Why BCIs work poorly with the patients who need them the most?

Séguin, P.; Maby, Emmanuel; Mattout, Jérémie

doi:10.3217/978-3-85125-682-6-48

Cited by 2 publications

(2 citation statements)

References 75 publications

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“…First, the quality of the signal is, on average, lower in patients (due to several factors: mechanical ventilation, erratic muscle activity, electrical interference due to hospital beds, etc.). Second, there is more and more evidence that motor impairments come with cognitive impairments, whatever the etiology [30]. In this context, it might be that our paradigm is cognitively too demanding for the patients: binaural listening requires not only focusing on the “ATTENDED” stream, but also inhibiting the “IGNORED” one.…”

Section: Discussionmentioning

confidence: 99%

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The challenge of controlling an auditory BCI in the case of severe motor disability

Séguin

Maby

Fouillen

et al. 2023

Preprint

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Background: The locked-in syndrome (LIS), due to a lesion in the pons, impedes communication. This situation can also be met after some severe brain injury or in advanced Amyotrophic Lateral Sclerosis (ALS). In the most severe condition, the persons cannot communicate at all because of a complete oculomotor paralysis (Complete LIS or CLIS). This even prevents the detection of consciousness. Some studies suggest that auditory brain-computer interface (BCI) could restore a communication through a yes-no code. Methods: We developed an auditory EEG-based interface which makes use of voluntary modulations of attention, to restore a yes-no communication code in non-responding persons. This binary BCI uses repeated speech sounds (alternating "yes" on the right ear and "no" on the left ear) corresponding to either frequent (short) or rare (long) stimuli. Users are instructed to pay attention to the relevant stimuli only. We tested this BCI with 18 healthy subjects, and 7 people with severe motor disability (3 "classical" persons with locked-in syndrome and 4 persons with ALS). Results: We report online BCI performance and offline event-related potential analysis. On average in healthy subjects, online BCI accuracy reached 86% based on 50 questions. Only one out of 18 subjects could not perform above chance level. Ten subjects had an accuracy above 90%. However, most patients could not produce online performance above chance level, except for two people with ALS who obtained 100% accuracy. We report individual event-related potentials and their modulation by attention. In addition to the classical P3b, we observed a signature of sustained attention on responses to frequent sounds, but in healthy subjects and patients with good BCI control only. Conclusions: Auditory BCI can be very well controlled by healthy subjects, but it is not a guarantee that it can be readily used by the target population of persons in LIS or CLIS. A conclusion that is supported by a few previous findings in BCI and should now trigger research to assess the reasons of such a gap in order to propose new and efficient solutions.

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Section: Discussionmentioning

confidence: 99%

“…It seems difficult to further simplify the protocol given the intrinsic and technical limitations of EEG [30]. However, one possibly useful change to be tested would be to no longer present the “yes” and “no” streams concurrently, but alternately in the form of short separate blocks.…”

Section: Discussionmentioning

confidence: 99%

The challenge of controlling an auditory BCI in the case of severe motor disability

Séguin

Maby

Fouillen

et al. 2023

Preprint

View full text Add to dashboard Cite

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The challenge of controlling an auditory BCI in the case of severe motor disability

Séguin,

Maby,

Fouillen

et al. 2024

J NeuroEngineering Rehabil

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Background The locked-in syndrome (LIS), due to a lesion in the pons, impedes communication. This situation can also be met after some severe brain injury or in advanced Amyotrophic Lateral Sclerosis (ALS). In the most severe condition, the persons cannot communicate at all because of a complete oculomotor paralysis (Complete LIS or CLIS). This even prevents the detection of consciousness. Some studies suggest that auditory brain–computer interface (BCI) could restore a communication through a « yes–no» code. Methods We developed an auditory EEG-based interface which makes use of voluntary modulations of attention, to restore a yes–no communication code in non-responding persons. This binary BCI uses repeated speech sounds (alternating “yes” on the right ear and “no” on the left ear) corresponding to either frequent (short) or rare (long) stimuli. Users are instructed to pay attention to the relevant stimuli only. We tested this BCI with 18 healthy subjects, and 7 people with severe motor disability (3 “classical” persons with locked-in syndrome and 4 persons with ALS). Results We report online BCI performance and offline event-related potential analysis. On average in healthy subjects, online BCI accuracy reached 86% based on 50 questions. Only one out of 18 subjects could not perform above chance level. Ten subjects had an accuracy above 90%. However, most patients could not produce online performance above chance level, except for two people with ALS who obtained 100% accuracy. We report individual event-related potentials and their modulation by attention. In addition to the classical P3b, we observed a signature of sustained attention on responses to frequent sounds, but in healthy subjects and patients with good BCI control only. Conclusions Auditory BCI can be very well controlled by healthy subjects, but it is not a guarantee that it can be readily used by the target population of persons in LIS or CLIS. A conclusion that is supported by a few previous findings in BCI and should now trigger research to assess the reasons of such a gap in order to propose new and efficient solutions. Clinical trial registrations: No. NCT02567201 (2015) and NCT03233282 (2013).

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Why BCIs work poorly with the patients who need them the most?

Cited by 2 publications

References 75 publications

The challenge of controlling an auditory BCI in the case of severe motor disability

The challenge of controlling an auditory BCI in the case of severe motor disability

The challenge of controlling an auditory BCI in the case of severe motor disability

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