Bottlenecks to clinical translation of direct brain-computer interfaces

Post-stroke Rehabilitation of Severe Upper Limb Paresis in Germany - Toward Long-Term Treatment With Brain-Computer Interfaces

Severe upper limb paresis can represent an immense burden for stroke survivors. Given the rising prevalence of stroke, restoration of severe upper limb motor impairment remains a major challenge for rehabilitation medicine because effective treatment strategies are lacking. Commonly applied interventions in Germany, such as mirror therapy and impairment-oriented training, are limited in efficacy, demanding for new strategies to be found. By translating brain signals into control commands of external devices, brain-computer interfaces (BCIs) and brain-machine interfaces (BMIs) represent promising, neurotechnology-based alternatives for stroke patients with highly restricted arm and hand function. In this mini-review, we outline perspectives on how BCI-based therapy can be integrated into the different stages of neurorehabilitation in Germany to meet a long-term treatment approach: We found that it is most appropriate to start therapy with BCI-based neurofeedback immediately after early rehabilitation. BCI-driven functional electrical stimulation (FES) and BMI robotic therapy are well suited for subsequent post hospital curative treatment in the subacute stage. BCI-based hand exoskeleton training can be continued within outpatient occupational therapy to further improve hand function and address motivational issues in chronic stroke patients. Once the rehabilitation potential is exhausted, BCI technology can be used to drive assistive devices to compensate for impaired function. However, there are several challenges yet to overcome before such long-term treatment strategies can be implemented within broad clinical application: 1. developing reliable BCI systems with better usability; 2. conducting more research to improve BCI training paradigms and 3. establishing reliable methods to identify suitable patients.

Brain-Computer Interfaces in Neurorecovery and Neurorehabilitation

Recent advances in brain-computer interface technology to restore and rehabilitate neurologic function aim to enable persons with disabling neurologic conditions to communicate, interact with the environment, and achieve other key activities of daily living and personal goals. Here we evaluate the principles, benefits, challenges, and future directions of brain-computer interfaces in the context of neurorehabilitation. We then explore the clinical translation of these technologies and propose an approach to facilitate implementation of brain-computer interfaces for persons with neurologic disease.

Robust and accurate decoding of hand kinematics from entire spiking activity using deep learning

OBJECTIVE

Brain-machine interfaces (BMIs) seek to restore lost motor functions in individuals with neurological disorders by enabling them to control external devices directly with their thoughts. This work aims to improve robustness and decoding accuracy that currently become major challenges in the clinical translation of intracortical BMIs.

APPROACH

We propose entire spiking activity (ESA) -an envelope of spiking activity that can be extracted by a simple, threshold-less, and automated technique- as the input signal. We couple ESA with deep learning-based decoding algorithm that uses quasi-recurrent neural network (QRNN) architecture. We evaluate comprehensively the performance of ESA-driven QRNN decoder for decoding hand kinematics from neural signals chronically recorded from the primary motor cortex area of three non-human primates performing different tasks.

MAIN RESULTS

Our proposed method yields consistently higher decoding performance than any other combinations of the input signal and decoding algorithm previously reported across long term recording sessions. It can sustain high decoding performance even when removing spikes from the raw signals, when using the different number of channels, and when using a smaller amount of training data.

SIGNIFICANCE

Overall results demonstrate exceptionally high decoding accuracy and chronic robustness, which is highly desirable given it is an unresolved challenge in BMIs.

Clinician awareness of brain computer interfaces: a Canadian national survey

Background

Individuals with severe neurological disabilities but preserved cognition, including children, are often precluded from connecting with their environments. Brain computer interfaces (BCI) are a potential solution where advancing technologies create new clinical opportunities. We evaluated clinician awareness as a modifiable barrier to progress and identified eligible populations.

Methods

We executed a national, population-based, cross-sectional survey of physician specialists caring for persons with severe disability. An evidence- and experience-based survey had three themes: clinician BCI knowledge, eligible populations, and potential impact. A BCI knowledge index was created and scored. Canadian adult and pediatric neurologists, physiatrists and a subset of developmental pediatricians were contacted. Secure, web-based software administered the survey via email with online data collection.

Results

Of 922 valid emails (664 neurologists, 253 physiatrists), 137 (15%) responded. One third estimated that ≥10% of their patients had severe neurological disability with cognitive capacity. BCI knowledge scores were low with > 40% identifying as less than “vaguely aware” and only 15% as “somewhat familiar” or better. Knowledge did not differ across specialties. Only 6 physicians (4%) had patients using BCI. Communication and wheelchair control rated highest for potentially improving quality of life. Most (81%) felt BCI had high potential to improve quality of life. Estimates suggested that > 13,000 Canadians (36 M population) might benefit from BCI technologies.

Conclusions

Despite high potential and thousands of patients who might benefit, BCI awareness among clinicians caring for disabled persons is poor. Further, functional priorities for BCI applications may differ between medical professionals and potential BCI users, perhaps reflecting that clinicians possess a less accurate understanding of the desires and needs of potential end-users. Improving knowledge and engaging both clinicians and patients could facilitate BCI program development to improve patient outcomes.

Towards Real-Time, Continuous Decoding of Gripping Force From Deep Brain Local Field Potentials

Lack of force information and longevity issues are impediments to the successful translation of brain-computer interface systems for prosthetic control from experimental settings to widespread clinical application. The ability to decode force using deep brain stimulation electrodes in the subthalamic nucleus (STN) of the basal ganglia provides an opportunity to address these limitations. This paper explores the use of various classes of algorithms (Wiener filter, Wiener-Cascade model, Kalman filter, and dynamic neural networks) and recommends the use of a Wiener-Cascade model for decoding force from STN. This recommendation is influenced by a combination of accuracy and practical considerations to enable real-time, continuous operation. This paper demonstrates an ability to decode a continuous signal (force) from the STN in real time, allowing the possibility of decoding more than two states from the brain at low latency.

Clinically Significant Gains in Skillful Grasp Coordination by an Individual With Tetraplegia Using an Implanted Brain-Computer Interface With Forearm Transcutaneous Muscle Stimulation

OBJECTIVE

To demonstrate naturalistic motor control speed, coordinated grasp, and carryover from trained to novel objects by an individual with tetraplegia using a brain-computer interface (BCI)-controlled neuroprosthetic.

DESIGN

Phase I trial for an intracortical BCI integrated with forearm functional electrical stimulation (FES). Data reported span postimplant days 137 to 1478.

SETTING

Tertiary care outpatient rehabilitation center.

PARTICIPANT

A 27-year-old man with C5 class A (on the American Spinal Injury Association Impairment Scale) traumatic spinal cord injury INTERVENTIONS: After array implantation in his left (dominant) motor cortex, the participant trained with BCI-FES to control dynamic, coordinated forearm, wrist, and hand movements.

MAIN OUTCOME MEASURES

Performance on standardized tests of arm motor ability (Graded Redefined Assessment of Strength, Sensibility, and Prehension [GRASSP], Action Research Arm Test [ARAT], Grasp and Release Test [GRT], Box and Block Test), grip myometry, and functional activity measures (Capabilities of Upper Extremity Test [CUE-T], Quadriplegia Index of Function-Short Form [QIF-SF], Spinal Cord Independence Measure-Self-Report [SCIM-SR]) with and without the BCI-FES.

RESULTS

With BCI-FES, scores improved from baseline on the following: Grip force (2.9 kg); ARAT cup, cylinders, ball, bar, and blocks; GRT can, fork, peg, weight, and tape; GRASSP strength and prehension (unscrewing lids, pouring from a bottle, transferring pegs); and CUE-T wrist and hand skills. QIF-SF and SCIM-SR eating, grooming, and toileting activities were expected to improve with home use of BCI-FES. Pincer grips and mobility were unaffected. BCI-FES grip skills enabled the participant to play an adapted "Battleship" game and manipulate household objects.

CONCLUSIONS

Using BCI-FES, the participant performed skillful and coordinated grasps and made clinically significant gains in tests of upper limb function. Practice generalized from training objects to household items and leisure activities. Motor ability improved for palmar, lateral, and tip-to-tip grips. The expects eventual home use to confer greater independence for activities of daily living, consistent with observed neurologic level gains from C5-6 to C7-T1. This marks a critical translational step toward clinical viability for BCI neuroprosthetics.

A new parameter tuning approach for enhanced motor imagery EEG signal classification

A brain-computer interface (BCI) system allows direct communication between the brain and the external world. Common spatial pattern (CSP) has been used effectively for feature extraction of data used in BCI systems. However, many studies show that the performance of a BCI system using CSP largely depends on the filter parameters. The filter parameters that yield most discriminating information vary from subject to subject and manually tuning of the filter parameters is a difficult and time-consuming exercise. In this paper, we propose a new automated filter tuning approach for motor imagery electroencephalography (EEG) signal classification, which automatically and flexibly finds the filter parameters for optimal performance. We have evaluated the performance of our proposed method on two public benchmark datasets. Compared to the existing conventional CSP approach, our method reduces the average classification error rate by 2.89% and 3.61% for BCI Competition III dataset IVa and BCI Competition IV dataset I, respectively. Moreover, our proposed approach also achieved lowest average classification error rate compared to state-of-the-art methods studied in this paper. Thus, our proposed method can be potentially used for developing improved BCI systems, which can assist people with disabilities to recover their environmental control. It can also be used for enhanced disease recognition such as epileptic seizure detection using EEG signals. Graphical abstract ᅟ.

An improved discriminative filter bank selection approach for motor imagery EEG signal classification using mutual information

BACKGROUND

Common spatial pattern (CSP) has been an effective technique for feature extraction in electroencephalography (EEG) based brain computer interfaces (BCIs). However, motor imagery EEG signal feature extraction using CSP generally depends on the selection of the frequency bands to a great extent.

METHODS

In this study, we propose a mutual information based frequency band selection approach. The idea of the proposed method is to utilize the information from all the available channels for effectively selecting the most discriminative filter banks. CSP features are extracted from multiple overlapping sub-bands. An additional sub-band has been introduced that cover the wide frequency band (7-30 Hz) and two different types of features are extracted using CSP and common spatio-spectral pattern techniques, respectively. Mutual information is then computed from the extracted features of each of these bands and the top filter banks are selected for further processing. Linear discriminant analysis is applied to the features extracted from each of the filter banks. The scores are fused together, and classification is done using support vector machine.

RESULTS

The proposed method is evaluated using BCI Competition III dataset IVa, BCI Competition IV dataset I and BCI Competition IV dataset IIb, and it outperformed all other competing methods achieving the lowest misclassification rate and the highest kappa coefficient on all three datasets.

CONCLUSIONS

Introducing a wide sub-band and using mutual information for selecting the most discriminative sub-bands, the proposed method shows improvement in motor imagery EEG signal classification.

CSP-TSM: Optimizing the performance of Riemannian tangent space mapping using common spatial pattern for MI-BCI

BACKGROUND

Classification of electroencephalography (EEG) signals for motor imagery based brain computer interface (MI-BCI) is an exigent task and common spatial pattern (CSP) has been extensively explored for this purpose. In this work, we focused on developing a new framework for classification of EEG signals for MI-BCI.

METHOD

We propose a single band CSP framework for MI-BCI that utilizes the concept of tangent space mapping (TSM) in the manifold of covariance matrices. The proposed method is named CSP-TSM. Spatial filtering is performed on the bandpass filtered MI EEG signal. Riemannian tangent space is utilized for extracting features from the spatial filtered signal. The TSM features are then fused with the CSP variance based features and feature selection is performed using Lasso. Linear discriminant analysis (LDA) is then applied to the selected features and finally classification is done using support vector machine (SVM) classifier.

RESULTS

The proposed framework gives improved performance for MI EEG signal classification in comparison with several competing methods. Experiments conducted shows that the proposed framework reduces the overall classification error rate for MI-BCI by 3.16%, 5.10% and 1.70% (for BCI Competition III dataset IVa, BCI Competition IV Dataset I and BCI Competition IV Dataset IIb, respectively) compared to the conventional CSP method under the same experimental settings.

CONCLUSION

The proposed CSP-TSM method produces promising results when compared with several competing methods in this paper. In addition, the computational complexity is less compared to that of TSM method. Our proposed CSP-TSM framework can be potentially used for developing improved MI-BCI systems.