Enhancing clinical communication assessments using an audiovisual BCI for patients with disorders of consciousness

Abstract

Objective. The JFK coma recovery scale-revised (JFK CRS-R), a behavioral observation scale, is widely used in the clinical diagnosis/assessment of patients with disorders of consciousness (DOC). However, the JFK CRS-R is associated with a high rate of misdiagnosis (approximately 40%) because DOC patients cannot provide sufficient behavioral responses. A brain–computer interface (BCI) that detects command/intention-specific changes in electroencephalography (EEG) signals without the need for behavioral expression may provide an alternative method. Approach. In this paper, we proposed an audiovisual BCI communication system based on audiovisual ‘yes’ and ‘no’ stimuli to supplement the JFK CRS-R for assessing the communication ability of DOC patients. Specifically, patients were given situation-orientation questions as in the JFK CRS-R and instructed to select the answers using the BCI. Main results. Thirteen patients (eight vegetative state (VS) and five minimally conscious state (MCS)) participated in our experiments involving both the BCI- and JFK CRS-R-based assessments. One MCS patient who received a score of 1 in the JFK CRS-R achieved an accuracy of 86.5% in the BCI-based assessment. Seven patients (four VS and three MCS) obtained unresponsive results in the JFK CRS-R-based assessment but responsive results in the BCI-based assessment, and 4 of those later improved scores in the JFK CRS-R-based assessment. Five patients (four VS and one MCS) obtained usresponsive results in both assessments. Significance. The experimental results indicated that the audiovisual BCI could provide more sensitive results than the JFK CRS-R and therefore supplement the JFK CRS-R.

The N400 for brain computer interfacing: complexities and opportunities

“…This is not a BCI application in the traditional sense of offering control to the user, but a BCI as a (offline) diagnostics or prognostics tool. Possibilities for providing communication BCIs for these patients have also been explored, with a number of studies showing that for certain patients, command following (i.e., performing a mental task when prompted) can be detected (e.g., in fMRI [63,64] or EEG [65,66]).…”

Emotion-Related Consciousness Detection in Patients With Disorders of Consciousness Through an EEG-Based BCI System

“…However, motor responses may be difficult to discern or inconsistent in this patient group, and it is becoming increasingly clear that relying on an overt behavioral response may result in misdiagnosis of a patients level of consciousness (Cruse and Owen, 2010 ; Coyle et al, 2017 ). In recent years, researchers have employed electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) techniques (Owen et al, 2002 ; Laureys et al, 2004 ; Di et al, 2007 ; Monti et al, 2010 ; Cruse et al, 2012a ; Li et al, 2015b ; Wang et al, 2017 ) to detect residual brain functions and provide motor-independent evidence of consciousness in certain patients with DOC (see Noirhomme et al, 2013 ; Kotchoubey, 2017 ; Lancioni et al, 2017 for reviews).…”

30+ years of P300 brain–computer interfaces

“…The results from assessment with passive and (especially) active command‐following tasks could indicate conscious function, which might lead to re‐assessment of the patient's condition. P300‐based systems could also provide communication and facilitate outcome prediction (Chatelle et al, 2012; Chennu et al, 2017; Guger et al, 2017; Lugo, Quitadamo, et al, 2014; Lugo, Rodriguez, et al, 2014; Real et al, 2016; Spataro et al, 2018; Wang et al, 2017).…”

“…Visual P300 BCIs provide communication for a higher percentage of users than other approaches typically provide (Fazel‐Rezai et al, 2012; Kaufmann, Holz, & Kübler, 2013). Recent studies have extended P300 BCIs to assist individuals with disorder of consciousness (DOC) or aphasia resulting from stroke (Kleih, Gottschalt, Teichlein, & Weilbach, 2016; Nam et al, 2018; Wang et al, 2017). With further development, P300 BCIs should benefit a broader range of patients.…”