Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke.

Brain-computer interfaces (BCI) are used in stroke rehabilitation to translate brain signals into intended movements of the paralyzed limb. However, the efficacy and mechanisms of BCI-based therapies remain unclear. Here we show that BCI coupled to functional electrical stimulation (FES) elicits significant, clinically relevant, and lasting motor recovery in chronic stroke survivors more effectively than sham FES. Such recovery is associated to quantitative signatures of functional neuroplasticity. BCI patients exhibit a significant functional recovery after the intervention, which remains 6-12 months after the end of therapy. Electroencephalography analysis pinpoints significant differences in favor of the BCI group, mainly consisting in an increase in functional connectivity between motor areas in the affected hemisphere. This increase is significantly correlated with functional improvement. Results illustrate how a BCI-FES therapy can drive significant functional recovery and purposeful plasticity thanks to contingent activation of body natural efferent and afferent pathways.

Context-aware adaptive spelling in motor imagery BCI.

OBJECTIVE: This work presents a first motor imagery-based, adaptive brain-computer interface (BCI) speller, which is able to exploit application-derived context for improved, simultaneous classifier adaptation and spelling. Online spelling experiments with ten able-bodied users evaluate the ability of our scheme, first, to alleviate non-stationarity of brain signals for restoring the subject's performances, second, to guide naive users into BCI control avoiding initial offline BCI calibration and, third, to outperform regular unsupervised adaptation. APPROACH: Our co-adaptive framework combines the BrainTree speller with smooth-batch linear discriminant analysis adaptation. The latter enjoys contextual assistance through BrainTree's language model to improve online expectation-maximization maximum-likelihood estimation. MAIN RESULTS: Our results verify the possibility to restore single-sample classification and BCI command accuracy, as well as spelling speed for expert users. Most importantly, context-aware adaptation performs significantly better than its unsupervised equivalent and similar to the supervised one. Although no significant differences are found with respect to the state-of-the-art PMean approach, the proposed algorithm is shown to be advantageous for 30% of the users. SIGNIFICANCE: We demonstrate the possibility to circumvent supervised BCI recalibration, saving time without compromising the adaptation quality. On the other hand, we show that this type of classifier adaptation is not as efficient for BCI training purposes.

The effect of multimodal and enriched feedback on SMR-BCI performance.

OBJECTIVE: This study investigated the effect of multimodal (visual and auditory) continuous feedback with information about the uncertainty of the input signal on motor imagery based BCI performance. A liquid floating through a visualization of a funnel (funnel feedback) provided enriched visual or enriched multimodal feedback. METHODS: In a between subject design 30 healthy SMR-BCI naive participants were provided with either conventional bar feedback (CB), or visual funnel feedback (UF), or multimodal (visual and auditory) funnel feedback (MF). Subjects were required to imagine left and right hand movement and were trained to control the SMR based BCI for five sessions on separate days. RESULTS: Feedback accuracy varied largely between participants. The MF feedback lead to a significantly better performance in session 1 as compared to the CB feedback and could significantly enhance motivation and minimize frustration in BCI use across the five training sessions. CONCLUSION: The present study demonstrates that the BCI funnel feedback allows participants to modulate sensorimotor EEG rhythms. Participants were able to control the BCI with the funnel feedback with better performance during the initial session and less frustration compared to the CB feedback. SIGNIFICANCE: The multimodal funnel feedback provides an alternative to the conventional cursorbar feedback for training subjects to modulate their sensorimotor rhythms.

EEG-based decoding of error-related brain activity in a real-world driving task.

OBJECTIVES: Recent studies have started to explore the implementation of brain-computer interfaces (BCI) as part of driving assistant systems. The current study presents an EEG-based BCI that decodes error-related brain activity. Such information can be used, e.g., to predict driver's intended turning direction before reaching road intersections. APPROACH: We executed experiments in a car simulator (N = 22) and a real car (N = 8). While subject was driving, a directional cue was shown before reaching an intersection, and we classified the presence or not of an error-related potentials from EEG to infer whether the cued direction coincided with the subject's intention. In this protocol, the directional cue can correspond to an estimation of the driving direction provided by a driving assistance system. We analyzed ERPs elicited during normal driving and evaluated the classification performance in both offline and online tests. RESULTS: An average classification accuracy of 0.698 ± 0.065 was obtained in offline experiments in the car simulator, while tests in the real car yielded a performance of 0.682 ± 0.059. The results were significantly higher than chance level for all cases. Online experiments led to equivalent performances in both simulated and real car driving experiments. These results support the feasibility of decoding these signals to help estimating whether the driver's intention coincides with the advice provided by the driving assistant in a real car. SIGNIFICANCE: The study demonstrates a BCI system in real-world driving, extending the work from previous simulated studies. As far as we know, this is the first online study in real car decoding driver's error-related brain activity. Given the encouraging results, the paradigm could be further improved by using more sophisticated machine learning approaches and possibly be combined with applications in intelligent vehicles.

Clinical evaluation of BrainTree, a motor imagery hybrid BCI speller.

OBJECTIVE: While brain-computer interfaces (BCIs) for communication have reached considerable technical maturity, there is still a great need for state-of-the-art evaluation by the end-users outside laboratory environments. To achieve this primary objective, it is necessary to augment a BCI with a series of components that allow end-users to type text effectively. APPROACH: This work presents the clinical evaluation of a motor imagery (MI) BCI text-speller, called BrainTree, by six severely disabled end-users and ten able-bodied users. Additionally, we define a generic model of code-based BCI applications, which serves as an analytical tool for evaluation and design. MAIN RESULTS: We show that all users achieved remarkable usability and efficiency outcomes in spelling. Furthermore, our model-based analysis highlights the added value of human-computer interaction techniques and hybrid BCI error-handling mechanisms, and reveals the effects of BCI performances on usability and efficiency in code-based applications. SIGNIFICANCE: This study demonstrates the usability potential of code-based MI spellers, with BrainTree being the first to be evaluated by a substantial number of end-users, establishing them as a viable, competitive alternative to other popular BCI spellers. Another major outcome of our model-based analysis is the derivation of a 80% minimum command accuracy requirement for successful code-based application control, revising upwards previous estimates attempted in the literature.

Modular organization of reaching and grasping movements investigated using EEG microstates.

How movements are generated and controlled by the central nervous system (CNS) is still not well understood. In this work, we tested the hypothesis of a modular organization of the brain activity during the execution of voluntary movements. In particular, we extracted meta-stable topographies as a measure for global brain state, so-called microstates, from electroencephalography (EEG) data during pure planar reaching movements as well as reaching and grasping of different objects, and we compared them with those extracted during resting-state. The results showed the emergence of specific EEG microstates related to movement execution. Our results provide evidence about the benefits of EEG microstate analysis for motor control studies and their importance to better understand brain reorganization in neurological pathologies.

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.