Feasibility of an EEG-based brain-computer interface in the intensive care unit

Chatelle, Camille; Spencer, Camille A.; Cash, Sydney S.; Hochberg, Leigh R.; Edlow, Brian L.

doi:10.1016/j.clinph.2018.04.747

Cited by 33 publications

(31 citation statements)

References 33 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Approaches that integrate task-based fMRI and EEG are currently being used to characterize the clinical characteristics of CMD in patients in the ICU and provide insights into its underlying mechanisms 169 . Meaningful communication with CMD patients is currently infeasible but, in the future, EEG-supported brain–computer interface systems could enable patients with acute CMD to communicate 175 , 176 .…”

Section: Acute Disorders Of Consciousnessmentioning

confidence: 99%

Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies

et al. 2020

Self Cite

View full text Add to dashboard Cite

Section: Acute Disorders Of Consciousnessmentioning

confidence: 99%

Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies

et al. 2020

Self Cite

View full text Add to dashboard Cite

“…46 With fewer electrodes to record from, the statistical rigor with which task-based EEG paradigms can assess for command-following may be limited. 7, 47 Nevertheless, emerging evidence suggests that reliable command-following can be detected from a small number of scalp electrodes in certain patients. 48, 49 Furthermore, given that task-based EEG does not require traveling out of the ICU or lying supine, EEG has several feasibility and safety advantages compared to fMRI for critically ill patients with acute brain injuries.…”

Section: Task-based Eeg In the Icumentioning

confidence: 99%

Assessment of Covert Consciousness in the Intensive Care Unit: Clinical and Ethical Considerations

Edlow

Fins

2018

Journal of Head Trauma Rehabilitation

Self Cite

View full text Add to dashboard Cite

Objective: To propose a practical ethical framework for how task-based functional MRI (fMRI) and electroencephalography (EEG) may be used in the intensive care unit (ICU) to identify covert consciousness in patients with acute severe traumatic brain injury (TBI). Methods: We present two clinical scenarios in which investigational task-based fMRI and EEG were performed in critically ill patients with acute severe TBI who appeared unconscious on the bedside behavioral assessment. From these cases, we consider the clinical and ethical challenges that emerge and suggest how to reconcile them. We also provide recommendations regarding communication with families about ICU patients with covert consciousness. Results: Covert consciousness was detected acutely in a patient who died in the ICU due to withdrawal of life-sustaining therapy, whereas covert consciousness was not detected in a patient who subsequently recovered consciousness, communication, and functional independence. These cases raise ethical challenges about how assessment of covert consciousness in the ICU might inform treatment decisions, prognostication, and perceptions about the benefits and burdens of ongoing care. Conclusions: Given that covert consciousness can be detected acutely in the ICU, we recommend that clinicians reconsider evaluative norms for ICU patients. As our clinical appreciation of covert consciousness evolves and its ethical import unfolds, we urge prognostic humility and transparency when clinicians communicate with families in the ICU about goals of care.

show abstract

“…Patients were evaluated several times with the CRS-R [ 29 ]. Precisely, the patients in LI were assessed five times within one week of the BCI assessment including once on the day of the BCI assessment; the patients in BA were repeatedly tested every two weeks before study enrolment and retested on the day of BCI assessment.…”

Section: Methodsmentioning

confidence: 99%

“…The BCI system includes a data processing tool, consisting of automatic EEG preprocessing, artefact rejection and calculation of the true positive rate of the deviant stimulus detection (see below and Figure 1 for an overview of the data processing, or [ 29 ]).…”

Section: Methodsmentioning

confidence: 99%

Auditory and Somatosensory P3 Are Complementary for the Assessment of Patients with Disorders of Consciousness

Annen

Mertel

et al. 2020

Brain Sciences

Self Cite

View full text Add to dashboard Cite

The evaluation of the level of consciousness in patients with disorders of consciousness (DOC) is primarily based on behavioural assessments. Patients with unresponsive wakefulness syndrome (UWS) do not show any sign of awareness of their environment, while minimally conscious state (MCS) patients show reproducible but fluctuating signs of awareness. Some patients, although with remaining cognitive abilities, are not able to exhibit overt voluntary responses at the bedside and may be misdiagnosed as UWS. Several studies investigated functional neuroimaging and neurophysiology as an additional tool to evaluate the level of consciousness and to detect covert command following in DOC. Most of these studies are based on auditory stimulation, neglecting patients suffering from decreased or absent hearing abilities. In the present study, we aim to assess the response to a P3-based paradigm in 40 patients with DOC and 12 healthy participants using auditory (AEP) and vibrotactile (VTP) stimulation. To this end, an EEG-based brain-computer interface was used at DOC patient’s bedside. We compared the significance of the P3 performance (i.e., the interpretation of significance of the evoked P3 response) as obtained by ‘direct processing’ (i.e., theoretical-based significance threshold) and ‘offline processing’ (i.e., permutation-based single subject level threshold). We evaluated whether the P3 performances were dependent on clinical variables such as diagnosis (UWS and MCS), aetiology and time since injury. Last we tested the dependency of AEP and VTP performances at the single subject level. Direct processing tends to overestimate P3 performance. We did not find any difference in the presence of a P3 performance according to the level of consciousness (UWS vs. MCS) or the aetiology (traumatic vs. non-traumatic brain injury). The performance achieved at the AEP paradigm was independent from what was achieved at the VTP paradigm, indicating that some patients performed better on the AEP task while others performed better on the VTP task. Our results support the importance of using multimodal approaches in the assessment of DOC patients in order to optimise the evaluation of patient’s abilities.

show abstract

Feasibility of an EEG-based brain-computer interface in the intensive care unit

Abstract: The accuracy of the paradigms for detecting consciousness must be improved and the duration of the protocol should be shortened before this commercially available BCI is ready for clinical implementation in the ICU in patients with acute DoC.

Cited by 33 publications

References 33 publications

Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies

Recovery from disorders of consciousness: mechanisms, prognosis and emerging therapies

Assessment of Covert Consciousness in the Intensive Care Unit: Clinical and Ethical Considerations

Auditory and Somatosensory P3 Are Complementary for the Assessment of Patients with Disorders of Consciousness

Contact Info

Product

Resources

About