Steady-State Somatosensory Evoked Potential for Brain-Computer Interface-Present and Future

Further characterisation of late somatosensory evoked potentials using electroencephalogram and magnetoencephalogram source imaging

Beside the well-documented involvement of secondary somatosensory area, the cortical network underlying late somatosensory evoked potentials (P60/N60 and P100/N100) is still unknown. Electroencephalogram and magnetoencephalogram source imaging were performed to further investigate the origin of the brain cortical areas involved in late somatosensory evoked potentials, using sensory inputs of different strengths and by testing the correlation between cortical sources. Simultaneous high-density electroencephalograms and magnetoencephalograms were performed in 19 participants, and electrical stimulation was applied to the median nerve (wrist level) at intensity between 1.5 and 9 times the perceptual threshold. Source imaging was undertaken to map the stimulus-induced brain cortical activity according to each individual brain magnetic resonance imaging, during three windows of analysis covering early and late somatosensory evoked potentials. Results for P60/N60 and P100/N100 were compared with those for P20/N20 (early response). According to literature, maximal activity during P20/N20 was found in central sulcus contralateral to stimulation site. During P60/N60 and P100/N100, activity was observed in contralateral primary sensorimotor area, secondary somatosensory area (on both hemispheres) and premotor and multisensory associative cortices. Late responses exhibited similar characteristics but different from P20/N20, and no significant correlation was found between early and late generated activities. Specific clusters of cortical activities were activated with specific input/output relationships underlying early and late somatosensory evoked potentials. Cortical networks, partly common to and distinct from early somatosensory responses, contribute to late responses, all participating in the complex somatosensory brain processing.

TSANet: multibranch attention deep neural network for classifying tactile selective attention in brain-computer interfaces

Brain-computer interfaces (BCIs) enable communication between the brain and a computer and electroencephalography (EEG) has been widely used to implement BCIs because of its high temporal resolution and noninvasiveness. Recently, a tactile-based EEG task was introduced to overcome the current limitations of visual-based tasks, such as visual fatigue from sustained attention. However, the classification performance of tactile-based BCIs as control signals is unsatisfactory. Therefore, a novel classification approach is required for this purpose. Here, we propose TSANet, a deep neural network, that uses multibranch convolutional neural networks and a feature-attention mechanism to classify tactile selective attention (TSA) in a tactile-based BCI system. We tested TSANet under three evaluation conditions, namely, within-subject, leave-one-out, and cross-subject. We found that TSANet achieved the highest classification performance compared with conventional deep neural network models under all evaluation conditions. Additionally, we show that TSANet extracts reasonable features for TSA by investigating the weights of spatial filters. Our results demonstrate that TSANet has the potential to be used as an efficient end-to-end learning approach in tactile-based BCIs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13534-023-00309-4.

Somatosensory Event-Related Potential as an Electrophysiological Correlate of Endogenous Spatial Tactile Attention: Prospects for Electrotactile Brain-Computer Interface for Sensory Training

Tactile attention tasks are used in the diagnosis and treatment of neurological and sensory processing disorders, while somatosensory event-related potentials (ERP) measured by electroencephalography (EEG) are used as neural correlates of attention processes. Brain-computer interface (BCI) technology provides an opportunity for the training of mental task execution via providing online feedback based on ERP measures. Our recent work introduced a novel electrotactile BCI for sensory training, based on somatosensory ERP; however, no previous studies have addressed specific somatosensory ERP morphological features as measures of sustained endogenous spatial tactile attention in the context of BCI control. Here we show the morphology of somatosensory ERP responses induced by a novel task introduced within our electrotactile BCI platform i.e., the sustained endogenous spatial electrotactile attention task. By applying pulsed electrical stimuli to the two proximal stimulation hotspots at the user's forearm, stimulating sequentially the mixed branches of radial and median nerves with equal probability of stimuli occurrence, we successfully recorded somatosensory ERPs for both stimulation locations, in the attended and unattended conditions. Waveforms of somatosensory ERP responses for both mixed nerve branches showed similar morphology in line with previous reports on somatosensory ERP components obtained by stimulation of exclusively sensory nerves. Moreover, we found statistically significant increases in ERP amplitude on several components, at both stimulation hotspots, while sustained endogenous spatial electrotactile attention task is performed. Our results revealed the existence of general ERP windows of interest and signal features that can be used to detect sustained endogenous tactile attention and classify between spatial attention locations in 11 healthy subjects. The current results show that features of N140, P3a and P3b somatosensory ERP components are the most prominent global markers of sustained spatial electrotactile attention, over all subjects, within our novel electrotactile BCI task/paradigm, and this work proposes the features of those components as markers of sustained endogenous spatial tactile attention in online BCI control. Immediate implications of this work are the possible improvement of online BCI control within our novel electrotactile BCI system, while these finding can be used for other tactile BCI applications in the diagnosis and treatment of neurological disorders by employing mixed nerve somatosensory ERPs and sustained endogenous electrotactile attention task as control paradigms.

Novel electrotactile brain-computer interface with somatosensory event-related potential based control

Objective

A brain computer interface (BCI) allows users to control external devices using non-invasive brain recordings, such as electroencephalography (EEG). We developed and tested a novel electrotactile BCI prototype based on somatosensory event-related potentials (sERP) as control signals, paired with a tactile attention task as a control paradigm.

Approach

A novel electrotactile BCI comprises commercial EEG device, an electrical stimulator and custom software for EEG recordings, electrical stimulation control, synchronization between devices, signal processing, feature extraction, selection, and classification. We tested a novel BCI control paradigm based on tactile attention on a sensation at a target stimulation location on the forearm. Tactile stimuli were electrical pulses delivered at two proximal locations on the user's forearm for stimulating branches of radial and median nerves, with equal probability of the target and distractor stimuli occurrence, unlike in any other ERP-based BCI design. We proposed a compact electrical stimulation electrodes configuration for delivering electrotactile stimuli (target and distractor) using 2 stimulation channels and 3 stimulation electrodes. We tested the feasibility of a single EEG channel BCI control, to determine pseudo-online BCI performance, in ten healthy subjects. For optimizing the BCI performance we compared the results for two classifiers, sERP averaging approaches, and novel dedicated feature extraction/selection methods via cross-validation procedures.

Main results

We achieved a single EEG channel BCI classification accuracy in the range of 75.1 to 88.1% for all subjects. We have established an optimal combination of: single trial averaging to obtain sERP, feature extraction/selection methods and classification approach.

Significance

The obtained results demonstrate that a novel electrotactile BCI paradigm with equal probability of attended (target) and unattended (distractor) stimuli and proximal stimulation sites is feasible. This method may be used to drive restorative BCIs for sensory retraining in stroke or brain injury, or assistive BCIs for communication in severely disabled users.

High-Frequency Vibrating Stimuli Using the Low-Cost Coin-Type Motors for SSSEP-Based BCI

Steady-state somatosensory-evoked potential- (SSSEP-) based brain-computer interfaces (BCIs) have been applied for assisting people with physical disabilities since it does not require gaze fixation or long-time training. Despite the advancement of various noninvasive electroencephalogram- (EEG-) based BCI paradigms, researches on SSSEP with the various frequency range and related classification algorithms are relatively unsettled. In this study, we investigated the feasibility of classifying the SSSEP within high-frequency vibration stimuli induced by a versatile coin-type eccentric rotating mass (ERM) motor. Seven healthy subjects performed selective attention (SA) tasks with vibration stimuli attached to the left and right index fingers. Three EEG feature extraction methods, followed by a support vector machine (SVM) classifier, have been tested: common spatial pattern (CSP), filter-bank CSP (FBCSP), and mutual information-based best individual feature (MIBIF) selection after the FBCSP. Consequently, the FBCSP showed the highest performance at $71.5\pm 2.5$ % for classifying the left and right-hand SA tasks than the other two methods (i.e., CSP and FBCSP-MIBIF). Based on our findings and approach, the high-frequency vibration stimuli using low-cost coin motors with the FBCSP-based feature selection can be potentially applied to developing practical SSSEP-based BCI systems.

Performance Variation of a Somatosensory BCI Based on Imagined Sensation: A Large Population Study

A proportion of users cannot achieve adequate brain-computer interface (BCI) control. The diversity of BCI modalities provides a way to solve this emerging issue. Here, we investigate the accuracy of a somatosensory BCI based on sensory imagery (SI). During the SI tasks, subjects were instructed to imagine a tactile sensation and to maintain the attention on the corresponding hand, as if there was tactile stimulus on the skin of the wrist. The performance across 106 healthy subjects in left- and right-hand SI discrimination was 78.9±13.2%. In 70.7% of the subjects the performance was above 70%. The SI task induced a contralateral cortical activation, and high-density EEG source localization showed that the real tactile stimulation and imagined tactile stimulation shared similar cortical activations within the somatosensory cortex. The somatosensory BCI based on SI provides a new signal modality for independent BCI development. Moreover, a combination of SI and other BCI modalities, such as motor imagery, may provide new avenues for further improving BCI usage and applicability, especially in those subjects unable to attain adequate BCI control with conventional BCI modalities.

Detection of tACS Entrainment Critically Depends on Epoch Length

Neural entrainment is the phase synchronization of a population of neurons to an external rhythmic stimulus such as applied in the context of transcranial alternating current stimulation (tACS). tACS can cause profound effects on human behavior. However, there remain a significant number of studies that find no behavioral effect when tACS is applied to human subjects. To investigate this discrepancy, we applied time sensitive phase lock value (PLV) based analysis to single unit data from the rat motor cortex. The analysis revealed that detection of neural entrainment depends critically on the epoch length within which spiking information is accumulated. Increasing the epoch length allowed for detection of progressively weaker levels of neural entrainment. Based on this single unit analysis, we hypothesized that tACS effects on human behavior would be more easily detected in a behavior paradigm which utilizes longer epoch lengths. We tested this by using tACS to entrain tremor in patients and healthy volunteers. When the behavioral data were analyzed using short duration epochs tremor entrainment effects were not detectable. However, as the epoch length was progressively increased, weak tremor entrainment became detectable. These results suggest that tACS behavioral paradigms that rely on the accumulation of information over long epoch lengths will tend to be successful at detecting behavior effects. However, tACS paradigms that rely on short epoch lengths are less likely to detect effects.

Continuous Hybrid BCI Control for Robotic Arm Using Noninvasive Electroencephalogram, Computer Vision, and Eye Tracking

The controlling of robotic arms based on brain–computer interface (BCI) can revolutionize the quality of life and living conditions for individuals with physical disabilities. Invasive electroencephalography (EEG)-based BCI has been able to control multiple degrees of freedom (DOFs) robotic arms in three dimensions. However, it is still hard to control a multi-DOF robotic arm to reach and grasp the desired target accurately in complex three-dimensional (3D) space by a noninvasive system mainly due to the limitation of EEG decoding performance. In this study, we propose a noninvasive EEG-based BCI for a robotic arm control system that enables users to complete multitarget reach and grasp tasks and avoid obstacles by hybrid control. The results obtained from seven subjects demonstrated that motor imagery (MI) training could modulate brain rhythms, and six of them completed the online tasks using the hybrid-control-based robotic arm system. The proposed system shows effective performance due to the combination of MI-based EEG, computer vision, gaze detection, and partially autonomous guidance, which drastically improve the accuracy of online tasks and reduce the brain burden caused by long-term mental activities.

Individual Optimal Attentional Strategy in Motor Learning Tasks Characterized by Steady-State Somatosensory and Visual Evoked Potentials

Focus of attention is one of the most influential factors facilitating motor performance. Previous evidence supports that the external focus (EF) strategy, which directs attention to movement outcomes, is associated with better motor performance than the internal focus (IF) strategy, which directs attention to body movements. However, recent studies have reported that the EF strategy is not effective for some individuals. Furthermore, neuroimaging studies have demonstrated that the frontal and parietal areas characterize individual optimal attentional strategies for motor tasks. However, whether the sensory cortices are also functionally related to individual optimal attentional strategy remains unclear. Therefore, the present study examined whether an individual’s sensory processing ability would reflect the optimal attentional strategy. To address this point, we explored the relationship between responses in the early sensory cortex and individuals’ optimal attentional strategy by recording steady-state somatosensory evoked potentials (SSSEP) and steady-state visual evoked potentials (SSVEP). Twenty-six healthy young participants first performed a motor learning task with reaching movements under IF and EF conditions. Of the total sample, 12 individuals showed higher after-effects under the IF condition than the EF condition (IF-dominant group), whereas the remaining individuals showed the opposite trend (EF-dominant group). Subsequently, we measured SSSEP from bilateral primary somatosensory cortices while presenting vibrotactile stimuli and measured SSVEP from bilateral primary visual cortices while presenting checkerboard visual stimuli. The degree of increasing SSSEP response when the individuals in the IF-dominant group directed attention to vibrotactile stimuli was significantly more potent than those in the EF-dominant individuals. By contrast, the individuals in the EF-dominant group showed a significantly larger SSVEP increase while they directed attention to visual stimuli compared with the IF-dominant individuals. Furthermore, a significant correlation was observed such that individuals with more robust IF dominance showed more pronounced SSSEP attention modulation. These results suggest that the early sensory areas have crucial brain dynamics to characterize an individual’s optimal attentional strategy during motor tasks. The response characteristics may reflect the individual sensory processing ability, such as control of priority to the sensory inputs. Considering individual cognitive traits based on the suitable attentional strategy could enhance adaptability in motor tasks.

EEG-based brain-computer interfaces exploiting steady-state somatosensory-evoked potentials: a literature review

A brain-computer interface (BCI) aims to derive commands from the user's brain activity in order to relay them to an external device. To do so, it can either detect a spontaneous change in the mental state, in the so-called 'active' BCIs, or a transient or sustained change in the brain response to an external stimulation, in 'reactive' BCIs. In the latter, external stimuli are perceived by the user through a sensory channel, usually sight or hearing. When the stimulation is sustained and periodical, the brain response reaches an oscillatory steady-state that can be detected rather easily. We focus our attention on electroencephalography-based BCIs (EEG-based BCI) in which a periodical signal, either mechanical or electrical, stimulates the user skin. This type of stimulus elicits a steady-state response of the somatosensory system that can be detected in the recorded EEG. The oscillatory and phase-locked voltage component characterising this response is called a steady-state somatosensory-evoked potential (SSSEP). It has been shown that the amplitude of the SSSEP is modulated by specific mental tasks, for instance when the user focuses their attention or not to the somatosensory stimulation, allowing the translation of this variation into a command. Actually, SSSEP-based BCIs may benefit from straightforward analysis techniques of EEG signals, like reactive BCIs, while allowing self-paced interaction, like active BCIs. In this paper, we present a survey of scientific literature related to EEG-based BCI exploiting SSSEP. Firstly, we endeavour to describe the main characteristics of SSSEPs and the calibration techniques that allow the tuning of stimulation in order to maximise their amplitude. Secondly, we present the signal processing and data classification algorithms implemented by authors in order to elaborate commands in their SSSEP-based BCIs, as well as the classification performance that they evaluated on user experiments.

Multi-Domain Convolutional Neural Networks for Lower-Limb Motor Imagery Using Dry vs. Wet Electrodes

Motor imagery (MI) brain–computer interfaces (BCIs) have been used for a wide variety of applications due to their intuitive matching between the user’s intentions and the performance of tasks. Applying dry electroencephalography (EEG) electrodes to MI BCI applications can resolve many constraints and achieve practicality. In this study, we propose a multi-domain convolutional neural networks (MD-CNN) model that learns subject-specific and electrode-dependent EEG features using a multi-domain structure to improve the classification accuracy of dry electrode MI BCIs. The proposed MD-CNN model is composed of learning layers for three domain representations (time, spatial, and phase). We first evaluated the proposed MD-CNN model using a public dataset to confirm 78.96% classification accuracy for multi-class classification (chance level accuracy: 30%). After that, 10 healthy subjects participated and performed three classes of MI tasks related to lower-limb movement (gait, sitting down, and resting) over two sessions (dry and wet electrodes). Consequently, the proposed MD-CNN model achieved the highest classification accuracy (dry: 58.44%; wet: 58.66%; chance level accuracy: 43.33%) with a three-class classifier and the lowest difference in accuracy between the two electrode types (0.22%, d = 0.0292) compared with the conventional classifiers (FBCSP, EEGNet, ShallowConvNet, and DeepConvNet) that used only a single domain. We expect that the proposed MD-CNN model could be applied for developing robust MI BCI systems with dry electrodes.

Inter-stimulus phase coherence in steady-state somatosensory evoked potentials and its application in improving the performance of single-channel MI-BCI

Objective. With the development of clinical applications of motor imagery-based brain-computer interfaces (MI-BCIs), a single-channel MI-BCI system that can be easily assembled is an attractive goal. However, due to the low quality of the spectral power features in the traditional MI-BCI paradigm, the recognition performance of current single-channel systems is far lower than that of multi-channel systems, impeding their use in clinical applications.Approach.In this study, the subjects' right and left hands were stimulated simultaneously at different frequencies to induce steady-state somatosensory evoked potentials (SSSEP). Subjects then performed motor imagery (MI) tasks. A new electroencephalography (EEG) index, inter-stimulus phase coherence (ISPC), was built to measure phase desynchronization of SSSEP caused by MI. Then, ISPC is introduced as a feature into left-hand and right-hand MI recognition.Main results.ISPC analysis found that left-handed MI can cause a significant decrease in phase synchronization in contralateral sensorimotor SSSEP, while right-handed MI has little effect on it, and vice versa. Combining ISPC features with traditional spectral power features, the single-channel left-hand versus right-hand MI recognition accuracy reaches 81.0%, which is much higher than that observed with traditional MI paradigms (about 60%).Significance.This work shows that the hybrid MI-SSSEP paradigm can provide more sensitive EEG features to decode motor intentions, demonstrating its potential for clinical applications.

EEG-based hybrid QWERTY mental speller with high information transfer rate

BACKGROUND

Brain-computer interface (BCI) spellers detect variations in brain waves to help subjects communicate with the world. This study introduces a P300-SSVEP hybrid BCI-based QWERTY speller.

METHODS

The proposed hybrid speller, combines SSVEP and P300 features using a hybrid paradigm. P300 was used as time division multiplexing index which results in the use of lesser number of assumed frequencies for SSVEP elicitation. Each flickering frequency was also assigned a unique colour, to enhance system accuracy.

RESULTS

On the basis of 20 subjects, an average accuracy of classification of 96.42% and a mean information transfer rate (ITR) of 131.0 bits per min. (BPM) was achieved during the free spelling trial (trial-F).

COMPARISON

The t test results revealed that the hybrid QWERTY speller performed significantly better (on the basis of mean classification accuracy and ITR) as compared to the traditional P300 speller) and the QWERTY SSVEP speller. Also, the amount of time taken to spell a word was significantly lesser in the case of hybrid QWERTY speller in contrast to traditional P300 speller while it was almost the same as compared to QWERTY SSVEP speller.

CONCLUSION

QWERTY speller outperformed the stereotypical P300 speller as well as QWERTY SSVEP speller.

A Survey on the Use of Haptic Feedback for Brain-Computer Interfaces and Neurofeedback

Neurofeedback (NF) and brain-computer interface (BCI) applications rely on the registration and real-time feedback of individual patterns of brain activity with the aim of achieving self-regulation of specific neural substrates or control of external devices. These approaches have historically employed visual stimuli. However, in some cases vision is unsuitable or inadequately engaging. Other sensory modalities, such as auditory or haptic feedback have been explored, and multisensory stimulation is expected to improve the quality of the interaction loop. Moreover, for motor imagery tasks, closing the sensorimotor loop through haptic feedback may be relevant for motor rehabilitation applications, as it can promote plasticity mechanisms. This survey reviews the various haptic technologies and describes their application to BCIs and NF. We identify major trends in the use of haptic interfaces for BCI and NF systems and discuss crucial aspects that could motivate further studies.

Electrical stimulation-induced SSSEP as an objective index to evaluate the difference of tactile acuity between the left and right hand

OBJECTIVE

The objective of this study is to propose an objective index to evaluate the difference of tactile acuity between the left and right hand based on steady-state somatosensory evoked potential (SSSEP).

APPROACH

Two kinds of tactile sensations (vibration and pressure) with three levels of intensities (low/medium/high) were evoked on two finger areas of the left or right hand (thumb and index for healthy hands, thumb and index-projected areas for disabled hands) via transcutaneous electrical nerve stimulation (TENS). Three forearm amputees and 13 able-bodied subjects were recruited to discriminate the specific level and area of the applied stimulation. Electroencephalography was adopted to simultaneously record the somatosensory cortex response to TENS. We assessed the discrimination performance (discrimination accuracy rate (AR) and response time (RT)) to quantify the tactile acuity, while the evoked SSSEP was synchronously analyzed. Linear regression analyses were performed between the difference of SSSEP amplitudes and the difference of discrimination performance for the left and right hand stimulation.

MAIN RESULTS

Frequency domain analysis revealed that SSSEP amplitude increased with the increase of the stimulation intensity. There were positive correlations between the difference of SSSEP amplitudes and the difference of ARs for the left and right hand stimulation in the sensations of vibration (R ²  =  0.6389 for able-bodied subjects, R ²  =  0.5328 for amputees) and pressure (R ²  =  0.6102 for able-bodied subjects, R ²  =  0.5452 for amputees), respectively. Significance The SSSEP amplitude could be used as an objective index to evaluate the difference of the tactile acuity between the left and right hand and has the potential to be applied in sensory rehabilitation for amputees or stroke patients.

Locomotion Control of Pigeons using Polymer-based Deep Brain Electrodes

This paper describes the electrical modulation of locomotion in pigeons using deep brain electrodes. Polymer-based depth electrodes with four channels were fabricated. Based on the location of the nucleus intercollicularis (ICo), the shanks of the depth electrodes were designed to be a length of 11 mm. After the implantation of the depth electrode into the ICo region of the brain, it was connected by wires to a custom-made stimulator, and biphasic current pulses were delivered. Current pulses with an amplitude of 0.5 mA, a rate of 58.0 Hz, and a duration of $320\mu \mathrm{s} $s were applied for 0.5 s. When the ICo region was electrically stimulated, taking-off behavior was successfully induced for 0.4 s. Induction of taking-off behavior by electrical stimulation, when coupled to control of turning and running forward locomotions, may contribute to the development of remote flight-control system of freely moving pigeon.

Connectivity steered graph Fourier transform for motor imagery BCI decoding

OBJECTIVE

Graph signal processing (GSP) concepts are exploited for brain activity decoding and particularly the detection and recognition of a motor imagery (MI) movement. A novel signal analytic technique that combines graph Fourier transform (GFT) with estimates of cross-frequency coupling (CFC) and discriminative learning is introduced as a means to recover the subject's intention from the multichannel signal.

APPROACH

Adopting a multi-view perspective, based on the popular concept of co-existing and interacting brain rhythms, a multilayer network model is first built from empirical data and its connectivity graph is used to derive the GFT-basis. A personalized decoding scheme supporting a binary decision, either 'left versus right' or 'rest versus MI', is crafted from a small set of training trials. Electroencephalographic (EEG) activity from 12 volunteers recorded during two randomly alternating, externally cued, MI tasks (clenching either left or right fist) and a rest condition is used to introduce and validate our methodology. In addition, the introduced methodology was further validated based on dataset IVa of BCI III competition.

MAIN RESULTS

Our GFT-domain decoding scheme achieves nearly optimal performance and proves superior to alternative techniques that are very popular in the field.

SIGNIFICANCE

At a conceptual level, our work suggests a fruitful way to introduce network neuroscience in BCI research. At a more practical level, it is characterized by efficiency. Training is realized using a small number of exemplar trials and decoding requires very simple operations that leaves room for real-time implementation.

tACS motor system effects can be caused by transcutaneous stimulation of peripheral nerves

Transcranial alternating current stimulation (tACS) is a noninvasive neuromodulation method which has been shown to modulate hearing, motor, cognitive and memory function. However, the mechanisms underpinning these findings are controversial, as studies show that the current reaching the cortex may not be strong enough to entrain neural activity. Here, we propose a new hypothesis to reconcile these opposing results: tACS effects are caused by transcutaneous stimulation of peripheral nerves in the skin and not transcranial stimulation of cortical neurons. Rhythmic activity from peripheral nerves then entrains cortical neurons. A series of experiments in rats and humans isolated the transcranial and transcutaneous mechanisms and showed that the reported effects of tACS on the motor system can be caused by transcutaneous stimulation of peripheral nerves. Whether or not the transcutaneous mechanism will generalize to tACS effects on other systems is debatable but should be investigated.

Transcranial alternating current stimulation (tACS) uses weak electrical currents, applied to the head, to modulate brain activity. Here, the authors show that contrary to previous assumptions, the effects of tACS on the brain may be mediated by its effect on peripheral nerves in the skin, not direct.

Performance Differences Using a Vibro-Tactile P300 BCI in LIS-Patients Diagnosed With Stroke and ALS

Patients with locked-in syndrome (LIS) are typically unable to move or communicate and can be misdiagnosed as patients with disorders of consciousness (DOC). Behavioral assessment scales are limited in their ability to detect signs of consciousness in this population. Recent research has shown that brain-computer interface (BCI) technology could supplement behavioral scales and allows to establish communication with these severely disabled patients. In this study, we compared the vibro-tactile P300 based BCI performance in two groups of patients with LIS of different etiologies: stroke (n = 6) and amyotrophic lateral sclerosis (ALS) (n = 9). Two vibro-tactile paradigms were administered to the patients to assess conscious function and command following. The first paradigm is called vibrotactile evoked potentials (EPs) with two tactors (VT2), where two stimulators were placed on the patient’s left and right wrist, respectively. The patients were asked to count the rare stimuli presented to one wrist to elicit a P300 complex to target stimuli only. In the second paradigm, namely vibrotactile EPs with three tactors (VT3), two stimulators were placed on the wrists as done in VT2, and one additional stimulator was placed on his/her back. The task was to count the rare stimuli presented to one wrist, to elicit the event-related potentials (ERPs). The VT3 paradigm could also be used for communication. For this purpose, the patient had to count the stimuli presented to the left hand to answer “yes” and to count the stimuli presented to the right hand to answer “no.” All patients except one performed above chance level in at least one run in the VT2 paradigm. In the VT3 paradigm, all 6 stroke patients and 8/9 ALS patients showed at least one run above chance. Overall, patients achieved higher accuracies in VT2 than VT3. LIS patients due to ALS exhibited higher accuracies that LIS patients due to stroke, in both the VT2 and VT3 paradigms. These initial data suggest that controlling this type of BCI requires specific cognitive abilities that may be impaired in certain sub-groups of severely motor-impaired patients. Future studies on a larger cohort of patients are needed to better identify and understand the underlying cortical mechanisms of these differences.

Assessing Command-Following and Communication With Vibro-Tactile P300 Brain-Computer Interface Tools in Patients With Unresponsive Wakefulness Syndrome

Persons diagnosed with disorders of consciousness (DOC) typically suffer from motor disablities, and thus assessing their spared cognitive abilities can be difficult. Recent research from several groups has shown that non-invasive brain-computer interface (BCI) technology can provide assessments of these patients' cognitive function that can supplement information provided through conventional behavioral assessment methods. In rare cases, BCIs may provide a binary communication mechanism. Here, we present results from a vibrotactile BCI assessment aiming at detecting command-following and communication in 12 unresponsive wakefulness syndrome (UWS) patients. Two different paradigms were administered at least once for every patient: (i) VT2 with two vibro-tactile stimulators fixed on the patient's left and right wrists and (ii) VT3 with three vibro-tactile stimulators fixed on both wrists and on the back. The patients were instructed to mentally count either the stimuli on the left or right wrist, which may elicit a robust P300 for the target wrist only. The EEG data from −100 to +600 ms around each stimulus were extracted and sub-divided into 8 data segments. This data was classified with linear discriminant analysis (using a 10 × 10 cross validation) and used to calibrate a BCI to assess command following and YES/NO communication abilities. The grand average VT2 accuracy across all patients was 38.3%, and the VT3 accuracy was 26.3%. Two patients achieved VT3 accuracy ≥80% and went through communication testing. One of these patients answered 4 out of 5 questions correctly in session 1, whereas the other patient answered 6/10 and 7/10 questions correctly in sessions 2 and 4. In 6 other patients, the VT2 or VT3 accuracy was above the significance threshold of 23% for at least one run, while in 4 patients, the accuracy was always below this threshold. The study highlights the importance of repeating EEG assessments to increase the chance of detecting command-following in patients with severe brain injury. Furthermore, the study shows that BCI technology can test command following in chronic UWS patients and can allow some of these patients to answer YES/NO questions.

Use of Sine Shaped High-Frequency Rhythmic Visual Stimuli Patterns for SSVEP Response Analysis and Fatigue Rate Evaluation in Normal Subjects

Background: Recent EEG-SSVEP signal based BCI studies have used high frequency square pulse visual stimuli to reduce subjective fatigue. However, the effect of total harmonic distortion (THD) has not been considered. Compared to CRT and LCD monitors, LED screen displays high-frequency wave with better refresh rate. In this study, we present high frequency sine wave simple and rhythmic patterns with low THD rate by LED to analyze SSVEP responses and evaluate subjective fatigue in normal subjects. Materials and Methods: We used patterns of 3-sequence high-frequency sine waves (25, 30, and 35 Hz) to design our visual stimuli. Nine stimuli patterns, 3 simple (repetition of each of above 3 frequencies e.g., P25-25-25) and 6 rhythmic (all of the frequencies in 6 different sequences e.g., P25-30-35) were chosen. A hardware setup with low THD rate (<0.1%) was designed to present these patterns on LED. Twenty two normal subjects (aged 23-30 (25 ± 2.1) yrs) were enrolled. Visual analog scale (VAS) was used for subjective fatigue evaluation after presentation of each stimulus pattern. PSD, CCA, and LASSO methods were employed to analyze SSVEP responses. The data including SSVEP features and fatigue rate for different visual stimuli patterns were statistically evaluated. Results: All 9 visual stimuli patterns elicited SSVEP responses. Overall, obtained accuracy rates were 88.35% for PSD and > 90% for CCA and LASSO (for TWs > 1 s). High frequency rhythmic patterns group with low THD rate showed higher accuracy rate (99.24%) than simple patterns group (98.48%). Repeated measure ANOVA showed significant difference between rhythmic pattern features (P < 0.0005). Overall, there was no significant difference between the VAS of rhythmic [3.85 ± 2.13] compared to the simple patterns group [3.96 ± 2.21], (P = 0.63). Rhythmic group had lower within group VAS variation (min = P25-30-35 [2.90 ± 2.45], max = P35-25-30 [4.81 ± 2.65]) as well as least individual pattern VAS (P25-30-35). Discussion and Conclusion: Overall, rhythmic and simple pattern groups had higher and similar accuracy rates. Rhythmic stimuli patterns showed insignificantly lower fatigue rate than simple patterns. We conclude that both rhythmic and simple visual high frequency sine wave stimuli require further research for human subject SSVEP-BCI studies.

Psychological Predictors of Visual and Auditory P300 Brain-Computer Interface Performance

Brain-Computer Interfaces (BCIs) provide communication channels independent from muscular control. In the current study we used two versions of the P300-BCI: one based on visual the other on auditory stimulation. Up to now, data on the impact of psychological variables on P300-BCI control are scarce. Hence, our goal was to identify new predictors with a comprehensive psychological test-battery. A total of N = 40 healthy BCI novices took part in a visual and an auditory BCI session. Psychological variables were measured with an electronic test-battery including clinical, personality, and performance tests. The personality factor "emotional stability" was negatively correlated (Spearman's rho = -0.416; p < 0.01) and an output variable of the non-verbal learning test (NVLT), which can be interpreted as ability to learn, correlated positively (Spearman's rho = 0.412; p < 0.01) with visual P300-BCI performance. In a linear regression analysis both independent variables explained 24% of the variance. "Emotional stability" was also negatively related to auditory P300-BCI performance (Spearman's rho = -0.377; p < 0.05), but failed significance in the regression analysis. Psychological parameters seem to play a moderate role in visual P300-BCI performance. "Emotional stability" was identified as a new predictor, indicating that BCI users who characterize themselves as calm and rational showed worse BCI performance. The positive relation of the ability to learn and BCI performance corroborates the notion that also for P300 based BCIs learning may constitute an important factor. Further studies are needed to consolidate or reject the presented predictors.

Complete Locked-in and Locked-in Patients: Command Following Assessment and Communication with Vibro-Tactile P300 and Motor Imagery Brain-Computer Interface Tools

Many patients with locked-in syndrome (LIS) or complete locked-in syndrome (CLIS) also need brain-computer interface (BCI) platforms that do not rely on visual stimuli and are easy to use. We investigate command following and communication functions of mindBEAGLE with 9 LIS, 3 CLIS patients and three healthy controls. This tests were done with vibro-tactile stimulation with 2 or 3 stimulators (VT2 and VT3 mode) and with motor imagery (MI) paradigms. In VT2 the stimulators are fixed on the left and right wrist and the participant has the task to count the stimuli on the target hand in order to elicit a P300 response. In VT3 mode an additional stimulator is placed as a distractor on the shoulder and the participant is counting stimuli either on the right or left hand. In motor imagery mode the participant is instructed to imagine left or right hand movement. VT3 and MI also allow the participant to answer yes and no questions. Healthy controls achieved a mean assessment accuracy of 100% in VT2, 93% in VT3, and 73% in MI modes. They were able to communicate with VT3 (86.7%) and MI (83.3%) after 2 training runs. The patients achieved a mean accuracy of 76.6% in VT2, 63.1% in VT3, and 58.2% in MI modes after 1-2 training runs. 9 out of 12 LIS patients could communicate by using the vibro-tactile P300 paradigms (answered on average 8 out of 10 questions correctly) and 3 out of 12 could communicate with the motor imagery paradigm (answered correctly 4,7 out of 5 questions). 2 out of the 3 CLIS patients could use the system to communicate with VT3 (90 and 70% accuracy). The results show that paradigms based on non-visual evoked potentials and motor imagery can be effective for these users. It is also the first study that showed EEG-based BCI communication with CLIS patients and was able to bring 9 out of 12 patients to communicate with higher accuracies than reported before. More importantly this was achieved within less than 15-20 min.