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Rezvani S, Hosseini-Zahraei SH, Tootchi A, Guger C, Chaibakhsh Y, Saberi A, Chaibakhsh A. A review on the performance of brain-computer interface systems used for patients with locked-in and completely locked-in syndrome. Cogn Neurodyn 2024; 18:1419-1443. [PMID: 39104673 PMCID: PMC11297882 DOI: 10.1007/s11571-023-09995-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/28/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2024] Open
Abstract
Patients with locked-in syndrome (LIS) and complete locked-in syndrome (CLIS) own a fully functional brain restricted within a non-functional body. In order to help LIS patients stay connected with their surroundings, brain-computer interfaces (BCIs) and related technologies have emerged. BCIs translate brain activity into actions that can be performed by external devices enabling LIS patients to communicate, leading to an increase in their quality of life. The past decade has seen the rapid development of BCIs that have the potential to be used for patients with locked-in syndrome, from which a great deal is tested only on healthy subjects and not on actual patients. This study aims to (1) provide the readers with a comprehensive study that contributes to this growing area of research by exploring the performance of BCIs tested specifically on LIS and CLIS patients, (2) give an overview of different modalities and paradigms used in different stages of the locked-in syndrome, and (3) discuss the contributions and limitations of BCIs introduced for the LIS and CLIS patients in the state-of-the-art and lay a groundwork for researchers interested in this field.
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Affiliation(s)
- Sanaz Rezvani
- Department of Mechanical Engineering, University, University of Guilan, Campus 2, Rasht, 41447-84475 Guilan Iran
- Intelligent Systems and Advanced Control Lab, University of Guilan, Rasht, 41938-13776 Guilan Iran
| | | | - Amirreza Tootchi
- Department of Mechanical & Energy Engineering, Indiana University - Purdue University Indianapolis (IUPUI), 723 W Michigan Street, Indianapolis, IN 46202 USA
| | | | - Yasmin Chaibakhsh
- Department of Cardiac Anesthesia, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, 19956-14331 Iran
| | - Alia Saberi
- Department of Neurology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, 41937-13194 Guilan Iran
| | - Ali Chaibakhsh
- Intelligent Systems and Advanced Control Lab, University of Guilan, Rasht, 41938-13776 Guilan Iran
- Faculty of Mechanical Engineering, University of Guilan, Rasht, 41996-13776 Guilan Iran
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Séguin P, Maby E, Fouillen M, Otman A, Luauté J, Giraux P, Morlet D, Mattout J. The challenge of controlling an auditory BCI in the case of severe motor disability. J Neuroeng Rehabil 2024; 21:9. [PMID: 38238759 PMCID: PMC10795353 DOI: 10.1186/s12984-023-01289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The locked-in syndrome (LIS), due to a lesion in the pons, impedes communication. This situation can also be met after some severe brain injury or in advanced Amyotrophic Lateral Sclerosis (ALS). In the most severe condition, the persons cannot communicate at all because of a complete oculomotor paralysis (Complete LIS or CLIS). This even prevents the detection of consciousness. Some studies suggest that auditory brain-computer interface (BCI) could restore a communication through a « yes-no» code. METHODS We developed an auditory EEG-based interface which makes use of voluntary modulations of attention, to restore a yes-no communication code in non-responding persons. This binary BCI uses repeated speech sounds (alternating "yes" on the right ear and "no" on the left ear) corresponding to either frequent (short) or rare (long) stimuli. Users are instructed to pay attention to the relevant stimuli only. We tested this BCI with 18 healthy subjects, and 7 people with severe motor disability (3 "classical" persons with locked-in syndrome and 4 persons with ALS). RESULTS We report online BCI performance and offline event-related potential analysis. On average in healthy subjects, online BCI accuracy reached 86% based on 50 questions. Only one out of 18 subjects could not perform above chance level. Ten subjects had an accuracy above 90%. However, most patients could not produce online performance above chance level, except for two people with ALS who obtained 100% accuracy. We report individual event-related potentials and their modulation by attention. In addition to the classical P3b, we observed a signature of sustained attention on responses to frequent sounds, but in healthy subjects and patients with good BCI control only. CONCLUSIONS Auditory BCI can be very well controlled by healthy subjects, but it is not a guarantee that it can be readily used by the target population of persons in LIS or CLIS. A conclusion that is supported by a few previous findings in BCI and should now trigger research to assess the reasons of such a gap in order to propose new and efficient solutions. CLINICAL TRIAL REGISTRATIONS No. NCT02567201 (2015) and NCT03233282 (2013).
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Affiliation(s)
- Perrine Séguin
- Lyon Neuroscience Research Center, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
- University Hospital of Saint-Etienne, 42000, Saint-Etienne, France
- Jean Monnet University, 42000, Saint-Etienne, France
| | - Emmanuel Maby
- Lyon Neuroscience Research Center, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
| | - Mélodie Fouillen
- Lyon Neuroscience Research Center, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
| | - Anatole Otman
- Lyon Neuroscience Research Center, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
| | - Jacques Luauté
- Lyon Neuroscience Research Center, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
- Hospices Civils de Lyon, 69000, Lyon, France
| | - Pascal Giraux
- Lyon Neuroscience Research Center, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
- University Hospital of Saint-Etienne, 42000, Saint-Etienne, France
- Jean Monnet University, 42000, Saint-Etienne, France
| | - Dominique Morlet
- Lyon Neuroscience Research Center, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France
| | - Jérémie Mattout
- Lyon Neuroscience Research Center, INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, 69000, Lyon, France.
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Voity K, Lopez T, Chan JP, Greenwald BD. Update on How to Approach a Patient with Locked-In Syndrome and Their Communication Ability. Brain Sci 2024; 14:92. [PMID: 38248307 PMCID: PMC10813368 DOI: 10.3390/brainsci14010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
Locked-in syndrome (LIS) is a rare and challenging condition that results in tetraplegia and cranial nerve paralysis while maintaining consciousness and variable cognitive function. Once acute management is completed, it is important to work with the patient on developing a plan to maintain and improve their quality of life (QOL). A key component towards increasing or maintaining QOL within this population involves the establishment of a functional communication system. Evaluating cognition in patients with LIS is vital for evaluating patients' communication needs along with physical rehabilitation to maximize their QOL. In the past decade or so, there has been an increase in research surrounding brain-computer interfaces to improve communication abilities for paralyzed patients. This article provides an update on the available technology and the protocol for finding the best way for patients with this condition to communicate. This article aims to increase knowledge of how to enhance and manage communication among LIS patients.
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Affiliation(s)
- Kaitlyn Voity
- Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA;
| | - Tara Lopez
- JFK Johnson Rehabilitation Institute, Edison, NJ 08820, USA; (T.L.); (J.P.C.)
| | - Jessie P. Chan
- JFK Johnson Rehabilitation Institute, Edison, NJ 08820, USA; (T.L.); (J.P.C.)
| | - Brian D. Greenwald
- JFK Johnson Rehabilitation Institute, Edison, NJ 08820, USA; (T.L.); (J.P.C.)
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Xu R, Spataro R, Allison BZ, Guger C. Brain-Computer Interfaces in Acute and Subacute Disorders of Consciousness. J Clin Neurophysiol 2022; 39:32-39. [PMID: 34474428 DOI: 10.1097/wnp.0000000000000810] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SUMMARY Disorders of consciousness include coma, unresponsive wakefulness syndrome (also known as vegetative state), and minimally conscious state. Neurobehavioral scales such as coma recovery scale-revised are the gold standard for disorder of consciousness assessment. Brain-computer interfaces have been emerging as an alternative tool for these patients. The application of brain-computer interfaces in disorders of consciousness can be divided into four fields: assessment, communication, prediction, and rehabilitation. The operational theoretical model of consciousness that brain-computer interfaces explore was reviewed in this article, with a focus on studies with acute and subacute patients. We then proposed a clinically friendly guideline, which could contribute to the implementation of brain-computer interfaces in neurorehabilitation settings. Finally, we discussed limitations and future directions, including major challenges and possible solutions.
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Affiliation(s)
- Ren Xu
- Guger Technologies OG, Schiedlberg, Austria
| | - Rossella Spataro
- g.tec medical engineering GmbH, Schiedlberg, Austria
- IRCCS Centro Neurolesi Bonino Pulejo, Palermo, Italy; and
| | - Brendan Z Allison
- Cognitive Science Department, University of California San Diego, La Jolla, California, U.S.A
| | - Christoph Guger
- Guger Technologies OG, Schiedlberg, Austria
- g.tec medical engineering GmbH, Schiedlberg, Austria
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Eliciting and Recording Event Related Potentials (ERPs) in Behaviourally Unresponsive Populations: A Retrospective Commentary on Critical Factors. Brain Sci 2021; 11:brainsci11070835. [PMID: 34202435 PMCID: PMC8301772 DOI: 10.3390/brainsci11070835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/19/2021] [Accepted: 06/19/2021] [Indexed: 12/05/2022] Open
Abstract
A consistent limitation when designing event-related potential paradigms and interpreting results is a lack of consideration of the multivariate factors that affect their elicitation and detection in behaviorally unresponsive individuals. This paper provides a retrospective commentary on three factors that influence the presence and morphology of long-latency event-related potentials—the P3b and N400. We analyze event-related potentials derived from electroencephalographic (EEG) data collected from small groups of healthy youth and healthy elderly to illustrate the effect of paradigm strength and subject age; we analyze ERPs collected from an individual with severe traumatic brain injury to illustrate the effect of stimulus presentation speed. Based on these critical factors, we support that: (1) the strongest paradigms should be used to elicit event-related potentials in unresponsive populations; (2) interpretation of event-related potential results should account for participant age; and (3) speed of stimulus presentation should be slower in unresponsive individuals. The application of these practices when eliciting and recording event-related potentials in unresponsive individuals will help to minimize result interpretation ambiguity, increase confidence in conclusions, and advance the understanding of the relationship between long-latency event-related potentials and states of consciousness.
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The Effect of Transcutaneous Auricular Vagal Nerve Stimulation (taVNS) on P3 Event-Related Potentials during a Bayesian Oddball Task. Brain Sci 2020; 10:brainsci10060404. [PMID: 32630571 PMCID: PMC7349824 DOI: 10.3390/brainsci10060404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
Transcutaneous auricular Vagal Nerve Stimulation (taVNS) is a non-invasive brain stimulation technique associated with possible modulation of norepinephrinergic (NE) activity. NE is suspected to contribute to generation of the P3 event-related potential. Recent evidence has produced equivocal evidence whether taVNS influences the P3 in healthy individuals during oddball tasks. We examined the effect of taVNS on P3 amplitudes using a novel visual Bayesian oddball task, which presented 200 sequences of three stimuli. The three consecutive stimuli in each sequence are labelled Draw 1, Draw 2 and Draw 3. In total, 47 Subjects completed this visual Bayesian oddball task under randomised sham and active taVNS stimulation in parallel with an electroencephalographic (EEG) recording. We conducted exploratory analyses of the effect of taVNS on P3 amplitudes separately for Draws. We found typical oddball effects on P3 amplitudes at Draws 1 and 2, but not Draw 3. At Draw 2, the oddball effect was enhanced during active compared to sham taVNS stimulation. These data provide evidence that taVNS influences parietal P3 amplitudes under specific circumstances. Only P3 amplitudes at Draw 2 were affected, which may relate to closure of Bayesian inference after Draw 2. Our findings seemingly support previously reported links between taVNS and the NE system.
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Czyżewski A, Kurowski A, Odya P, Szczuko P. Multifactor consciousness level assessment of participants with acquired brain injuries employing human-computer interfaces. Biomed Eng Online 2020; 19:2. [PMID: 31924202 PMCID: PMC6954635 DOI: 10.1186/s12938-019-0746-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 12/31/2019] [Indexed: 11/27/2022] Open
Abstract
Background A lack of communication with people suffering from acquired brain injuries may lead to drawing erroneous conclusions regarding the diagnosis or therapy of patients. Information technology and neuroscience make it possible to enhance the diagnostic and rehabilitation process of patients with traumatic brain injury or post-hypoxia. In this paper, we present a new method for evaluation possibility of communication and the assessment of such patients’ state employing future generation computers extended with advanced human–machine interfaces. Methods First, the hearing abilities of 33 participants in the state of coma were evaluated using auditory brainstem response measurements (ABR). Next, a series of interactive computer-based exercise sessions were performed with the therapist’s assistance. Participants’ actions were monitored with an eye-gaze tracking (EGT) device and with an electroencephalogram EEG monitoring headset. The data gathered were processed with the use of data clustering techniques. Results Analysis showed that the data gathered and the computer-based methods developed for their processing are suitable for evaluating the participants’ responses to stimuli. Parameters obtained from EEG signals and eye-tracker data were correlated with Glasgow Coma Scale (GCS) scores and enabled separation between GCS-related classes. The results show that in the EEG and eye-tracker signals, there are specific consciousness-related states discoverable. We observe them as outliers in diagrams on the decision space generated by the autoencoder. For this reason, the numerical variable that separates particular groups of people with the same GCS is the variance of the distance of points from the cluster center that the autoencoder generates. The higher the GCS score, the greater the variance in most cases. The results proved to be statistically significant in this context. Conclusions The results indicate that the method proposed may help to assess the consciousness state of participants in an objective manner.
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Affiliation(s)
- Andrzej Czyżewski
- Multimedia Systems Department, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, Gdańsk, Poland
| | - Adam Kurowski
- Multimedia Systems Department, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, Gdańsk, Poland.
| | - Piotr Odya
- Multimedia Systems Department, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, Gdańsk, Poland
| | - Piotr Szczuko
- Multimedia Systems Department, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, Gdańsk, Poland
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Annen J, Laureys S, Gosseries O. Brain-computer interfaces for consciousness assessment and communication in severely brain-injured patients. BRAIN-COMPUTER INTERFACES 2020; 168:137-152. [DOI: 10.1016/b978-0-444-63934-9.00011-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lanzilotti C, Dumas R, Grassi M, Schön D. Prolonged exposure to highly rhythmic music affects brain dynamics and perception. Neuropsychologia 2019; 129:191-199. [PMID: 31015025 DOI: 10.1016/j.neuropsychologia.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/17/2022]
Abstract
Rhythmic stimulation is a powerful tool to improve temporal prediction and parsing of the auditory signal. However, for long duration of stimulation, the rhythmic and repetitive aspects of music have often been associated to a trance state. In this study we conceived an auditory monitoring task that allows tracking changes of psychophysical auditory thresholds. Participants performed the task while listening to rhythmically regular and an irregular (scrambled but spectrally identical) music that were presented with an intermittent (short) and continuous (long) type of stimulation. Results show that psychophysical auditory thresholds increase following a Continuous versus Intermittent stimulation and this is accompanied by a reduction of the amplitude of two event-related potentials to target stimuli. These effects are larger with regular music, thus do not simply derive from the duration of stimulation. Interestingly, they seem to be related to a frequency selective neural coupling as well as an increase of network connectivity in the alpha band between frontal and central regions. Our study shows that the idea that rhythmic presentation of sensory stimuli facilitates perception might be limited to short streams, while long, highly regular, repetitive and strongly engaging streams may have an opposite perceptual impact.
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Affiliation(s)
- Cosima Lanzilotti
- Aix Marseille Univ, Inserm, INS, Inst Neurosci Syst, Marseille, France
| | | | - Massimo Grassi
- Università di Padova, Dipartimento di Psicologia Generale, Padova, Italy
| | - Daniele Schön
- Aix Marseille Univ, Inserm, INS, Inst Neurosci Syst, Marseille, France.
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Measuring Depth in Still Water: Electrophysiologic Indicators of Residual Consciousness in the Unresponsive Patient. Epilepsy Curr 2018; 18:147-150. [PMID: 29950932 DOI: 10.5698/1535-7597.18.3.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Searching for evidence of consciousness in outwardly unresponsive patients presents significant clinical challenges as the spectrum of disorders of consciousness has become more clearly defined, with clinical examination, functional MRI, and electrophysiologic tests having complementary roles in the investigation of minimally conscious patients, those in a locked-in state, coma, or in a vegetative state. Serial bedside electrophysiologic testing can probe for higher order cortical responses temporally and spatially propagated through cortical networks, while long-latency event-related potentials may help differentiate patients with coma or vegetative state from a state of residual consciousness. Transcranial magnetic stimulation co-registered to high-density EEG may reveal widespread pulse-stimulated cortical activation of various brain regions. These emerging electrophysiologic techniques show promise as powerful diagnostic, prognostic, and therapeutic tools.
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Leroy A, Petit G, Zarka D, Cebolla A, Palmero-Soler E, Strul J, Dan B, Verbanck P, Cheron G. EEG Dynamics and Neural Generators in Implicit Navigational Image Processing in Adults with ADHD. Neuroscience 2018; 373:92-105. [DOI: 10.1016/j.neuroscience.2018.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 01/12/2023]
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