Neural Internet: Web Surfing with Brain Potentials for the Completely Paralyzed

Karim, Ahmed A.; Hinterberger, Thilo; Richter, Jürgen; Mellinger, Jürgen; Neumann, Nicola; Flor, Herta; Kübler, Andrea; Birbaumer, Niels

doi:10.1177/1545968306290661

Cited by 99 publications

(62 citation statements)

References 27 publications

(43 reference statements)

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“…Brain activity linked to specific imagery or evoked by sensory stimula tion is recorded, filtered, classified, and translated into command signals to control a device (Dornhege et al, 2007). BCIs have been used by LIS patients to communicate (Birbaumer et al, 1999;Neumann et al, 2003;Nijboer et al, 2008), to surf on the Internet (Karim et al, 2006;Mugler et al, 2008), and even to paint . BCI-controlled devices also permitted patients with spinal cord injury to regain move ment (e.g., grasping could be restored with a BCI linked to functional electric stimulation; Pfurtscheller et al, 2003) and control a wheelchair (Galá n et al, 2008;Iturrate et al, 2009).…”

Section: Alternative Communication Devicesmentioning

confidence: 99%

Life can be worth living in locked-in syndrome

Lulé

Zickler

Häcker

et al. 2009

Progress in Brain Research

168

104

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The locked-in syndrome (LIS) describes patients who are awake and conscious but severely deefferented leaving the patient in a state of almost complete immobility and loss of verbal communication. The etiology ranges from acute (e.g., brainstem stroke, which is the most frequent cause of LIS) to chronic causes (e.g., amyotrophic lateral sclerosis; ALS). In this article we review and present new data on the psychosocial adjustment to LIS. We refer to quality of life (QoL) and the degree of depressive symptoms as a measure of psychosocial adjustment. Various studies suggest that despite their extreme motor impairment, a significant number of LIS patients maintain a good QoL that seems unrelated to their state of physical functioning. Likewise, depression is not predicted by the physical state of the patients. A successful psychological adjustment to the disease was shown to be related to problem-oriented coping strategies, like seeking for information, and emotional coping strategies like denial -the latter may, nevertheless, vary with disease stage. Perceived social support seems to be the strongest predictor of psychosocial adjustment. QoL in LIS patients is often in the same range as in age-matched healthy individuals. Interestingly, there is evidence that significant others, like primary caregivers or spouses, rate LIS patients' QoL significantly lower than the patients themselves. With regard to depressed mood, ALS patients without symptoms focus significantly more often on internal factors that can be retained in the course of the disease contrary to patients with depressive symptoms who preferably name external factors as very important, such as health, which will degrade in the course of the disease. Typically, ALS patients with a higher degree of depressive symptoms experience significantly less ''very pleasant'' situations. The herein presented data strongly question the assumption among doctors, health-care workers, lay persons, and politicians that severe motor disability necessarily is intolerable and leads to end-of-life decisions or euthanasia. Existing evidence supports that biased clinicians provide less-aggressive medical treatment in LIS patients. Thus, psychological treatment for depression, effective strategies for coping with the disease, and support concerning the maintenance of the social network are needed to cope with the disease. Novel communication devices and assistive technology now offers an increasing number of LIS patients to resume a meaningful life and an active role in society.

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Section: Alternative Communication Devicesmentioning

confidence: 99%

Life can be worth living in locked-in syndrome

Lulé

Zickler

Häcker

et al. 2009

Progress in Brain Research

168

104

View full text Add to dashboard Cite

show abstract

“…Although in animals this research has been focused on invasive methods (intracraneal), the most popular recording method for humans has been the EEG. So far, systems based on human EEG have been used to control a mouse on the screen [4], for communication like a speller [1], [5], an Internet browser [6], [7], etc. Furthermore, the research on brain-machine interfaces applied to human control of physical devices has been broadly focused mainly in two directions: neuroprosthetics and brain-actuated wheelchairs.…”

mentioning

confidence: 99%

A Noninvasive Brain-Actuated Wheelchair Based on a P300 Neurophysiological Protocol and Automated Navigation

et al. 2009

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Abstract-This paper describes a new noninvasive brainactuated wheelchair that relies on a P300 neurophysiological protocol and automated navigation. When in operation, the user faces a screen displaying a real-time virtual reconstruction of the scenario and concentrates on the location of the space to reach. A visual stimulation process elicits the neurological phenomenon, and the electroencephalogram (EEG) signal processing detects the target location. This location is transferred to the autonomous navigation system that drives the wheelchair to the desired location while avoiding collisions with obstacles in the environment detected by the laser scanner. This concept gives the user the flexibility to use the device in unknown and evolving scenarios. The prototype was validated with five healthy participants in three consecutive steps: screening (an analysis of three different groups of visual interface designs), virtual-environment driving, and driving sessions with the wheelchair. On the basis of the results, this paper reports the following evaluation studies: 1) a technical evaluation of the device and all functionalities; 2) a users' behavior study; and 3) a variability study. The overall result was that all the participants were able to successfully operate the device with relative ease, thus showing a great adaptation as well as a high robustness and low variability of the system.

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“…electroencephalography (EEG) employing slow cortical potentials (Birbaumer et al, 1999;Karim et al, 2006;Kubler et al, 1999), brain oscillations (Pfurtscheller et al, 2000), or event-related potentials (Nijboer et al, 2008), 2. intracortical recordings (ICoR) using ensemble spiking activity (Hochberg et al, 2006), and 3. magnetoencephalography (MEG) through volitional modulation of micro-rhythm amplitudes (Buch et al, 2008).…”

Section: Patient Care and Treatmentmentioning

confidence: 99%

Another kind of ‘BOLD Response’: answering multiple-choice questions via online decoded single-trial brain signals

Sorger

Dahmen

Reithler

et al. 2009

Progress in Brain Research

111

101

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Abstract:The term 'locked-in' syndrome (LIS) describes a medical condition in which persons concerned are severely paralyzed and at the same time fully conscious and awake. The resulting anarthria makes it impossible for these patients to naturally communicate, which results in diagnostic as well as serious practical and ethical problems. Therefore, developing alternative, muscle-independent communication means is of prime importance. Such communication means can be realized via brain-computer interfaces (BCIs) circumventing the muscular system by using brain signals associated with preserved cognitive, sensory, and emotional brain functions. Primarily, BCIs based on electrophysiological measures have been developed and applied with remarkable success. Recently, also blood flow-based neuroimaging methods, such as functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS), have been explored in this context.After reviewing recent literature on the development of especially hemodynamically based BCIs, we introduce a highly reliable and easy-to-apply communication procedure that enables untrained participants to motor-independently and relatively effortlessly answer multiple-choice questions based on intentionally generated single-trial fMRI signals that can be decoded online. Our technique takes advantage of the participants' capability to voluntarily influence certain spatio-temporal aspects of the blood oxygenation level-dependent (BOLD) signal: source location (by using different mental tasks), signal onset and offset. We show that healthy participants are capable of hemodynamically encoding at least four distinct information units on a single-trial level without extensive pretraining and with little effort. Moreover, realtime data analysis based on simple multi-filter correlations allows for automated answer decoding with a high accuracy (94.9%) demonstrating the robustness of the presented method. Following our 'proof of concept', the next step will involve clinical trials with LIS patients, undertaken in close collaboration with their relatives and caretakers in order to elaborate individually tailored communication protocols.� Corresponding author. As our procedure can be easily transferred to MRI-equipped clinical sites, it may constitute a simple and effective possibility for online detection of residual consciousness and for LIS patients to communicate basic thoughts and needs in case no other alternative communication means are available (yet) -especially in the acute phase of the LIS. Future research may focus on further increasing the efficiency and accuracy of fMRI-based BCIs by implementing sophisticated data analysis methods (e.g., multivariate and independent component analysis) and neurofeedback training techniques. Finally, the presented BCI approach could be transferred to portable fNIRS systems as only this would enable hemodynamically based communication in daily life situations.

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Neural Internet: Web Surfing with Brain Potentials for the Completely Paralyzed

Cited by 99 publications

References 27 publications

Life can be worth living in locked-in syndrome

Life can be worth living in locked-in syndrome

A Noninvasive Brain-Actuated Wheelchair Based on a P300 Neurophysiological Protocol and Automated Navigation

Another kind of ‘BOLD Response’: answering multiple-choice questions via online decoded single-trial brain signals

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