Andrea Kübler

A spelling device for the paralysed.

When Jean-Dominique Bauby suffered from a cortico-subcortical stroke that led to complete paralysis with totally intact sensory and cognitive functions, he described his experience in The Diving-Bell and the Butterfly as “something like a giant invisible diving-bell holds my whole body prisoner”. This horrifying condition also occurs as a consequence of a progressive neurological disease, amyotrophic lateral sclerosis, which involves progressive degeneration of all the motor neurons of the somatic motor system. These ‘locked-in’ patients ultimately become unable to express themselves and to communicate even their most basic wishes or desires, as they can no longer control their muscles to activate communication devices. We have developed a new means of communication for the completely paralysed that uses slow cortical potentials (SCPs) of the electro-encephalogram to drive an electronic spelling device.

A P300-based brain–computer interface for people with amyotrophic lateral sclerosis

OBJECTIVE The current study evaluates the efficacy of a P300-based brain-computer interface (BCI) communication device for individuals with advanced ALS. METHODS Participants attended to one cell of a N x N matrix while the N rows and N columns flashed randomly. Each cell of the matrix contained one character. Every flash of an attended character served as a rare event in an oddball sequence and elicited a P300 response. Classification coefficients derived using a stepwise linear discriminant function were applied to the data after each set of flashes. The character receiving the highest discriminant score was presented as feedback. RESULTS In Phase I, six participants used a 6 x 6 matrix on 12 separate days with a mean rate of 1.2 selections/min and mean online and offline accuracies of 62% and 82%, respectively. In Phase II, four participants used either a 6 x 6 or a 7 x 7 matrix to produce novel and spontaneous statements with a mean online rate of 2.1 selections/min and online accuracy of 79%. The amplitude and latency of the P300 remained stable over 40 weeks. CONCLUSIONS Participants could communicate with the P300-based BCI and performance was stable over many months. SIGNIFICANCE BCIs could provide an alternative communication and control technology in the daily lives of people severely disabled by ALS.

Combining Brain–Computer Interfaces and Assistive Technologies: State-of-the-Art and Challenges

In recent years, new research has brought the field of electroencephalogram (EEG)-based brain–computer interfacing (BCI) out of its infancy and into a phase of relative maturity through many demonstrated prototypes such as brain-controlled wheelchairs, keyboards, and computer games. With this proof-of-concept phase in the past, the time is now ripe to focus on the development of practical BCI technologies that can be brought out of the lab and into real-world applications. In particular, we focus on the prospect of improving the lives of countless disabled individuals through a combination of BCI technology with existing assistive technologies (AT). In pursuit of more practical BCIs for use outside of the lab, in this paper, we identify four application areas where disabled individuals could greatly benefit from advancements in BCI technology, namely, “Communication and Control”, “Motor Substitution”, “Entertainment”, and “Motor Recovery”. We review the current state of the art and possible future developments, while discussing the main research issues in these four areas. In particular, we expect the most progress in the development of technologies such as hybrid BCI architectures, user–machine adaptation algorithms, the exploitation of users’ mental states for BCI reliability and confidence measures, the incorporation of principles in human–computer interaction (HCI) to improve BCI usability, and the development of novel BCI technology including better EEG devices.

The thought translation device (TTD) for completely paralyzed patients

The thought translation device trains locked-in patients to self-regulate slow cortical potentials (SCPs) of their electroencephalogram (EEG). After operant learning of SCP self-control, patients select letters, words or pictograms in a computerized language support program. Results of five respirated, locked-in-patients are described, demonstrating the usefulness of the thought translation device as an alternative communication channel in motivated totally paralyzed patients with amyotrophic lateral sclerosis.

Brain-computer communication: unlocking the locked in.

With the increasing efficiency of life-support systems and better intensive care, more patients survive severe injuries of the brain and spinal cord. Many of these patients experience locked-in syndrome: The active mind is locked in a paralyzed body. Consequently, communication is extremely restricted or impossible. A muscle-independent communication channel overcomes this problem and is realized through a brain-computer interface, a direct connection between brain and computer. The number of technically elaborated brain-computer interfaces is in contrast with the number of systems used in the daily life of locked-in patients. It is hypothesized that a profound knowledge and consideration of psychological principles are necessary to make brain-computer interfaces feasible for locked-in patients.

Patients with ALS can use sensorimotor rhythms to operate a brain-computer interface

People with severe motor disabilities can maintain an acceptable quality of life if they can communicate. Brain-computer interfaces (BCIs), which do not depend on muscle control, can provide communication. Four people severely disabled by ALS learned to operate a BCI with EEG rhythms recorded over sensorimotor cortex. These results suggest that a sensorimotor rhythm–based BCI could help maintain quality of life for people with ALS.

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

OBJECTIVE To investigate the relationship between physical impairment and brain-computer interface (BCI) performance. METHOD We present a meta-analysis of 29 patients with amyotrophic lateral sclerosis and six patients with other severe neurological diseases in different stages of physical impairment who were trained with a BCI. In most cases voluntary regulation of slow cortical potentials has been used as input signal for BCI-control. More recently sensorimotor rhythms and the P300 event-related brain potential were recorded. RESULTS A strong correlation has been found between physical impairment and BCI performance, indicating that performance worsens as impairment increases. Seven patients were in the complete locked-in state (CLIS) with no communication possible. After removal of these patients from the analysis, the relationship between physical impairment and BCI performance disappeared. The lack of a relation between physical impairment and BCI performance was confirmed when adding BCI data of patients from other BCI research groups. CONCLUSIONS Basic communication (yes/no) was not restored in any of the CLIS patients with a BCI. Whether locked-in patients can transfer learned brain control to the CLIS remains an open empirical question. SIGNIFICANCE Voluntary brain regulation for communication is possible in all stages of paralysis except the CLIS.

An MEG-based Brain-Computer Interface (BCI)

Brain-computer interfaces (BCIs) allow for communicating intentions by mere brain activity, not involving muscles. Thus, BCIs may offer patients who have lost all voluntary muscle control the only possible way to communicate. Many recent studies have demonstrated that BCIs based on electroencephalography (EEG) can allow healthy and severely paralyzed individuals to communicate. While this approach is safe and inexpensive, communication is slow. Magnetoencephalography (MEG) provides signals with higher spatiotemporal resolution than EEG and could thus be used to explore whether these improved signal properties translate into increased BCI communication speed. In this study, we investigated the utility of an MEG-based BCI that uses voluntary amplitude modulation of sensorimotor mu and beta rhythms. To increase the signal-to-noise ratio, we present a simple spatial filtering method that takes the geometric properties of signal propagation in MEG into account, and we present methods that can process artifacts specifically encountered in an MEG-based BCI. Exemplarily, six participants were successfully trained to communicate binary decisions by imagery of limb movements using a feedback paradigm. Participants achieved significant mu rhythm self control within 32 min of feedback training. For a subgroup of three participants, we localized the origin of the amplitude modulated signal to the motor cortex. Our results suggest that an MEG-based BCI is feasible and efficient in terms of user training.

An auditory brain–computer interface (BCI)

Brain-computer interfaces (BCIs) translate brain activity into signals controlling external devices. BCIs based on visual stimuli can maintain communication in severely paralyzed patients, but only if intact vision is available. Debilitating neurological disorders however, may lead to loss of intact vision. The current study explores the feasibility of an auditory BCI. Sixteen healthy volunteers participated in three training sessions consisting of 30 2-3 min runs in which they learned to increase or decrease the amplitude of sensorimotor rhythms (SMR) of the EEG. Half of the participants were presented with visual and half with auditory feedback. Mood and motivation were assessed prior to each session. Although BCI performance in the visual feedback group was superior to the auditory feedback group there was no difference in performance at the end of the third session. Participants in the auditory feedback group learned slower, but four out of eight reached an accuracy of over 70% correct in the last session comparable to the visual feedback group. Decreasing performance of some participants in the visual feedback group is related to mood and motivation. We conclude that with sufficient training time an auditory BCI may be as efficient as a visual BCI. Mood and motivation play a role in learning to use a BCI.

The thought translation device: a neurophysiological approach to communication in total motor paralysis

Abstract A thought translation device (TTD) for brain-computer communication is described. Three patients diagnosed with amyotrophic lateral sclerosis (ALS), with total motor paralysis, were trained for several months. In order to enable such patients to communicate without any motor activity, a technique was developed where subjects learn to control their slow cortical potentials (SCP) in a 2-s rhythm, producing either cortical negativity or positivity according to the task requirement. SCP differences between a baseline interval and an active control interval are transformed into vertical or horizontal cursor movements on a computer screen. Learning SCP self regulation followed an operant-conditioning paradigm with individualized shaping procedures. After prolonged training over more than 100 sessions, all patients achieved self-control, leading to a 70–80% accuracy for two patients. The learned cortical skill enabled the patients to select letters or words in a language-supporting program (LSP) developed for inter-personal communication. The results demonstrate that the fast and stable SCP self-control can be achieved with operant training and without mediation of any muscle activity. The acquired skill allows communication even in total locked-in states.