Clinician awareness of brain computer interfaces: a Canadian national survey

Towards user-centric BCI design: Markov chain-based user assessment for mental imagery EEG-BCIs

Objective.While electroencephalography (EEG)-based brain-computer interfaces (BCIs) have many potential clinical applications, their use is impeded by poor performance for many users. To improve BCI performance, either via enhanced signal processing or user training, it is critical to understand and describe each user's ability to perform mental control tasks and produce discernible EEG patterns. While classification accuracy has predominantly been used to assess user performance, limitations and criticisms of this approach have emerged, thus prompting the need to develop novel user assessment approaches with greater descriptive capability. Here, we propose a combination of unsupervised clustering and Markov chain models to assess and describe user skill.Approach.Using unsupervisedK-means clustering, we segmented the EEG signal space into regions representing pattern states that users could produce. A user's movement through these pattern states while performing different tasks was modeled using Markov chains. Finally, using the steady-state distributions and entropy rates of the Markov chains, we proposed two metricstaskDistinctandrelativeTaskInconsistencyto assess, respectively, a user's ability to (i) produce distinct task-specific patterns for each mental task and (ii) maintain consistent patterns during individual tasks.Main results.Analysis of data from 14 adolescents using a three-class BCI revealed significant correlations between thetaskDistinctandrelativeTaskInconsistencymetrics and classification F1 score. Moreover, analysis of the pattern states and Markov chain models yielded descriptive information regarding user performance not immediately apparent from classification accuracy.Significance.Our proposed user assessment method can be used in concert with classifier-based analysis to further understand the extent to which users produce task-specific, time-evolving EEG patterns. In turn, this information could be used to enhance user training or classifier design.

End-User Perspectives of the Importance of Rehabilitation Technologies and Related Values for Implementation

Despite the increased availability of rehabilitation technologies (such as robotics) and evidence to support their use, their adoption is still limited in practice. To begin to address this issue, we sought to better understand the perspectives of end-users regarding the implementation of rehabilitation technologies through an online survey. Fifty unique responses across Client (e.g., people with disability and carers), Allied Health (e.g., occupational and physical therapists, podiatrists, psychologists, dieticians, audiologists, exercise physiologists), and Medical (i.e., physicians and nurses) groups were analyzed. Respondents considered rehabilitation technologies to be important (median across groups of 9 out of 10). Across groups, value statements related to the implementation of rehabilitation technologies ranked from most to least important related to: benefits of technology to its intended end-user with disability, practical use of technologies, the technologies themselves (e.g., innovative, established, stand-alone), and their impact on health professionals or the health system as a whole. There were similarities and differences in ranking within and across end-user groups. The prioritization of statements indicates where development efforts can be focused to address end-user goals, and disparity in results across groups supports rich stakeholder engagement during rehabilitation technology development.

A Moral Imperative to Advance Brain-Computer Interfaces for Children With Neurological Disability

This Viewpoint describes the need to expand use of brain-computer interface systems to children with neurological disabilities.

BCI-activated electrical stimulation in children with perinatal stroke and hemiparesis: A pilot study

Background

Perinatal stroke (PS) causes most hemiparetic cerebral palsy (CP) and results in lifelong disability. Children with severe hemiparesis have limited rehabilitation options. Brain computer interface- activated functional electrical stimulation (BCI-FES) of target muscles may enhance upper extremity function in hemiparetic adults. We conducted a pilot clinical trial to assess the safety and feasibility of BCI-FES in children with hemiparetic CP.

Methods

Thirteen participants (mean age = 12.2 years, 31% female) were recruited from a population-based cohort. Inclusion criteria were: (1) MRI-confirmed PS, (2) disabling hemiparetic CP, (3) age 6–18 years, (4) informed consent/assent. Those with neurological comorbidities or unstable epilepsy were excluded. Participants attended two BCI sessions: training and rehabilitation. They wore an EEG-BCI headset and two forearm extensor stimulation electrodes. Participants’ imagination of wrist extension was classified on EEG, after which muscle stimulation and visual feedback were provided when the correct visualization was detected.

Results

No serious adverse events or dropouts occurred. The most common complaints were mild headache, headset discomfort and muscle fatigue. Children ranked the experience as comparable to a long car ride and none reported as unpleasant. Sessions lasted a mean of 87 min with 33 min of stimulation delivered. Mean classification accuracies were (M = 78.78%, SD = 9.97) for training and (M = 73.48, SD = 12.41) for rehabilitation. Mean Cohen’s Kappa across rehabilitation trials was M = 0.43, SD = 0.29, range = 0.019–1.00, suggesting BCI competency.

Conclusion

Brain computer interface-FES was well -tolerated and feasible in children with hemiparesis. This paves the way for clinical trials to optimize approaches and test efficacy.

Neurosurgical Team Acceptability of Brain-Computer Interfaces: A Two-Stage International Cross-Sectional Survey

OBJECTIVE

Invasive brain-computer interfaces (BCIs) require neurosurgical implantation, which confers a range of risks. Despite this situation, no studies have assessed the acceptability of invasive BCIs among the neurosurgical team. This study aims to establish baseline knowledge of BCIs within the neurosurgical team and identify attitudes toward different applications of invasive BCI.

METHODS

A 2-stage cross-sectional international survey of the neurosurgical team (neurosurgeons, anesthetists, and operating room nurses) was conducted. Results from the first, qualitative, survey were used to guide the second-stage quantitative survey, which assessed acceptability of invasive BCI applications. Five-part Likert scales were used to collect quantitative data. Surveys were distributed internationally via social media and collaborators.

RESULTS

A total of 108 qualitative responses were collected. Themes included the promise of BCIs positively affecting disease targets, concerns regarding stability, and an overall positive emotional reaction to BCI technology. The quantitative survey generated 538 responses from 32 countries. Baseline knowledge of BCI technology was poor, with 9% claiming to have a good or expert knowledge of BCIs. Acceptability of invasive BCI for rehabilitative purposes was >80%. Invasive BCI for augmentation in healthy populations divided opinion.

CONCLUSIONS

The neurosurgical team's view of the acceptability of invasive BCI was divided across a range of indications. Some applications (e.g., stroke rehabilitation) were viewed as more appropriate than other applications (e.g., augmentation for military use). This range in views highlights the need for stakeholder consultation on acceptable use cases along with regulation and guidance to govern initial BCI implantations if patients are to realize the potential benefits.

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.

Establishing a Clinical Brain-Computer Interface Program for Children With Severe Neurological Disabilities

Background: Children with severe motor impairment but intact cognition are deprived of fundamental human rights. Quadriplegic cerebral palsy is the most common scenario where rehabilitation options remain limited. Brain-computer interfaces (BCI) represent a potential solution, but pediatric populations have been neglected. Direct engagement of children and families could provide meaningful opportunities while informing program development. We describe a patient-centered, clinical, non-invasive pediatric BCI program.

Methods: Eligible children were identified within a population-based, tertiary care children’s hospital. Criteria included 1) age six to 18 years, 2) severe physical disability (non-ambulatory, minimal hand use), 3) severely limited speech, and 4) evidence of grade 1 cognitive capacity. After initial screening for BCI competency, participants attended regular sessions, attempting commercially available and customized systems to play computer games, control devices, and attempt communication.

Results: We report the first 10 participants (median 11 years, range 6-16, 60% male). Over 334 hours of participation, there were no serious adverse events. BCI training was well tolerated, with favorable feedback from children and parents. All but one participant demonstrated the ability to perform BCI tasks. The majority performed well, using motor imagery based tasks for games and entertainment. Difficulties were most significant using P300, visual evoked potential based paradigms where maintenance of attention was challenging. Children and families expressed interest in continuing and informing program development.

Conclusions: Patient-centered clinical BCI programs are feasible for children with severe disabilities. Carefully selected participants can often learn quickly to perform meaningful tasks on readily available systems. Patient and family motivation and engagement appear high.

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.

Can Children With Perinatal Stroke Use a Simple Brain Computer Interface?

[Figure: see text].

Brain-Computer Interfaces in Neurorecovery and Neurorehabilitation

Recent advances in brain-computer interface technology to restore and rehabilitate neurologic function aim to enable persons with disabling neurologic conditions to communicate, interact with the environment, and achieve other key activities of daily living and personal goals. Here we evaluate the principles, benefits, challenges, and future directions of brain-computer interfaces in the context of neurorehabilitation. We then explore the clinical translation of these technologies and propose an approach to facilitate implementation of brain-computer interfaces for persons with neurologic disease.

KITE-BCI: A brain-computer interface system for functional electrical stimulation therapy

CONTEXT/OBJECTIVE

Integrating brain-computer interface (BCI) technology with functional electrical stimulation therapy (FEST) is an emerging strategy for upper limb motor rehabilitation after spinal cord injury (SCI). Despite promising results, the combined use of these technologies (BCI-FEST) in clinical practice is minimal. To address this issue, we developed KITE-BCI, a BCI system specifically designed for clinical application and integration with dynamic FEST. In this paper, we report its technical features and performance. In addition, we discuss the differences in distributions of the BCI- and therapist-triggered stimulation latencies.

DESIGN

Two single-arm 40-session interventional studies to test the feasibility of BCI-controlled FEST for upper limb motor rehabilitation in individuals with cervical SCI.

SETTING

Rehabilitation programs within the University and Lyndhurst Centres of the Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.

PARTICIPANTS

Five individuals with sub-acute (< 6 months post-injury) SCI at the C4-C5 level, AIS B-D, and three individuals with chronic (> 24 months post-injury) SCI at C4 level, AIS B-C.

OUTCOME MEASURES

We measured BCI setup duration, and to characterize the performance of KITE-BCI, we recorded BCI sensitivity, defined as the percentage of successful BCI activations out of the total number of cued movements.

RESULTS

The overall BCI sensitivities were 74.46% and 79.08% for the sub-acute and chronic groups, respectively. The average KITE-BCI setup duration across the two studies was 11 min and 13 s.

CONCLUSION

KITE-BCI demonstrates a clinically viable single-channel BCI system for integration with FEST resulting in a versatile technology-enhanced upper limb motor rehabilitation strategy after SCI.

Advancing Brain-Computer Interface Applications for Severely Disabled Children Through a Multidisciplinary National Network: Summary of the Inaugural Pediatric BCI Canada Meeting

Thousands of youth suffering from acquired brain injury or other early-life neurological disease live, mature, and learn with only limited communication and interaction with their world. Such cognitively capable children are ideal candidates for brain-computer interfaces (BCI). While BCI systems are rapidly evolving, a fundamental gap exists between technological innovators and the patients and families who stand to benefit. Forays into translating BCI systems to children in recent years have revealed that kids can learn to operate simple BCI with proficiency akin to adults. BCI could bring significant boons to the lives of many children with severe physical impairment, supporting their complex physical and social needs. However, children have been neglected in BCI research and a collaborative BCI research community is required to unite and push pediatric BCI development forward. To this end, the pediatric BCI Canada collaborative network (BCI-CAN) was formed, under a unified goal to cooperatively drive forward pediatric BCI innovation and impact. This article reflects on the topics and discussions raised in the foundational BCI-CAN meeting held in Toronto, ON, Canada in November 2019 and suggests the next steps required to see BCI impact the lives of children with severe neurological disease and their families.