TY - JOUR T1 - Transition from the locked in to the completely locked-in state: a physiological analysis. JF - Clin Neurophysiol Y1 - 2011 A1 - Murguialday, A Ramos A1 - Jeremy Jeremy Hill A1 - Bensch, M A1 - Martens, S M M A1 - S Halder A1 - Nijboer, F A1 - Schoelkopf, Bernhard A1 - Niels Birbaumer A1 - Gharabaghi, A KW - Adult KW - Amyotrophic Lateral Sclerosis KW - Area Under Curve KW - Brain KW - Communication Aids for Disabled KW - Disease Progression KW - Electroencephalography KW - Electromyography KW - Humans KW - Male KW - Signal Processing, Computer-Assisted KW - User-Computer Interface AB -

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.

VL - 122 UR - http://www.ncbi.nlm.nih.gov/pubmed/20888292 IS - 5 ER - TY - JOUR T1 - A P300-based brain-computer interface for people with amyotrophic lateral sclerosis. JF - Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology Y1 - 2008 A1 - Nijboer, F. A1 - Sellers, E. W. A1 - Mellinger, J. A1 - Jordan, M. A. A1 - Matuz, T. A1 - Adrian Furdea A1 - S Halder A1 - Mochty, U. A1 - Krusienski, D. J. A1 - Theresa M Vaughan A1 - Jonathan Wolpaw A1 - Niels Birbaumer A1 - Kübler, A. KW - Amyotrophic Lateral Sclerosis KW - brain-computer interface KW - electroencephalogram KW - event-related potentials KW - P300 KW - Rehabilitation AB - OBJECTIVE: The current study evaluates the efficacy of a P300-based brain-computer interface (BCI) communication device for individuals with advanced ALS. METHODS: Participants attended to one cell of a N x N matrix while the N rows and N columns flashed randomly. Each cell of the matrix contained one character. Every flash of an attended character served as a rare event in an oddball sequence and elicited a P300 response. Classification coefficients derived using a stepwise linear discriminant function were applied to the data after each set of flashes. The character receiving the highest discriminant score was presented as feedback. RESULTS: In Phase I, six participants used a 6 x 6 matrix on 12 separate days with a mean rate of 1.2 selections/min and mean online and offline accuracies of 62% and 82%, respectively. In Phase II, four participants used either a 6 x 6 or a 7 x 7 matrix to produce novel and spontaneous statements with a mean online rate of 2.1 selections/min and online accuracy of 79%. The amplitude and latency of the P300 remained stable over 40 weeks. CONCLUSIONS: Participants could communicate with the P300-based BCI and performance was stable over many months. SIGNIFICANCE: BCIs could provide an alternative communication and control technology in the daily lives of people severely disabled by ALS. VL - 119 UR - http://www.ncbi.nlm.nih.gov/pubmed/18571984 ER -