Objective. Steady-state visually evoked potential (SSVEP)-based brain-computer interfaces (BCIs) allow healthy subjects to communicate. However, their dependence on gaze control prevents their use with severely disabled patients. Gaze-independent SSVEP-BCIs have been designed but have shown a drop in accuracy and have not been tested in brain-injured patients. In the present paper, we propose a novel independent SSVEP-BCI based on covert attention with an improved classification rate. We study the influence of feature extraction algorithms and the number of harmonics. Finally, we test online communication on healthy volunteers and patients with locked-in syndrome (LIS). Approach. Twenty-four healthy subjects and six LIS patients participated in this study. An independent covert two-class SSVEP paradigm was used with a newly developed portable light emitting diode-based 'interlaced squares' stimulation pattern. Main results. Mean offline and online accuracies on healthy subjects were respectively 85 ± 2% and 74 ± 13%, with eight out of twelve subjects succeeding to communicate efficiently with 80 ± 9% accuracy. Two out of six LIS patients reached an offline accuracy above the chance level, illustrating a response to a command. One out of four LIS patients could communicate online. Significance. We have demonstrated the feasibility of online communication with a covert SSVEP paradigm that is truly independent of all neuromuscular functions. The potential clinical use of the presented BCI system as a diagnostic (i.e., detecting command-following) and communication tool for severely brain-injured patients will need to be further explored.

Brain-computer interface (BCI) has been used for many years for communication in severely disabled patients. BCI based on electrophysiological signals has enabled communication, using auditory or visual stimuli to elicit event-related potentials (ERPs). The aim of this study was to determine whether patients with locked-in syndrome (LIS) could elicit a P300 wave, using a vibrotactile oddball paradigm for establishing somatosensory BCI-based communication. Six chronic LIS patients performed 2 electroencephalography (EEG)-based vibrotactile P300 oddball tasks. After a simple mental counting task of the target stimuli, participants were instructed to answer 5 questions by counting the vibration on either the right wrist for "yes" or the left wrist for "no." All participants were able to elicit a P300 wave using the vibrotactile oddball paradigm BCI task. In the counting task, 4 patients got accuracies of 100% (average above chance). In the communication task, one patient achieved 100% accuracy (average above chance). We have shown the feasibility of eliciting a P300 response using vibrotactile stimulation in patients with LIS. The present study provides evidence that this approach can be used for EEG-based BCI communications in this patient group. This is the first study to prove the feasibility of a BCI based on somatosensory (vibratory) stimulation in a group of brain-injured patients. Furthermore, this approach could be used for the detection of consciousness in non-communicating patients due to severe brain injuries.

The results highlight the possibility to recover non-eye dependent communication, speech production and some functional movement in the majority of chronic LIS patients.