Daniela S. Klobassa

The auditory P300-based single-switch brain-computer interface

OBJECTIVE Within this work an auditory P300 brain-computer interface based on tone stream segregation, which allows for binary decisions, was developed and evaluated. METHODS AND MATERIALS Two tone streams consisting of short beep tones with infrequently appearing deviant tones at random positions were used as stimuli. This paradigm was evaluated in 10 healthy subjects and applied to 12 patients in a minimally conscious state (MCS) at clinics in Graz, Würzburg, Rome, and Liège. A stepwise linear discriminant analysis classifier with 10×10 cross-validation was used to detect the presence of any P300 and to investigate attentional modulation of the P300 amplitude. RESULTS The results for healthy subjects were promising and most classification results were better than random. In 8 of the 10 subjects, focused attention on at least one of the tone streams could be detected on a single-trial basis. By averaging 10 data segments, classification accuracies up to 90.6% could be reached. However, for MCS patients only a small number of classification results were above chance level and none of the results were sufficient for communication purposes. Nevertheless, signs of consciousness were detected in 9 of the 12 patients, not on a single-trial basis, but after averaging of all corresponding data segments and computing significant differences. These significant results, however, strongly varied across sessions and conditions. CONCLUSION This work shows the transition of a paradigm from healthy subjects to MCS patients. Promising results with healthy subjects are, however, no guarantee of good results with patients. Therefore, more investigations are required before any definite conclusions about the usability of this paradigm for MCS patients can be drawn. Nevertheless, this paradigm might offer an opportunity to support bedside clinical assessment of MCS patients and eventually, to provide them with a means of communication.

A SINGLE-SWITCH BCI BASED ON PASSIVE AND IMAGINED MOVEMENTS: TOWARD RESTORING COMMUNICATION IN MINIMALLY CONSCIOUS PATIENTS

We investigate whether an electroencephalography technique could be used for yes/no communication with auditory scanning. To be usable by the target group, i.e., minimally conscious individuals, such a brain-computer interface (BCI) has to be very simple and robust. This leads to the concept of a single-switch BCI (ssBCI). With an ssBCI it is possible to reliably detect one certain, individually trained, brain pattern of the individual, and use it to control all kinds of applications using yes/no responses. A total of 10 healthy volunteers (20-27 years) participated in an initial cue-based session with a motor imagery (MI) task after brisk passive feet/hand movement. Four of them reached MI classification accuracies above 70% and, thus, fulfilled the inclusion criterion for participation in the 2nd session. In the 2nd session, MI was used to communicate yes/no answers to a series of questions in an auditory scanning mode. Two of the three participants of the 2nd session were able to reliably communicate their intent with 90% or above correct and 0% false responses. This work showed, for the 1st time, the use of a ssBCI based on passive and imagined movements for communication in auditory scanning mode.

Brisk heart rate and EEG changes during execution and withholding of cue-paced foot motor imagery

Cue-paced motor imagery (MI) is a frequently used mental strategy to realize a Brain-Computer Interface (BCI). Recently it has been reported that two MI tasks can be separated with a high accuracy within the first second after cue presentation onset. To investigate this phenomenon in detail we studied the dynamics of motor cortex beta oscillations in EEG and the changes in heart rate (HR) during visual cue-paced foot MI using a go (execution of imagery) vs. nogo (withholding of imagery) paradigm in 16 healthy subjects. Both execution and withholding of MI resulted in a brisk centrally localized beta event-related desynchronization (ERD) with a maximum at ~400 ms and a concomitant HR deceleration. We found that response patterns within the first second after stimulation differed between conditions. The ERD was significantly larger in go as compared to nogo. In contrast the HR deceleration was somewhat smaller and followed by an acceleration in go as compared to nogo. These findings suggest that the early beta ERD reflects visually induced preparatory activity in motor cortex networks. Both the early beta ERD and the HR deceleration are the result of automatic operating processes that are likely part of the orienting reflex (OR). Of interest, however, is that the preparatory cortical activity is strengthened and the HR modulated already within the first second after stimulation during the execution of MI. The subtraction of the HR time course of the nogo from the go condition revealed a slight HR acceleration in the first seconds most likely due to the increased mental effort associated with the imagery process.

The auditory p300-based SSBCI: A door to minimally conscious patients?

In this study we report on the evaluation of a novel auditory single-switch BCI in nine patients diagnosed with MCS. The task included a simple and a complex oddball paradigm, the latter uses the tone stream segregation phenomenon. In all patients a significant difference between deviant and frequent tones could be observed in EEG. However, in some cases the deviant tones produce a significant negative peak and in some a very late positive peak. These preliminary findings are relevant in order to address future customization of this auditory ssBCI-based paradigm for unresponsive patients.

About the Stability of Phase Shifts Between Slow Oscillations Around 0.1 Hz in Cardiovascular and Cerebral Systems

One important feature of the baroreflex loop is its strong preference for oscillations around 0.1 Hz. In this study, we investigated heart rate intervals, arterial blood pressure (BP), and prefrontal oxyhemoglobin changes during 5 min rest and during brisk finger movements in 19 healthy subjects. We analyzed the phase coupling around 0.1 Hz between cardiovascular and (de)oxyhemoglobin oscillations, using the cross-spectral method. The analyses revealed phase shifts for slow oscillations in BP and heart rate intervals between -10° and -118° (BP always leading). These phase shifts increased significantly (p <; 0.01) in the movement session. The coupling between cardiovascular and oxyhemoglobin oscillations was less clear. Only 12 subjects demonstrated a phase coupling (COH2 ≥ 0.5) between oxyhemoglobin and BP oscillations. This may be explained by an overwhelming proportion of nonlinearity in cardiovascular and hemodynamic systems. The phase shifts between slow cardiovascular and hemodynamic oscillations are relatively stable subject-specific biometric features and could be of interest for person identification in addition to other biometric data. Slow BP-coupled oscillations in prefrontal oxyhemoglobin changes can seriously impair the detection of mentally induced hemodynamic changes in an optical brain-computer interface, a novel nonmuscular communication system.

Detection of mental imagery and attempted movements in patients with disorders of consciousness using EEG

Further development of an EEG based communication device for patients with disorders of consciousness (DoC) could benefit from addressing the following gaps in knowledge—first, an evaluation of different types of motor imagery; second, an evaluation of passive feet movement as a mean of an initial classifier setup; and third, rapid delivery of biased feedback. To that end we investigated whether complex and/or familiar mental imagery, passive, and attempted feet movement can be reliably detected in patients with DoC using EEG recordings, aiming to provide them with a means of communication. Six patients in a minimally conscious state (MCS) took part in this study. The patients were verbally instructed to perform different mental imagery tasks (sport, navigation), as well as attempted feet movements, to induce distinctive event-related (de)synchronization (ERD/S) patterns in the EEG. Offline classification accuracies above chance level were reached in all three tasks (i.e., attempted feet, sport, and navigation), with motor tasks yielding significant (p < 0.05) results more often than navigation (sport: 10 out of 18 sessions; attempted feet: 7 out of 14 sessions; navigation: 4 out of 12 sessions). The passive feet movements, evaluated in one patient, yielded mixed results: whereas time-frequency analysis revealed task-related EEG changes over neurophysiological plausible cortical areas, the classification results were not significant enough (p < 0.05) to setup an initial classifier for the detection of attempted movements. Concluding, the results presented in this study are consistent with the current state of the art in similar studies, to which we contributed by comparing different types of mental tasks, notably complex motor imagery and attempted feet movements, within patients. Furthermore, we explored new venues, such as an evaluation of passive feet movement as a mean of an initial classifier setup, and rapid delivery of biased feedback.

Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units : A prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS)

BackgroundSepsis is one of the main reasons for non-elective admission to pediatric intensive care units (PICUs), but little is known about determinants influencing outcome. We characterized children admitted with community-acquired sepsis to European PICUs and studied risk factors for mortality and disability.MethodsData were collected within the collaborative Seventh Framework Programme (FP7)-funded EUCLIDS study, which is a prospective multicenter cohort study aiming to evaluate genetic determinants of susceptibility and/or severity in sepsis. This report includes 795 children admitted with community-acquired sepsis to 52 PICUs from seven European countries between July 2012 and January 2016. The primary outcome measure was in-hospital death. Secondary outcome measures were PICU-free days censured at day 28, hospital length of stay, and disability. Independent predictors were identified by multivariate regression analysis.ResultsPatients most commonly presented clinically with sepsis without a source (n = 278, 35%), meningitis/encephalitis (n = 182, 23%), or pneumonia (n = 149, 19%). Of 428 (54%) patients with confirmed bacterial infection, Neisseria meningitidis (n = 131, 31%) and Streptococcus pneumoniae (n = 78, 18%) were the main pathogens. Mortality was 6% (51/795), increasing to 10% in the presence of septic shock (45/466). Of the survivors, 31% were discharged with disability, including 24% of previously healthy children who survived with disability. Mortality and disability were independently associated with S. pneumoniae infections (mortality OR 4.1, 95% CI 1.1–16.0, P = 0.04; disability OR 5.4, 95% CI 1.8–15.8, P < 0.01) and illness severity as measured by Pediatric Index of Mortality (PIM2) score (mortality OR 2.8, 95% CI 1.3–6.1, P < 0.01; disability OR 3.4, 95% CI 1.8–6.4, P < 0.001).ConclusionsDespite widespread immunization campaigns, invasive bacterial disease remains responsible for substantial morbidity and mortality in critically ill children in high-income countries. Almost one third of sepsis survivors admitted to the PICU were discharged with some disability. More research is required to delineate the long-term outcome of pediatric sepsis and to identify interventional targets. Our findings emphasize the importance of improved early sepsis-recognition programs to address the high burden of disease.

Evaluation of Healthy EEG Responses for Spelling Through Listener-Assisted Scanning

We investigated whether listener-assisted scanning, an alternative communication method for persons with severe motor and visual impairments but preserved cognitive skills, could be used for spelling with EEG. To that end spoken letters were presented sequentially, and the participants made selections by performing motor execution/imagery or a cognitive task. The motor task was a brisk dorsiflexion of both feet, and the cognitive task was related to working memory and perception of human voice. The motor imagery task yielded the most promising results with respect to letter selection accuracy, albeit with a large variation in individual performance. The cognitive task yielded significant (p = 0.05) albeit moderate results. Closer inspection of grand average ERPs for the cognitive task revealed task-related modulation of a late negative component, which is novel in the auditory BCI literature. Guidelines for further development are presented.