Brain-computer interfaces: barriers and opportunities to widespread clinical adoption (Preprint)

Abstract

BACKGROUND Brain-computer Interface (BCI) is an emerging neurotechnology with potential applications primarily for neurological disorders. There is a rising interest in the clinical use of BCI to improve quality of care. Despite their therapeutic potential, BCI use is still mostly limited to research stages and its translation into mainstream clinical applications and widespread adoption is lagging. OBJECTIVE This study revises the current potential clinical applications of BCIs in humans, attempts to understand barriers and opportunities to wider clinical adoption of this radical innovation in neurological-related care and draws its health policy and management implications. METHODS The methodology followed a two-step approach which included a systematic review of potential clinical applications of BCIs and a qualitative study, using focus group method, to understand and integrate professionals’ experiences, perceptions, thoughts and feelings on the wide clinical adoption of BCIs. The systematic review aimed to review potential relevant clinical applications of BCIs and included 25 studies, published from 2017 to 2021. The qualitative study included 3 focus groups with a total of 22 participants from medical, engineering and management fields. RESULTS Clinical evidence of BCI applications included predominantly neurorehabilitation with non-invasive devices and the control of assistive devices with invasive BCIs (e.g., upper limb rehabilitation in stroke patients or control of spelling systems in LIS patients). Several barriers to wider clinical adoption of BCIs were identified, mostly these were technological barriers like materials biocompatibility and insulation, miniaturization, wireless interfaces and batteries, advanced signal processing and recalibration. Nowadays, with the current pace of technological development, these technological barriers seem addressable in the near future. However, to achieve mainstream clinical applicability, BCIs will have to deal with systemic barriers to innovation in healthcare ecosystem. A comprehensive and multidisciplinary approach will be needed to integrate and adopt BCIs in clinical contexts. CONCLUSIONS The successful integration of BCIs into clinical practice requires a multifaceted approach that addresses various barriers. This includes ensuring the clinical relevance of BCIs, securing funding and addressing potential negative impacts. It is essential to engage with end-users to understand their needs and perspectives and to work collaboratively across private and public institutions to create opportunities for the widespread use of BCIs. The involvement of medical doctors and the development of clinical guidelines will also be crucial for the adoption of BCIs. Ultimately, a concerted effort to engage with a wide range of stakeholders and to foster confidence and support for these devices will pave the way for progress in healthcare contexts.