%0 Journal Article %J Clin Neurophysiol %D 2011 %T Transition from the locked in to the completely locked-in state: a physiological analysis. %A Murguialday, A Ramos %A Jeremy Jeremy Hill %A Bensch, M %A Martens, S M M %A S Halder %A Nijboer, F %A Schoelkopf, Bernhard %A Niels Birbaumer %A Gharabaghi, A %K Adult %K Amyotrophic Lateral Sclerosis %K Area Under Curve %K Brain %K Communication Aids for Disabled %K Disease Progression %K Electroencephalography %K Electromyography %K Humans %K Male %K Signal Processing, Computer-Assisted %K User-Computer Interface %X

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.

%B Clin Neurophysiol %V 122 %P 925-33 %8 06/2011 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/20888292 %N 5 %R 10.1016/j.clinph.2010.08.019 %0 Journal Article %J Neural Netw %D 2009 %T A note on ethical aspects of BCI. %A Haselager, Pim %A Vlek, Rutger %A Jeremy Jeremy Hill %A Nijboer, F %K Bioethics %K Brain %K Communication %K Communications Media %K Cooperative Behavior %K Humans %K Informed Consent %K Professional-Patient Relations %K Quadriplegia %K User-Computer Interface %X

This paper focuses on ethical aspects of BCI, as a research and a clinical tool, that are challenging for practitioners currently working in the field. Specifically, the difficulties involved in acquiring informed consent from locked-in patients are investigated, in combination with an analysis of the shared moral responsibility in BCI teams, and the complications encountered in establishing effective communication with media.

%B Neural Netw %V 22 %P 1352-7 %8 11/2009 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/19616405 %N 9 %R 10.1016/j.neunet.2009.06.046 %0 Book Section %D 2007 %T Brain Computer Interfaces for Communication in Paralysis: a Clinical-Experimental Approach. %A Hinterberger, T. %A Nijboer, F %A Kübler, A. %A Matuz, T. %A Adrian Furdea %A Mochty, Ursula %A Jordan, M. %A Lal, T.N %A Jeremy Jeremy Hill %A Mellinger, Jürgen %A Bensch, M %A Tangermann, Michael %A Widmann, G. %A Elger, Christian %A Rosenstiel, W. %A Schölkopf, B %A Niels Birbaumer %K brain-computer interfaces %K EEG %K experiment %K Medical sciences Medicine %K paralyzed patients %K slow cortical potentials %K Thought-Translation Device %X

An overview of different approaches to brain-computer interfaces (BCIs) developed in our laboratory is given. An important clinical application of BCIs is to enable communication or environmental control in severely paralyzed patients. The BCI “Thought-Translation Device (TTD)” allows verbal communication through the voluntary self-regulation of brain signals (e.g., slow cortical potentials (SCPs)), which is achieved by operant feedback training. Humans' ability to self-regulate their SCPs is used to move a cursor toward a target that contains a selectable letter set. Two different approaches were followed to developWeb browsers that could be controlled with binary brain responses. Implementing more powerful classification methods including different signal parameters such as oscillatory features improved our BCI considerably. It was also tested on signals with implanted electrodes. Most BCIs provide the user with a visual feedback interface. Visually impaired patients require an auditory feedback mode. A procedure using auditory (sonified) feedback of multiple EEG parameters was evaluated. Properties of the auditory systems are reported and the results of two experiments with auditory feedback are presented. Clinical data of eight ALS patients demonstrated that all patients were able to acquire efficient brain control of one of the three available BCI systems (SCP, µ-rhythm, and P300), most of them used the SCP-BCI. A controlled comparison of the three systems in a group of ALS patients, however, showed that P300-BCI and the µ-BCI are faster and more easily acquired than SCP-BCI, at least in patients with some rudimentary motor control left. Six patients who started BCI training after entering the completely locked-in state did not achieve reliable communication skills with any BCI system. One completely locked-in patient was able t o communicate shortly with a ph-meter, but lost control afterward.

%I Virtual Library of Psychology at Saarland University and State Library, GERMANY, PsyDok [http://psydok.sulb.uni-saarland.de/phpoai/oai2.php] (Germany) %@ 9780262256049 %G eng %U http://psydok.sulb.uni-saarland.de/volltexte/2008/2154/ %0 Journal Article %J IEEE Trans Neural Syst Rehabil Eng %D 2006 %T Classifying EEG and ECoG signals without subject training for fast BCI implementation: comparison of nonparalyzed and completely paralyzed subjects. %A Jeremy Jeremy Hill %A Lal, T.N %A Schröder, Michael %A Hinterberger, T. %A Wilhelm, Barbara %A Nijboer, F %A Mochty, Ursula %A Widman, Guido %A Elger, Christian %A Schölkopf, B %A Kübler, A. %A Niels Birbaumer %K Algorithms %K Artificial Intelligence %K Cluster Analysis %K Computer User Training %K Electroencephalography %K Evoked Potentials %K Female %K Humans %K Imagination %K Male %K Middle Aged %K Paralysis %K Pattern Recognition, Automated %K User-Computer Interface %X

We summarize results from a series of related studies that aim to develop a motor-imagery-based brain-computer interface using a single recording session of electroencephalogram (EEG) or electrocorticogram (ECoG) signals for each subject. We apply the same experimental and analytical methods to 11 nonparalysed subjects (eight EEG, three ECoG), and to five paralyzed subjects (four EEG, one ECoG) who had been unable to communicate for some time. While it was relatively easy to obtain classifiable signals quickly from most of the nonparalyzed subjects, it proved impossible to classify the signals obtained from the paralyzed patients by the same methods. This highlights the fact that though certain BCI paradigms may work well with healthy subjects, this does not necessarily indicate success with the target user group. We outline possible reasons for this failure to transfer.

%B IEEE Trans Neural Syst Rehabil Eng %V 14 %P 183-6 %8 06/2006 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/16792289 %N 2 %R 10.1109/TNSRE.2006.875548 %0 Journal Article %J Neurology %D 2005 %T Patients with ALS can use sensorimotor rhythms to operate a brain-computer interface. %A Kübler, A. %A Nijboer, F %A Mellinger, Jürgen %A Theresa M Vaughan %A Pawelzik, H %A Gerwin Schalk %A Dennis J. McFarland %A Niels Birbaumer %A Jonathan Wolpaw %K Aged %K Amyotrophic Lateral Sclerosis %K Electroencephalography %K Evoked Potentials, Motor %K Evoked Potentials, Somatosensory %K Female %K Humans %K Imagination %K Male %K Middle Aged %K Motor Cortex %K Movement %K Paralysis %K Photic Stimulation %K Prostheses and Implants %K Somatosensory Cortex %K Treatment Outcome %K User-Computer Interface %X

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.

%B Neurology %V 64 %P 1775-7 %8 05/2005 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/15911809 %N 10 %R 10.1212/01.WNL.0000158616.43002.6D %0 Journal Article %J Biomedizinische Technik %D 2004 %T P300 for communication: Evidence from patients with amyotrophic lateral sclerosis (ALS). %A Mellinger, Jürgen %A Nijboer, F %A Pawelzik, H %A Gerwin Schalk %A Dennis J. McFarland %A Theresa M Vaughan %A Jonathan Wolpaw %A Niels Birbaumer %A Kuebler, A. %B Biomedizinische Technik %G eng