Advancing Brain-Computer Interface Applications for Severely Disabled Children Through a Multidisciplinary National Network: Summary of the Inaugural Pediatric BCI Canada Meeting

Considering preferences, speed and the animation of multiple symbols in developing P300 brain-computer interface for children

PURPOSE

Prior research has begun establishing the efficacy of animation in brain-computer interfaces access to augmentative and alternative communication (BCI-AAC). However, the use of animation in P300-BCI-AAC for children is in the early stages and largely limited to single item highlighting of extended durations. In pursuit of practical application, the present study aims to evaluate children's event-related potential (ERP) characteristics and user experience during a task involving an animated P300-BCI-AAC system.

MATERIALS AND METHODS

The system utilizes multi-item zoom animations to access a 28-pictorial symbols. Participants completed a fast (100 ms) and slow (200 ms) zoom animation highlighting conditions wherein four pictorial symbols were highlighted concurrently.

RESULTS

The proposed display appears feasible, eliciting all targeted ERPs. However, ERP amplitudes may be reduced in comparison to single-item animation highlighting, possibly due to distraction. Ratings of mental effort were significantly higher for the 100 ms condition, though differences in the frontal P200/P300 ERP did not achieve significance. Most participants identified a preference for the 100 ms condition, though age may impact preference.

CONCLUSIONS

Overall, findings support the preliminary feasibility of a proposed 28-item interface that utilises group zoom animation highlighting of pictorial symbols. Further research is needed evaluating ERP characteristics and outcomes from online (real-time) use of animation-based P300-BCI-AAC for children with severe speech and physical impairments across multiple training sessions.

Fatigue in children using motor imagery and P300 brain-computer interfaces

BACKGROUND

Brain-computer interface (BCI) technology offers children with quadriplegic cerebral palsy unique opportunities for communication, environmental exploration, learning, and game play. Research in adults demonstrates a negative impact of fatigue on BCI enjoyment, while effects on BCI performance are variable. To date, there have been no pediatric studies of BCI fatigue. The purpose of this study was to assess the effects of two different BCI paradigms, motor imagery and visual P300, on the development of self-reported fatigue and an electroencephalography (EEG) biomarker of fatigue in typically developing children.

METHODS

Thirty-seven typically-developing school-aged children were recruited to a prospective, crossover study. Participants attended three sessions: (A) motor imagery-BCI, (B) visual P300-BCI, and (C) video viewing (control). The motor imagery task involved an imagined left- or right-hand squeeze. The P300 task involved attending to one square on a 3 × 3 grid during a random single flash sequence. Each paradigm had respective calibration periods and a similar visual counting game. Primary outcomes were self-reported fatigue and the power of the EEG alpha band both collected during resting-state periods pre- and post-task. Self-reported fatigue was measured using a 10-point visual analog scale. EEG alpha band power was calculated as the integrated power spectral density from 8 to 12 Hz of the EEG spectrum.

RESULTS

Thirty-two children completed the protocol (age range 7-16, 63% female). Self-reported fatigue and EEG alpha band power increased across all sessions (F(1,155) = 33.9, p < 0.001; F = 5.0(1,149), p = 0.027 respectively). No differences in fatigue development were observed between session types. There was no correlation between self-reported fatigue and EEG alpha band power change. BCI performance varied between participants and paradigms as expected but was not associated with self-reported fatigue or EEG alpha band power.

CONCLUSION

Short periods (30-mintues) of BCI use can increase self-reported fatigue and EEG alpha band power to a similar degree in children performing motor imagery and P300 BCI paradigms. Performance was not associated with our measures of fatigue; the impact of fatigue on useability and enjoyment is unclear. Our results reflect the variability of fatigue and the BCI experience more broadly in children and warrant further investigation.

The lived experiences of play and the perspectives of disabled children and their parents surrounding brain-computer interfaces

Brain-computer interfaces (BCI) offer promise to the play of children with significant physical impairments, as BCI technology can enable disabled children to control computer devices, toys, and robots using only their brain signals. However, there is little research on the unique needs of disabled children when it comes to BCI-enabled play. Thus, this paper explored the lived experiences of play for children with significant physical impairments and examined how BCI could potentially be implemented into disabled children's play experiences by applying a social model of childhood disability. Descriptive qualitative methodology was employed by conducting four semi-structured interviews with two children with significant physical impairments and their parents. We found that disabled children's play can be interpreted as passive or active depending on one's definition and perceptions surrounding play. Moreover, disabled children continue to face physical, economic, and technological barriers in their play, as well as play restrictions from physical impairments. We urge that future research should strive to directly hear from disabled children themselves, as their perspectives may differ from their parents' views. Also, future BCI development should strive to incorporate video games, recreational and entertainment applications/platforms, toys and switch-adapted toys, and power wheelchairs to better support the play of children with significant physical impairments.Implications for RehabilitationAssistive technology research should strive to examine the social, infrastructural, and environmental barriers that continue to disable and restrict participation for disabled children and their families through applying a social model of childhood disability and other holistic frameworks that look beyond individual factorsFuture research that examines the needs and lives of disabled children should strive to directly seek the opinions and perspectives of disabled children themselvesBrain-computer interface development should strive to incorporate video games, recreational and entertainment applications/platforms, toys and switch-adapted toys, and power wheelchairs to better support the play of children with significant physical impairments.

Pediatric disorders of consciousness: Considerations, controversies, and caveats

Pediatric disorders of consciousness (PedDOC) encompass conditions that may occur following very severe traumatic or other forms of acquired brain injury sustained during childhood. As in adults, PedDOC is described as a disturbance of awareness and/or responsiveness. PedDOC is a complex condition that requires specialized care, infrastructures, and technologies. PedDOC poses many challenges to healthcare providers and caregivers during recovery and throughout development. In this commentary, we intend to highlight some considerations, controversies, and caveats on the diagnosis, prognosis and treatment of PedDOC.

Promoting Simple and Engaging Brain-Computer Interface Designs for Children by Evaluating Contrasting Motion Techniques

PURPOSE

There is an increasing focus on using motion in augmentative and alternative communication (AAC) systems. In considering brain-computer interface access to AAC (BCI-AAC), motion may provide a simpler or more intuitive avenue for BCI-AAC control. Different motion techniques may be utilized in supporting competency with AAC devices including simple (e.g., zoom) and complex (behaviorally relevant animation) methods. However, how different pictorial symbol animation techniques impact BCI-AAC is unclear.

METHOD

Sixteen healthy children completed two experimental conditions. These conditions included highlighting of pictorial symbols via both functional (complex) and zoom (simple) animation to evaluate the effects of motion techniques on P300-based BCI-AAC signals and offline (predicted) BCI-AAC performance.

RESULTS

Functional (complex) animation significantly increased attentional-related P200/P300 event-related potential (ERP) amplitudes in the parieto-occipital area. Zoom (simple) animation significantly decreased N400 latency. N400 ERP amplitude was significantly greater, and occurred significantly earlier, on the right versus left side for the functional animation condition within the parieto-occipital bin. N200 ERP latency was significantly reduced over the left hemisphere for the zoom condition in the central bin. As hypothesized, elicitation of all targeted ERP components supported offline (predicted) BCI-AAC performance being similar between conditions.

CONCLUSION

Study findings provide continued support for the use of animation in BCI-AAC systems for children and highlight differences in neural and attentional processing between complex and simple animation techniques.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24085623.

Brain-computer interface: trend, challenges, and threats

Brain-computer interface (BCI), an emerging technology that facilitates communication between brain and computer, has attracted a great deal of research in recent years. Researchers provide experimental results demonstrating that BCI can restore the capabilities of physically challenged people, hence improving the quality of their lives. BCI has revolutionized and positively impacted several industries, including entertainment and gaming, automation and control, education, neuromarketing, and neuroergonomics. Notwithstanding its broad range of applications, the global trend of BCI remains lightly discussed in the literature. Understanding the trend may inform researchers and practitioners on the direction of the field, and on where they should invest their efforts more. Noting this significance, we have analyzed 25,336 metadata of BCI publications from Scopus to determine advancement of the field. The analysis shows an exponential growth of BCI publications in China from 2019 onwards, exceeding those from the United States that started to decline during the same period. Implications and reasons for this trend are discussed. Furthermore, we have extensively discussed challenges and threats limiting exploitation of BCI capabilities. A typical BCI architecture is hypothesized to address two prominent BCI threats, privacy and security, as an attempt to make the technology commercially viable to the society.

Use of Invasive Brain-Computer Interfaces in Pediatric Neurosurgery: Technical and Ethical Considerations

Invasive brain-computer interfaces hold promise to alleviate disabilities in individuals with neurologic injury, with fully implantable brain-computer interface systems expected to reach the clinic in the upcoming decade. Children with severe neurologic disabilities, like quadriplegic cerebral palsy or cervical spine trauma, could benefit from this technology. However, they have been excluded from clinical trials of intracortical brain-computer interface to date. In this manuscript, we discuss the ethical considerations related to the use of invasive brain-computer interface in children with severe neurologic disabilities. We first review the technical hardware and software considerations for the application of intracortical brain-computer interface in children. We then discuss ethical issues related to motor brain-computer interface use in pediatric neurosurgery. Finally, based on the input of a multidisciplinary panel of experts in fields related to brain-computer interface (functional and restorative neurosurgery, pediatric neurosurgery, mathematics and artificial intelligence research, neuroengineering, pediatric ethics, and pragmatic ethics), we then formulate initial recommendations regarding the clinical use of invasive brain-computer interfaces in children.

EEG hybrid brain-computer interfaces: A scoping review applying an existing hybrid-BCI taxonomy and considerations for pediatric applications

Most hybrid brain-computer interfaces (hBCI) aim at improving the performance of single-input BCI. Many combinations are possible to configure an hBCI, such as using multiple brain input signals, different stimuli or more than one input system. Multiple studies have been done since 2010 where such interfaces have been tested and analyzed. Results and conclusions are promising but little has been discussed as to what is the best approach for the pediatric population, should they use hBCI as an assistive technology. Children might face greater challenges when using BCI and might benefit from less complex interfaces. Hence, in this scoping review we included 42 papers that developed hBCI systems for the purpose of control of assistive devices or communication software, and we analyzed them through the lenses of potential use in clinical settings and for children. We extracted taxonomic categories proposed in previous studies to describe the types of interfaces that have been developed. We also proposed interface characteristics that could be observed in different hBCI, such as type of target, number of targets and number of steps before selection. Then, we discussed how each of the extracted characteristics could influence the overall complexity of the system and what might be the best options for applications for children. Effectiveness and efficiency were also collected and included in the analysis. We concluded that the least complex hBCI interfaces might involve having a brain inputs and an external input, with a sequential role of operation, and visual stimuli. Those interfaces might also use a minimal number of targets of the strobic type, with one or two steps before the final selection. We hope this review can be used as a guideline for future hBCI developments and as an incentive to the design of interfaces that can also serve children who have motor impairments.

2020 International brain-computer interface competition: A review

The brain-computer interface (BCI) has been investigated as a form of communication tool between the brain and external devices. BCIs have been extended beyond communication and control over the years. The 2020 international BCI competition aimed to provide high-quality neuroscientific data for open access that could be used to evaluate the current degree of technical advances in BCI. Although there are a variety of remaining challenges for future BCI advances, we discuss some of more recent application directions: (i) few-shot EEG learning, (ii) micro-sleep detection (iii) imagined speech decoding, (iv) cross-session classification, and (v) EEG(+ear-EEG) detection in an ambulatory environment. Not only did scientists from the BCI field compete, but scholars with a broad variety of backgrounds and nationalities participated in the competition to address these challenges. Each dataset was prepared and separated into three data that were released to the competitors in the form of training and validation sets followed by a test set. Remarkable BCI advances were identified through the 2020 competition and indicated some trends of interest to BCI researchers.

Applying Implementation Science to Support Active Collaboration in Noninvasive Brain-Computer Interface Development and Translation for Augmentative and Alternative Communication

PURPOSE

The purpose of this article is to consider how, alongside engineering advancements, noninvasive brain-computer interface (BCI) for augmentative and alternative communication (AAC; BCI-AAC) developments can leverage implementation science to increase the clinical impact of this technology. We offer the Consolidated Framework for Implementation Research (CFIR) as a structure to help guide future BCI-AAC research. Specifically, we discuss CFIR primary domains that include intervention characteristics, the outer and inner settings, the individuals involved in the intervention, and the process of implementation, alongside pertinent subdomains including adaptability, cost, patient needs and recourses, implementation climate, other personal attributes, and the process of engaging. The authors support their view with current citations from both the AAC and BCI-AAC fields.

CONCLUSIONS

The article aimed to provide thoughtful considerations for how future research may leverage the CFIR to support meaningful BCI-AAC translation for those with severe physical impairments. We believe that, although significant barriers to BCI-AAC development still exist, incorporating implementation research may be timely for the field of BCI-AAC and help account for diversity in end users, navigate implementation obstacles, and support a smooth and efficient translation of BCI-AAC technology. Moreover, the sooner clinicians, individuals who use AAC, their support networks, and engineers collectively improve BCI-AAC outcomes and the efficiency of translation, the sooner BCI-AAC may become an everyday tool in the AAC arsenal.

Brain-Computer Interfaces for Children With Complex Communication Needs and Limited Mobility: A Systematic Review

Brain-computer interfaces (BCIs) represent a new frontier in the effort to maximize the ability of individuals with profound motor impairments to interact and communicate. While much literature points to BCIs' promise as an alternative access pathway, there have historically been few applications involving children and young adults with severe physical disabilities. As research is emerging in this sphere, this article aims to evaluate the current state of translating BCIs to the pediatric population. A systematic review was conducted using the Scopus, PubMed, and Ovid Medline databases. Studies of children and adolescents that reported BCI performance published in English in peer-reviewed journals between 2008 and May 2020 were included. Twelve publications were identified, providing strong evidence for continued research in pediatric BCIs. Research evidence was generally at multiple case study or exploratory study level, with modest sample sizes. Seven studies focused on BCIs for communication and five on mobility. Articles were categorized and grouped based on type of measurement (i.e., non-invasive and invasive), and the type of brain signal (i.e., sensory evoked potentials or movement-related potentials). Strengths and limitations of studies were identified and used to provide requirements for clinical translation of pediatric BCIs. This systematic review presents the state-of-the-art of pediatric BCIs focused on developing advanced technology to support children and youth with communication disabilities or limited manual ability. Despite a few research studies addressing the application of BCIs for communication and mobility in children, results are encouraging and future works should focus on customizable pediatric access technologies based on brain activity.