] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/14/2013] [Accepted: 03/19/2013] [Indexed: 01/30/2023] Open
Abstract
In February of 2012, the first international conference on real time functional magnetic resonance imaging (rtfMRI) neurofeedback was held at the Swiss Federal Institute of Technology Zurich (ETHZ), Switzerland. This review summarizes progress in the field, introduces current debates, elucidates open questions, and offers viewpoints derived from the conference. The review offers perspectives on study design, scientific and clinical applications, rtfMRI learning mechanisms and future outlook.
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Affiliation(s)
- J. Sulzer
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, (ETH), Zurich CH-8092, Switzerland
| | - S. Haller
- University of Geneva, Geneva University Hospital CH-1211, Switzerland
| | - F. Scharnowski
- Department of Radiology and Medical Informatics - CIBM, University of Geneva, Switzerland
- Institute of Bioengineering, Swiss Institute of Technology Lausanne (EPFL) CH-1015, Switzerland
| | - N. Weiskopf
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, University College London WC1E 6BT, UK
| | - N. Birbaumer
- The Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen 72074, Germany
- Ospedale San Camillo, IRCCS, Venice 30126, Italy
| | - M.L. Blefari
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, (ETH), Zurich CH-8092, Switzerland
| | - A.B. Bruehl
- Department of Psychiatry, Psychotherapy and Psychosomatica, Zürich University Hospital for Psychiatry, Zurich CH-8032, Switzerland
| | - L.G. Cohen
- National Institutes of Health, Bethesda 20892, USA
| | | | - R. Gassert
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology, (ETH), Zurich CH-8092, Switzerland
| | - R. Goebel
- Department of Neurocognition, University of Maastricht 6200, The Netherlands
| | - U. Herwig
- Department of Psychiatry, Psychotherapy and Psychosomatica, Zürich University Hospital for Psychiatry, Zurich CH-8032, Switzerland
- Department of Psychiatry and Psychotherapy III, University of Ulm, Germany
| | - S. LaConte
- Virginia Tech Carilion Research Institute 24016, USA
| | | | - A. Luft
- Department of Neurology, University Hospital Zurich, Switzerland
- University of Zurich CH-8008, Switzerland
| | - E. Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatica, Zürich University Hospital for Psychiatry, Zurich CH-8032, Switzerland
| | - R. Sitaram
- The Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen 72074, Germany
- Department of Biomedical Engineering, University of Florida, Gainesville 32611, USA
- Sri Chitra Tirunal Institute of Medical Science and Technology, Trivandrum, India
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