Femke Nijboer

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.

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.

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 influence of psychological state and motivation on Brain–computer interface performance in patients with amyotrophic lateral sclerosis – a longitudinal study

The current study investigated the effects of psychological well-being measured as quality of life (QoL), depression, current mood and motivation on brain–computer interface (BCI) performance in amyotrophic lateral sclerosis (ALS). Six participants with most advanced ALS were trained either for a block of 20 sessions with a BCI based on sensorimotor rhythms (SMR) or a block of 10 sessions with a BCI based on event-related potentials, or both. Questionnaires assessed QoL and severity of depressive symptoms before each training block and mood and motivation before each training session. The SMR-BCI required more training than the P300-BCI. The information transfer rate was higher with the P300-BCI (3.25 bits/min) than with the SMR-BCI (1.16 bits/min). Mood and motivation were related to the number of BCI sessions. Motivational factors, specifically challenge and mastery confidence, were positively related to BCI performance (controlled for the number of sessions) in tow participants, while incompetence fear was negatively related with performance in one participant. BCI performance was not related to motivational factors in three other participants nor to mood in any of the six participants. We conclude that motivational factors may be related to BCI performance in individual subjects and suggest that motivational factors and well-being should be assessed in standard BCI protocols. We also recommend using P300-based BCI as first choice in severely paralyzed patients who present with a P300 evoked potential.

A Brain-Computer Interface Controlled Auditory Event-Related Potential (P300) Spelling System for Locked-In Patients

Using brain–computer interfaces (BCI) humans can select letters or other targets on a computer screen without any muscular involvement. An intensively investigated kind of BCI is based on the recording of visual event‐related brain potentials (ERP). However, some severely paralyzed patients who need a BCI for communication have impaired vision or lack control of gaze movement, thus making a BCI depending on visual input no longer feasible. In an effort to render the ERP–BCI usable for this group of patients, the ERP–BCI was adapted to auditory stimulation. Letters of the alphabet were assigned to cells in a 5 × 5 matrix. Rows of the matrix were coded with numbers 1 to 5, and columns with numbers 6 to 10, and the numbers were presented auditorily. To select a letter, users had to first select the row and then the column containing the desired letter. Four severely paralyzed patients in the end‐stage of a neurodegenerative disease were examined. All patients performed above chance level. Spelling accuracy was significantly lower with the auditory system as compared with a similar visual system. Patients reported difficulties in concentrating on the task when presented with the auditory system. In future studies, the auditory ERP–BCI should be adjusted by taking into consideration specific features of severely paralyzed patients, such as reduced attention span. This adjustment in combination with more intensive training will show whether an auditory ERP–BCI can become an option for visually impaired patients.

A Dry EEG-System for Scientific Research and Brain–Computer Interfaces

Although it ranks among the oldest tools in neuroscientific research, electroencephalography (EEG) still forms the method of choice in a wide variety of clinical and research applications. In the context of brain–computer interfacing (BCI), EEG recently has become a tool to enhance human–machine interaction. EEG could be employed in a wider range of environments, especially for the use of BCI systems in a clinical context or at the homes of patients. However, the application of EEG in these contexts is impeded by the cumbersome preparation of the electrodes with conductive gel that is necessary to lower the impedance between electrodes and scalp. Dry electrodes could provide a solution to this barrier and allow for EEG applications outside the laboratory. In addition, dry electrodes may reduce the time needed for neurological exams in clinical practice. This study evaluates a prototype of a three-channel dry electrode EEG system, comparing it to state-of-the-art conventional EEG electrodes. Two experimental paradigms were used: first, event-related potentials (ERP) were investigated with a variant of the oddball paradigm. Second, features of the frequency domain were compared by a paradigm inducing occipital alpha. Furthermore, both paradigms were used to evaluate BCI classification accuracies of both EEG systems. Amplitude and temporal structure of ERPs as well as features in the frequency domain did not differ significantly between the EEG systems. BCI classification accuracies were equally high in both systems when the frequency domain was considered. With respect to the oddball classification accuracy, there were slight differences between the wet and dry electrode systems. We conclude that the tested dry electrodes were capable to detect EEG signals with good quality and that these signals can be used for research or BCI applications. Easy to handle electrodes may help to foster the use of EEG among a wider range of potential users.

Motivation modulates the P300 amplitude during brain-computer interface use

OBJECTIVE This study examined the effect of motivation as a possible psychological influencing variable on P300 amplitude and performance in a brain-computer interface (BCI) controlled by event-related potentials (ERP). METHODS Participants were instructed to copy spell a sentence by attending to cells of a randomly flashing 7*7 matrix. Motivation was manipulated by monetary reward. In two experimental groups participants received 25 (N=11) or 50 (N=11) Euro cent for each correctly selected character; the control group (N=11) was not rewarded. BCI performance was defined as the overall percentage of correctly selected characters (correct response rate=CRR). RESULTS Participants performed at an average of 99%. At electrode location Cz the P300 amplitude was positively correlated to self-rated motivation. The P300 amplitude of the most motivated participants was significantly higher than that of the least motivated participants. Highly motivated participants were able to communicate correctly faster with the ERP-BCI than less motivated participants. CONCLUSIONS Motivation modulates the P300 amplitude in an ERP-BCI. SIGNIFICANCE Motivation may contribute to variance in BCI performance and should be monitored in BCI settings.

An auditory oddball brain–computer interface for binary choices

OBJECTIVE Brain-computer interfaces (BCIs) provide non-muscular communication for individuals diagnosed with late-stage motoneuron disease (e.g., amyotrophic lateral sclerosis (ALS)). In the final stages of the disease, a BCI cannot rely on the visual modality. This study examined a method to achieve high accuracies using auditory stimuli only. METHODS We propose an auditory BCI based on a three-stimulus paradigm. This paradigm is similar to the standard oddball but includes an additional target (i.e. two target stimuli, one frequent stimulus). Three versions of the task were evaluated in which the target stimuli differed in loudness, pitch or direction. RESULTS Twenty healthy participants achieved an average information transfer rate (ITR) of up to 2.46 bits/min and accuracies of 78.5%. Most subjects (14 of 20) achieved their best performance with targets differing in pitch. CONCLUSIONS With this study, the viability of the paradigm was shown for healthy participants and will next be evaluated with individuals diagnosed with ALS or locked-in syndrome (LIS) after stroke. SIGNIFICANCE The here presented BCI offers communication with binary choices (yes/no) independent of vision. As it requires only little time per selection, it may constitute a reliable means of communication for patients who lost all motor function and have a short attention span.

Classifying EEG and ECoG signals without subject training for fast BCI implementation: comparison of nonparalyzed and completely paralyzed subjects

We summarize results from a series of related studies that aim to develop a motor-imagery-based brain-computer interface using a single recording session of electroencephalogram (EEG) or electrocorticogram (ECoG) signals for each subject. We apply the same experimental and analytical methods to 11 nonparalysed subjects (eight EEG, three ECoG), and to five paralyzed subjects (four EEG, one ECoG) who had been unable to communicate for some time. While it was relatively easy to obtain classifiable signals quickly from most of the nonparalyzed subjects, it proved impossible to classify the signals obtained from the paralyzed patients by the same methods. This highlights the fact that though certain BCI paradigms may work well with healthy subjects, this does not necessarily indicate success with the target user group. We outline possible reasons for this failure to transfer.

Transition from the locked in to the completely locked-in state: a physiological analysis.

OBJECTIVE To clarify the physiological and behavioral boundaries between locked-in (LIS) and the completely locked-in state (CLIS) (no voluntary eye movements, no communication possible) through electrophysiological data and to secure brain-computer-interface (BCI) communication. METHODS Electromyography from facial muscles, external anal sphincter (EAS), electrooculography and electrocorticographic data during different psychophysiological tests were acquired to define electrophysiological differences in an amyotrophic lateral sclerosis (ALS) patient with an intracranially implanted grid of 112 electrodes for nine months while the patient passed from the LIS to the CLIS. RESULTS At the very end of the LIS there was no facial muscle activity, nor external anal sphincter but eye control. Eye movements were slow and lasted for short periods only. During CLIS event related brain potentials (ERP) to passive limb movements and auditory stimuli were recorded, vibrotactile stimulation of different body parts resulted in no ERP response. CONCLUSIONS The results presented contradict the commonly accepted assumption that the EAS is the last remaining muscle under voluntary control and demonstrate complete loss of eye movements in CLIS. The eye muscle was shown to be the last muscle group under voluntary control. The findings suggest ALS as a multisystem disorder, even affecting afferent sensory pathways. SIGNIFICANCE Auditory and proprioceptive brain-computer-interface (BCI) systems are the only remaining communication channels in CLIS.