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van Stuijvenberg OC, Samlal DPS, Vansteensel MJ, Broekman MLD, Jongsma KR. The ethical significance of user-control in AI-driven speech-BCIs: a narrative review. Front Hum Neurosci 2024; 18:1420334. [PMID: 39006157 PMCID: PMC11240287 DOI: 10.3389/fnhum.2024.1420334] [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: 04/19/2024] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
AI-driven brain-computed interfaces aimed at restoring speech for individuals living with locked-in-syndrome are paired with ethical implications for user's autonomy, privacy and responsibility. Embedding options for sufficient levels of user-control in speech-BCI design has been proposed to mitigate these ethical challenges. However, how user-control in speech-BCIs is conceptualized and how it relates to these ethical challenges is underdetermined. In this narrative literature review, we aim to clarify and explicate the notion of user-control in speech-BCIs, to better understand in what way user-control could operationalize user's autonomy, privacy and responsibility and explore how such suggestions for increasing user-control can be translated to recommendations for the design or use of speech-BCIs. First, we identified types of user control, including executory control that can protect voluntariness of speech, and guidance control that can contribute to semantic accuracy. Second, we identified potential causes for a loss of user-control, including contributions of predictive language models, a lack of ability for neural control, or signal interference and external control. Such a loss of user control may have implications for semantic accuracy and mental privacy. Third we explored ways to design for user-control. While embedding initiation signals for users may increase executory control, they may conflict with other aims such as speed and continuity of speech. Design mechanisms for guidance control remain largely conceptual, similar trade-offs in design may be expected. We argue that preceding these trade-offs, the overarching aim of speech-BCIs needs to be defined, requiring input from current and potential users. Additionally, conceptual clarification of user-control and other (ethical) concepts in this debate has practical relevance for BCI researchers. For instance, different concepts of inner speech may have distinct ethical implications. Increased clarity of such concepts can improve anticipation of ethical implications of speech-BCIs and may help to steer design decisions.
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Affiliation(s)
- O C van Stuijvenberg
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - D P S Samlal
- Department of Philosophy, Utrecht University, Utrecht, Netherlands
- Department of Anatomy, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - M J Vansteensel
- University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - M L D Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - K R Jongsma
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Padfield N, Agius Anastasi A, Camilleri T, Fabri S, Bugeja M, Camilleri K. BCI-controlled wheelchairs: end-users' perceptions, needs, and expectations, an interview-based study. Disabil Rehabil Assist Technol 2024; 19:1539-1551. [PMID: 37166297 DOI: 10.1080/17483107.2023.2211602] [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: 01/03/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Brain-computer interface (BCI)-controlled wheelchairs have the potential to improve the independence of people with mobility impairments. The low uptake of BCI devices has been linked to a lack of knowledge among researchers of the needs of end-users that should influence BCI development. MATERIALS AND METHODS This study used semi-structured interviews to learn about the perceptions, needs, and expectations of spinal cord injury (SCI) patients with regards to a BCI-controlled wheelchair. Topics discussed in the interview include: paradigms, shared control, safety, robustness, channel selection, hardware, and experimental design. The interviews were recorded and then transcribed. Analysis was carried out using coding based on grounded theory principles. RESULTS The majority of participants had a positive view of BCI-controlled wheelchair technology and were willing to use the technology. Core issues were raised regarding safety, cost and aesthetics. Interview discussions were linked to state-of-the-art BCI technology. The results challenge the current reliance of researchers on the motor-imagery paradigm by suggesting end-users expect highly intuitive paradigms. There also needs to be a stronger focus on obstacle avoidance and safety features in BCI wheelchairs. Finally, the development of control approaches that can be personalized for individual users may be instrumental for widespread adoption of these devices. CONCLUSIONS This study, based on interviews with SCI patients, indicates that BCI-controlled wheelchairs are a promising assistive technology that would be well received by end-users. Recommendations for a more person-centered design of BCI controlled wheelchairs are made and clear avenues for future research are identified.
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Affiliation(s)
- Natasha Padfield
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
| | | | - Tracey Camilleri
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
| | - Simon Fabri
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
| | - Marvin Bugeja
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
| | - Kenneth Camilleri
- Centre for Biomedical Cybernetics, University of Malta, Msida, Malta
- Department of Systems and Control Engineering, University of Malta, Msida, Malta
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Klein E, Kinsella M, Stevens I, Fried-Oken M. Ethical issues raised by incorporating personalized language models into brain-computer interface communication technologies: a qualitative study of individuals with neurological disease. Disabil Rehabil Assist Technol 2024; 19:1041-1051. [PMID: 36403143 PMCID: PMC10351684 DOI: 10.1080/17483107.2022.2146217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 09/01/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine the views of individuals with neurodegenerative diseases about ethical issues related to incorporating personalized language models into brain-computer interface (BCI) communication technologies. METHODS Fifteen semi-structured interviews and 51 online free response surveys were completed with individuals diagnosed with neurodegenerative disease that could lead to loss of speech and motor skills. Each participant responded to questions after six hypothetical ethics vignettes were presented that address the possibility of building language models with personal words and phrases in BCI communication technologies. Data were analyzed with consensus coding, using modified grounded theory. RESULTS Four themes were identified. (1) The experience of a neurodegenerative disease shapes preferences for personalized language models. (2) An individual's identity will be affected by the ability to personalize the language model. (3) The motivation for personalization is tied to how relationships can be helped or harmed. (4) Privacy is important to people who may need BCI communication technologies. Responses suggest that the inclusion of personal lexica raises ethical issues. Stakeholders want their values to be considered during development of BCI communication technologies. CONCLUSIONS With the rapid development of BCI communication technologies, it is critical to incorporate feedback from individuals regarding their ethical concerns about the storage and use of personalized language models. Stakeholder values and preferences about disability, privacy, identity and relationships should drive design, innovation and implementation.IMPLICATIONS FOR REHABILITATIONIndividuals with neurodegenerative diseases are important stakeholders to consider in development of natural language processing within brain-computer interface (BCI) communication technologies.The incorporation of personalized language models raises issues related to disability, identity, relationships, and privacy.People who may one day rely on BCI communication technologies care not just about usability of communication technology but about technology that supports their values and priorities.Qualitative ethics-focused research is a valuable tool for exploring stakeholder perspectives on new capabilities of BCI communication technologies, such as the storage and use of personalized language models.
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Affiliation(s)
- Eran Klein
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
| | - Michelle Kinsella
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR USA
| | - Ian Stevens
- Department of Neurosurgery, Oregon Health & Science University, Portland, OR USA
| | - Melanie Fried-Oken
- Department of Neurology, Oregon Health & Science University, Portland, OR USA
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR USA
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Madanian S, Nakarada-Kordic I, Reay S, Chetty T. Patients' perspectives on digital health tools. PEC INNOVATION 2023; 2:100171. [PMID: 37384154 PMCID: PMC10294099 DOI: 10.1016/j.pecinn.2023.100171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023]
Abstract
Objective Digital technology has changed the way healthcare is delivered and accessed. However, the focus is mostly on technology and clinical aspects. This review aimed to integrate and critically analyse the available knowledge regarding patients' perspectives on digital health tools and identify facilitators and barriers to their uptake. Methods A narrative review was conducted using the Scopus and Google Scholar databases. Information related to facilitators and barriers to uptake was synthesised and interpreted using thematic and content analyses, respectively. Results Seventy-one out of 1722 articles identified were eligible for inclusion. Patient empowerment, self-management, and personalisation were identified as the main factors that contributed to patient uptake in using digital health tools. Digital literacy, health literacy, and privacy concerns were identified as barriers to the uptake of digital health technology. Conclusion Digital health technologies have changed the way healthcare is experienced by patients. Research highlights the disconnect between the development and implementation of digital health tools and the patients they are created for. This review may serve as the foundation for future research incorporating patients' perspectives to help increase patients' engagement with emerging technologies. Innovation Participatory design approaches have the potential to support the creation of patient-centred digital health tools.
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Affiliation(s)
- Samaneh Madanian
- Department of Computer Science and Software Engineering, School of Engineering, Computer and Mathematical Science, Auckland University of Technology (AUT), 6 St. Paul Street, AUT WZ Building, Auckland 1010, New Zealand
| | - Ivana Nakarada-Kordic
- Good Health Design, School of Art and Design, Auckland University of Technology (AUT), 27 St. Paul Street, AUT WE Building, Auckland 1010, New Zealand
| | - Stephen Reay
- Good Health Design, School of Art and Design, Auckland University of Technology (AUT), 27 St. Paul Street, AUT WE Building, Auckland 1010, New Zealand
| | - T'heniel Chetty
- Good Health Design, School of Art and Design, Auckland University of Technology (AUT), 27 St. Paul Street, AUT WE Building, Auckland 1010, New Zealand
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Branco MP, Pels EGM, Nijboer F, Ramsey NF, Vansteensel MJ. Brain-Computer interfaces for communication: preferences of individuals with locked-in syndrome, caregivers and researchers. Disabil Rehabil Assist Technol 2023; 18:963-973. [PMID: 34383613 PMCID: PMC9259829 DOI: 10.1080/17483107.2021.1958932] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The development of Brain-Computer Interfaces to restore communication (cBCIs) in people with severe motor impairment ideally relies on a close collaboration between end-users and other stakeholders, such as caregivers and researchers. Awareness about potential differences in opinion between these groups is crucial for development of usable cBCIs and access technology (AT) in general. In this study, we compared the opinions of prospective cBCI users, their caregivers and cBCI researchers regarding: (1) what applications would users like to control with a cBCI; (2) what mental strategies would users prefer to use for cBCI control; and (3) at what stage of their clinical trajectory would users like to be informed about AT and cBCIs. METHODS We collected data from 28 individuals with locked-in syndrome, 29 of their caregivers and 28 cBCI researchers. The questionnaire was supported with animation videos to explain different cBCI concepts, the utility of which was also assessed. RESULTS Opinions of the three groups were aligned with respect to the most desired cBCI applications, but diverged regarding mental strategies and the timing of being informed about cBCIs. Animation videos were regarded as clear and useful tools to explain cBCIs and mental strategies to end-users and other stakeholders. CONCLUSIONS Disagreements were clear between stakeholders regarding which mental strategies users prefer to use and when they would like to be informed about cBCIs. To move forward in the development and clinical implementation of cBCIs, it will be necessary to align the research agendas with the needs of the end-users and caregivers.IMPLICATIONS FOR REHABILITATIONBrain-Computer Interfaces may offer people with severe motor impairment a brain-based and muscle-independent approach to control communication-technology. The successful development of communication BCIs (cBCIs) relies on a close collaboration between end-users and other stakeholders, such as caregivers and researchers.Our work reveals that people with locked-in syndrome (end-users), their caregivers and researchers developing cBCIs agree that direct and private forms of communication are the most desired cBCI applications, but disagree regarding the preferred mental strategies for cBCI control and when to be informed about cBCIs.Animation videos are an effective tool for providing information to individuals, independent of their level of health literacy, regarding the concept of cBCIs and mental strategies for control.The misalignment in opinions of different groups of stakeholders about cBCIs strengthens the argument for a user-centered design approach in the development of cBCIs and access technology designed for daily life usage.
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Affiliation(s)
- Mariana P Branco
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elmar GM Pels
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Femke Nijboer
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, The Netherlands
- Biomedical Signals and Systems Department, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - Nick F Ramsey
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariska J Vansteensel
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Beyeler M, Sanchez-Garcia M. Towards a Smart Bionic Eye: AI-powered artificial vision for the treatment of incurable blindness. J Neural Eng 2022; 19:10.1088/1741-2552/aca69d. [PMID: 36541463 PMCID: PMC10507809 DOI: 10.1088/1741-2552/aca69d] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
Objective.How can we return a functional form of sight to people who are living with incurable blindness? Despite recent advances in the development of visual neuroprostheses, the quality of current prosthetic vision is still rudimentary and does not differ much across different device technologies.Approach.Rather than aiming to represent the visual scene as naturally as possible, aSmart Bionic Eyecould provide visual augmentations through the means of artificial intelligence-based scene understanding, tailored to specific real-world tasks that are known to affect the quality of life of people who are blind, such as face recognition, outdoor navigation, and self-care.Main results.Complementary to existing research aiming to restore natural vision, we propose a patient-centered approach to incorporate deep learning-based visual augmentations into the next generation of devices.Significance.The ability of a visual prosthesis to support everyday tasks might make the difference between abandoned technology and a widely adopted next-generation neuroprosthetic device.
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Affiliation(s)
- Michael Beyeler
- Department of Computer Science,University of California,Santa Barbara, CA, United States of America
- Department of Psychological & Brain Sciences, University of California, Santa Barbara, CA, United States of America
| | - Melani Sanchez-Garcia
- Department of Computer Science,University of California,Santa Barbara, CA, United States of America
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Sattler S, Pietralla D. Public attitudes towards neurotechnology: Findings from two experiments concerning Brain Stimulation Devices (BSDs) and Brain-Computer Interfaces (BCIs). PLoS One 2022; 17:e0275454. [PMID: 36350815 PMCID: PMC9645609 DOI: 10.1371/journal.pone.0275454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/17/2022] [Indexed: 11/10/2022] Open
Abstract
This study contributes to the emerging literature on public perceptions of neurotechnological devices (NTDs) in their medical and non-medical applications, depending on their invasiveness, framing effects, and interindividual differences related to personal needs and values. We conducted two web-based between-subject experiments (2×2×2) using a representative, nation-wide sample of the adult population in Germany. Using vignettes describing how two NTDs, brain stimulation devices (BSDs; NExperiment 1 = 1,090) and brain-computer interfaces (BCIs; NExperiment 2 = 1,089), function, we randomly varied the purpose (treatment vs. enhancement) and invasiveness (noninvasive vs. invasive) of the NTD, and assessed framing effects (variable order of assessing moral acceptability first vs. willingness to use first). We found a moderate moral acceptance and willingness to use BSDs and BCIs. Respondents preferred treatment over enhancement purposes and noninvasive over invasive devices. We also found a framing effect and explored the role of personal characteristics as indicators of personal needs and values (e.g., stress, religiosity, and gender). Our results suggest that the future demand for BSDs or BCIs may depend on the purpose, invasiveness, and personal needs and values. These insights can inform technology developers about the public's needs and concerns, and enrich legal and ethical debates.
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Affiliation(s)
- Sebastian Sattler
- Faculty of Sociology, Bielefeld University, Bielefeld, Germany
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Montréal, Canada
| | - Dana Pietralla
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany
- Department of Psychology, University of Cologne, Cologne, Germany
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A Comprehensive Review of Endogenous EEG-Based BCIs for Dynamic Device Control. SENSORS 2022; 22:s22155802. [PMID: 35957360 PMCID: PMC9370865 DOI: 10.3390/s22155802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/23/2022] [Accepted: 07/30/2022] [Indexed: 11/28/2022]
Abstract
Electroencephalogram (EEG)-based brain–computer interfaces (BCIs) provide a novel approach for controlling external devices. BCI technologies can be important enabling technologies for people with severe mobility impairment. Endogenous paradigms, which depend on user-generated commands and do not need external stimuli, can provide intuitive control of external devices. This paper discusses BCIs to control various physical devices such as exoskeletons, wheelchairs, mobile robots, and robotic arms. These technologies must be able to navigate complex environments or execute fine motor movements. Brain control of these devices presents an intricate research problem that merges signal processing and classification techniques with control theory. In particular, obtaining strong classification performance for endogenous BCIs is challenging, and EEG decoder output signals can be unstable. These issues present myriad research questions that are discussed in this review paper. This review covers papers published until the end of 2021 that presented BCI-controlled dynamic devices. It discusses the devices controlled, EEG paradigms, shared control, stabilization of the EEG signal, traditional machine learning and deep learning techniques, and user experience. The paper concludes with a discussion of open questions and avenues for future work.
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Schicktanz S, Schweda M. Aging 4.0? Rethinking the ethical framing of technology-assisted eldercare. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2021; 43:93. [PMID: 34342739 PMCID: PMC8332600 DOI: 10.1007/s40656-021-00447-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/04/2021] [Indexed: 05/31/2023]
Abstract
Technological approaches are increasingly discussed as a solution for the provision of support in activities of daily living as well as in medical and nursing care for older people. The development and implementation of such assistive technologies for eldercare raise manifold ethical, legal, and social questions. The discussion of these questions is influenced by theoretical perspectives and approaches from medical and nursing ethics, especially the principlist framework of autonomy, non-maleficence, beneficence, and justice. Tying in with previous criticism, the present contribution is taking these principles as a starting point and as a frame of reference to be critically re-examined. It thus aims to outline how existing ethical frameworks need to be extended or reconsidered to capture the ethical issues posed by technological developments regarding care for older people. In a first step, we provide a brief overview of assistive technologies in eldercare according to their purposes and functions. In the next step, we discuss how the questions and problems raised by new technologies in eldercare call for an expansion, re-interpretation, and revision of the principlist framework. We underline that the inclusion of ethical perspectives from engineering and computer science as well as a closer consideration of socio-political dimensions and fundamental anthropological and praxeological questions are needed.
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Affiliation(s)
- Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldt Allee 36, 37073, Göttingen, Germany.
| | - Mark Schweda
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstr. 114-118, 26111, Oldenburg, Germany
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Rostamzadeh A, Schwegler C, Gil-Navarro S, Rosende-Roca M, Romotzky V, Ortega G, Canabate P, Moreno M, Schmitz-Luhn B, Boada M, Jessen F, Woopen C. Biomarker-Based Risk Prediction of Alzheimer’s Disease Dementia in Mild Cognitive Impairment: Psychosocial, Ethical, and Legal Aspects. J Alzheimers Dis 2021; 80:601-617. [DOI: 10.3233/jad-200484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Today, a growing number of individuals with mild cognitive impairment (MCI) wish to assess their risk of developing Alzheimer’s disease (AD) dementia. The expectations as well as the effects on quality of life (QoL) in MCI patients and their close others through biomarker-based dementia risk estimation are not well studied. Objective: The PreDADQoL project aims at providing empirical data on effects of such prediction on QoL and at developing an ethical and legal framework of biomarker-based dementia risk estimation in MCI. Methods: In the empirical study, 100 MCI-patients and their close others will be recruited from two sites (Germany and Spain). They receive standardized counselling on cerebrospinal fluid (CSF) biomarker-based prediction of AD dementia and a risk disclosure based on their AD biomarker status. A mixed methods approach will be applied to assess outcomes. Results: The pilot-study yielded a specification of the research topics and newly developed questionnaires for the main assessment. Within this binational quantitative and qualitative study, data on attitudes and expectations toward AD risk prediction, QoL, risk communication, coping strategies, mental health, lifestyle changes, and healthcare resource utilization will be obtained. Together with the normative part of the project, an empirically informed ethical and legal framework for biomarker-based dementia risk estimation will be developed. Conclusion: The empirical research of the PreDADQoL study together with the ethical and legal considerations and implications will help to improve the process of counselling and risk disclosure and thereby positively affect QoL and health of MCI-patients and their close others in the context of biomarker-based dementia risk estimation.
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Affiliation(s)
- Ayda Rostamzadeh
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Carolin Schwegler
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
| | - Silvia Gil-Navarro
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maitée Rosende-Roca
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Vanessa Romotzky
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
| | - Gemma Ortega
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pilar Canabate
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mariola Moreno
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Björn Schmitz-Luhn
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
- Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Venusberg Campus 1, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Christiane Woopen
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne, Cologne, Germany
- Institute for the History of Medicine and Medical Ethics, Research Unit Ethics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Branco MP, Pels EGM, Sars RH, Aarnoutse EJ, Ramsey NF, Vansteensel MJ, Nijboer F. Brain-Computer Interfaces for Communication: Preferences of Individuals With Locked-in Syndrome. Neurorehabil Neural Repair 2021; 35:267-279. [PMID: 33530868 PMCID: PMC7934157 DOI: 10.1177/1545968321989331] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Brain-computer interfaces (BCIs) have been proposed as an assistive technology (AT) allowing people with locked-in syndrome (LIS) to use neural signals to communicate. To design a communication BCI (cBCI) that is fully accepted by the users, their opinion should be taken into consideration during the research and development process. OBJECTIVE We assessed the preferences of prospective cBCI users regarding (1) the applications they would like to control with a cBCI, (2) the mental strategies they would prefer to use to control the cBCI, and (3) when during their clinical trajectory they would like to be informed about AT and cBCIs. Furthermore, we investigated if individuals diagnosed with progressive and sudden onset (SO) disorders differ in their opinion. METHODS We interviewed 28 Dutch individuals with LIS during a 3-hour home visit using multiple-choice, ranking, and open questions. During the interview, participants were informed about BCIs and the possible mental strategies. RESULTS Participants rated (in)direct forms of communication, computer use, and environmental control as the most desired cBCI applications. In addition, active cBCI control strategies were preferred over reactive strategies. Furthermore, individuals with progressive and SO disorders preferred to be informed about AT and cBCIs at the moment they would need it. CONCLUSIONS We show that individuals diagnosed with progressive and SO disorders preferred, in general, the same applications, mental strategies, and time of information. By collecting the opinion of a large sample of individuals with LIS, this study provides valuable information to stakeholders in cBCI and other AT development.
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Affiliation(s)
| | | | - Ruben H. Sars
- University Medical Center Utrecht, Netherlands
- Leiden University, Netherlands
| | | | | | | | - Femke Nijboer
- Leiden University, Netherlands
- University of Twente, Enschede, Netherlands
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Saha S, Mamun KA, Ahmed K, Mostafa R, Naik GR, Darvishi S, Khandoker AH, Baumert M. Progress in Brain Computer Interface: Challenges and Opportunities. Front Syst Neurosci 2021; 15:578875. [PMID: 33716680 PMCID: PMC7947348 DOI: 10.3389/fnsys.2021.578875] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/06/2021] [Indexed: 12/13/2022] Open
Abstract
Brain computer interfaces (BCI) provide a direct communication link between the brain and a computer or other external devices. They offer an extended degree of freedom either by strengthening or by substituting human peripheral working capacity and have potential applications in various fields such as rehabilitation, affective computing, robotics, gaming, and neuroscience. Significant research efforts on a global scale have delivered common platforms for technology standardization and help tackle highly complex and non-linear brain dynamics and related feature extraction and classification challenges. Time-variant psycho-neurophysiological fluctuations and their impact on brain signals impose another challenge for BCI researchers to transform the technology from laboratory experiments to plug-and-play daily life. This review summarizes state-of-the-art progress in the BCI field over the last decades and highlights critical challenges.
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Affiliation(s)
- Simanto Saha
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
- Department of Electrical and Electronic Engineering, United International University, Dhaka, Bangladesh
| | - Khondaker A. Mamun
- Advanced Intelligent Multidisciplinary Systems (AIMS) Lab, Department of Computer Science and Engineering, United International University, Dhaka, Bangladesh
| | - Khawza Ahmed
- Department of Electrical and Electronic Engineering, United International University, Dhaka, Bangladesh
| | - Raqibul Mostafa
- Department of Electrical and Electronic Engineering, United International University, Dhaka, Bangladesh
| | - Ganesh R. Naik
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Sam Darvishi
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Ahsan H. Khandoker
- Healthcare Engineering Innovation Center, Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
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Kögel J, Jox RJ, Friedrich O. What is it like to use a BCI? - insights from an interview study with brain-computer interface users. BMC Med Ethics 2020; 21:2. [PMID: 31906947 PMCID: PMC6945485 DOI: 10.1186/s12910-019-0442-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022] Open
Abstract
Background The neurotechnology behind brain-computer interfaces (BCIs) raises various ethical questions. The ethical literature has pinpointed several issues concerning safety, autonomy, responsibility and accountability, psychosocial identity, consent, privacy and data security. This study aims to assess BCI users’ experiences, self-observations and attitudes in their own right and looks for social and ethical implications. Methods We conducted nine semi-structured interviews with BCI users, who used the technology for medical reasons. The transcribed interviews were analyzed according to the Grounded Theory coding method. Results BCI users perceive themselves as active operators of a technology that offers them social participation and impacts their self-definition. Each of these aspects bears its own opportunities and risks. BCIs can contribute to retaining or regaining human capabilities. At the same time, BCI use contains elements that challenge common experiences, for example when the technology is in conflict with the affective side of BCI users. The potential benefits of BCIs are regarded as outweighing the risks in that BCI use is considered to promote valuable qualities and capabilities. BCI users appreciate the opportunity to regain lost capabilities as well as to gain new ones. Conclusions BCI users appreciate the technology for various reasons. The technology is highly appreciated in cases where it is beneficial in terms of agency, participation and self-definitions. Rather than questioning human nature, the technology can retain and restore characteristics and abilities which enrich our lives.
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Affiliation(s)
- Johannes Kögel
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, 80336, Munich, Germany.
| | - Ralf J Jox
- Clinical Ethics Unit and Institute of Humanities in Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, University of Lausanne, Avenue de Provence 82, CH-1007, Lausanne, Switzerland
| | - Orsolya Friedrich
- Institute of Philosophy, Faculty of Cultural and Social Sciences, FernUniversität in Hagen, Universitätsstr. 33, 58097, Hagen, Germany
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Kögel J, Schmid JR, Jox RJ, Friedrich O. Using brain-computer interfaces: a scoping review of studies employing social research methods. BMC Med Ethics 2019; 20:18. [PMID: 30845952 PMCID: PMC6407281 DOI: 10.1186/s12910-019-0354-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 02/22/2019] [Indexed: 12/11/2022] Open
Abstract
Background The rapid expansion of research on Brain-Computer Interfaces (BCIs) is not only due to the promising solutions offered for persons with physical impairments. There is also a heightened need for understanding BCIs due to the challenges regarding ethics presented by new technology, especially in its impact on the relationship between man and machine. Here we endeavor to present a scoping review of current studies in the field to gain insight into the complexity of BCI use. By examining studies related to BCIs that employ social research methods, we seek to demonstrate the multitude of approaches and concerns from various angles in considering the social and human impact of BCI technology. Methods For this scoping review of research on BCIs’ social and ethical implications, we systematically analyzed six databases, encompassing the fields of medicine, psychology, and the social sciences, in order to identify empirical studies on BCIs. The search yielded 73 publications that employ quantitative, qualitative, or mixed methods. Results Of the 73 publications, 71 studies address the user perspective. Some studies extend to consideration of other BCI stakeholders such as medical technology experts, caregivers, or health care professionals. The majority of the studies employ quantitative methods. Recurring themes across the studies examined were general user opinion towards BCI, central technical or social issues reported, requests/demands made by users of the technology, the potential/future of BCIs, and ethical aspects of BCIs. Conclusions Our findings indicate that while technical aspects of BCIs such as usability or feasibility are being studied extensively, comparatively little in-depth research has been done on the self-image and self-experience of the BCI user. In general there is also a lack of focus or examination of the caregiver’s perspective. Electronic supplementary material The online version of this article (10.1186/s12910-019-0354-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes Kögel
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, D-80336, Munich, Germany.
| | - Jennifer R Schmid
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, D-80336, Munich, Germany
| | - Ralf J Jox
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, D-80336, Munich, Germany
| | - Orsolya Friedrich
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, D-80336, Munich, Germany
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Burwell S, Sample M, Racine E. Ethical aspects of brain computer interfaces: a scoping review. BMC Med Ethics 2017; 18:60. [PMID: 29121942 PMCID: PMC5680604 DOI: 10.1186/s12910-017-0220-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain-Computer Interface (BCI) is a set of technologies that are of increasing interest to researchers. BCI has been proposed as assistive technology for individuals who are non-communicative or paralyzed, such as those with amyotrophic lateral sclerosis or spinal cord injury. The technology has also been suggested for enhancement and entertainment uses, and there are companies currently marketing BCI devices for those purposes (e.g., gaming) as well as health-related purposes (e.g., communication). The unprecedented direct connection created by BCI between human brains and computer hardware raises various ethical, social, and legal challenges that merit further examination and discussion. METHODS To identify and characterize the key issues associated with BCI use, we performed a scoping review of biomedical ethics literature, analyzing the ethics concerns cited across multiple disciplines, including philosophy and medicine. RESULTS Based on this investigation, we report that BCI research and its potential translation to therapeutic intervention generate significant ethical, legal, and social concerns, notably with regards to personhood, stigma, autonomy, privacy, research ethics, safety, responsibility, and justice. Our review of the literature determined, furthermore, that while these issues have been enumerated extensively, few concrete recommendations have been expressed. CONCLUSIONS We conclude that future research should focus on remedying a lack of practical solutions to the ethical challenges of BCI, alongside the collection of empirical data on the perspectives of the public, BCI users, and BCI researchers.
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Affiliation(s)
- Sasha Burwell
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada
| | - Matthew Sample
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada.,Departments of Neurology and Neurosurgery, Experimental Medicine and Biomedical Ethics Unit, McGill University, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada
| | - Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada. .,Department of Experimental Medicine, McGill University, Montréal, Canada. .,Department of Medicine and Department of Social and Preventative Medicine, Université de Montréal, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada. .,Departments of Neurology and Neurosurgery, Experimental Medicine and Biomedical Ethics Unit, McGill University, 110 avenue des Pins Ouest, H2W lR7, Montréal, QC, Canada.
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Specker Sullivan L, Illes J. Beyond ‘communication and control’: towards ethically complete rationales for brain-computer interface research. BRAIN-COMPUTER INTERFACES 2016. [DOI: 10.1080/2326263x.2016.1213603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Laura Specker Sullivan
- National Core for Neuroethics, University of British Columbia, Vancouver, Canada
- Center for Sensorimotor Neural Engineering, University of Washington, Box 37, 1414 NE 42nd Street Suite 204, Seattle, WA 98105-6271, USA
- Department of Philosophy, University of Washington, USA
| | - Judy Illes
- National Core for Neuroethics, University of British Columbia, Vancouver, Canada
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Riccio A, Pichiorri F, Schettini F, Toppi J, Risetti M, Formisano R, Molinari M, Astolfi L, Cincotti F, Mattia D. Interfacing brain with computer to improve communication and rehabilitation after brain damage. PROGRESS IN BRAIN RESEARCH 2016; 228:357-87. [PMID: 27590975 DOI: 10.1016/bs.pbr.2016.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Communication and control of the external environment can be provided via brain-computer interfaces (BCIs) to replace a lost function in persons with severe diseases and little or no chance of recovery of motor abilities (ie, amyotrophic lateral sclerosis, brainstem stroke). BCIs allow to intentionally modulate brain activity, to train specific brain functions, and to control prosthetic devices, and thus, this technology can also improve the outcome of rehabilitation programs in persons who have suffered from a central nervous system injury (ie, stroke leading to motor or cognitive impairment). Overall, the BCI researcher is challenged to interact with people with severe disabilities and professionals in the field of neurorehabilitation. This implies a deep understanding of the disabled condition on the one hand, and it requires extensive knowledge on the physiology and function of the human brain on the other. For these reasons, a multidisciplinary approach and the continuous involvement of BCI users in the design, development, and testing of new systems are desirable. In this chapter, we will focus on noninvasive EEG-based systems and their clinical applications, highlighting crucial issues to foster BCI translation outside laboratories to eventually become a technology usable in real-life realm.
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Affiliation(s)
- A Riccio
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - F Pichiorri
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy; Sapienza University of Rome, Rome, Italy
| | - F Schettini
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - J Toppi
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy; Sapienza University of Rome, Rome, Italy
| | - M Risetti
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - R Formisano
- Post-Coma Unit, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - M Molinari
- Spinal Cord Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | - L Astolfi
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy; Sapienza University of Rome, Rome, Italy
| | - F Cincotti
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy; Sapienza University of Rome, Rome, Italy
| | - D Mattia
- Neuroelectrical Imaging and Brain-Computer Interface Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy.
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Aparicio A. Immobilis in mobili: performing arts, BCI, and locked-in syndrome. BRAIN-COMPUTER INTERFACES 2015. [DOI: 10.1080/2326263x.2015.1100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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