Background A major challenge with BCI use is the requirement for subject-specific calibration, which is often tedious and unengaging, but necessary to improve performance. This is especially true for children, whose limited attention and motivation may restrict the duration of endurable calibration periods. Several studies have shown that the addition of scoring systems and rewards to tasks, a process known as “gamification”, can increase motivation, attention, and task performance in children. This randomized, prospective, cross-over study aimed to address this challenge by comparing the effects of gamified versus non-gamified calibration environments on classification accuracy and BCI performance on utility-driven tasks. Methods Thirty-two typically developing children (14 female, mean age 11.9 years, range 5.8–17.9) attended two sessions lasting between 1.5-2 hours, to perform two standard paradigms: spelling using visual P300 event-related potentials (P300) and cursor control using sensorimotor rhythm (SMR) modulation, following gamified and non-gamified calibration. Gamified paradigms incorporated elements of game design, such as meaningful stories, quests, points and sounds. The primary outcome was BCI performance, which included performance of the classification model and online accuracy. Motivation, tolerability, and mental workload (NASA-TLX) were evaluated following each paradigm. Results For the P300 paradigm, mean classification accuracy was similar after gamified (96.81 ± 3.46%) and non-gamified (96.52 ± 2.42%) calibration. Mean classification accuracy for the SMR paradigm was 61.81 ± 13.35% with gamification and 59.84 ± 11.36% without gamification (n.s.). Mean online accuracy for SMR cursor control was 63.23% for both conditions. For the P300 spelling task, online performance was significantly lower following gamified training (p < 0.01). There were no significant differences found between classification accuracy, online BCI performance, motivation, tolerability, or perceived mental workload. Conclusion To our knowledge, this is the first study to investigate the effects of gamified calibration paradigms on classification accuracy and BCI performance in children. Our results reinforce the ability of typical children to control advanced BCI systems with performance comparable to adults. Gamified calibration environments may not enhance BCI classification and performance in children though the gamified environments utilized in this study may not have been engaging enough. This work underscores the need for further research to optimize BCI training paradigms for pediatric use.
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 healthy 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 3x3 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 8–12 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 = 4.0(1,149), p = 0.047 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.
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