assessment-communication-for-people-with-disorders

Assessment and Communication for People with Disorders of Consciousness

In this experiment, we demonstrate a suite of hybrid Brain-Computer Interface (BCI)-based paradigms that are designed for two applications: assessing the ...

Guger Technologies OG

Slow oscillations around 0.1 Hz are characteristic features of both the cardiovascular and central nervous systems. Such oscillation have been reported, e.g. in blood pressure, heart rate, EEG and brain oxygenation. Hence, conscious intention of a motor act may occur only as a result of brain activity changes in frontal and related brain areas, or might be entrained by slow oscillations in the blood pressure. Twenty-six subjects were asked to perform voluntary, self-paced (at free will) brisk finger movements. Some subjects performed self-paced movements in relatively periodic intervals of around 10s at the decreasing slope of the slow 0.1-Hz blood pressure oscillation. Our study reveals the first time that self-paced movements, at least in some subjects, do not stem from "free will" based on brain activity alone, but are influenced by slow blood pressure oscillations.

Does conscious intention to perform a motor act depend on slow cardiovascular rhythms?

This work introduces a hybrid brain-computer interface (BCI) composed of an imagery-based brain switch and a steady-state visual evoked potential (SSVEP)-based BCI. The brain switch (event related synchronization (ERS)-based BCI) was used to activate the four-step SSVEP-based orthosis (via gazing at a 8 Hz LED to open and gazing at a 13 Hz LED to close) only when needed for control, and to deactivate the LEDs during resting periods. Only two EEG channels were required, one over the motor cortex and one over the visual cortex. As a basis for comparison, the orthosis was also operated without using the brain switch. Six subjects participated in this study. This combination of two BCIs operated with different mental strategies is one example of a "hybrid" BCI and revealed a much lower rate of FPs per minute during resting periods or breaks compared to the SSVEP BCI alone ( FP=1.46+/-1.18 versus 5.40 +/- 0.90). Four out of the six subjects succeeded in operating the self-paced hybrid BCI with a good performance (positive prediction value PPVb > 0.70).

Self-paced operation of an SSVEP-Based orthosis with and without an imagery-based "brain switch:" a feasibility study towards a hybrid BCI.

Brain-computer interface (BCI) systems allow people to send messages or commands without moving, and hence can provide an alternative communication and control channel for people with limited motor function. In this study, we demonstrate a BCI system for orthosis control. Our BCI was asynchronous, meaning that subjects could move the orthosis whenever they wanted, instead of pacing themselves to external cues. Seven subjects each performed two tasks with a BCI that relied on steady state visual evoked potentials (SSVEPs). Although none of the subjects had any training, six subjects showed good control with a positive predictive value (PPV) higher than 60%. The overall PPV for all subjects reached 78% ±10%. However, the false positive rate was high, and some subjects dislike the flickering lights required in SSVEP BCIs. In follow-up work, we hope to reduce both the false positive rate and the annoyance produced by flickering lights by hybridizing this BCI with a "brain switch," which could allow people to turn the SSVEP system on or off using a second type of brain activity when they do not wish to control the orthosis. We also hope to validate this approach with people with tetraplegia.

An SSVEP BCI to control a hand orthosis for persons with tetraplegia.

A Brain-Computer Interface (BCI) provides a completely new output pathway and so, an additional possible way a person can express himself if he/she suffers from disorders like amyotrophic lateral sclerosis (ALS), brainstem stroke, brain or spinal cord injury, or other diseases which impair the function of the common output pathways which are responsible for the control of muscles or impair the muscles. Although most BCIs are thought to help people with disabilities, they are mainly tested on healthy, young subjects who may achieve better results than people with impairments. In this study we compare measurements, performed on 10 physically disabled people, to the results of a previous study, taken using 100 healthy participants. We prove that, under certain constraints, most patients are able to control a P300-based spelling device with almost the same accuracy as the healthy ones. Tuning parameters are discussed, as well as criteria for people who are not able to use this device.

Accuracy of a Brain Computer Interface (P300 spelling device) used by people with motor impairments.

A Brain-Computer Interface (BCI) provides a completely new output pathway that can provide an additional option for a person to express himself/herself if he/she suffers a disorder like amyotrophic lateral sclerosis (ALS), brainstem stroke, brain or spinal cord injury or other diseases which impair the function of the common output pathways which are responsible for the control of muscles. For a P300 based BCI a matrix of randomly flashing characters is presented to the participant. To spell a character the person has to attend to it and to count how many times the character flashes. Although most BCIs are designed to help people with disabilities, they are mainly tested on healthy, young subjects who may achieve better results than people with impairments. In this study we compare measurements, performed on people suffering motor impairments, such as stroke or ALS, to measurements performed on healthy people. The overall accuracy of the persons with motor impairments reached 70.1% in comparison to 91% obtained for the group of healthy subjects. When looking at single subjects, one interesting example shows that under certain circumstances, when it is difficult for a patient to concentrate on one character for a longer period of time, the accuracy is higher when fewer flashes (i.e., stimuli) are presented. Furthermore, the influence of several tuning parameters is discussed as it shows that for some participants adaptations for achieving valuable spelling results are required. Finally, exclusion criteria for people who are not able to use the device are defined.

Accuracy of a P300 speller for people with motor impairments: a comparison.

Brain-computer interface (BCI) has been used for many years for communication in severely disabled patients. BCI based on electrophysiological signals has enabled communication, using auditory or visual stimuli to elicit event-related potentials (ERPs). The aim of this study was to determine whether patients with locked-in syndrome (LIS) could elicit a P300 wave, using a vibrotactile oddball paradigm for establishing somatosensory BCI-based communication. Six chronic LIS patients performed 2 electroencephalography (EEG)-based vibrotactile P300 oddball tasks. After a simple mental counting task of the target stimuli, participants were instructed to answer 5 questions by counting the vibration on either the right wrist for "yes" or the left wrist for "no." All participants were able to elicit a P300 wave using the vibrotactile oddball paradigm BCI task. In the counting task, 4 patients got accuracies of 100% (average above chance). In the communication task, one patient achieved 100% accuracy (average above chance). We have shown the feasibility of eliciting a P300 response using vibrotactile stimulation in patients with LIS. The present study provides evidence that this approach can be used for EEG-based BCI communications in this patient group. This is the first study to prove the feasibility of a BCI based on somatosensory (vibratory) stimulation in a group of brain-injured patients. Furthermore, this approach could be used for the detection of consciousness in non-communicating patients due to severe brain injuries.

A vibrotactile p300-based brain-computer interface for consciousness detection and communication.

Conventional therapies do not provide paralyzed patients with closed-loop sensorimotor integration for motor rehabilitation. Paired associative stimulation (PAS) uses brain-computer interface (BCI) technology to monitor patients' movement imagery in real-time, and utilizes the information to control functional electrical stimulation (FES) and bar feedback for complete sensorimotor closed loop. To realize this approach, we introduce the recoveriX system, a hardware and software platform for PAS. After 10 sessions of recoveriX training, one stroke patient partially regained control of dorsiflexion in her paretic wrist. A controlled group study is planned with a new version of the recoveriX system, which will use a new FES system and an avatar instead of bar feedback.

Paired Associative Stimulation Using Brain-Computer Interfaces for Stroke Rehabilitation: A Pilot Study.

Many patients with locked-in syndrome (LIS) or complete locked-in syndrome (CLIS) also need brain-computer interface (BCI) platforms that do not rely on visual stimuli and are easy to use. We investigate command following and communication functions of mindBEAGLE with 9 LIS, 3 CLIS patients and three healthy controls. This tests were done with vibro-tactile stimulation with 2 or 3 stimulators (VT2 and VT3 mode) and with motor imagery (MI) paradigms. In VT2 the stimulators are fixed on the left and right wrist and the participant has the task to count the stimuli on the target hand in order to elicit a P300 response. In VT3 mode an additional stimulator is placed as a distractor on the shoulder and the participant is counting stimuli either on the right or left hand. In motor imagery mode the participant is instructed to imagine left or right hand movement. VT3 and MI also allow the participant to answer yes and no questions. Healthy controls achieved a mean assessment accuracy of 100% in VT2, 93% in VT3, and 73% in MI modes. They were able to communicate with VT3 (86.7%) and MI (83.3%) after 2 training runs. The patients achieved a mean accuracy of 76.6% in VT2, 63.1% in VT3, and 58.2% in MI modes after 1-2 training runs. 9 out of 12 LIS patients could communicate by using the vibro-tactile P300 paradigms (answered on average 8 out of 10 questions correctly) and 3 out of 12 could communicate with the motor imagery paradigm (answered correctly 4,7 out of 5 questions). 2 out of the 3 CLIS patients could use the system to communicate with VT3 (90 and 70% accuracy). The results show that paradigms based on non-visual evoked potentials and motor imagery can be effective for these users. It is also the first study that showed EEG-based BCI communication with CLIS patients and was able to bring 9 out of 12 patients to communicate with higher accuracies than reported before. More importantly this was achieved within less than 15-20 min.

Complete Locked-in and Locked-in Patients: Command Following Assessment and Communication with Vibro-Tactile P300 and Motor Imagery Brain-Computer Interface Tools.

Article	Year
Does conscious intention to perform a motor act depend on slow cardiovascular rhythms? Neuroscience letters\| PubMed ID: 19861147	2010
Self-paced operation of an SSVEP-Based orthosis with and without an imagery-based "brain switch:" a feasibility study towards a hybrid BCI. IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society\| PubMed ID: 20144923	2010
An SSVEP BCI to control a hand orthosis for persons with tetraplegia. IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society\| PubMed ID: 20875978	2011
Accuracy of a Brain Computer Interface (P300 spelling device) used by people with motor impairments. Studies in health technology and informatics\| PubMed ID: 21685664	2011
Accuracy of a P300 speller for people with motor impairments: a comparison. Clinical EEG and neuroscience\| PubMed ID: 22208117	2011
A vibrotactile p300-based brain-computer interface for consciousness detection and communication. Clinical EEG and neuroscience\| PubMed ID: 24415400	2014
Paired Associative Stimulation Using Brain-Computer Interfaces for Stroke Rehabilitation: A Pilot Study. European journal of translational myology\| PubMed ID: 27990240	2016
Complete Locked-in and Locked-in Patients: Command Following Assessment and Communication with Vibro-Tactile P300 and Motor Imagery Brain-Computer Interface Tools. Frontiers in neuroscience\| PubMed ID: 28529473	2017

Rupert Ortner

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