Brain–computer interfaces and communication in paralysis: Extinction of goal directed thinking in completely paralysed patients?

Kübler, Andrea; Birbaumer, Niels

doi:10.1016/j.clinph.2008.06.019

Cited by 379 publications

(302 citation statements)

References 45 publications

(51 reference statements)

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“…Our results also show that for the individuals with CP involved in our study no statistical relationship was found between the degree of impairment and their ability to control a BCI. Thus, our findings add to and support those reported in (Kübler et al, 2008).…”

Section: Discussionsupporting

confidence: 92%

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On the control of brain-computer interfaces by users with cerebral palsy

Daly

Billinger

Laparra-Hernández³

et al. 2013

Clinical Neurophysiology

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Highlights1. We conduct a feasibility study with 14 individuals with cerebral palsy (CP) to evaluate their control of two online Brain-computer interfaces. 2. Eight of the individuals with CP were able to control at least one of the BCIs at a statistically significant level of accuracy. 3. Analysis of the results reveals that BCIs may be controlled by some individuals with CP. Abstract ObjectiveBrain-computer interfaces (BCIs) have been proposed as a potential assistive device for individuals with cerebral palsy (CP) to assist with their communication needs. However, it is unclear how well-suited BCIs are to individuals with CP. Therefore, this study aims to investigate to what extent these users are able to gain control of BCIs. MethodsThis study is conducted with 14 individuals with CP attempting to control two standard online BCIs (1) based upon sensorimotor rhythm modulations, and (2) based upon steady state visual evoked potentials.Email address: reinhold.scherer@tugraz.at (Reinhold Scherer*) Preprint submitted to Clinical NeurophysiologyMarch 27, 2013 ResultsOf the 14 users, 8 are able to use one or other of the BCIs, online, with a statistically significant level of accuracy, without prior training. Classification results are driven by neurophysiological activity and not seen to correlate with occurrences of artifacts. However, many of these users' accuracies, while statistically significant, would require either more training or more advanced methods before practical BCI control would be possible. ConclusionsThe results indicate that BCIs may be controlled by individuals with CP but that many issues need to be overcome before practical application use may be achieved. SignificanceThis is the first study to assess the ability of a large group of different individuals with CP to gain control of an online BCI system. The results indicate that six users could control a sensorimotor rhythm BCI and three a steady state visual evoked potential BCI at statistically significant levels of accuracy (SMR accuracies; mean ± STD, 0.821 ± 0.116, SSVEP accuracies; 0.422 ± 0.069).

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Section: Discussionsupporting

confidence: 92%

“…This finding may be considered alongside a large meta-analysis performed by (Kübler et al, 2008) in which the efficacies of three different types of BCI for use as communication and control devices with a range of patient populations were assessed. The three BCIs assessed were SMR, slow cortical potential, and ERP based BCIs.…”

Section: Discussionmentioning

confidence: 99%

On the control of brain-computer interfaces by users with cerebral palsy

Daly

Billinger

Laparra-Hernández³

et al. 2013

Clinical Neurophysiology

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“…A binomial test [33] evaluated the chance level at 63% (α = 0.05, 60 trials). An online correct response rate (CRR) of 70% was considered the lowest rate of performance necessary to achieve efficient communication in a BCI with binary choice [37].…”

Section: Resultsmentioning

confidence: 99%

“…The accuracies obtained in patients are lower than those presented by (1) Parini et al [35] on patients with Duchenne muscular dystrophy using a four-class overt SSVEP-BCI and (2) Combaz et al [36] using an overt SSVEP speller in patients with incomplete LIS. Kübler and Birbaumer tested a visual P300 speller with patients [37]. Two out of five LIS patients were able to communicate with the system.…”

Section: Discussionmentioning

confidence: 99%

An independent SSVEP-based brain–computer interface in locked-in syndrome

et al. 2014

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Objective. Steady-state visually evoked potential (SSVEP)-based brain-computer interfaces (BCIs) allow healthy subjects to communicate. However, their dependence on gaze control prevents their use with severely disabled patients. Gaze-independent SSVEP-BCIs have been designed but have shown a drop in accuracy and have not been tested in brain-injured patients. In the present paper, we propose a novel independent SSVEP-BCI based on covert attention with an improved classification rate. We study the influence of feature extraction algorithms and the number of harmonics. Finally, we test online communication on healthy volunteers and patients with locked-in syndrome (LIS). Approach. Twenty-four healthy subjects and six LIS patients participated in this study. An independent covert two-class SSVEP paradigm was used with a newly developed portable light emitting diode-based 'interlaced squares' stimulation pattern. Main results. Mean offline and online accuracies on healthy subjects were respectively 85 ± 2% and 74 ± 13%, with eight out of twelve subjects succeeding to communicate efficiently with 80 ± 9% accuracy. Two out of six LIS patients reached an offline accuracy above the chance level, illustrating a response to a command. One out of four LIS patients could communicate online. Significance. We have demonstrated the feasibility of online communication with a covert SSVEP paradigm that is truly independent of all neuromuscular functions. The potential clinical use of the presented BCI system as a diagnostic (i.e., detecting command-following) and communication tool for severely brain-injured patients will need to be further explored.

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“…The one notable exception is perceived patients with completely locked-in syndrome (CLIS) [16]. But we should be aware that a patient's intent recognition, the response to stimulus (and associated output of BCIs) in patients with DoCs is not fully studied and might not be reliable.…”

Section: Areas Of Particular Ethical Awarenessmentioning

confidence: 99%

Ethical considerations in the use of brain-computer interfaces

Mikołajewska

Mikołajewski²

2013

Open Medicine

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AbstractNervous system disorders are among the most severe disorders. Significant breakthroughs in contemporary clinical practice may provide brain-computer interfaces (BCIs) and neuroprostheses (NPs). The aim of this article is to investigate the extent to which the ethical considerations in the clinical application of brain-computer interfaces and associated threats are being identified. Ethical considerations and implications may significantly influence further development of BCIs and NPs. Moreover, there is significant public interest in supervising this development. Awareness of BCIs’ and NPs’ threats and limitations allow for wise planning and management in further clinical practice, especially in the area of long-term neurorehabilitation and care.

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Brain–computer interfaces and communication in paralysis: Extinction of goal directed thinking in completely paralysed patients?

Cited by 379 publications

References 45 publications

On the control of brain-computer interfaces by users with cerebral palsy

On the control of brain-computer interfaces by users with cerebral palsy

An independent SSVEP-based brain–computer interface in locked-in syndrome

Ethical considerations in the use of brain-computer interfaces

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