@article {2131, title = {Transition from the locked in to the completely locked-in state: a physiological analysis.}, journal = {Clin Neurophysiol}, volume = {122}, year = {2011}, month = {06/2011}, pages = {925-33}, abstract = {

OBJECTIVE:\ 

To clarify the physiological and behavioral boundaries between locked-in (LIS) and the completely locked-in state (CLIS) (no voluntary eye movements, no communication possible) through electrophysiological data and to secure\ brain-computer-interface\ (BCI) communication.

METHODS:\ 

Electromyography from facial muscles, external anal sphincter (EAS), electrooculography and electrocorticographic data during different psychophysiological tests were acquired to define electrophysiological differences in an amyotrophic lateral sclerosis (ALS) patient with an intracranially implanted grid of 112 electrodes for nine months while the patient passed from the LIS to the CLIS.

RESULTS:\ 

At the very end of the LIS there was no facial muscle activity, nor external anal sphincter but eye control. Eye movements were slow and lasted for short periods only. During CLIS event related\ brainpotentials (ERP) to passive limb movements and auditory stimuli were recorded, vibrotactile stimulation of different body parts resulted in no ERP response.

CONCLUSIONS:\ 

The results presented contradict the commonly accepted assumption that the EAS is the last remaining muscle under voluntary control and demonstrate complete loss of eye movements in CLIS. The eye muscle was shown to be the last muscle group under voluntary control. The findings suggest ALS as a multisystem disorder, even affecting afferent sensory pathways.

SIGNIFICANCE:\ 

Auditory and proprioceptive\ brain-computer-interface\ (BCI) systems are the only remaining communication channels in CLIS.

}, keywords = {Adult, Amyotrophic Lateral Sclerosis, Area Under Curve, Brain, Communication Aids for Disabled, Disease Progression, Electroencephalography, Electromyography, Humans, Male, Signal Processing, Computer-Assisted, User-Computer Interface}, issn = {1872-8952}, doi = {10.1016/j.clinph.2010.08.019}, url = {http://www.ncbi.nlm.nih.gov/pubmed/20888292}, author = {Murguialday, A Ramos and Jeremy Jeremy Hill and Bensch, M and Martens, S M M and S Halder and Nijboer, F and Schoelkopf, Bernhard and Niels Birbaumer and Gharabaghi, A} } @article {2169, title = {Patients with ALS can use sensorimotor rhythms to operate a brain-computer interface.}, journal = {Neurology}, volume = {64}, year = {2005}, month = {05/2005}, pages = {1775-7}, abstract = {

People with severe motor disabilities can maintain an acceptable quality of life if they can communicate.\ Brain-computer interfaces\ (BCIs), which do not depend on muscle control, can provide communication. Four people severely disabled by ALS learned to operate a BCI with EEG rhythms recorded over sensorimotor cortex. These results suggest that a sensorimotor rhythm-based\ BCI could help maintain quality of life for people with ALS.

}, keywords = {Aged, Amyotrophic Lateral Sclerosis, Electroencephalography, Evoked Potentials, Motor, Evoked Potentials, Somatosensory, Female, Humans, Imagination, Male, Middle Aged, Motor Cortex, Movement, Paralysis, Photic Stimulation, Prostheses and Implants, Somatosensory Cortex, Treatment Outcome, User-Computer Interface}, issn = {1526-632X}, doi = {10.1212/01.WNL.0000158616.43002.6D}, url = {http://www.ncbi.nlm.nih.gov/pubmed/15911809}, author = {K{\"u}bler, A. and Nijboer, F and Mellinger, J{\"u}rgen and Theresa M Vaughan and Pawelzik, H and Gerwin Schalk and Dennis J. McFarland and Niels Birbaumer and Jonathan Wolpaw} }