Usability and Workload of Access Technology for People With Severe Motor Impairment

Eye did this! Sense of agency in eye movements

This study investigates the sense of agency (SoA) for saccades with implicit and explicit agency measures. In two eye tracking experiments, participants moved their eyes towards on-screen stimuli that subsequently changed color. Participants then either reproduced the temporal interval between saccade and color-change (Experiment 1) or reported the time points of these events with an auditory Libet clock (Experiment 2) to measure temporal binding effects as implicit indices of SoA. Participants were either made to believe to exert control over the color change or not (agency manipulation). Explicit ratings indicated that the manipulation of causal beliefs and hence agency was successful. However, temporal binding was only evident for caused effects, and only when a sufficiently sensitive procedure was used (auditory Libet clock). This suggests a feebler connection between temporal binding and SoA than previously proposed. The results also provide evidence for a relatively fast acquisition of sense of agency for previously never experienced types of action-effect associations. This indicates that the underlying processes of action control may be rooted in more intricate and adaptable cognitive models than previously thought. Oculomotor SoA as addressed in the present study presumably represents an important cognitive foundation of gaze-based social interaction (social sense of agency) or gaze-based human-machine interaction scenarios. PUBLIC SIGNIFICANCE STATEMENT: In this study, sense of agency for eye movements in the non-social domain is investigated in detail, using both explicit and implicit measures. Therefore, it offers novel and specific insights into comprehending sense of agency concerning effects induced by eye movements, as well as broader insights into agency pertaining to entirely newly acquired types of action-effect associations. Oculomotor sense of agency presumably represents an important cognitive foundation of gaze-based social interaction (social agency) or gaze-based human-machine interaction scenarios. Due to peculiarities of the oculomotor domain such as the varying degree of volitional control, eye movements could provide new information regarding more general theories of sense of agency in future research.

A scoping review of gaze and eye tracking-based control methods for assistive robotic arms

Background: Assistive Robotic Arms are designed to assist physically disabled people with daily activities. Existing joysticks and head controls are not applicable for severely disabled people such as people with Locked-in Syndrome. Therefore, eye tracking control is part of ongoing research. The related literature spans many disciplines, creating a heterogeneous field that makes it difficult to gain an overview. Objectives: This work focuses on ARAs that are controlled by gaze and eye movements. By answering the research questions, this paper provides details on the design of the systems, a comparison of input modalities, methods for measuring the performance of these controls, and an outlook on research areas that gained interest in recent years. Methods: This review was conducted as outlined in the PRISMA 2020 Statement. After identifying a wide range of approaches in use the authors decided to use the PRISMA-ScR extension for a scoping review to present the results. The identification process was carried out by screening three databases. After the screening process, a snowball search was conducted. Results: 39 articles and 6 reviews were included in this article. Characteristics related to the system and study design were extracted and presented divided into three groups based on the use of eye tracking. Conclusion: This paper aims to provide an overview for researchers new to the field by offering insight into eye tracking based robot controllers. We have identified open questions that need to be answered in order to provide people with severe motor function loss with systems that are highly useable and accessible.

Blink-To-Live eye-based communication system for users with speech impairments

Eye-based communication languages such as Blink-To-Speak play a key role in expressing the needs and emotions of patients with motor neuron disorders. Most invented eye-based tracking systems are complex and not affordable in low-income countries. Blink-To-Live is an eye-tracking system based on a modified Blink-To-Speak language and computer vision for patients with speech impairments. A mobile phone camera tracks the patient's eyes by sending real-time video frames to computer vision modules for facial landmarks detection, eye identification and tracking. There are four defined key alphabets in the Blink-To-Live eye-based communication language: Left, Right, Up, and Blink. These eye gestures encode more than 60 daily life commands expressed by a sequence of three eye movement states. Once the eye gestures encoded sentences are generated, the translation module will display the phrases in the patient's native speech on the phone screen, and the synthesized voice can be heard. A prototype of the Blink-To-Live system is evaluated using normal cases with different demographic characteristics. Unlike the other sensor-based eye-tracking systems, Blink-To-Live is simple, flexible, and cost-efficient, with no dependency on specific software or hardware requirements. The software and its source are available from the GitHub repository ( https://github.com/ZW01f/Blink-To-Live ).

Towards clinical application of implantable brain-computer interfaces for people with late-stage ALS: medical and ethical considerations

Individuals with amyotrophic lateral sclerosis (ALS) frequently develop speech and communication problems in the course of their disease. Currently available augmentative and alternative communication technologies do not present a solution for many people with advanced ALS, because these devices depend on residual and reliable motor activity. Brain-computer interfaces (BCIs) use neural signals for computer control and may allow people with late-stage ALS to communicate even when conventional technology falls short. Recent years have witnessed fast progression in the development and validation of implanted BCIs, which place neural signal recording electrodes in or on the cortex. Eventual widespread clinical application of implanted BCIs as an assistive communication technology for people with ALS will have significant consequences for their daily life, as well as for the clinical management of the disease, among others because of the potential interaction between the BCI and other procedures people with ALS undergo, such as tracheostomy. This article aims to facilitate responsible real-world implementation of implanted BCIs. We review the state of the art of research on implanted BCIs for communication, as well as the medical and ethical implications of the clinical application of this technology. We conclude that the contribution of all BCI stakeholders, including clinicians of the various ALS-related disciplines, will be needed to develop procedures for, and shape the process of, the responsible clinical application of implanted BCIs.

An Evaluation of the P300 Brain-Computer Interface, EyeLink Board, and Eye-Tracking Camera as Augmentative and Alternative Communication Devices

PURPOSE

Augmentative and alternative communication (AAC) systems are important to support communication for individuals with complex communication needs. A recent addition to AAC system options is the brain-computer interface (BCI). This study aimed to compare the clinical application of the P300 speller BCI with two more common AAC systems, the EyeLink board, and an eye-tracking camera.

METHOD

Ten participants without communication impairment (18-35 years of age) used each of the three AAC systems to spell three-letter words in one session. Accuracy and speed of letter selection were measured, and questionnaires were administered to evaluate usability, cognitive workload, and user preferences.

RESULTS

The results showed that the BCI was significantly less accurate, slower, and with lower usability and higher cognitive workload compared to the eye-tracking camera and EyeLink board. Participants rated the eye-tracking camera as the most favorable AAC system on all measures.

CONCLUSIONS

The results demonstrated that while the P300 speller BCI was usable by most participants, it did not function as well as the eye-tracking camera and EyeLink board. The clinical use of the BCI is, therefore, currently difficult to justify for most individuals, particularly when considering the substantial cost and setup resourcing needed.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21291384.

Initiation and Withdrawal of Invasive Ventilation for Patients with Amyotrophic Lateral Sclerosis: A Narrative Literature Review

Decisions regarding invasive ventilation with tracheostomy (TIV) in patients with amyotrophic lateral sclerosis (ALS) involve serious ethical issues. Cultural differences in the attitudes of patients, caregivers, and physicians toward TIV initiation and withdrawal decisions have been analyzed based on a narrative review approach, comparing the situation between Japan and the U.S. Three main issues were identified regarding the implementation of TIV. The first is the lack of Advance Care Planning. Second, some patients may choose TIV based on the wishes of their physicians or caregivers, even if the patients themselves do not want TIV in the Japanese context. Third is the influence of patient associations, which advocate for the protection of patients’ rights. Next, this study identifies the following issues related to TIV discontinuation. The main concern here is cultural differences in legislation and ethical intuitions regarding the discontinuation of TIV. The treatment guidelines for patients with ALS advise physicians to reassure patients that TIV can be withdrawn at any point. However, TIV withdrawal is not explicitly discussed in Japan. Moreover, Japanese ALS treatment guidelines state that ventilation withdrawal is currently impossible, due to a lack of legal support. Most Japanese physicians have told patients that they are not allowed to stop ventilation via such a request. Unlike in the U.S., withholding and withdrawing ventilators are not ethically equivalent in Japan. In conclusion, the decision-making process regarding TIV is difficult, not only for the patients and caregivers, but also for physicians. Even if patients are legally entitled to refuse unwanted treatment, there have been cases in which Japanese physicians have felt an ethical dilemma in stopping TIV for patients with ALS. However, few studies have investigated in detail why physicians oppose the patient’s right to discontinue TIV in Japan.

A Brain Controlled Command-Line Interface to Enhance the Accessibility of Severe Motor Disabled People to Personnel Computer

There are many applications controlled by the brain signals to bridge the gap in the digital divide between the disabled and the non-disabled people. The deployment of novel assistive technologies using brain-computer interface (BCI) will go a long way toward achieving this lofty goal, especially after the successes demonstrated by these technologies in the daily life of people with severe disabilities. This paper contributes in this direction by proposing an integrated framework to control the operating system functionalities using Electroencephalography signals. Different signal processing algorithms were applied to remove artifacts, extract features, and classify trials. The proposed approach includes different classification algorithms dedicated to detecting the P300 responses efficiently. The predicted commands passed through a socket to the API system, permitting the control of the operating system functionalities. The proposed system outperformed those obtained by the winners of the BCI competition and reached an accuracy average of 94.5% according to the offline approach. The framework was evaluated according to the online process and achieved an excellent accuracy attaining 97% for some users but not less than 90% for others. The suggested framework enhances the information accessibility for people with severe disabilities and helps them perform their daily tasks efficiently. It permits the interaction between the user and personal computers through the brain signals without any muscular efforts.

Neural decoding of semantic concepts: A systematic literature review

Objective Semantic concepts are coherent entities within our minds. They underpin our thought processes and are a part of the basis for our understanding of the world. Modern neuroscience research is increasingly exploring how individual semantic concepts are encoded within our brains and a number of studies are beginning to reveal key patterns of neural activity that underpin specific concepts. Building upon this basic understanding of the process of semantic neural encoding, neural engineers are beginning to explore tools and methods for semantic decoding: identifying which semantic concepts an individual is focused on at a given moment in time from recordings of their neural activity. In this paper we review the current literature on semantic neural decoding. Approach We conducted this review according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Specifically, we assess the eligibility of published peer-reviewed reports via a search of PubMed and Google Scholar. We identify a total of 74 studies in which semantic neural decoding is used to attempt to identify individual semantic concepts from neural activity. Results Our review reveals how modern neuroscientific tools have been developed to allow decoding of individual concepts from a range of neuroimaging modalities. We discuss specific neuroimaging methods, experimental designs, and machine learning pipelines that are employed to aid the decoding of semantic concepts. We quantify the efficacy of semantic decoders by measuring information transfer rates. We also discuss current challenges presented by this research area and present some possible solutions. Finally, we discuss some possible emerging and speculative future directions for this research area. Significance Semantic decoding is a rapidly growing area of research. However, despite its increasingly widespread popularity and use in neuroscientific research this is the first literature review focusing on this topic across neuroimaging modalities and with a focus on quantifying the efficacy of semantic decoders.

Emerging technologies for management of patients with amyotrophic lateral sclerosis: from telehealth to assistive robotics and neural interfaces

Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease, is characterized by the degeneration of both upper and lower motor neurons, which leads to muscle weakness and subsequently paralysis. It begins subtly with focal weakness but spreads relentlessly to involve most muscles, thus proving to be effectively incurable. Typically, death due to respiratory paralysis occurs in 3–5 years. To date, it has been shown that the management of ALS patients is best achieved with a multidisciplinary approach, and with the help of emerging technologies ranging from multidisciplinary teleconsults (for monitoring the dysphagia, respiratory function, and nutritional status) to brain-computer interfaces and eye tracking for alternative augmentative communication, until robotics, it may increase effectiveness. The COVID-19 pandemic created a spasmodic need to accelerate the development and implementation of such technologies in clinical practice, to improve the daily lives of both ALS patients and caregivers. However, despite the remarkable strides that have been made in the field, there are still issues to be addressed. This review will be discussed on the eureka moment of emerging technologies for ALS, used as a blueprint not only for neurodegenerative diseases, examining the current technologies already in place or being evaluated, highlighting the pros and cons for future clinical applications.

Applying Implementation Science to Support Active Collaboration in Noninvasive Brain-Computer Interface Development and Translation for Augmentative and Alternative Communication

PURPOSE

The purpose of this article is to consider how, alongside engineering advancements, noninvasive brain-computer interface (BCI) for augmentative and alternative communication (AAC; BCI-AAC) developments can leverage implementation science to increase the clinical impact of this technology. We offer the Consolidated Framework for Implementation Research (CFIR) as a structure to help guide future BCI-AAC research. Specifically, we discuss CFIR primary domains that include intervention characteristics, the outer and inner settings, the individuals involved in the intervention, and the process of implementation, alongside pertinent subdomains including adaptability, cost, patient needs and recourses, implementation climate, other personal attributes, and the process of engaging. The authors support their view with current citations from both the AAC and BCI-AAC fields.

CONCLUSIONS

The article aimed to provide thoughtful considerations for how future research may leverage the CFIR to support meaningful BCI-AAC translation for those with severe physical impairments. We believe that, although significant barriers to BCI-AAC development still exist, incorporating implementation research may be timely for the field of BCI-AAC and help account for diversity in end users, navigate implementation obstacles, and support a smooth and efficient translation of BCI-AAC technology. Moreover, the sooner clinicians, individuals who use AAC, their support networks, and engineers collectively improve BCI-AAC outcomes and the efficiency of translation, the sooner BCI-AAC may become an everyday tool in the AAC arsenal.

Morse glasses: an IoT communication system based on Morse code for users with speech impairments

The advent of internet of things has opened the opportunities for people with disabilities, increased their inclusion and productivity in their living society. Most of the invented smart sensing devices including the wearable ones for users with speech impairments are expensive and not affordable for patients in the low income countries such as Egypt. Morse Glasses is a cost efficient wearable device based on IoT technology and a modified Morse code that tracks the patient’s eyes blinks and translates it into a generated speech. A sequence of Morse encoded alphabets/sentences along with the frequently used ones is displayed and heard on any android supported device that is installed Morse Glasses mobile application. With cost less than 30$, patients with motor neuron diseases such as Amyotrophic Lateral Sclerosis (ALS) can communicate easily with the others, express their needs and simply live their life normally.

Decoding of semantic categories of imagined concepts of animals and tools in fNIRS

Objective.Semantic decoding refers to the identification of semantic concepts from recordings of an individual's brain activity. It has been previously reported in functional magnetic resonance imaging and electroencephalography. We investigate whether semantic decoding is possible with functional near-infrared spectroscopy (fNIRS). Specifically, we attempt to differentiate between the semantic categories of animals and tools. We also identify suitable mental tasks for potential brain-computer interface (BCI) applications.Approach.We explore the feasibility of a silent naming task, for the first time in fNIRS, and propose three novel intuitive mental tasks based on imagining concepts using three sensory modalities: visual, auditory, and tactile. Participants are asked to visualize an object in their minds, imagine the sounds made by the object, and imagine the feeling of touching the object. A general linear model is used to extract hemodynamic responses that are then classified via logistic regression in a univariate and multivariate manner.Main results.We successfully classify all tasks with mean accuracies of 76.2% for the silent naming task, 80.9% for the visual imagery task, 72.8% for the auditory imagery task, and 70.4% for the tactile imagery task. Furthermore, we show that consistent neural representations of semantic categories exist by applying classifiers across tasks.Significance.These findings show that semantic decoding is possible in fNIRS. The study is the first step toward the use of semantic decoding for intuitive BCI applications for communication.

Human–Robot Interaction through Eye Tracking for Artistic Drawing

In this paper, authors present a novel architecture for controlling an industrial robot via an eye tracking interface for artistic purposes. Humans and robots interact thanks to an acquisition system based on an eye tracker device that allows the user to control the motion of a robotic manipulator with his gaze. The feasibility of the robotic system is evaluated with experimental tests in which the robot is teleoperated to draw artistic images. The tool can be used by artists to investigate novel forms of art and by amputees or people with movement disorders or muscular paralysis, as an assistive technology for artistic drawing and painting, since, in these cases, eye motion is usually preserved.

New technologies and Amyotrophic Lateral Sclerosis - Which step forward rushed by the COVID-19 pandemic?

Amyotrophic Lateral Sclerosis (ALS) is a fast-progressive neurodegenerative disease leading to progressive physical immobility with usually normal or mild cognitive and/or behavioural involvement. Many patients are relatively young, instructed, sensitive to new technologies, and professionally active when developing the first symptoms. Older patients usually require more time, encouragement, reinforcement and a closer support but, nevertheless, selecting user-friendly devices, provided earlier in the course of the disease, and engaging motivated carers may overcome many technological barriers. ALS may be considered a model for neurodegenerative diseases to further develop and test new technologies. From multidisciplinary teleconsults to telemonitoring of the respiratory function, telemedicine has the potentiality to embrace other fields, including nutrition, physical mobility, and the interaction with the environment. Brain-computer interfaces and eye tracking expanded the field of augmentative and alternative communication in ALS but their potentialities go beyond communication, to cognition and robotics. Virtual reality and different forms of artificial intelligence present further interesting possibilities that deserve to be investigated. COVID-19 pandemic is an unprecedented opportunity to speed up the development and implementation of new technologies in clinical practice, improving the daily living of both ALS patients and carers. The present work reviews the current technologies for ALS patients already in place or being under evaluation with published publications, prompted by the COVID-19 pandemic.

P300-Based Brain-Computer Interface Speller: Usability Evaluation of Three Speller Sizes by Severely Motor-Disabled Patients

Brain-computer interface (BCI) spellers allow severe motor-disabled patients to communicate using their brain activity without muscular mobility. Different visual configurations of the widely studied P300-based BCI speller had been assessed with healthy and motor-disabled users. However, the speller size (in terms of cm) had only been assessed for healthy subjects. We think that the speller size might be limiting for some severely motor-disabled patients with restricted head and eye movements. The usability of three speller sizes was assessed for seven patients diagnosed with amyotrophic lateral sclerosis (ALS) and a participant diagnosed with Duchenne muscular dystrophy (DMD). This is the first usability evaluation of speller size with severely motor-disabled participants. Effectiveness (in the online results) and efficiency (in the workload test) of the medium speller was remarkably better. Satisfaction was significantly the highest with the medium size speller and the lowest with the small size. These results correlate with previously described findings in healthy subjects. In conclusion, the speller size should be considered when designing a speller paradigm, especially for motor-disabled individuals, since it might affect their performance and user experience while controlling a BCI speller.

A survey of research trends in assistive technologies using information modelling techniques

BACKGROUND

Despite the rapid proliferation and emphasis on technology, the use of assistive technology among individuals with varying disabilities and age is different. This situation instigates the need for a systematic review to gain a realistic understanding of prominent issues, research trends and assistive technology applications with minimal bias.

OBJECTIVE

Identification of leading researchers and prominent publications in assistive technologies. Subsequently, semantic relation between qualitative and quantitative research literature on assistive technologies was explored to future research directions.

METHODS

A manual search across reputed research databases was done to find out relevant literature from January 2005 to April 2020. In this paper, latent semantic analysis (LSA) was done to develop an information model for achieving defined objectives.

RESULTS

A corpus of 367 research papers published during 2005-2020 was processed using LSA. Term frequency, inverse document frequency of high loading terms provided five major topic solutions. Marcia Scherer, Rory Cooper and Stefano Federici are most noticed authors in assistive technology research. "Smart Assistive Technologies" and "Wearable Technologies for Rehabilitation" came out as contemporary research trends within assistive technologies.

CONCLUSIONS

The manuscript concludes the fact that assistive technologies for rehabilitation are experiencing a transition from standalone mechanical devices towards smart, wearable and connected devices.Implications for RehabilitationCustomized assistive devices could be programmed for multiple uses.User data privacy and internet dependency of smart assistive technologies must be taken care of while designing smart assistive devices for rehabilitation.Fog devices could eliminate the latency issues associated with cloud-based rehabilitation services.

Brain-computer interfaces for amyotrophic lateral sclerosis

A brain-computer interface (BCI) is a device that detects signals from the brain and transforms them into useful commands. Researchers have developed BCIs that utilize different kinds of brain signals. These different BCI systems have differing characteristics, such as the amount of training required and the degree to which they are or are not invasive. Much of the research on BCIs to date has involved healthy individuals and evaluation of classification algorithms. Some BCIs have been shown to have potential benefit for users with minimal muscular function as a result of amyotrophic lateral sclerosis. However, there are still several challenges that need to be successfully addressed before BCIs can be clinically useful.

Eye tracking metrics to screen and assess cognitive impairment in patients with neurological disorders

PURPOSE OF REVIEW

Eye tracking is a powerful method to investigate the relationship between behavior and neural mechanisms. In recent years, eye movement analysis has been used in patients with neurological disorders to assess cognitive function. In this review, we explore the latest eye tracking researches in neurological disorders that are commonly associated with cognitive deficits, specifically, amyotrophic lateral sclerosis (ALS), Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), and epilepsy. We focus on the application of ocular measures in these disorders, with the goal of understanding how eye tracking technology can be used in the clinical setting.

FINDINGS

Eye tracking tasks (especially saccadic tasks) are often used as an adjunct to traditional scales for cognitive assessment. Eye tracking data confirmed that executive dysfunction is common in PD and ALS, whereas AD and MS are characterized by attention deficits. Research in evaluating cognitive function in epilepsy using eye tracking is still in its early stages, but this approach has shown advantages as a sensitive quantitative method with high temporal and spatial resolution. Eye tracking technology can facilitate the assessment of cognitive impairment with higher temporal resolution and finer granularity than traditional cognitive assessment. Oculomotor data collected during cognitive tasks can provide insight into biological processes. Eye tracking provides a nonverbal and less cognitively demanding method of measuring disease progression in cognitively impaired patients.

A Hybrid Speller Design Using Eye Tracking and SSVEP Brain-Computer Interface

Steady-state visual evoked potentials (SSVEPs) have been extensively utilized to develop brain-computer interfaces (BCIs) due to the advantages of robustness, large number of commands, high classification accuracies, and information transfer rates (ITRs). However, the use of several simultaneous flickering stimuli often causes high levels of user discomfort, tiredness, annoyingness, and fatigue. Here we propose to design a stimuli-responsive hybrid speller by using electroencephalography (EEG) and video-based eye-tracking to increase user comfortability levels when presented with large numbers of simultaneously flickering stimuli. Interestingly, a canonical correlation analysis (CCA)-based framework was useful to identify target frequency with a 1 s duration of flickering signal. Our proposed BCI-speller uses only six frequencies to classify forty-eight targets, thus achieve greatly increased ITR, whereas basic SSVEP BCI-spellers use an equal number of frequencies to the number of targets. Using this speller, we obtained an average classification accuracy of 90.35 ± 3.597% with an average ITR of 184.06 ± 12.761 bits per minute in a cued-spelling task and an ITR of 190.73 ± 17.849 bits per minute in a free-spelling task. Consequently, our proposed speller is superior to the other spellers in terms of targets classified, classification accuracy, and ITR, while producing less fatigue, annoyingness, tiredness and discomfort. Together, our proposed hybrid eye tracking and SSVEP BCI-based system will ultimately enable a truly high-speed communication channel.

Hearing the needs of clinical users

In the past 10 years, brain-computer interfaces (BCIs) for controlling assistive devices have seen tremendous progress with respect to reliability and learnability, and numerous exemplary applications were demonstrated to be controllable by a BCI. Yet, BCI-controlled applications are hardly used for patients with neurologic or neurodegenerative disease. Such patient groups are considered potential end-users of BCI, specifically for replacing or improving lost function. We argue that BCI research and development still faces a translational gap, i.e., the knowledge of how to bring BCIs from the laboratory to the field is insufficient. BCI-controlled applications lack usability and accessibility; both constitute two sides of one coin, which is the key to use in daily life and to prevent nonuse. To increase usability, we suggest rigorously adopting the user-centered design in applied BCI research and development. To provide accessibility, assistive technology (AT) experts, providers, and other stakeholders have to be included in the user-centered process. BCI experts have to ensure the transfer of knowledge to AT professionals, and listen to the needs of primary, secondary, and tertiary end-users of BCI technology. Addressing both, usability and accessibility, in applied BCI research and development will bridge the translational gap and ensure that the needs of clinical end-users are heard, understood, addressed, and fulfilled.

Critiquing the Concept of BCI Illiteracy

Brain-computer interfaces (BCIs) are a form of technology that read a user's neural signals to perform a task, often with the aim of inferring user intention. They demonstrate potential in a wide range of clinical, commercial, and personal applications. But BCIs are not always simple to operate, and even with training some BCI users do not operate their systems as intended. Many researchers have described this phenomenon as "BCI illiteracy," and a body of research has emerged aiming to characterize, predict, and solve this perceived problem. However, BCI illiteracy is an inadequate concept for explaining difficulty that users face in operating BCI systems. BCI illiteracy is a methodologically weak concept; furthermore, it relies on the flawed assumption that BCI users possess physiological or functional traits that prevent proficient performance during BCI use. Alternative concepts to BCI illiteracy may offer better outcomes for prospective users and may avoid the conceptual pitfalls that BCI illiteracy brings to the BCI research process.

Gaze-controlled Laser Pointer Platform for People with Severe Motor Impairments: Preliminary Test in Telepresence

This paper describes the implementation and the preliminary evaluation of a novel interaction solution for people with severe motor impairments, and particularly for those affected by Amyotrophic Laterals Sclerosis (ALS) in Locked-In State (LIS): patients able to control only the ocular muscles. The proposed communication approach allows the person to control a laser beam and interact with the environment or interlocutors in an intuitive way by pointing at objects through their gaze. For this, a tip-tilt laser control device was developed and mounted on a small robot equipped with a high definition video camera. In addition, a gaze-tracking user interface was developed to control of both systems, i.e., laser and robot. This new platform was then preliminary assessed through trials with 14 subjects without disabilities, who performed tasks of robot navigation and pointing at objects along its path. User experience was evaluated with encouraging results, indicating the proposed technology has real potential to assist communication and interaction acts of people with ALS.

Effects of simulated visual acuity and ocular motility impairments on SSVEP brain-computer interface performance: An experiment with Shuffle Speller

Individuals with severe speech and physical impairments may have concomitant visual acuity impairments (VAI) or ocular motility impairments (OMI) impacting visual BCI use. We report on the use of the Shuffle Speller typing interface for an SSVEP BCI copy-spelling task under three conditions: simulated VAI, simulated OMI, and unimpaired vision. To mitigate the effect of visual impairments, we introduce a method that adaptively selects a user-specific trial length to maximize expected information transfer rate (ITR); expected ITR is shown to closely approximate the rate of correct letter selections. All participants could type under the unimpaired and simulated VAI conditions, with no significant differences in typing accuracy or speed. Most participants (31 of 37) could not type under the simulated OMI condition; some achieved high accuracy but with slower typing speeds. Reported workload and discomfort were low, and satisfaction high, under the unimpaired and simulated VAI conditions. Implications and future directions to examine effect of visual impairment on BCI use is discussed.

Code-VEP vs. Eye Tracking: A Comparison Study

Even with state-of-the-art techniques there are individuals whose paralysis prevents them from communicating with others. Brain⁻Computer-Interfaces (BCI) aim to utilize brain waves to construct a voice for those whose needs remain unmet. In this paper we compare the efficacy of a BCI input signal, code-VEP via Electroencephalography, against eye gaze tracking, among the most popular modalities used. These results, on healthy individuals without paralysis, suggest that while eye tracking works well for some, it does not work well or at all for others; the latter group includes individuals with corrected vision or those who squint their eyes unintentionally while focusing on a task. It is also evident that the performance of the interface is more sensitive to head/body movements when eye tracking is used as the input modality, compared to using c-VEP. Sensitivity to head/body movement could be better in eye tracking systems which are tracking the head or mounted on the face and are designed specifically as assistive devices. The sample interface developed for this assessment has the same reaction time when driven with c-VEP or with eye tracking; approximately 0.5⁻1 second is needed to make a selection among the four options simultaneously presented. Factors, such as system reaction time and robustness play a crucial role in participant preferences.

Evaluation of Switch and Continuous Navigation Paradigms to Command a Brain-Controlled Wheelchair

A brain-computer interface (BCI) is a technology allowing patients with severe motor dysfunctions to use their electroencephalographic signals to create a communication channel to control devices. The objective of this paper is to study the feasibility of continuous and switch control modes for a brain-controlled wheelchair (BCW) using sensorimotor rhythms (SMR) modulated through a right-hand motor imagery task. Previous studies, which used a continuous navigation control with SMR, have reported the difficulty of maintaining the motor imagery task for a long time, especially for the forward command. The switch control has been presented as a proposal that may help to solve this issue since this task is only used temporary for either disabling or enabling the movement. Regarding the methodology, 10 of 15 able-bodied users, who had overcome the criterion of 30% error rate in the calibration phase, controlled the BCW using both paradigms. The navigation tasks consisted of a straight path divided in five sections: in three of them the users had to move forward, and in the other two the users had to maintain their position. To assess user performance in the device management, a usability approach was adopted, measuring the factors of effectiveness, efficiency, and satisfaction. Then, variables related to the time employed and commands selected by the user or parameters related to the confusion matrix were applied. In addition, the scores in NASA-TLX and two ad hoc questionnaires were considered to discuss the user experience controlling the wheelchair. Despite the results showed that the best system for a specific user relies on his/her abilities and preferences, the switch control mode obtained better accuracy (0.59 ± 0.17 for continuous and 0.72 ± 0.05 for switch). Furthermore, the switch paradigm can be recommended for the advance sections as with it users could complete the advance sections in less time (42.2 ± 28.7 s for continuous and 15.47 ± 3.43 s for switch), while the continuous mode seems to be better at keeping the wheelchair stopped (42.45 ± 16.01 s for continuous and 24.35 ± 10.94 s for switch).

Comparison of Four Control Methods for a Five-Choice Assistive Technology

Severe motor impairments can affect the ability to communicate. The ability to see has a decisive influence on the augmentative and alternative communication (AAC) systems available to the user. To better understand the initial impressions users have of AAC systems we asked naïve healthy participants to compare two visual (a visual P300 brain-computer interface (BCI) and an eye-tracker) and two non-visual systems (an auditory and a tactile P300 BCI). Eleven healthy participants performed 20 selections in a five choice task with each system. The visual P300 BCI used face stimuli, the auditory P300 BCI used Japanese Hiragana syllables and the tactile P300 BCI used a stimulator on the small left finger, middle left finger, right thumb, middle right finger and small right finger. The eye-tracker required a dwell time of 3 s on the target for selection. We calculated accuracies and information-transfer rates (ITRs) for each control method using the selection time that yielded the highest ITR and an accuracy above 70% for each system. Accuracies of 88% were achieved with the visual P300 BCI (4.8 s selection time, 20.9 bits/min), of 70% with the auditory BCI (19.9 s, 3.3 bits/min), of 71% with the tactile BCI (18 s, 3.4 bits/min) and of 100% with the eye-tracker (5.1 s, 28.2 bits/min). Performance between eye-tracker and visual BCI correlated strongly, correlation between tactile and auditory BCI performance was lower. Our data showed no advantage for either non-visual system in terms of ITR but a lower correlation of performance which suggests that choosing the system which suits a particular user is of higher importance for non-visual systems than visual systems.

Brain-Computer Interfaces for Augmentative and Alternative Communication: A Tutorial

PURPOSE

Brain-computer interfaces (BCIs) have the potential to improve communication for people who require but are unable to use traditional augmentative and alternative communication (AAC) devices. As BCIs move toward clinical practice, speech-language pathologists (SLPs) will need to consider their appropriateness for AAC intervention.

METHOD

This tutorial provides a background on BCI approaches to provide AAC specialists foundational knowledge necessary for clinical application of BCI. Tutorial descriptions were generated based on a literature review of BCIs for restoring communication.

RESULTS

The tutorial responses directly address 4 major areas of interest for SLPs who specialize in AAC: (a) the current state of BCI with emphasis on SLP scope of practice (including the subareas: the way in which individuals access AAC with BCI, the efficacy of BCI for AAC, and the effects of fatigue), (b) populations for whom BCI is best suited, (c) the future of BCI as an addition to AAC access strategies, and (d) limitations of BCI.

CONCLUSION

Current BCIs have been designed as access methods for AAC rather than a replacement; therefore, SLPs can use existing knowledge in AAC as a starting point for clinical application. Additional training is recommended to stay updated with rapid advances in BCI.

EEG-Based Brain-Computer Interfaces for Communication and Rehabilitation of People with Motor Impairment: A Novel Approach of the 21 st Century

People with severe neurological impairments face many challenges in sensorimotor functions and communication with the environment; therefore they have increased demand for advanced, adaptive and personalized rehabilitation. During the last several decades, numerous studies have developed brain-computer interfaces (BCIs) with the goals ranging from providing means of communication to functional rehabilitation. Here we review the research on non-invasive, electroencephalography (EEG)-based BCI systems for communication and rehabilitation. We focus on the approaches intended to help severely paralyzed and locked-in patients regain communication using three different BCI modalities: slow cortical potentials, sensorimotor rhythms and P300 potentials, as operational mechanisms. We also review BCI systems for restoration of motor function in patients with spinal cord injury and chronic stroke. We discuss the advantages and limitations of these approaches and the challenges that need to be addressed in the future.

Brain computer interface with the P300 speller: Usability for disabled people with amyotrophic lateral sclerosis

OBJECTIVES

Amyotrophic lateral sclerosis (ALS), a progressive neurodegenerative disease, restricts patients' communication capacity a few years after onset. A proof-of-concept of brain-computer interface (BCI) has shown promise in ALS and "locked-in" patients, mostly in pre-clinical studies or with only a few patients, but performance was estimated not high enough to support adoption by people with physical limitation of speech. Here, we evaluated a visual BCI device in a clinical study to determine whether disabled people with multiple deficiencies related to ALS would be able to use BCI to communicate in a daily environment.

METHODS

After clinical evaluation of physical, cognitive and language capacities, 20 patients with ALS were included. The P300 speller BCI system consisted of electroencephalography acquisition connected to real-time processing software and separate keyboard-display control software. It was equipped with original features such as optimal stopping of flashes and word prediction. The study consisted of two 3-block sessions (copy spelling, free spelling and free use) with the system in several modes of operation to evaluate its usability in terms of effectiveness, efficiency and satisfaction.

RESULTS

The system was effective in that all participants successfully achieved all spelling tasks and was efficient in that 65% of participants selected more than 95% of the correct symbols. The mean number of correct symbols selected per minute ranged from 3.6 (without word prediction) to 5.04 (with word prediction). Participants expressed satisfaction: the mean score was 8.7 on a 10-point visual analog scale assessing comfort, ease of use and utility. Patients quickly learned how to operate the system, which did not require much learning effort.

CONCLUSION

With its word prediction and optimal stopping of flashes, which improves information transfer rate, the BCI system may be competitive with alternative communication systems such as eye-trackers. Remaining requirements to improve the device for suitable ergonomic use are in progress.

Locked Out

Brain-computer interfaces (BCIs) can enable communication for persons in severe paralysis including locked-in syndrome (LIS); that is, being unable to move or speak while aware. In cases of complete loss of muscle control, termed "complete locked-in syndrome," a BCI may be the only viable solution to restore communication. However, a widespread ignorance regarding quality of life in LIS, current BCIs, and their potential as an assistive technology for persons in LIS, needlessly causes a harmful situation for this cohort. In addition to their medical condition, these persons also face social barriers often perceived as more impairing than their physical condition. Through social exclusion, stigmatization, and frequently being underestimated in their abilities, these persons are being locked out in addition to being locked-in. In this article, we (1) show how persons in LIS are being locked out, including how key issues addressed in the existing literature on ethics, LIS, and BCIs for communication, such as autonomy, quality of life, and advance directives, may reinforce these confinements; (2) show how these practices violate the United Nations Convention on the Rights of Persons with Disabilities, and suggest that we have a moral responsibility to prevent and stop this exclusion; and (3) discuss the role of BCIs for communication as one means to this end and suggest that a novel approach to BCI research is necessary to acknowledge the moral responsibility toward the end users and avoid violating the human rights of persons in LIS.

Composing only by thought: Novel application of the P300 brain-computer interface

The P300 event-related potential is a well-known pattern in the electroencephalogram (EEG). This kind of brain signal is used for many different brain-computer interface (BCI) applications, e.g., spellers, environmental controllers, web browsers, or for painting. In recent times, BCI systems are mature enough to leave the laboratories to be used by the end-users, namely severely disabled people. Therefore, new challenges arise and the systems should be implemented and evaluated according to user-centered design (USD) guidelines. We developed and implemented a new system that utilizes the P300 pattern to compose music. Our Brain Composing system consists of three parts: the EEG acquisition device, the P300-based BCI, and the music composing software. Seventeen musical participants and one professional composer performed a copy-spelling, a copy-composing, and a free-composing task with the system. According to the USD guidelines, we investigated the efficiency, the effectiveness and subjective criteria in terms of satisfaction, enjoyment, frustration, and attractiveness. The musical participants group achieved high average accuracies: 88.24% (copy-spelling), 88.58% (copy-composing), and 76.51% (free-composing). The professional composer achieved also high accuracies: 100% (copy-spelling), 93.62% (copy-composing), and 98.20% (free-composing). General results regarding the subjective criteria evaluation were that the participants enjoyed the usage of the Brain Composing system and were highly satisfied with the system. Showing very positive results with healthy people in this study, this was the first step towards a music composing system for severely disabled people.

An emergency call system for patients in locked-in state using an SSVEP-based brain switch

Patients in a locked-in state (LIS) due to severe neurological disorders such as amyotrophic lateral sclerosis (ALS) require seamless emergency care by their caregivers or guardians. However, it is a difficult job for the guardians to continuously monitor the patients' state, especially when direct communication is not possible. In the present study, we developed an emergency call system for such patients using a steady-state visual evoked potential (SSVEP)-based brain switch. Although there have been previous studies to implement SSVEP-based brain switch system, they have not been applied to patients in LIS, and thus their clinical value has not been validated. In this study, we verified whether the SSVEP-based brain switch system can be practically used as an emergency call system for patients in LIS. The brain switch used for our system adopted a chromatic visual stimulus, which proved to be visually less stimulating than conventional checkerboard-type stimuli but could generate SSVEP responses strong enough to be used for brain-computer interface (BCI) applications. To verify the feasibility of our emergency call system, 14 healthy participants and 3 patients with severe ALS took part in online experiments. All three ALS patients successfully called their guardians to their bedsides in about 6.56 seconds. Furthermore, additional experiments with one of these patients demonstrated that our emergency call system maintains fairly good performance even up to 4 weeks after the first experiment without renewing initial calibration data. Our results suggest that our SSVEP-based emergency call system might be successfully used in practical scenarios.

Characterizing Computer Access Using a One-Channel EEG Wireless Sensor

This work studies the feasibility of using mental attention to access a computer. Brain activity was measured with an electrode placed at the Fp1 position and the reference on the left ear; seven normally developed people and three subjects with cerebral palsy (CP) took part in the experimentation. They were asked to keep their attention high and low for as long as possible during several trials. We recorded attention levels and power bands conveyed by the sensor, but only the first was used for feedback purposes. All of the information was statistically analyzed to find the most significant parameters and a classifier based on linear discriminant analysis (LDA) was also set up. In addition, 60% of the participants were potential users of this technology with an accuracy of over 70%. Including power bands in the classifier did not improve the accuracy in discriminating between the two attentional states. For most people, the best results were obtained by using only the attention indicator in classification. Tiredness was higher in the group with disabilities (2.7 in a scale of 3) than in the other (1.5 in the same scale); and modulating the attention to access a communication board requires that it does not contain many pictograms (between 4 and 7) on screen and has a scanning period of a relatively high tscan≈ 10 s. The information transfer rate (ITR) is similar to the one obtained by other brain computer interfaces (BCI), like those based on sensorimotor rhythms (SMR) or slow cortical potentials (SCP), and makes it suitable as an eye-gaze independent BCI.

Fusion of P300 and eye-tracker data for spelling using BCI2000

OBJECTIVE

Various augmentative and alternative communication (AAC) devices have been developed in order to aid communication for individuals with communication disorders. Recently, there has been interest in combining EEG data and eye-gaze data with the goal of developing a hybrid (or 'fused') BCI (hBCI) AAC system. This work explores the effectiveness of a speller that fuses data from an eye-tracker and the P300 speller in order to create a hybrid P300 speller.

APPROACH

This hybrid speller collects both eye-tracking and EEG data in parallel, and the user spells characters on the screen in the same way that they would if they were only using the P300 speller. Online and offline experiments were performed. The online experiments measured the performance of the speller for sixteen non-disabled participants, while the offline simulations were used to assess the robustness of the hybrid system.

MAIN RESULTS

Online results showed that for fifteen non-disabled participants, using eye-gaze in a Bayesian framework with EEG data from the P300 speller improved accuracy ([Formula: see text], [Formula: see text], [Formula: see text] for estimated, medium and high variance configurations) and reduced the average number of flashes required to spell a character compared to the standard P300 speller that relies solely on EEG data ([Formula: see text], [Formula: see text], [Formula: see text] for estimated, medium and high variance configurations). Offline simulations indicate that the system provides more robust performance than a standalone eye gaze system.

SIGNIFICANCE

The results of this work on non-disabled participants shows the potential efficacy of hybrid P300 and eye-tracker speller. Further validation on the amyotrophic lateral sceloris population is needed to assess the benefit of this hybrid system.

A systematic review of hybrid brain-computer interfaces: Taxonomy and usability perspectives

A new Brain-Computer Interface (BCI) technique, which is called a hybrid BCI, has recently been proposed to address the limitations of conventional single BCI system. Although some hybrid BCI studies have shown promising results, the field of hybrid BCI is still in its infancy and there is much to be done. Especially, since the hybrid BCI systems are so complicated and complex, it is difficult to understand the constituent and role of a hybrid BCI system at a glance. Also, the complicated and complex systems make it difficult to evaluate the usability of the systems. We systematically reviewed and analyzed the current state-of-the-art hybrid BCI studies, and proposed a systematic taxonomy for classifying the types of hybrid BCIs with multiple taxonomic criteria. After reviewing 74 journal articles, hybrid BCIs could be categorized with respect to 1) the source of brain signals, 2) the characteristics of the brain signal, and 3) the characteristics of operation in each system. In addition, we exhaustively reviewed recent literature on usability of BCIs. To identify the key evaluation dimensions of usability, we focused on task and measurement characteristics of BCI usability. We classified and summarized 31 BCI usability journal articles according to task characteristics (type and description of task) and measurement characteristics (subjective and objective measures). Afterwards, we proposed usability dimensions for BCI and hybrid BCI systems according to three core-constructs: Satisfaction, effectiveness, and efficiency with recommendations for further research. This paper can help BCI researchers, even those who are new to the field, can easily understand the complex structure of the hybrid systems at a glance. Recommendations for future research can also be helpful in establishing research directions and gaining insight in how to solve ergonomics and HCI design issues surrounding BCI and hybrid BCI systems by usability evaluation.

A Novel Hybrid Mental Spelling Application Based on Eye Tracking and SSVEP-Based BCI

Steady state visual evoked potentials (SSVEPs)-based Brain-Computer interfaces (BCIs), as well as eyetracking devices, provide a pathway for re-establishing communication for people with severe disabilities. We fused these control techniques into a novel eyetracking/SSVEP hybrid system, which utilizes eye tracking for initial rough selection and the SSVEP technology for fine target activation. Based on our previous studies, only four stimuli were used for the SSVEP aspect, granting sufficient control for most BCI users. As Eye tracking data is not used for activation of letters, false positives due to inappropriate dwell times are avoided. This novel approach combines the high speed of eye tracking systems and the high classification accuracies of low target SSVEP-based BCIs, leading to an optimal combination of both methods. We evaluated accuracy and speed of the proposed hybrid system with a 30-target spelling application implementing all three control approaches (pure eye tracking, SSVEP and the hybrid system) with 32 participants. Although the highest information transfer rates (ITRs) were achieved with pure eye tracking, a considerable amount of subjects was not able to gain sufficient control over the stand-alone eye-tracking device or the pure SSVEP system (78.13% and 75% of the participants reached reliable control, respectively). In this respect, the proposed hybrid was most universal (over 90% of users achieved reliable control), and outperformed the pure SSVEP system in terms of speed and user friendliness. The presented hybrid system might offer communication to a wider range of users in comparison to the standard techniques.

Reaching and Grasping a Glass of Water by Locked-In ALS Patients through a BCI-Controlled Humanoid Robot

Locked-in Amyotrophic Lateral Sclerosis (ALS) patients are fully dependent on caregivers for any daily need. At this stage, basic communication and environmental control may not be possible even with commonly used augmentative and alternative communication devices. Brain Computer Interface (BCI) technology allows users to modulate brain activity for communication and control of machines and devices, without requiring a motor control. In the last several years, numerous articles have described how persons with ALS could effectively use BCIs for different goals, usually spelling. In the present study, locked-in ALS patients used a BCI system to directly control the humanoid robot NAO (Aldebaran Robotics, France) with the aim of reaching and grasping a glass of water. Four ALS patients and four healthy controls were recruited and trained to operate this humanoid robot through a P300-based BCI. A few minutes training was sufficient to efficiently operate the system in different environments. Three out of the four ALS patients and all controls successfully performed the task with a high level of accuracy. These results suggest that BCI-operated robots can be used by locked-in ALS patients as an artificial alter-ego, the machine being able to move, speak and act in his/her place.

An eye-tracking controlled neuropsychological battery for cognitive assessment in neurological diseases

Traditional cognitive assessment in neurological conditions involving physical disability is often prevented by the presence of verbal-motor impairment; to date, an extensive motor-verbal-free neuropsychological battery is not available for such purposes. We adapted a set of neuropsychological tests, assessing language, attentional abilities, executive functions and social cognition, for eye-tracking (ET) control, and explored its feasibility in a sample of healthy participants. Thirty healthy subjects performed a neuropsychological assessment, using an ET-based neuropsychological battery, together with standard "paper and pencil" cognitive measures for frontal (Frontal Assessment Battery-FAB) and working memory abilities (Digit Sequencing Task) and for global cognitive efficiency (Montreal Cognitive Assessment-MoCA). Psychological measures of anxiety (State-Trait Anxiety Inventory-Y-STAI-Y) and depression (Beck Depression Inventory-BDI) were also collected, and a usability questionnaire was administered. Significant correlations were observed between the "paper and pencil" screening of working memory abilities and the ET-based neuropsychological measures. The ET-based battery also correlated with the MoCA, while poor correlations were observed with the FAB. Usability aspects were found to be influenced by both working memory abilities and psychological components. The ET-based neuropsychological battery developed could provide an extensive assessment of cognitive functions, allowing participants to perform tasks independently from the integrity of motor or verbal channels. Further studies will be aimed at investigating validity and usability components in neurological populations with motor-verbal impairments.

An Evaluation of Training with an Auditory P300 Brain-Computer Interface for the Japanese Hiragana Syllabary

Gaze-independent brain-computer interfaces (BCIs) are a possible communication channel for persons with paralysis. We investigated if it is possible to use auditory stimuli to create a BCI for the Japanese Hiragana syllabary, which has 46 Hiragana characters. Additionally, we investigated if training has an effect on accuracy despite the high amount of different stimuli involved. Able-bodied participants (N = 6) were asked to select 25 syllables (out of fifty possible choices) using a two step procedure: First the consonant (ten choices) and then the vowel (five choices). This was repeated on 3 separate days. Additionally, a person with spinal cord injury (SCI) participated in the experiment. Four out of six healthy participants reached Hiragana syllable accuracies above 70% and the information transfer rate increased from 1.7 bits/min in the first session to 3.2 bits/min in the third session. The accuracy of the participant with SCI increased from 12% (0.2 bits/min) to 56% (2 bits/min) in session three. Reliable selections from a 10 × 5 matrix using auditory stimuli were possible and performance is increased by training. We were able to show that auditory P300 BCIs can be used for communication with up to fifty symbols. This enables the use of the technology of auditory P300 BCIs with a variety of applications.

Interfacing brain with computer to improve communication and rehabilitation after brain damage

Communication and control of the external environment can be provided via brain-computer interfaces (BCIs) to replace a lost function in persons with severe diseases and little or no chance of recovery of motor abilities (ie, amyotrophic lateral sclerosis, brainstem stroke). BCIs allow to intentionally modulate brain activity, to train specific brain functions, and to control prosthetic devices, and thus, this technology can also improve the outcome of rehabilitation programs in persons who have suffered from a central nervous system injury (ie, stroke leading to motor or cognitive impairment). Overall, the BCI researcher is challenged to interact with people with severe disabilities and professionals in the field of neurorehabilitation. This implies a deep understanding of the disabled condition on the one hand, and it requires extensive knowledge on the physiology and function of the human brain on the other. For these reasons, a multidisciplinary approach and the continuous involvement of BCI users in the design, development, and testing of new systems are desirable. In this chapter, we will focus on noninvasive EEG-based systems and their clinical applications, highlighting crucial issues to foster BCI translation outside laboratories to eventually become a technology usable in real-life realm.

Comparison of eye tracking, electrooculography and an auditory brain-computer interface for binary communication: a case study with a participant in the locked-in state

BACKGROUND

In this study, we evaluated electrooculography (EOG), an eye tracker and an auditory brain-computer interface (BCI) as access methods to augmentative and alternative communication (AAC). The participant of the study has been in the locked-in state (LIS) for 6 years due to amyotrophic lateral sclerosis. He was able to communicate with slow residual eye movements, but had no means of partner independent communication. We discuss the usability of all tested access methods and the prospects of using BCIs as an assistive technology.

METHODS

Within four days, we tested whether EOG, eye tracking and a BCI would allow the participant in LIS to make simple selections. We optimized the parameters in an iterative procedure for all systems.

RESULTS

The participant was able to gain control over all three systems. Nonetheless, due to the level of proficiency previously achieved with his low-tech AAC method, he did not consider using any of the tested systems as an additional communication channel. However, he would consider using the BCI once control over his eye muscles would no longer be possible. He rated the ease of use of the BCI as the highest among the tested systems, because no precise eye movements were required; but also as the most tiring, due to the high level of attention needed to operate the BCI.

CONCLUSIONS

In this case study, the partner based communication was possible due to the good care provided and the proficiency achieved by the interlocutors. To ease the transition from a low-tech AAC method to a BCI once control over all muscles is lost, it must be simple to operate. For persons, who rely on AAC and are affected by a progressive neuromuscular disease, we argue that a complementary approach, combining BCIs and standard assistive technology, can prove valuable to achieve partner independent communication and ease the transition to a purely BCI based approach. Finally, we provide further evidence for the importance of a user-centered approach in the design of new assistive devices.