Long-term independent brain-computer interface home use improves quality of life of a patient in the locked-in state: a case study.

OBJECTIVE: Despite intense brain-computer interface (BCI) research for >2 decades, BCIs have hardly been established at patients' homes. The current study aimed at demonstrating expert independent BCI home use by a patient in the locked-in state and the effect it has on quality of life. DESIGN: In this case study, the P300 BCI-controlled application Brain Painting was facilitated and installed at the patient's home. Family and caregivers were trained in setting up the BCI system. After every BCI session, the end user indicated subjective level of control, loss of control, level of exhaustion, satisfaction, frustration, and enjoyment. To monitor BCI home use, evaluation data of every session were automatically sent and stored on a remote server. Satisfaction with the BCI as an assistive device and subjective workload was indicated by the patient. In accordance with the user-centered design, usability of the BCI was evaluated in terms of its effectiveness, efficiency, and satisfaction. The influence of the BCI on quality of life of the end user was assessed. SETTING: At the patient's home. PARTICIPANT: A 73-year-old patient with amyotrophic lateral sclerosis in the locked-in state. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The BCI has been used by the patient independent of experts for >14 months. The patient painted in about 200 BCI sessions (1-3 times per week) with a mean painting duration of 81.86 minutes (SD=52.15, maximum: 230.41). BCI improved quality of life of the patient. RESULTS: In most of the BCI sessions the end user's satisfaction was high (mean=7.4, SD=3.24; range, 0-10). Dissatisfaction occurred mostly because of technical problems at the beginning of the study or varying BCI control. The subjective workload was moderate (mean=40.61; range, 0-100). The end user was highy satisfied with all components of the BCI (mean 4.42-5.0; range, 1-5). A perfect match between the user and the BCI technology was achieved (mean: 4.8; range, 1-5). Brain Painting had a positive impact on the patient's life on all three dimensions: competence (1.5), adaptability (2.17) and self-esteem (1.5); (range: -3 = maximum negative impact; 3 maximum positive impact). The patient had her first public art exhibition in July 2013; future exhibitions are in preparation. CONCLUSIONS: Independent BCI home use is possible with high satisfaction for the end user. The BCI indeed positively influenced quality of life of the patient and supports social inclusion. Results demonstrate that visual P300 BCIs can be valuable for patients in the locked-in state even if other means of communication are still available (eye tracker).

Toward independent home use of brain-computer interfaces: a decision algorithm for selection of potential end-users.

Noninvasive brain-computer interfaces (BCIs) use scalp-recorded electrical activity from the brain to control an application. Over the past 20 years, research demonstrating that BCIs can provide communication and control to individuals with severe motor impairment has increased almost exponentially. Although considerable effort has been dedicated to offline analysis for improving signal detection and translation, far less effort has been made to conduct online studies with target populations. Thus, there remains a great need for both long-term and translational BCI studies that include individuals with disabilities in their own homes. Completing these studies is the only sure means to answer questions about BCI utility and reliability. Here we suggest an algorithm for candidate selection for electroencephalographic (EEG)-based BCI home studies. This algorithm takes into account BCI end-users and their environment and should assist in study design and substantially improve subject retention rates, thereby improving the overall efficacy of BCI home studies. It is the result of a workshop at the Fifth International BCI Meeting that allowed us to leverage the expertise of multiple research laboratories and people from multiple backgrounds in BCI research.

Hybrid P300-based brain-computer interface to improve usability for people with severe motor disability: electromyographic signals for error correction during a spelling task.

OBJECTIVE: To evaluate the impact of a hybrid control on usability of a P300-based brain-computer interface (BCI) system that was designed to control an assistive technology software and was integrated with an electromyographic channel for error correction. DESIGN: Proof-of-principle study with a convenience sample. SETTING: Neurologic rehabilitation hospital. PARTICIPANTS: Participants (N=11) in this pilot study included healthy (n=8) and severely motor impaired (n=3) persons. The 3 people with severe motor disability were identified as potential candidates to benefit from the proposed hybrid BCI system for communication and environmental interaction. INTERVENTIONS: To eventually investigate the improvement in usability, we compared 2 modalities of BCI system control: a P300-based and a hybrid P300 electromyographic-based mode of control. MAIN OUTCOME MEASURES: System usability was evaluated according to the following outcome measures within 3 domains: (1) effectiveness (overall system accuracy and P300-based BCI accuracy); (2) efficiency (throughput time and users' workload); and (3) satisfaction (users' satisfaction). We also considered the information transfer rate and time for selection. RESULTS: Findings obtained in healthy participants were in favor of a higher usability of the hybrid control as compared with the nonhybrid. A similar trend was indicated by the observational results gathered from each of the 3 potential end-users. CONCLUSIONS: The proposed hybrid BCI control modality could provide end-users with severe motor disability with an option to exploit some residual muscular activity, which could not be fully reliable for properly controlling an assistive technology device. The findings reported in this pilot study encourage the implementation of a clinical trial involving a large cohort of end-users.

Brain-computer interface controlled gaming: evaluation of usability by severely motor restricted end-users.

OBJECTIVE: Connect-Four, a new sensorimotor rhythm (SMR) based brain-computer interface (BCI) gaming application, was evaluated by four severely motor restricted end-users; two were in the locked-in state and had unreliable eye-movement. METHODS: Following the user-centred approach, usability of the BCI prototype was evaluated in terms of effectiveness (accuracy), efficiency (information transfer rate (ITR) and subjective workload) and users' satisfaction. RESULTS: Online performance varied strongly across users and sessions (median accuracy (%) of end-users: A=.65; B=.60; C=.47; D=.77). Our results thus yielded low to medium effectiveness in three end-users and high effectiveness in one end-user. Consequently, ITR was low (0.05-1.44bits/min). Only two end-users were able to play the game in free-mode. Total workload was moderate but varied strongly across sessions. Main sources of workload were mental and temporal demand. Furthermore, frustration contributed to the subjective workload of two end-users. Nevertheless, most end-users accepted the BCI application well and rated satisfaction medium to high. Sources for dissatisfaction were (1) electrode gel and cap, (2) low effectiveness, (3) time-consuming adjustment and (4) not easy-to-use BCI equipment. All four end-users indicated ease of use as being one of the most important aspect of BCI. CONCLUSION: Effectiveness and efficiency are lower as compared to applications using the event-related potential as input channel. Nevertheless, the SMR-BCI application was satisfactorily accepted by the end-users and two of four could imagine using the BCI application in their daily life. Thus, despite moderate effectiveness and efficiency BCIs might be an option when controlling an application for entertainment.

Theta-gamma phase synchronization during memory matching in visual working memory.

In most cases, object recognition is related to the matching of internal memory contents and bottom-up external sensory stimulation. The aim of this study was to investigate the electrophysiological correlates of memory matching based on EEG oscillatory phase synchronization analysis. Healthy subjects completed a delayed-match to sample task in which items stored in visual-spatial short-term memory had to be compared with a matching or non-matching probe. The results show that memory matching appears as transient phase-synchronization over parieto-occipital regions between theta (4-8 Hz) and high gamma (50-70 Hz) oscillations, 150-200 ms post probe presentation. When memory representation and visual information match, phase-synchronization is stronger in the right hemisphere; conversely, when they do not match, stronger phase synchronization is observed in the left hemisphere. The present results reveal the integrative role of oscillatory activity in the memory matching process.

EEG correlates of action observation in humans.

To investigate electrophysiological correlates of action observation electroencephalogram (EEG) was recorded while participants observed repetitive biological (human) or non-biological movements (at a rate of 2 Hz). Steady-state evoked potentials were analyzed and their neural sources were investigated using low resolution electromagnetic tomography analysis (LORETA). Results revealed significantly higher activation in the primary motor and premotor cortex, supplementary motor area as well as the posterior parietal cortices during observation of biological movements, supporting mirror properties of cortical motor neurons. In addition interregional communication was analyzed. Increased coherence for distributed networks at delta (0.5-4 Hz) and lower alpha (8-10 Hz) frequencies were obtained suggesting integration and functional coupling between the activated cortical regions during human action observation.