Independent home use of a brain-computer interface by people with amyotrophic lateral sclerosis

Feasibility of source-level motor imagery classification for people with multiple sclerosis

Objective.There is limited work investigating brain-computer interface (BCI) technology in people with multiple sclerosis (pwMS), a neurodegenerative disorder of the central nervous system. Present work is limited to recordings at the scalp, which may be significantly altered by changes within the cortex due to volume conduction. The recordings obtained from the sensors, therefore, combine disease-related alterations and task-relevant neural signals, as well as signals from other regions of the brain that are not relevant. The current study aims to unmix signals affected by multiple sclerosis (MS) progression and BCI task-relevant signals using estimated source activity to improve classification accuracy.Approach.Data was collected from eight participants with a range of MS severity and ten neurotypical participants. This dataset was used to report the classification accuracy of imagined movements of the hands and feet at the sensor-level and the source-level in the current study.K-means clustering of equivalent current dipoles was conducted to unmix temporally independent signals. The location of these dipoles was compared between MS and control groups and used for classification of imagined movement. Linear discriminant analysis classification was performed at each time-frequency point to highlight differences in frequency band delay.Main Results.Source-level signal acquisition significantly improved decoding accuracy of imagined movement vs rest and movement vs movement classification in pwMS and controls. There was no significant difference found in alpha (7-13 Hz) and beta (13-30 Hz) band classification delay between the neurotypical control and MS group, including imagery of limbs with weakness or paralysis.Significance.This study is the first to demonstrate the advantages of source-level analysis for BCI applications in pwMS. The results highlight the potential for enhanced clinical outcomes and emphasize the need for longitudinal studies to assess the impact of MS progression on BCI performance, which is crucial for effective clinical translation of BCI technology.

Towards developing brain-computer interfaces for people with Multiple Sclerosis

BACKGROUND

Multiple Sclerosis (MS) can be a severely disabling condition that leads to various neurological symptoms. A Brain-Computer Interface (BCI) may substitute some lost function; however, there is a lack of BCI research in people with MS. Present BCI designs have also overlooked the unique pathological changes associated with MS and have not considered needs of users within their home environments. To progress this research area effectively and efficiently, we aimed to evaluate user needs and assess the feasibility and user-centric requirements of a BCI for people with MS. We hypothesised that (i) people with MS would be interested in adopting BCI technology and (ii) those with reduced independence would prefer a higher-performing invasive BCI.

METHODS

We conducted an online survey of people with MS to describe user preferences and establish the initial steps of user-centred design. The survey aimed to understand their interest in BCI applications, bionic applications, device preferences, and development considerations and related these to symptoms and assistance needs.

RESULTS

We demonstrated widespread interest for BCI applications in all stages of MS, with a preference for a non-invasive (n = 12) or minimally invasive (n = 15) BCI over carer assistance (n = 6). Descriptive analysis indicated that level of independence did not influence preference towards the higher performing but highly invasive BCI.

CONCLUSIONS

The needs of end users reported in this study are crucial for efficient development of BCI systems that can be effectively translated into the home environment. Considering the potential to enhance independence and quality of life for people living with MS, the results emphasise the importance of user-centred design for future advancement of BCIs that account for the unique pathological changes associated with MS.

Designing an online BCI forum: insights from researchers and end-users

Objective.Brain-computer interfaces (BCIs) can support non-muscular communication and device control for severely paralyzed people. However, efforts that directly involve potential or actual end-users and address their individual needs are scarce, demonstrating a translational gap. An online BCI forum supported by the BCI Society could initiate and sustainably strengthen interactions between BCI researchers and end-users to bridge this gap.Approach.We interviewed six severely paralyzed individuals and surveyed 121 BCI researchers to capture their opinions and wishes concerning an online BCI forum. Data were analyzed with a mixed-method quantitative and qualitative content analysis.Main results.All end-users and most researchers (83%) reported an interest in participating in an online BCI forum. Rating questions and open comments to identify design aspects included what should be featured most prominently, how people would get engaged in the online BCI forum, and which pitfalls should be considered.Significance.Responses support establishing an online BCI forum to serve as a meaningful resource for the entire BCI community.

The 'Brussels 4': essential requirements for implantable brain-computer interface user autonomy

Objective. Implantable brain-computer interfaces (iBCIs) hold great promise for individuals with severe paralysis and are advancing toward commercialization. The features required for successful clinical translation and patient adoption of iBCIs may be under recognized within traditional academic iBCI research and deserve further consideration.Approach. Here we consider potentially critical factors to achieve iBCI user autonomy, reflecting the authors' perspectives on discussions during various sessions and workshops across the 10th International BCI Society Meeting, Brussels, 2023.Main results. Four key considerations were identified: (1) immediate use, (2) easy to use, (3) continuous use, and (4) stable system use.Significance. Addressing these considerations may enable successful clinical translation of iBCIs.

Brain-computer interface for augmentative and alternative communication access: The initial training needs and learning preferences of speech-language pathologists

PURPOSE

To enable the codesign of a training framework for brain-computer interfaces for augmentative and alternative communications access (BCI-AAC), the aim of this study is to evaluate the initial BCI-AAC training needs and preferred learning strategies of speech-language pathologists (SLPs) with AAC experience.

METHOD

Eleven SLPs employed across a broad range of settings completed a semi-structured interview. A grounded theory approach alongside peer debriefing and review, member checking, and triangulation procedures were utilised for thematic analysis to help ensure data reliability and credibility.

RESULT

Regarding critical training needs, SLPs identified the subthemes of (a) personalisation of intervention, (b) technical aspects, (c) BCI-AAC system types and access, and (d) how to support stakeholders in BCI-AAC implementation. Regarding learning strategy preferences, participants discussed (a) expert guidance and demonstrations, (b) hands-on experience, alongside (c) media and presentations.

CONCLUSION

Findings present a continuum of critical training needs ranging from more foundational information to more personalised assessment and intervention consideration. These thematic results present a first step in developing a basic framework for SLP training in BCI-AAC to utilise and build from as technology development continues, and provides an important initial starting point for the codesign of clinically focused BCI-AAC trainings.

Decoding imagined movement in people with multiple sclerosis for brain-computer interface translation

Objective.Multiple sclerosis (MS) is a heterogeneous autoimmune-mediated disorder affecting the central nervous system, commonly manifesting as fatigue and progressive limb impairment. This can significantly impact quality of life due to weakness or paralysis in the upper and lower limbs. A brain-computer interface (BCI) aims to restore quality of life through control of an external device, such as a wheelchair. However, the limited BCI research in people with MS has been confined to exploring the P300 response and brain signals associated with attempted movement. The current study aims to expand the MS-BCI literature by highlighting the feasibility of decoding MS imagined movement.Approach.We collected electroencephalography data from eight participants with various symptoms of MS and ten neurotypical control participants. Participants made imagined movements of the hands and feet as directed by a go no-go protocol. Binary regularised linear discriminant analysis was used to classify imagined movement vs. rest and vs. movement at individual time-frequency points. The frequency bands which provided the maximal accuracy, and the associated latency, were compared.Main Results.In all MS participants, the classification algorithm achieved above 70% accuracy in at least one imagined movement vs. rest classification and most movement vs. movement classifications. There was no significant difference between classification of limbs with weakness or paralysis to neurotypical controls. Both the MS and control groups possessed decodable information within the alpha (7-13 Hz) and beta (16-30 Hz) bands at similar latency.Significance.This study is the first to demonstrate the feasibility of decoding imagined movements in people with MS. As an alternative to the P300 response, motor imagery-based control of a BCI may also be combined with existing motor imagery therapy to supplement MS rehabilitation. These promising results merit further long term BCI studies to investigate the effect of MS progression on classification performance.

Considering preferences, speed and the animation of multiple symbols in developing P300 brain-computer interface for children

PURPOSE

Prior research has begun establishing the efficacy of animation in brain-computer interfaces access to augmentative and alternative communication (BCI-AAC). However, the use of animation in P300-BCI-AAC for children is in the early stages and largely limited to single item highlighting of extended durations. In pursuit of practical application, the present study aims to evaluate children's event-related potential (ERP) characteristics and user experience during a task involving an animated P300-BCI-AAC system.

MATERIALS AND METHODS

The system utilizes multi-item zoom animations to access a 28-pictorial symbols. Participants completed a fast (100 ms) and slow (200 ms) zoom animation highlighting conditions wherein four pictorial symbols were highlighted concurrently.

RESULTS

The proposed display appears feasible, eliciting all targeted ERPs. However, ERP amplitudes may be reduced in comparison to single-item animation highlighting, possibly due to distraction. Ratings of mental effort were significantly higher for the 100 ms condition, though differences in the frontal P200/P300 ERP did not achieve significance. Most participants identified a preference for the 100 ms condition, though age may impact preference.

CONCLUSIONS

Overall, findings support the preliminary feasibility of a proposed 28-item interface that utilises group zoom animation highlighting of pictorial symbols. Further research is needed evaluating ERP characteristics and outcomes from online (real-time) use of animation-based P300-BCI-AAC for children with severe speech and physical impairments across multiple training sessions.

Quantum Computing in the Realm of Neurosurgery

Quantum computing leverages the principles of quantum mechanics to provide unprecedented computational power by processing data in a fundamentally different way from classical binary computers. Quantum computers use "qubits" which superimpose 0 and 1. Because qubits can exist in multiple states at the same time, quantum computers can perform "quantum parallelism" wherein data are processed simultaneously rather than sequentially. The quantum parallelism is what enables the computer to have exponentially larger processing capabilities and consider all potential outcomes simultaneously to derive solutions. Our study aims to explore aspects of neurosurgery through which quantum computing could improve patient outcomes and enhance quality of care. Quantum computing has the potential for future applications in neuroprosthetics, neurostimulation, surgical precision, diagnosis, and patient privacy and security. It promises improved patient outcomes, enhanced surgical precision, and personalized healthcare delivery. With its inherent sensitivity and precision, quantum computing could advance the understanding of disease processes and development, providing neurosurgeons with deeper insight into patient pathologies. Challenges such as biocompatibility, cost, and ethical considerations remain significant barriers to integrating the technology into neurosurgical practice. Addressing these challenges will be crucial for realizing the transformative potential of quantum computing in advancing neurosurgical care and improving clinical outcomes.

Making Video Games More Inclusive for People Living With Motor Neuron Disease: Scoping Review

BACKGROUND

Evidence suggests that individuals with motor neuron disease (MND), a terminal illness, find enjoyment and social connection through video games. However, MND-related barriers can make gaming challenging, exacerbating feelings of boredom, stress, isolation, and loss of control over daily life.

OBJECTIVE

We scoped the evidence to describe relevant research and practice regarding what may help reduce difficulties for people with MND when playing video games.

METHODS

A scoping review was conducted using the Arksey and O'Malley framework, recent scoping review guidance, and engaging with people with lived experience of MND. Peer-reviewed studies were sourced from PubMed and the Swinburne University of Technology Library. Gray literature was identified from government, not-for-profit, commercial, and community websites. Data were extracted and summarized from the collected literature.

RESULTS

The evidence base, consisting of quantitative and qualitative research, lived experience stories, information resources, reviews, and guidelines, included 85 documents. Only 8 (9%) directly addressed video games and people with MND; however, these studies were limited in depth and quality. The primary technologies examined included customized information and communications technology for communication and control of computing systems (including desktop, laptop, smartphone, tablet, and console systems) and video game software and hardware (including hand controllers and accessibility features, such as difficulty level, speed, and remappable buttons and controls). Common factors in the evidence base highlight barriers and enablers to enjoying video games for people with MND. These include technological, physical, social, and economic challenges. Addressing these requires greater involvement of people with MND in game and technology research and development. Changes to information and communications technology, game software and hardware, policies, and guidelines are needed to better meet their needs.

CONCLUSIONS

There is a significant gap in understanding the lived experience of people with MND with video games and what makes playing them easier, including appropriate customization of technology and the social experience of games. This gap perpetuates exclusion from gaming communities and recreation, potentially worsening social isolation. Existing evidence suggesting viable options for future research and practice. Video game and information and communications technology research and development must prioritize qualitative and quantitative research with people with MND at an appropriate scale, with a focus on lived experience, use of improved participant engagement techniques, and user-focused design for more inclusive games. Practical work needs to increase awareness of what can help make games more inclusive, including incorporation of accessibility early in the game production process, early incorporation of accessibility in game production, and affordable options for customized interfaces and other devices to play games.

Reconstructing Multi-Stroke Characters From Brain Signals Toward Generalizable Handwriting Brain-Computer Interfaces

Handwriting Brain-Computer Interfaces (BCIs) provides a promising communication avenue for individuals with paralysis. While English-based handwriting BCIs have achieved rapid typewriting with 26 lowercase letters (mostly containing one stroke each), it is difficult to extend to complex characters, especially those with multiple strokes and large character sets. The Chinese characters, including over 3500 commonly used characters with 10.3 strokes per character on average, represent a highly complex writing system. This paper proposes a Chinese handwriting BCI system, which reconstructs multi-stroke handwriting trajectories from brain signals. Through the recording of cortical neural signals from the motor cortex, we reveal distinct neural representations for stroke-writing and pen-lift phases. Leveraging this finding, we propose a stroke-aware approach to decode stroke-writing trajectories and pen-lift movements individually, which can reconstruct recognizable characters (accuracy of 86% with 400 characters). Our approach demonstrates high stability over 5 months, shedding light on generalized and adaptable handwriting BCIs.

A review of ethical considerations for the medical applications of brain-computer interfaces

The development and potential applications of brain-computer interfaces (BCIs) are directly related to the human brain and may have adverse effects on the users' physical and mental health. Ethical issues, particularly those associated with BCIs, including both non-medical and medical applications, have captured societal attention. This article initially reviews the application of three ethical frameworks in BCI technology: consequentialism, deontology, and virtue ethics. Subsequently, it introduces the ethical standards under consideration within the medical objective framework for BCI medical applications. Finally, the paper discusses and forecasts the ethical standards for BCI medical applications. The paper emphasizes the necessity to differentiate between the ethical issues of implantable and non-implantable BCIs, to approach the research on BCI-based "controlling the brain" with caution, and to establish standardized operational procedures and efficacy evaluation methods for BCI medical applications. This paper aims to provide ideas for the establishment of ethical standards in BCI medical applications.

A review on the performance of brain-computer interface systems used for patients with locked-in and completely locked-in syndrome

Patients with locked-in syndrome (LIS) and complete locked-in syndrome (CLIS) own a fully functional brain restricted within a non-functional body. In order to help LIS patients stay connected with their surroundings, brain-computer interfaces (BCIs) and related technologies have emerged. BCIs translate brain activity into actions that can be performed by external devices enabling LIS patients to communicate, leading to an increase in their quality of life. The past decade has seen the rapid development of BCIs that have the potential to be used for patients with locked-in syndrome, from which a great deal is tested only on healthy subjects and not on actual patients. This study aims to (1) provide the readers with a comprehensive study that contributes to this growing area of research by exploring the performance of BCIs tested specifically on LIS and CLIS patients, (2) give an overview of different modalities and paradigms used in different stages of the locked-in syndrome, and (3) discuss the contributions and limitations of BCIs introduced for the LIS and CLIS patients in the state-of-the-art and lay a groundwork for researchers interested in this field.

Brain-Computer Interfaces, Completely Locked-In State in Neurodegenerative Diseases, and End-of-Life Decisions

In the future, policies surrounding end-of-life decisions will be faced with the question of whether competent people in a completely locked-in state should be enabled to make end-of-life decisions via brain-computer interfaces (BCI). This article raises ethical issues with acting through BCIs in the context of these decisions, specifically self-administration requirements within assisted suicide policies. We argue that enabling patients to end their life even once they have entered completely locked-in state might, paradoxically, prolong and uphold their quality of life.

Design of aided augmentative and alternative communication systems for children with vision impairment: psychoacoustic perspectives

Children with complex communication needs often have multiple disabilities including visual impairments that impact their ability to interact with aided augmentative and alternative communication (AAC) systems. Just as the field benefited from a consideration of visual cognitive neuroscience in construction of visual displays, an exploration of psychoacoustics can potentially assist in maximizing the possibilities within AAC systems when the visual channel is either (a) not the primary sensory mode, or (b) is one that can be augmented to ultimately benefit AAC outcomes. The purpose of this paper is to highlight background information about psychoacoustics and present possible future directions for the design of aided AAC system technologies for children with visual impairments who rely on auditory information to learn and utilize AAC.

Endovascular Brain-Computer Interfaces in Poststroke Paralysis

Stroke is a leading cause of paralysis, most frequently affecting the upper limbs and vocal folds. Despite recent advances in care, stroke recovery invariably reaches a plateau, after which there are permanent neurological impairments. Implantable brain-computer interface devices offer the potential to bypass permanent neurological lesions. They function by (1) recording neural activity, (2) decoding the neural signal occurring in response to volitional motor intentions, and (3) generating digital control signals that may be used to control external devices. While brain-computer interface technology has the potential to revolutionize neurological care, clinical translation has been limited. Endovascular arrays present a novel form of minimally invasive brain-computer interface devices that have been deployed in human subjects during early feasibility studies. This article provides an overview of endovascular brain-computer interface devices and critically evaluates the patient with stroke as an implant candidate. Future opportunities are mapped, along with the challenges arising when decoding neural activity following infarction. Limitations arise when considering intracerebral hemorrhage and motor cortex lesions; however, future directions are outlined that aim to address these challenges.

Effect of motion state variability on error-related potentials during continuous feedback paradigms and their consequences for classification

BACKGROUND

An erroneous motion would elicit the error-related potential (ErrP) when humans monitor the behavior of the external devices. This EEG modality has been largely applied to brain-computer interface in an active or passive manner with discrete visual feedback. However, the effect of variable motion state on ErrP morphology and classification performance raises concerns when the interaction is conducted with continuous visual feedback.

NEW METHOD

In the present study, we designed a cursor control experiment. Participants monitored a continuously moving cursor to reach the target on one side of the screen. Motion state varied multiple times with two factors: (1) motion direction and (2) motion speed. The effects of these two factors on the morphological characteristics and classification performance of ErrP were analyzed. Furthermore, an offline simulation was performed to evaluate the effectiveness of the proposed extended ErrP-decoder in resolving the interference by motion direction changes.

RESULTS

The statistical analyses revealed that motion direction and motion speed significantly influenced the amplitude of feedback-ERN and frontal-Pe components, while only motion direction significantly affected the classification performance.

COMPARISON WITH EXISTING METHODS

Significant deviation was found in ErrP detection utilizing classical correct-versus-erroneous event training. However, this bias can be alleviated by 16% by the extended ErrP-decoder.

CONCLUSION

The morphology and classification performance of ErrP signal can be affected by motion state variability during continuous feedback paradigms. The results enhance the comprehension of ErrP morphological components and shed light on the detection of BCI's error behavior in practical continuous control.

Successful use of an eye gaze AAC communication board by a young adult with advanced Sanfilippo Syndrome (MPS IIIA): Case report

Sanfilippo syndrome (Mucopolysaccharidosis Type III or MPS III) is a family of rare, lysosomal disorders characterized by progressive cognitive and motor deterioration. Even though individuals with MPS III present with complex communication needs, research regarding augmentative and alternative communication (AAC) in this population is scarce. While life expectancy for individuals with MPS IIIA typically does not exceed 20 years of age, this case report involves a 22-year-old adult with postregression MPS IIIA. Prior to this study, the participant could not communicate using speech and only responded to yes/no questions using eye blink responses. The participant was given a low-tech AAC system utilizing eye gaze so that she could respond to a variety of caregiver questions and take conversational turns. The following communication outcomes were measured during each session in which caregivers used the AAC system: number of eye gaze responses, total number of responses (using any means), the percent of responses to questions asked, and the total count of expressive vocabulary words available to the participant with the AAC system. Increases were observed in the number of eye gaze responses per session and in the expressive vocabulary accessible via the eye gaze board. A higher percentage of responses given caregiver questions was noted for the intervention sessions (71%) compared to the baseline sessions (55%). There were also qualitative changes characterized by the types of questions the participant could respond to during conversational exchanges. Despite the progression of MPS IIIA, the results suggest that use of the eye gaze board resulted in quantitative and qualitative changes in functional communication. This case report provides preliminary evidence that AAC can improve communication in a young adult with postregression MPS IIIA.

Detecting passive and active response in patients with behaviourally diagnosed unresponsive wakefulness syndrome

The diagnosis of unresponsive wakefulness syndrome depends mostly on the motor response following verbal commands. However, there is a potential for misdiagnosis in patients who understand verbal commands (passive response) but cannot perform voluntary movements (active response). To evaluate passive and active responses in such patients, this study used an approach combining functional magnetic resonance imaging and passive listening tasks to evaluate the level of speech comprehension, with portable brain-computer interface modalities that were applied to elicit an active response to attentional modulation tasks at the bedside. We included ten patients who were clinically diagnosed as unresponsive wakefulness syndrome. Two of ten patients showed no significant activation, while limited activation in the auditory cortex was found in six patients. The remaining two patients showed significant activation in language areas, and were able to control the brain-computer interface with reliable accuracy. Using a combined passive/active approach, we identified unresponsive wakefulness syndrome patients who showed both active and passive neural responses. This suggests that some patients with unresponsive wakefulness syndrome diagnosed behaviourally are both wakeful and responsive, and the combined approach is useful for distinguishing a minimally conscious state from unresponsive wakefulness syndrome physiologically.

Promoting Simple and Engaging Brain-Computer Interface Designs for Children by Evaluating Contrasting Motion Techniques

PURPOSE

There is an increasing focus on using motion in augmentative and alternative communication (AAC) systems. In considering brain-computer interface access to AAC (BCI-AAC), motion may provide a simpler or more intuitive avenue for BCI-AAC control. Different motion techniques may be utilized in supporting competency with AAC devices including simple (e.g., zoom) and complex (behaviorally relevant animation) methods. However, how different pictorial symbol animation techniques impact BCI-AAC is unclear.

METHOD

Sixteen healthy children completed two experimental conditions. These conditions included highlighting of pictorial symbols via both functional (complex) and zoom (simple) animation to evaluate the effects of motion techniques on P300-based BCI-AAC signals and offline (predicted) BCI-AAC performance.

RESULTS

Functional (complex) animation significantly increased attentional-related P200/P300 event-related potential (ERP) amplitudes in the parieto-occipital area. Zoom (simple) animation significantly decreased N400 latency. N400 ERP amplitude was significantly greater, and occurred significantly earlier, on the right versus left side for the functional animation condition within the parieto-occipital bin. N200 ERP latency was significantly reduced over the left hemisphere for the zoom condition in the central bin. As hypothesized, elicitation of all targeted ERP components supported offline (predicted) BCI-AAC performance being similar between conditions.

CONCLUSION

Study findings provide continued support for the use of animation in BCI-AAC systems for children and highlight differences in neural and attentional processing between complex and simple animation techniques.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24085623.

Suppression of cortical electrostimulation artifacts using pre-whitening and null projection

Objective.Invasive brain-computer interfaces (BCIs) have shown promise in restoring motor function to those paralyzed by neurological injuries. These systems also have the ability to restore sensation via cortical electrostimulation. Cortical stimulation produces strong artifacts that can obscure neural signals or saturate recording amplifiers. While front-end hardware techniques can alleviate this problem, residual artifacts generally persist and must be suppressed by back-end methods.Approach.We have developed a technique based on pre-whitening and null projection (PWNP) and tested its ability to suppress stimulation artifacts in electroencephalogram (EEG), electrocorticogram (ECoG) and microelectrode array (MEA) signals from five human subjects.Main results.In EEG signals contaminated by narrow-band stimulation artifacts, the PWNP method achieved average artifact suppression between 32 and 34 dB, as measured by an increase in signal-to-interference ratio. In ECoG and MEA signals contaminated by broadband stimulation artifacts, our method suppressed artifacts by 78%-80% and 85%, respectively, as measured by a reduction in interference index. When compared to independent component analysis, which is considered the state-of-the-art technique for artifact suppression, our method achieved superior results, while being significantly easier to implement.Significance.PWNP can potentially act as an efficient method of artifact suppression to enable simultaneous stimulation and recording in bi-directional BCIs to biomimetically restore motor function.

Brain-Computer interfaces for communication: preferences of individuals with locked-in syndrome, caregivers and researchers

OBJECTIVES

The development of Brain-Computer Interfaces to restore communication (cBCIs) in people with severe motor impairment ideally relies on a close collaboration between end-users and other stakeholders, such as caregivers and researchers. Awareness about potential differences in opinion between these groups is crucial for development of usable cBCIs and access technology (AT) in general. In this study, we compared the opinions of prospective cBCI users, their caregivers and cBCI researchers regarding: (1) what applications would users like to control with a cBCI; (2) what mental strategies would users prefer to use for cBCI control; and (3) at what stage of their clinical trajectory would users like to be informed about AT and cBCIs.

METHODS

We collected data from 28 individuals with locked-in syndrome, 29 of their caregivers and 28 cBCI researchers. The questionnaire was supported with animation videos to explain different cBCI concepts, the utility of which was also assessed.

RESULTS

Opinions of the three groups were aligned with respect to the most desired cBCI applications, but diverged regarding mental strategies and the timing of being informed about cBCIs. Animation videos were regarded as clear and useful tools to explain cBCIs and mental strategies to end-users and other stakeholders.

CONCLUSIONS

Disagreements were clear between stakeholders regarding which mental strategies users prefer to use and when they would like to be informed about cBCIs. To move forward in the development and clinical implementation of cBCIs, it will be necessary to align the research agendas with the needs of the end-users and caregivers.IMPLICATIONS FOR REHABILITATIONBrain-Computer Interfaces may offer people with severe motor impairment a brain-based and muscle-independent approach to control communication-technology. The successful development of communication BCIs (cBCIs) relies on a close collaboration between end-users and other stakeholders, such as caregivers and researchers.Our work reveals that people with locked-in syndrome (end-users), their caregivers and researchers developing cBCIs agree that direct and private forms of communication are the most desired cBCI applications, but disagree regarding the preferred mental strategies for cBCI control and when to be informed about cBCIs.Animation videos are an effective tool for providing information to individuals, independent of their level of health literacy, regarding the concept of cBCIs and mental strategies for control.The misalignment in opinions of different groups of stakeholders about cBCIs strengthens the argument for a user-centered design approach in the development of cBCIs and access technology designed for daily life usage.

Applications of brain-computer interfaces in neurodegenerative diseases

Brain-computer interfaces (BCIs) provide the central nervous system with channels of direct communication to the outside world, without having to go through the peripheral nervous system. Neurodegenerative diseases (NDs) are notoriously incurable and burdensome medical conditions that will result in progressive deterioration of the nervous system. The applications of BCIs in NDs have been studied for decades now through different approaches, resulting in a considerable amount of literature in all related areas. In this study, we begin by introducing BCIs and proceed by explaining the principles of BCI-based neurorehabilitation. Then, we go through four specific types of NDs, including amyotrophic lateral sclerosis, Parkinson's disease, Alzheimer's disease, and spinal muscular atrophy, and review some of the applications of BCIs in the neural rehabilitation of these diseases. We conclude with a discussion of the characteristics, challenges, and future possibilities of research in the field. Going through the uses of BCIs in NDs, we can see that approaches and strategies employed to tackle the wide range of limitations caused by NDs are numerous and diverse. Furthermore, NDs can fall under different categories based on the target area of neurodegeneration and thus require different methods of BCI-based rehabilitation. In recent years, neurotechnology companies have substantially invested in research on BCIs, focusing on commercializing BCIs and bringing BCI-based technologies from bench to bedside. This can mean the beginning of a new era for BCI-based neurorehabilitation, with an anticipated spike in interest among researchers, practitioners, engineers, and entrepreneurs alike.

Current State and Future Directions in the Therapy of ALS

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disorder affecting upper and lower motor neurons, with death resulting mainly from respiratory failure three to five years after symptom onset. As the exact underlying causative pathological pathway is unclear and potentially diverse, finding a suitable therapy to slow down or possibly stop disease progression remains challenging. Varying by country Riluzole, Edaravone, and Sodium phenylbutyrate/Taurursodiol are the only drugs currently approved in ALS treatment for their moderate effect on disease progression. Even though curative treatment options, able to prevent or stop disease progression, are still unknown, recent breakthroughs, especially in the field of targeting genetic disease forms, raise hope for improved care and therapy for ALS patients. In this review, we aim to summarize the current state of ALS therapy, including medication as well as supportive therapy, and discuss the ongoing developments and prospects in the field. Furthermore, we highlight the rationale behind the intense research on biomarkers and genetic testing as a feasible way to improve the classification of ALS patients towards personalized medicine.

Can vibrotactile stimulation and tDCS help inefficient BCI users?

Brain-computer interface (BCI) has helped people by allowing them to control a computer or machine through brain activity without actual body movement. Despite this advantage, BCI cannot be used widely because some people cannot achieve controllable performance. To solve this problem, researchers have proposed stimulation methods to modulate relevant brain activity to improve BCI performance. However, multiple studies have reported mixed results following stimulation, and the comparative study of different stimulation modalities has been overlooked. Accordingly, this study was designed to compare vibrotactile stimulation and transcranial direct current stimulation's (tDCS) effects on brain activity modulation and motor imagery BCI performance among inefficient BCI users. We recruited 44 subjects and divided them into sham, vibrotactile stimulation, and tDCS groups, and low performers were selected from each stimulation group. We found that the latter's BCI performance in the vibrotactile stimulation group increased significantly by 9.13% (p < 0.01), and while the tDCS group subjects' performance increased by 5.13%, it was not significant. In contrast, sham group subjects showed no increased performance. In addition to BCI performance, pre-stimulus alpha band power and the phase locking values (PLVs) averaged over sensory motor areas showed significant increases in low performers following stimulation in the vibrotactile stimulation and tDCS groups, while sham stimulation group subjects and high performers showed no significant stimulation effects across all groups. Our findings suggest that stimulation effects may differ depending upon BCI efficiency, and inefficient BCI users have greater plasticity than efficient BCI users.

Neurocognitive and motor-control challenges for the realization of bionic augmentation

Robotic fingers and arms that augment the motor abilities of non-disabled individuals are increasingly feasible yet face neurocognitive barriers and hurdles in efferent motor control.

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.

Learning to control a BMI-driven wheelchair for people with severe tetraplegia

Mind-controlled wheelchairs are an intriguing assistive mobility solution applicable in complete paralysis. Despite progress in brain-machine interface (BMI) technology, its translation remains elusive. The primary objective of this study is to probe the hypothesis that BMI skill acquisition by end-users is fundamental to control a non-invasive brain-actuated intelligent wheelchair in real-world settings. We demonstrate that three tetraplegic spinal-cord injury users could be trained to operate a non-invasive, self-paced thought-controlled wheelchair and execute complex navigation tasks. However, only the two users exhibiting increasing decoding performance and feature discriminancy, significant neuroplasticity changes and improved BMI command latency, achieved high navigation performance. In addition, we show that dexterous, continuous control of robots is possible through low-degree of freedom, discrete and uncertain control channels like a motor imagery BMI, by blending human and artificial intelligence through shared-control methodologies. We posit that subject learning and shared-control are the key components paving the way for translational non-invasive BMI.

Challenges of brain-computer interface facilitated cognitive assessment for children with cerebral palsy

Brain-computer interfaces (BCIs) have been successfully used by adults, but little information is available on BCI use by children, especially children with severe multiple impairments who may need technology to facilitate communication. Here we discuss the challenges of using non-invasive BCI with children, especially children who do not have another established method of communication with unfamiliar partners. Strategies to manage these challenges require consideration of multiple factors related to accessibility, cognition, and participation. These factors include decisions regarding where (home, clinic, or lab) participation will take place, the number of sessions involved, and the degree of participation necessary for success. A strategic approach to addressing the unique challenges inherent in BCI use by children with disabilities will increase the potential for successful BCI calibration and adoption of BCI as a valuable access method for children with the most significant impairments in movement and communication.

A systematic review of research on augmentative and alternative communication brain-computer interface systems for individuals with disabilities

Augmentative and alternative communication brain-computer interface (AAC-BCI) systems are intended to offer communication access to people with severe speech and physical impairment (SSPI) without requiring volitional movement. As the field moves toward clinical implementation of AAC-BCI systems, research involving participants with SSPI is essential. Research has demonstrated variability in AAC-BCI system performance across users, and mixed results for comparisons of performance for users with and without disabilities. The aims of this systematic review were to (1) describe study, system, and participant characteristics reported in BCI research, (2) summarize the communication task performance of participants with disabilities using AAC-BCI systems, and (3) explore any differences in performance for participants with and without disabilities. Electronic databases were searched in May, 2018, and March, 2021, identifying 6065 records, of which 73 met inclusion criteria. Non-experimental study designs were common and sample sizes were typically small, with approximately half of studies involving five or fewer participants with disabilities. There was considerable variability in participant characteristics, and in how those characteristics were reported. Over 60% of studies reported an average selection accuracy ≤70% for participants with disabilities in at least one tested condition. However, some studies excluded participants who did not reach a specific system performance criterion, and others did not state whether any participants were excluded based on performance. Twenty-nine studies included participants both with and without disabilities, but few reported statistical analyses comparing performance between the two groups. Results suggest that AAC-BCI systems show promise for supporting communication for people with SSPI, but they remain ineffective for some individuals. The lack of standards in reporting outcome measures makes it difficult to synthesize data across studies. Further research is needed to demonstrate efficacy of AAC-BCI systems for people who experience SSPI of varying etiologies and severity levels, and these individuals should be included in system design and testing. Consensus in terminology and consistent participant, protocol, and performance description will facilitate the exploration of user and system characteristics that positively or negatively affect AAC-BCI use, and support innovations that will make this technology more useful to a broader group of people.

Clinical trial registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018095345, PROSPERO: CRD42018095345.

Visuo-auditory stimuli with semantic, temporal and spatial congruence for a P300-based BCI: An exploratory test with an ALS patient in a completely locked-in state

BACKGROUND

Brain-computer interfaces (BCIs) are a promising tool for communication with completely locked-in state (CLIS) patients. Despite the great efforts already made by the BCI research community, the cases of success are still very few, very exploratory, limited in time, and based on simple 'yes/no' paradigms.

NEW METHOD

A P300-based BCI is proposed comparing two conditions, one corresponding to purely spatial auditory stimuli (AU-S) and the other corresponding to hybrid visual and spatial auditory stimuli (HVA-S). In the HVA-S condition, there is a semantic, temporal, and spatial congruence between visual and auditory stimuli. The stimuli comprise a lexicon of 7 written and spoken words. Spatial sounds are generated through the head-related transfer function. Given the good results obtained with 10 able-bodied participants, we investigated whether a patient entering CLIS could use the proposed BCI.

RESULTS

The able-bodied group achieved 71.3 % and 90.5 % online classification accuracy for the auditory and hybrid BCIs respectively, while the patient achieved 30 % and chance level accuracies, for the same conditions. Notwithstanding, the patient's event-related potentials (ERPs) showed statistical discrimination between target and non-target events in different time windows.

COMPARISON WITH EXISTING METHODS

The results of the control group compare favorably with the state-of-the-art, considering a 7-class BCI controlled visual-covertly and with auditory stimuli. The integration of visual and auditory stimuli has not been tested before with CLIS patients.

CONCLUSIONS

The semantic, temporal, and spatial congruence of the stimuli increased the performance of the control group, but not of the CLIS patient, which can be due to impaired attention and cognitive function. The patient's unique ERP patterns make interpretation difficult, requiring further tests/paradigms to decouple patients' responses at different levels (reflexive, perceptual, cognitive). The ERPs discrimination found indicates that a simplification of the proposed approaches may be feasible.

Iterative Development of a Software to Facilitate Independent Home Use of BCI Technologies for Children with Quadriplegic Cerebral Palsy

Brain-computer interfaces (BCIs) are emerging as a new solution for children with severe disabilities to interact with the world. However, BCI technologies have yet to reach end-users in their daily lives due to significant translational gaps. To address these gaps, we applied user-centered design principles to establish a home BCI program for children with quadriplegic cerebral palsy. This work describes the technical development of the software we designed to facilitate BCI use at home. Children and their families were involved at each design stage to evaluate and provide feedback. Since deployment, seven families have successfully used the system independently at home and continue to use BCI at home to further enable participation and independence for their children. Clinical relevance- The design and successful implementation of user-centered software for home use will both inform on the feasibility of BCI as a long-term access solution for children with neurological disabilities as well as decrease barriers of accessibility and availability of BCI technologies for end-users.

Toward P300-brain-computer interface access to contextual scene displays for AAC: An initial exploration of context and asymmetry processing in healthy adults

Brain-computer interfaces for augmentative and alternative communication (BCI-AAC) may help overcome physical barriers to AAC access. Traditionally, visually based P300-BCI-AAC displays utilize a symmetrical grid layout. Contextual scene displays are composed of context-rich images (e.g., photographs) and may support AAC success. However, contextual scene displays contrast starkly with the standard P300-grid approach. Understanding the neurological processes from which BCI-AAC devices function is crucial to human-centered computing for BCI-AAC. Therefore, the aim of this multidisciplinary investigation is to provide an initial exploration of contextual scene use for BCI-AAC.

METHODS

Participants completed three experimental conditions to evaluate the effects of item arrangement asymmetry and context on P300-based BCI-AAC signals and offline BCI-AAC accuracy, including 1) the full contextual scene condition, 2) asymmetrical item arraignment without context condition and 3) the grid condition. Following each condition, participants completed task-evaluation ratings (e.g., engagement). Offline BCI-AAC accuracy for each condition was evaluated using cross-validation.

RESULTS

Display asymmetry significantly decreased P300 latency in the centro-parietal cluster. P300 amplitudes in the frontal cluster were decreased, though nonsignificantly. Display context significantly increased N170 amplitudes in the occipital cluster, and N400 amplitudes in the centro-parietal and occipital clusters. Scenes were rated as more visually appealing and engaging, and offline BCI-AAC performance for the scene condition was not statistically different from the grid standard.

CONCLUSION

Findings support the feasibility of incorporating scene-based displays for P300-BCI-AAC development to help provide communication for individuals with minimal or emerging language and literacy skills.

Usability of a Hybrid System Combining P300-Based Brain-Computer Interface and Commercial Assistive Technologies to Enhance Communication in People With Multiple Sclerosis

Brain-computer interface (BCI) can provide people with motor disabilities with an alternative channel to access assistive technology (AT) software for communication and environmental interaction. Multiple sclerosis (MS) is a chronic disease of the central nervous system that mostly starts in young adulthood and often leads to a long-term disability, possibly exacerbated by the presence of fatigue. Patients with MS have been rarely considered as potential BCI end-users. In this pilot study, we evaluated the usability of a hybrid BCI (h-BCI) system that enables both a P300-based BCI and conventional input devices (i.e., muscular dependent) to access mainstream applications through the widely used AT software for communication “Grid 3.” The evaluation was performed according to the principles of the user-centered design (UCD) with the aim of providing patients with MS with an alternative control channel (i.e., BCI), potentially less sensitive to fatigue. A total of 13 patients with MS were enrolled. In session I, participants were presented with a widely validated P300-based BCI (P3-speller); in session II, they had to operate Grid 3 to access three mainstream applications with (1) an AT conventional input device and (2) the h-BCI. Eight patients completed the protocol. Five out of eight patients with MS were successfully able to access the Grid 3 via the BCI, with a mean online accuracy of 83.3% (± 14.6). Effectiveness (online accuracy), satisfaction, and workload were comparable between the conventional AT inputs and the BCI channel in controlling the Grid 3. As expected, the efficiency (time for correct selection) resulted to be significantly lower for the BCI with respect to the AT conventional channels (Z = 0.2, p < 0.05). Although cautious due to the limited sample size, these preliminary findings indicated that the BCI control channel did not have a detrimental effect with respect to conventional AT channels on the ability to operate an AT software (Grid 3). Therefore, we inferred that the usability of the two access modalities was comparable. The integration of BCI with commercial AT input devices to access a widely used AT software represents an important step toward the introduction of BCIs into the AT centers’ daily practice.

Evaluating the clinical benefit of brain-computer interfaces for control of a personal computer

Brain-computer interfaces (BCIs) enabling the control of a personal computer could provide myriad benefits to individuals with disabilities including paralysis. However, to realize this potential, these BCIs must gain regulatory approval and be made clinically available beyond research participation. Therefore, a transition from engineering-oriented to clinically oriented outcome measures will be required in the evaluation of BCIs. This review examined how to assess the clinical benefit of BCIs for the control of a personal computer. We report that: 1) a variety of different patient-reported outcome measures can be used to evaluate improvements in how a patient feels, and we offer some considerations that should guide instrument selection. 2) Activities of daily living can be assessed to demonstrate improvements in how a patient functions, however, new instruments that are sensitive to increases in functional independence via the ability to perform digital tasks may be needed. 3) Benefits to how a patient survives has not previously been evaluated, but establishing patient-initiated communication channels using BCIs might facilitate quantifiable improvements in health outcomes.

Spelling interface using intracortical signals in a completely locked-in patient enabled via auditory neurofeedback training

Patients with amyotrophic lateral sclerosis (ALS) can lose all muscle-based routes of communication as motor neuron degeneration progresses, and ultimately, they may be left without any means of communication. While others have evaluated communication in people with remaining muscle control, to the best of our knowledge, it is not known whether neural-based communication remains possible in a completely locked-in state. Here, we implanted two 64 microelectrode arrays in the supplementary and primary motor cortex of a patient in a completely locked-in state with ALS. The patient modulated neural firing rates based on auditory feedback and he used this strategy to select letters one at a time to form words and phrases to communicate his needs and experiences. This case study provides evidence that brain-based volitional communication is possible even in a completely locked-in state.

Workshops of the Eighth International Brain-Computer Interface Meeting: BCIs: The Next Frontier

The Eighth International Brain-Computer Interface (BCI) Meeting was held June 7-9th, 2021 in a virtual format. The conference continued the BCI Meeting series' interactive nature with 21 workshops covering topics in BCI (also called brain-machine interface) research. As in the past, workshops covered the breadth of topics in BCI. Some workshops provided detailed examinations of specific methods, hardware, or processes. Others focused on specific BCI applications or user groups. Several workshops continued consensus building efforts designed to create BCI standards and increase the ease of comparisons between studies and the potential for meta-analysis and large multi-site clinical trials. Ethical and translational considerations were both the primary topic for some workshops or an important secondary consideration for others. The range of BCI applications continues to expand, with more workshops focusing on approaches that can extend beyond the needs of those with physical impairments. This paper summarizes each workshop, provides background information and references for further study, presents an overview of the discussion topics, and describes the conclusion, challenges, or initiatives that resulted from the interactions and discussion at the workshop.

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.

Bayesian Inferences on Neural Activity in EEG-Based Brain-Computer Interface

A brain-computer interface (BCI) is a system that translates brain activity into commands to operate technology. A common design for an electroencephalogram (EEG) BCI relies on the classification of the P300 event-related potential (ERP), which is a response elicited by the rare occurrence of target stimuli among common non-target stimuli. Few existing ERP classifiers directly explore the underlying mechanism of the neural activity. To this end, we perform a novel Bayesian analysis of the probability distribution of multi-channel real EEG signals under the P300 ERP-BCI design. We aim to identify relevant spatial temporal differences of the neural activity, which provides statistical evidence of P300 ERP responses and helps design individually efficient and accurate BCIs. As one key finding of our single participant analysis, there is a 90% posterior probability that the target ERPs of the channels around visual cortex reach their negative peaks around 200 milliseconds post-stimulus. Our analysis identifies five important channels (PO7, PO8, Oz, P4, Cz) for the BCI speller leading to a 100% prediction accuracy. From the analyses of nine other participants, we consistently select the identified five channels, and the selection frequencies are robust to small variations of bandpass filters and kernel hyper-parameters.

Implantable brain-computer interface for neuroprosthetic-enabled volitional hand grasp restoration in spinal cord injury

Loss of hand function after cervical spinal cord injury severely impairs functional independence. We describe a method for restoring volitional control of hand grasp in one 21-year-old male subject with complete cervical quadriplegia (C5 American Spinal Injury Association Impairment Scale A) using a portable fully implanted brain-computer interface within the home environment. The brain-computer interface consists of subdural surface electrodes placed over the dominant-hand motor cortex and connects to a transmitter implanted subcutaneously below the clavicle, which allows continuous reading of the electrocorticographic activity. Movement-intent was used to trigger functional electrical stimulation of the dominant hand during an initial 29-weeks laboratory study and subsequently via a mechanical hand orthosis during in-home use. Movement-intent information could be decoded consistently throughout the 29-weeks in-laboratory study with a mean accuracy of 89.0% (range 78-93.3%). Improvements were observed in both the speed and accuracy of various upper extremity tasks, including lifting small objects and transferring objects to specific targets. At-home decoding accuracy during open-loop trials reached an accuracy of 91.3% (range 80-98.95%) and an accuracy of 88.3% (range 77.6-95.5%) during closed-loop trials. Importantly, the temporal stability of both the functional outcomes and decoder metrics were not explored in this study. A fully implanted brain-computer interface can be safely used to reliably decode movement-intent from motor cortex, allowing for accurate volitional control of hand grasp.

Interprofessional Practitioners' Opinions on Features and Services for an Augmentative and Alternative Communication Brain-Computer Interface Device

BACKGROUND

Brain-computer interface (BCI) technology is an emerging access method to augmentative and alternative communication (AAC) devices.

OBJECTIVES

To identify, in the early stages of research and development, the perceptions and considerations of interprofessional practice (IPP) team members regarding features and functions for an AAC-BCI device.

DESIGN

Qualitative research methodology applying a grounded theory approach using focus groups with a follow-up survey of participants using NVivo analysis software supporting inductive coding of transcription data.

SETTING

Focus groups held at university, clinic, and industry conference rooms. Discussion was stimulated by a 14-minute video on an AAC-BCI device prototype. The prototype hardware and electroencephalography (EEG) gel and dry electrode headgear were on display.

PARTICIPANTS

Convenience sample of practitioners providing rehabilitation or clinical services to individuals with severe communication disorders and movement impairments who use AAC and/or other assistive technology.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Descriptive statistics using thematic analysis of participants' opinions, input, and feedback on the ideal design for a noninvasive, EEG-based P300 AAC-BCI device.

RESULTS

Interrater and interjudge reliability were at 98% and 100%, respectively, for transcription and researcher coding. Triangulation of multiple data sources supported theme and subtheme identification that included design features, set-up and calibration, services, and effectiveness. An AAC device with BCI access was unanimously confirmed (100%) as a desirable commercial product. Participants felt that the AAC-BCI prototype appeared effective for meeting daily communication needs (75%). Results showed that participants' preference on headgear types would change based on accuracy (91%) and rate (83%) of performance. A data-logging feature was considered beneficial by 100% of participants.

CONCLUSIONS

IPP teams provided critical impressions on design, services, and features for a commercial AAC-BCI device. Expressed feature and function preferences showed dependence on communication accuracy, rate, and effectiveness. This provides vital guidance for successful clinical deployment.

Brain Computer Interfaces for Assisted Communication in Paralysis and Quality of Life

The rapid evolution of Brain-Computer Interface (BCI) technology and the exponential growth of BCI literature during the past 20 years is a consequence of increasing computational power and the achievements of statistical learning theory and machine learning since the 1960s. Despite this rapid scientific progress, the range of successful clinical and societal applications remained limited, with some notable exceptions in the rehabilitation of chronic stroke and first steps towards BCI-based assisted verbal communication in paralysis. In this contribution, we focus on the effects of noninvasive and invasive BCI-based verbal communication on the quality of life (QoL) of patients with amyotrophic lateral sclerosis (ALS) in the locked-in state (LIS) and the completely locked-in state (CLIS). Despite a substantial lack of replicated scientific data, this paper complements the existing methodological knowledge and focuses future investigators' attention on (1) Social determinants of QoL and (2) Brain reorganization and behavior. While it is not documented in controlled studies that the good QoL in these patients is a consequence of BCI-based neurorehabilitation, the proposed determinants of QoL might become the theoretical background needed to develop clinically more useful BCI systems and to evaluate the effects of BCI-based communication on QoL for advanced ALS patients and other forms of severe paralysis.

A Voting-Enhanced Dynamic-Window-Length Classifier for SSVEP-Based BCIs

We present a dynamic window-length classifier for steady-state visual evoked potential (SSVEP)-based brain-computer interfaces (BCIs) that does not require the user to choose a feature extraction method or channel set. Instead, the classifier uses multiple feature extraction methods and channel selections to infer the SSVEP and relies on majority voting to pick the most likely target. The classifier extends the window length dynamically if no target obtains the majority of votes. Compared with existing solutions, our classifier: (i) does not assume that any single feature extraction method will consistently outperform the others; (ii) adapts the channel selection to individual users or tasks; (iii) uses dynamic window lengths; (iv) is unsupervised (i.e., does not need training). Collectively, these characteristics make the classifier easy-to-use, especially for caregivers and others with limited technical expertise. We evaluated the performance of our classifier on a publicly available benchmark dataset from 35 healthy participants. We compared the information transfer rate (ITR) of this new classifier to those of the minimum energy combination (MEC), maximum synchronization index (MSI), and filter bank canonical correlation analysis (FBCCA). The new classifier increases average ITR to 123.5 bits-per-minute (bpm), 47.5, 51.2, and 19.5 bpm greater than the MEC, MSI, and FBCCA classifiers, respectively.

A visual brain-computer interface as communication aid for patients with amyotrophic lateral sclerosis

OBJECTIVE

Brain-Computer Interface (BCI) spellers that make use of code-modulated Visual Evoked Potentials (cVEP) may provide a fast and more accurate alternative to existing visual BCI spellers for patients with Amyotrophic Lateral Sclerosis (ALS). However, so far the cVEP speller has only been tested on healthy participants.

METHODS

We assess the brain responses, BCI performance and user experience of the cVEP speller in 20 healthy participants and 10 ALS patients. All participants performed a cued and free spelling task, and a free selection of Yes/No answers.

RESULTS

27 out of 30 participants could perform the cued spelling task with an average accuracy of 79% for ALS patients, 88% for healthy older participants and 94% for healthy young participants. All 30 participants could answer Yes/No questions freely, with an average accuracy of around 90%.

CONCLUSIONS

With ALS patients typing on average 10 characters per minute, the cVEP speller presented in this paper outperforms other visual BCI spellers.

SIGNIFICANCE

These results support a general usability of cVEP signals for ALS patients, which may extend far beyond the tested speller to control e.g. an alarm, automatic door, or TV within a smart home.

Neuroprosthesis for Decoding Speech in a Paralyzed Person with Anarthria

BACKGROUND

Technology to restore the ability to communicate in paralyzed persons who cannot speak has the potential to improve autonomy and quality of life. An approach that decodes words and sentences directly from the cerebral cortical activity of such patients may represent an advancement over existing methods for assisted communication.

METHODS

We implanted a subdural, high-density, multielectrode array over the area of the sensorimotor cortex that controls speech in a person with anarthria (the loss of the ability to articulate speech) and spastic quadriparesis caused by a brain-stem stroke. Over the course of 48 sessions, we recorded 22 hours of cortical activity while the participant attempted to say individual words from a vocabulary set of 50 words. We used deep-learning algorithms to create computational models for the detection and classification of words from patterns in the recorded cortical activity. We applied these computational models, as well as a natural-language model that yielded next-word probabilities given the preceding words in a sequence, to decode full sentences as the participant attempted to say them.

RESULTS

We decoded sentences from the participant's cortical activity in real time at a median rate of 15.2 words per minute, with a median word error rate of 25.6%. In post hoc analyses, we detected 98% of the attempts by the participant to produce individual words, and we classified words with 47.1% accuracy using cortical signals that were stable throughout the 81-week study period.

CONCLUSIONS

In a person with anarthria and spastic quadriparesis caused by a brain-stem stroke, words and sentences were decoded directly from cortical activity during attempted speech with the use of deep-learning models and a natural-language model. (Funded by Facebook and others; ClinicalTrials.gov number, NCT03698149.).