Error-Related Neural Responses Recorded by Electroencephalography During Post-stroke Rehabilitation Movements

Error-related potential (ErrP) based assist-as-needed robot-therapy can be an effective rehabilitation method. To date, several studies have shown the presence of ErrP under various task situations. However, in the context of assist-as-needed methods, the existence of ErrP is unexplored. Therefore, the principal objective of this study is to determine if an ErrP can be evoked when a subject is unable to complete a physical exercise in a given time. Fifteen stroke patients participated in an experiment that involved performing a physical rehabilitation exercise. Results showed that the electroencephalographic (EEG) response of the trials, where patients failed to complete the exercise, against the trials, where patients successfully completed the exercise, significantly differ from each other, and the resulting difference of event-related potentials resembles the previously reported ErrP signals as well as has some unique features. Along with the highly statistically significant difference, the trials differ in time-frequency patterns and scalp distribution maps. In summary, the results of the study provide a novel basis for the detection of the failure against the success events while executing rehabilitation exercises that can be used to improve the state-of-the-art robot-assisted rehabilitation methods.

A Pilot Study on Falling-Risk Detection Method Based on Postural Perturbation Evoked Potential Features

In the human-robot hybrid system, due to the error recognition of the pattern recognition system, the robot may perform erroneous motor execution, which may lead to falling-risk. While, the human can clearly detect the existence of errors, which is manifested in the central nervous activity characteristics. To date, the majority of studies on falling-risk detection have focused primarily on computer vision and physical signals. There are no reports of falling-risk detection methods based on neural activity. In this study, we propose a novel method to monitor multi erroneous motion events using electroencephalogram (EEG) features. There were 15 subjects who participated in this study, who kept standing with an upper limb supported posture and received an unpredictable postural perturbation. EEG signal analysis revealed a high negative peak with a maximum averaged amplitude of −14.75 ± 5.99 μV, occurring at 62 ms after postural perturbation. The xDAWN algorithm was used to reduce the high-dimension of EEG signal features. And, Bayesian linear discriminant analysis (BLDA) was used to train a classifier. The detection rate of the falling-risk onset is 98.67%. And the detection latency is 334ms, when we set detection rate beyond 90% as the standard of dangerous event onset. Further analysis showed that the falling-risk detection method based on postural perturbation evoked potential features has a good generalization ability. The model based on typical event data achieved 94.2% detection rate for unlearned atypical perturbation events. This study demonstrated the feasibility of using neural response to detect dangerous fall events.

A Comprehensive sLORETA Study on the Contribution of Cortical Somatomotor Regions to Motor Imagery

Brain–computer interface (BCI) is a technology used to convert brain signals to control external devices. Researchers have designed and built many interfaces and applications in the last couple of decades. BCI is used for prevention, detection, diagnosis, rehabilitation, and restoration in healthcare. EEG signals are analyzed in this paper to help paralyzed people in rehabilitation. The electroencephalogram (EEG) signals recorded from five healthy subjects are used in this study. The sensor level EEG signals are converted to source signals using the inverse problem solution. Then, the cortical sources are calculated using sLORETA methods at nine regions marked by a neurophysiologist. The features are extracted from cortical sources by using the common spatial pattern (CSP) method and classified by a support vector machine (SVM). Both the sensor and the computed cortical signals corresponding to motor imagery of the hand and foot are used to train the SVM algorithm. Then, the signals outside the training set are used to test the classification performance of the classifier. The 0.1–30 Hz and mu rhythm band-pass filtered activity is also analyzed for the EEG signals. The classification performance and recognition of the imagery improved up to 100% under some conditions for the cortical level. The cortical source signals at the regions contributing to motor commands are investigated and used to improve the classification of motor imagery.

Design and Verification of a Dry Sensor-Based Multi-Channel Digital Active Circuit for Human Brain Electroencephalography Signal Acquisition Systems

A brain–computer interface (BCI) is a type of interface/communication system that can help users interact with their environments. Electroencephalography (EEG) has become the most common application of BCIs and provides a way for disabled individuals to communicate. While wet sensors are the most commonly used sensors for traditional EEG measurements, they require considerable preparation time, including the time needed to prepare the skin and to use the conductive gel. Additionally, the conductive gel dries over time, leading to degraded performance. Furthermore, requiring patients to wear wet sensors to record EEG signals is considered highly inconvenient. Here, we report a wireless 8-channel digital active-circuit EEG signal acquisition system that uses dry sensors. Active-circuit systems for EEG measurement allow people to engage in daily life while using these systems, and the advantages of these systems can be further improved by utilizing dry sensors. Moreover, the use of dry sensors can help both disabled and healthy people enjoy the convenience of BCIs in daily life. To verify the reliability of the proposed system, we designed three experiments in which we evaluated eye blinking and teeth gritting, measured alpha waves, and recorded event-related potentials (ERPs) to compare our developed system with a standard Neuroscan EEG system.

Design of Wearable Headset with Steady State Visually Evoked Potential-Based Brain Computer Interface

Brain-computer interface (BCI) is a system that allows people to communicate directly with external machines via recognizing brain activities without manual operation. However, for most current BCI systems, conventional electroencephalography (EEG) machines and computers are usually required to acquire EEG signal and translate them into control commands, respectively. The sizes of the above machines are usually large, and this increases the limitation for daily applications. Moreover, conventional EEG electrodes also require conductive gels to improve the EEG signal quality. This causes discomfort and inconvenience of use, while the conductive gels may also encounter the problem of drying out during prolonged measurements. In order to improve the above issues, a wearable headset with steady-state visually evoked potential (SSVEP)-based BCI is proposed in this study. Active dry electrodes were designed and implemented to acquire a good EEG signal quality without conductive gels from the hairy site. The SSVEP BCI algorithm was also implemented into the designed field-programmable gate array (FPGA)-based BCI module to translate SSVEP signals into control commands in real time. Moreover, a commercial tablet was used as the visual stimulus device to provide graphic control icons. The whole system was designed as a wearable device to improve convenience of use in daily life, and it could acquire and translate EEG signal directly in the front-end headset. Finally, the performance of the proposed system was validated, and the results showed that it had excellent performance (information transfer rate = 36.08 bits/min).

Direct Electrical Stimulation in Electrocorticographic Brain-Computer Interfaces: Enabling Technologies for Input to Cortex

Electrocorticographic brain computer interfaces (ECoG-BCIs) offer tremendous opportunities for restoring function in individuals suffering from neurological damage and for advancing basic neuroscience knowledge. ECoG electrodes are already commonly used clinically for monitoring epilepsy and have greater spatial specificity in recording neuronal activity than techniques such as electroencephalography (EEG). Much work to date in the field has focused on using ECoG signals recorded from cortex as control outputs for driving end effectors. An equally important but less explored application of an ECoG-BCI is directing input into cortex using ECoG electrodes for direct electrical stimulation (DES). Combining DES with ECoG recording enables a truly bidirectional BCI, where information is both read from and written to the brain. We discuss the advantages and opportunities, as well as the barriers and challenges presented by using DES in an ECoG-BCI. In this article, we review ECoG electrodes, the physics and physiology of DES, and the use of electrical stimulation of the brain for the clinical treatment of disorders such as epilepsy and Parkinson’s disease. We briefly discuss some of the translational, regulatory, financial, and ethical concerns regarding ECoG-BCIs. Next, we describe the use of ECoG-based DES for providing sensory feedback and for probing and modifying cortical connectivity. We explore future directions, which may draw on invasive animal studies with penetrating and surface electrodes as well as non-invasive stimulation methods such as transcranial magnetic stimulation (TMS). We conclude by describing enabling technologies, such as smaller ECoG electrodes for more precise targeting of cortical areas, signal processing strategies for simultaneous stimulation and recording, and computational modeling and algorithms for tailoring stimulation to each individual brain.

Detection of Driver Braking Intention Using EEG Signals During Simulated Driving

In this work, we developed a novel system to detect the braking intention of drivers in emergency situations using electroencephalogram (EEG) signals. The system acquired eight-channel EEG and motion-sensing data from a custom-designed EEG headset during simulated driving. A novel method for accurately labeling the training data during an extremely short period after the onset of an emergency stimulus was introduced. Two types of features, including EEG band power-based and autoregressive (AR)-based, were investigated. It turned out that the AR-based feature in combination with artificial neural network classifier provided better detection accuracy of the system. Experimental results for ten subjects indicated that the proposed system could detect the emergency braking intention approximately 600 ms before the onset of the executed braking event, with high accuracy of 91%. Thus, the proposed system demonstrated the feasibility of developing a brain-controlled vehicle for real-world applications.

Behavioral Outcomes Following Brain-Computer Interface Intervention for Upper Extremity Rehabilitation in Stroke: A Randomized Controlled Trial

Stroke is a leading cause of persistent upper extremity (UE) motor disability in adults. Brain-computer interface (BCI) intervention has demonstrated potential as a motor rehabilitation strategy for stroke survivors. This sub-analysis of ongoing clinical trial (NCT02098265) examines rehabilitative efficacy of this BCI design and seeks to identify stroke participant characteristics associated with behavioral improvement. Stroke participants (n = 21) with UE impairment were assessed using Action Research Arm Test (ARAT) and measures of function. Nine participants completed three assessments during the experimental BCI intervention period and at 1-month follow-up. Twelve other participants first completed three assessments over a parallel time-matched control period and then crossed over into the BCI intervention condition 1-month later. Participants who realized positive change (≥1 point) in total ARAT performance of the stroke affected UE between the first and third assessments of the intervention period were dichotomized as "responders" (<1 = "non-responders") and similarly analyzed. Of the 14 participants with room for ARAT improvement, 64% (9/14) showed some positive change at completion and approximately 43% (6/14) of the participants had changes of minimal detectable change (MDC = 3 pts) or minimally clinical important difference (MCID = 5.7 points). Participants with room for improvement in the primary outcome measure made significant mean gains in ARATtotal score at completion (ΔARATtotal = 2, p = 0.028) and 1-month follow-up (ΔARATtotal = 3.4, p = 0.0010), controlling for severity, gender, chronicity, and concordance. Secondary outcome measures, SISmobility, SISadl, SISstrength, and 9HPTaffected, also showed significant improvement over time during intervention. Participants in intervention through follow-up showed a significantly increased improvement rate in SISstrength compared to controls (p = 0.0117), controlling for severity, chronicity, gender, as well as the individual effects of time and intervention type. Participants who best responded to BCI intervention, as evaluated by ARAT score improvement, showed significantly increased outcome values through completion and follow-up for SISmobility (p = 0.0002, p = 0.002) and SISstrength (p = 0.04995, p = 0.0483). These findings may suggest possible secondary outcome measure patterns indicative of increased improvement resulting from this BCI intervention regimen as well as demonstrating primary efficacy of this BCI design for treatment of UE impairment in stroke survivors. Clinical Trial Registration: ClinicalTrials.gov, NCT02098265.

Existence of Initial Dip for BCI: An Illusion or Reality

A tight coupling between the neuronal activity and the cerebral blood flow (CBF) is the motivation of many hemodynamic response (HR)-based neuroimaging modalities. The increase in neuronal activity causes the increase in CBF that is indirectly measured by HR modalities. Upon functional stimulation, the HR is mainly categorized in three durations: (i) initial dip, (ii) conventional HR (i.e., positive increase in HR caused by an increase in the CBF), and (iii) undershoot. The initial dip is a change in oxygenation prior to any subsequent increase in CBF and spatially more specific to the site of neuronal activity. Despite additional evidence from various HR modalities on the presence of initial dip in human and animal species (i.e., cat, rat, and monkey); the existence/occurrence of an initial dip in HR is still under debate. This article reviews the existence and elusive nature of the initial dip duration of HR in intrinsic signal optical imaging (ISOI), functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). The advent of initial dip and its elusiveness factors in ISOI and fMRI studies are briefly discussed. Furthermore, the detection of initial dip and its role in brain-computer interface using fNIRS is examined in detail. The best possible application for the initial dip utilization and its future implications using fNIRS are provided.

Neuronal Activation Detection Using Vector Phase Analysis with Dual Threshold Circles: A Functional Near-Infrared Spectroscopy Study

In this paper, a new vector phase diagram differentiating the initial decreasing phase (i.e. initial dip) and the delayed hemodynamic response (HR) phase of oxy-hemoglobin changes ( Δ HbO) of functional near-infrared spectroscopy (fNIRS) is developed. The vector phase diagram displays the trajectories of Δ HbO and deoxy-hemoglobin changes ( Δ HbR), as orthogonal components, in the Δ HbO- Δ HbR polar coordinates. To determine the occurrence of an initial dip, dual threshold circles (an inner circle from the resting state, an outer circle from the peak values of the initial dip and the main HR) are incorporated into the phase diagram for making decisions. The proposed scheme is then applied to a brain-computer interface scheme, and its performance is evaluated in classifying two finger tapping tasks (right-hand thumb and little finger) from the left motor cortex. Three gamma functions are used to model the initial dip, the main HR, and the undershoot in generating the designed HR function. In classifying two tapping tasks, the signal mean and signal minimum values during 0-2.5 s, as features of initial dip, are used. The linear discriminant analysis was utilized as a classifier. The experimental results show that the active brain locations of the two tasks were quite distinctive ( p < 0.05 ), and moreover, spatially specific if using the initial dip map at 4 s in comparison to the map of HRs at 14 s. Also, the average classification accuracy was improved from 59% to 74.9% when using the phase diagram of dual threshold circles.

Effects of tDCS on Real-Time BCI Detection of Pedaling Motor Imagery

The purpose of this work is to strengthen the cortical excitability over the primary motor cortex (M1) and the cerebro-cerebellar pathway by means of a new transcranial direct current stimulation (tDCS) configuration to detect lower limb motor imagery (MI) in real time using two different cognitive neural states: relax and pedaling MI. The anode is located over the primary motor cortex in Cz, and the cathode over the right cerebro-cerebellum. The real-time brain-computer interface (BCI) designed is based on finding, for each electrode selected, the power at the particular frequency where the most difference between the two mental tasks is observed. Electroencephalographic (EEG) electrodes are placed over the brain's premotor area (PM), M1, supplementary motor area (SMA) and primary somatosensory cortex (S1). A single-blind study is carried out, where fourteen healthy subjects are separated into two groups: sham and active tDCS. Each subject is experimented on for five consecutive days. On all days, the results achieved by the active tDCS group were over 60% in real-time detection accuracy, with a five-day average of 62.6%. The sham group eventually reached those levels of accuracy, but it needed three days of training to do so.

Neural Correlates of Phrase Quadrature Perception in Harmonic Rhythm: An EEG Study Using a Brain-Computer Interface

For the sake of establishing the neural correlates of phrase quadrature perception in harmonic rhythm, a musical experiment has been designed to induce music-evoked stimuli related to one important aspect of harmonic rhythm, namely the phrase quadrature. Brain activity is translated to action through electroencephalography (EEG) by using a brain-computer interface. The power spectral value of each EEG channel is estimated to obtain how power variance distributes as a function of frequency. The results of processing the acquired signals are in line with previous studies that use different musical parameters to induce emotions. Indeed, our experiment shows statistical differences in theta and alpha bands between the fulfillment and break of phrase quadrature, an important cue of harmonic rhythm, in two classical sonatas.

Thermal Release Transfer Printing for Stretchable Conformal Bioelectronics

Soft neural electrode arrays that are mechanically matched between neural tissues and electrodes offer valuable opportunities for the development of disease diagnose and brain computer interface systems. Here, a thermal release transfer printing method for fabrication of stretchable bioelectronics, such as soft neural electrode arrays, is presented. Due to the large, switchable and irreversible change in adhesion strength of thermal release tape, a low-cost, easy-to-operate, and temperature-controlled transfer printing process can be achieved. The mechanism of this method is analyzed by experiments and fracture-mechanics models. Using the thermal release transfer printing method, a stretchable neural electrode array is fabricated by a sacrificial-layer-free process. The ability of the as-fabricated electrode array to conform different curvilinear surfaces is confirmed by experimental and theoretical studies. High-quality electrocorticography signals of anesthetized rat are collected with the as-fabricated electrode array, which proves good conformal interface between the electrodes and dura mater. The application of the as-fabricated electrode array on detecting the steady-state visual evoked potentials research is also demonstrated by in vivo experiments and the results are compared with those detected by stainless-steel screw electrodes.

Improving the Accuracy and Training Speed of Motor Imagery Brain-Computer Interfaces Using Wavelet-Based Combined Feature Vectors and Gaussian Mixture Model-Supervectors

In this paper, we propose a set of wavelet-based combined feature vectors and a Gaussian mixture model (GMM)-supervector to enhance training speed and classification accuracy in motor imagery brain–computer interfaces. The proposed method is configured as follows: first, wavelet transforms are applied to extract the feature vectors for identification of motor imagery electroencephalography (EEG) and principal component analyses are used to reduce the dimensionality of the feature vectors and linearly combine them. Subsequently, the GMM universal background model is trained by the expectation–maximization (EM) algorithm to purify the training data and reduce its size. Finally, a purified and reduced GMM-supervector is used to train the support vector machine classifier. The performance of the proposed method was evaluated for three different motor imagery datasets in terms of accuracy, kappa, mutual information, and computation time, and compared with the state-of-the-art algorithms. The results from the study indicate that the proposed method achieves high accuracy with a small amount of training data compared with the state-of-the-art algorithms in motor imagery EEG classification.

Neural Correlates of Phrase Rhythm: An EEG Study of Bipartite vs. Rondo Sonata Form

This paper introduces the neural correlates of phrase rhythm. In short, phrase rhythm is the rhythmic aspect of phrase construction and the relationships between phrases. For the sake of establishing the neural correlates, a musical experiment has been designed to induce music-evoked stimuli related to phrase rhythm. Brain activity is monitored through electroencephalography (EEG) by using a brain-computer interface. The power spectral value of each EEG channel is estimated to obtain how power variance distributes as a function of frequency. Our experiment shows statistical differences in theta and alpha bands in the phrase rhythm variations of two classical sonatas, one in bipartite form and the other in rondo form.

Robotic and Virtual Reality BCIs Using Spatial Tactile and Auditory Oddball Paradigms

The paper reviews nine robotic and virtual reality (VR) brain–computer interface (BCI) projects developed by the author, in collaboration with his graduate students, within the BCI–lab research group during its association with University of Tsukuba, Japan. The nine novel approaches are discussed in applications to direct brain-robot and brain-virtual-reality-agent control interfaces using tactile and auditory BCI technologies. The BCI user intentions are decoded from the brainwaves in realtime using a non-invasive electroencephalography (EEG) and they are translated to a symbiotic robot or virtual reality agent thought-based only control. A communication protocol between the BCI output and the robot or the virtual environment is realized in a symbiotic communication scenario using an user datagram protocol (UDP), which constitutes an internet of things (IoT) control scenario. Results obtained from healthy users reproducing simple brain-robot and brain-virtual-agent control tasks in online experiments support the research goal of a possibility to interact with robotic devices and virtual reality agents using symbiotic thought-based BCI technologies. An offline BCI classification accuracy boosting method, using a previously proposed information geometry derived approach, is also discussed in order to further support the reviewed robotic and virtual reality thought-based control paradigms.

The Role of Transient Target Stimuli in a Steady-State Somatosensory Evoked Potential-Based Brain-Computer Interface Setup

In earlier literature, so-called twitches were used to support a user in a steady-state somatosensory evoked potential (SSSEP) based brain–computer interface (BCI) to focus attention on the requested targets. Within this work, we investigate the impact of these transient target stimuli on SSSEPs in a real-life BCI setup. A hybrid BCI was designed which combines SSSEPs and P300 potentials evoked by twitches randomly embedded into the streams of tactile stimuli. The EEG of fourteen healthy subjects was recorded, while their left and right index fingers were simultaneously stimulated using frequencies selected in a screening procedure. The subjects were randomly instructed by a cue on a screen to focus attention on one or none of the fingers. Feature for SSSEPs and P300 potentials were extracted and classified using separately trained multi-class shrinkage LDA classifiers. Three-class classification accuracies significantly better than random could be reached by nine subjects using SSSEP features and by 12 subjects using P300 features respectively. The average classification accuracies were 48.6% using SSSEP and 50.7% using P300 features. By means of a Monte Carlo permutation test it could be shown that twitches have an attenuation effect on the SSSEP. Significant SSSEP blocking effects time-locked to twitch positions were found in seven subjects. Our findings suggest that the attempt to combine different types of stimulation signals like repetitive signals and twitches has a mutual influence on each other, which may be the main reason for the rather moderate BCI performance. This influence is originated at the level of stimulus generation but becomes apparent as physiological effect in the SSSEP. When designing a hybrid BCI based on SSSEPs and P300 potentials, one has to find an optimal tradeoff depending on the overall design goals or individual subjects' performance. Our results give therefore some new insights that may be useful for the successful design of hybrid BCIs.

PET Mapping for Brain-Computer Interface Stimulation of the Ventroposterior Medial Nucleus of the Thalamus in Rats with Implanted Electrodes

Brain-computer interface (BCI) technology has great potential for improving the quality of life for neurologic patients. This study aimed to use PET mapping for BCI-based stimulation in a rat model with electrodes implanted in the ventroposterior medial (VPM) nucleus of the thalamus.

METHODS

PET imaging studies were conducted before and after stimulation of the right VPM.

RESULTS

Stimulation induced significant orienting performance. (18)F-FDG uptake increased significantly in the paraventricular thalamic nucleus, septohippocampal nucleus, olfactory bulb, left crus II of the ansiform lobule of the cerebellum, and bilaterally in the lateral septum, amygdala, piriform cortex, endopiriform nucleus, and insular cortex, but it decreased in the right secondary visual cortex, right simple lobule of the cerebellum, and bilaterally in the somatosensory cortex.

CONCLUSION

This study demonstrated that PET mapping after VPM stimulation can identify specific brain regions associated with orienting performance. PET molecular imaging may be an important approach for BCI-based research and its clinical applications.

Single-trial EEG analysis using similarity measure

Single-trial electroencephalogram (EEG) data are analyzed with similarity measure. Time-frequency representation is constructed from EEG signals. It is then weighted with t-statistics. Finally, the test data are discriminated with similarity measure. Compared with non-weighted version, the experimental results indicate that the proposed method obtains better results in classification accuracy.

Qualitative assessment of patients' attitudes and expectations toward BCIs and implications for future technology development

Brain-computer-interfaces (BCIs) are important for the next generation of neuro-prosthesis innovations. Only few pilot projects have tested patients' abilities to control BCIs as well as their satisfaction with the offered technologies. On the one hand, little is known about patients' moral attitudes toward the benefit-risk-ratio of BCIs as well as their needs, priorities, and expectations. On the other hand, ethics experts intensively discuss the general risks of BCIs as well as the limits of neuro-enhancement. To our knowledge, we present here the first qualitative interview study with ten chronic patients matching the potential user categories for motor and communication BCIs to assess their practical and moral attitudes toward this technology. The interviews reveal practical and moral attitudes toward motor BCIs that can impact future technology development. We discuss our empirical findings on patients' perspectives and compare them to neuroscientists' and ethicists' perspectives. Our analysis indicates only partial overlap between the potential users' and the experts' assessments of BCI-technology. It points out the importance of considering the needs and desires of the targeted patient group. Based on our findings, we suggest a multi-fold approach to the development of clinical BCIs, rooted in the participatory technology-development. We conclude that clinical BCI development needs to be explored in a disease-related and culturally sensitive way.

Artificial bee colony algorithm for single-trial electroencephalogram analysis

In this study, we propose an analysis system combined with feature selection to further improve the classification accuracy of single-trial electroencephalogram (EEG) data. Acquiring event-related brain potential data from the sensorimotor cortices, the system comprises artifact and background noise removal, feature extraction, feature selection, and feature classification. First, the artifacts and background noise are removed automatically by means of independent component analysis and surface Laplacian filter, respectively. Several potential features, such as band power, autoregressive model, and coherence and phase-locking value, are then extracted for subsequent classification. Next, artificial bee colony (ABC) algorithm is used to select features from the aforementioned feature combination. Finally, selected subfeatures are classified by support vector machine. Comparing with and without artifact removal and feature selection, using a genetic algorithm on single-trial EEG data for 6 subjects, the results indicate that the proposed system is promising and suitable for brain-computer interface applications.

Brain-computer interface game applications for combined neurofeedback and biofeedback treatment for children on the autism spectrum

Individuals with autism spectrum disorder (ASD) show deficits in social and communicative skills, including imitation, empathy, and shared attention, as well as restricted interests and repetitive patterns of behaviors. Evidence for and against the idea that dysfunctions in the mirror neuron system are involved in imitation and could be one underlying cause for ASD is discussed in this review. Neurofeedback interventions have reduced symptoms in children with ASD by self-regulation of brain rhythms. However, cortical deficiencies are not the only cause of these symptoms. Peripheral physiological activity, such as the heart rate and its variability, is closely linked to neurophysiological signals and associated with social engagement. Therefore, a combined approach targeting the interplay between brain, body, and behavior could be more effective. Brain–computer interface applications for combined neurofeedback and biofeedback treatment for children with ASD are currently nonexistent. To facilitate their use, we have designed an innovative game that includes social interactions and provides neural- and body-based feedback that corresponds directly to the underlying significance of the trained signals as well as to the behavior that is reinforced.