02575nas a2200289   4500008004100000022001400041245014200055210006900197260001200266300001400278490000800292520157400300653003401874653003001908653002701938653001101965653002201976653001101998100002802009700001602037700002502053700002102078700002102099700002402120700002402144856011702168       2023                        eng d  a1432-145900aTowards clinical application of implantable brain-computer interfaces for people with late-stage ALS: medical and ethical considerations.0 aTowards clinical application of implantable braincomputer interf  c03/2023  a1323-13360 v2703 a<p>Individuals with amyotrophic lateral sclerosis (ALS) frequently develop speech and communication problems in the course of their disease. Currently available augmentative and alternative communication technologies do not present a solution for many people with advanced ALS, because these devices depend on residual and reliable motor activity. Brain-computer interfaces (BCIs) use neural signals for computer control and may allow people with late-stage ALS to communicate even when conventional technology falls short. Recent years have witnessed fast progression in the development and validation of implanted BCIs, which place neural signal recording electrodes in or on the cortex. Eventual widespread clinical application of implanted BCIs as an assistive communication technology for people with ALS will have significant consequences for their daily life, as well as for the clinical management of the disease, among others because of the potential interaction between the BCI and other procedures people with ALS undergo, such as tracheostomy. This article aims to facilitate responsible real-world implementation of implanted BCIs. We review the state of the art of research on implanted BCIs for communication, as well as the medical and ethical implications of the clinical application of this technology. We conclude that the contribution of all BCI stakeholders, including clinicians of the various ALS-related disciplines, will be needed to develop procedures for, and shape the process of, the responsible clinical application of implanted BCIs.</p>10aAmyotrophic Lateral Sclerosis10abrain-computer interfaces10aElectroencephalography10aHumans10aSelf-Help Devices10aSpeech1 aVansteensel, Mariska, J1 aKlein, Eran1 avan Thiel, Ghislaine1 aGaytant, Michael1 aSimmons, Zachary1 aWolpaw, Jonathan, R1 aVaughan, Theresa, M  uhttps://neurotechcenter.org/publications/2023/towards-clinical-application-implantable-brain-computer-interfaces02232nas a2200157   4500008004100000245007600041210006900117260001200186490000800198520166900206653003401875653004701909653002701956100001601983856007501999       2020                        eng d00aBrain-computer interfaces for people with amyotrophic lateral sclerosis0 aBraincomputer interfaces for people with amyotrophic lateral scl  c03/20200 v1683 aA brain-computer interface (BCI) records and extracts features from brain signals, and translates these features into commands that can replace, restore, enhance, supplement, or improve natural CNS outputs. As demonstrated in the other chapters of this book, the focus of the work of the last three decades of BCI research has been the replacement, restoration, or improvement of diminished or lost function in people with CNS disease or injury including those with amyotrophic lateral sclerosis (ALS). Due in part to the desire to conduct controlled studies, and, in part, to the complexity of BCI technology, most of this work has been carried out in laboratories with healthy controls or with limited numbers of potential consumers with a variety of diagnoses under supervised conditions.

The intention of this chapter is to describe the growing body of BCI research that has included people with amyotrophic lateral sclerosis (ALS). People in the late stages of ALS can lose all voluntary control, including the ability to communicate; and while recent research has provided new insights into underlying mechanisms, ALS remains a disease with no cure. As a result, people with ALS and their families, caregivers, and advocates have an active interest in both the current and potential capabilities of BCI technology. The focus of BCI research for people with ALS is on communication, and this topic is well covered elsewhere in this volume. This chapter focuses on the efforts dedicated to make BCI technology useful to people with ALS in their daily lives with a discussion of how researchers, clinicians, and patients must become partners in that process.10aAmyotrophic Lateral Sclerosis10aAugmentative and alternative communication10aElectroencephalography1 aVaughan, T.  uhttps://www.sciencedirect.com/science/article/pii/B978044463934900004402865nas a2200301   4500008004100000022001400041245009000055210006900145260001200214300001400226490000700240520184800247653003402095653003002129653001802159653002702177653001102204653003202215100002902247700001902276700002602295700002502321700003202346700002502378700002102403700002102424856011802445       2020                        eng d  a1558-021000aEnhancing Communication for People in Late-Stage ALS Using an fNIRS-Based BCI System.0 aEnhancing Communication for People in LateStage ALS Using an fNI  c05/2020  a1198-12070 v283 a<p><b>OBJECTIVE: </b>Brain-computer interface (BCI) based communication remains a challenge for people with later-stage amyotrophic lateral sclerosis (ALS) who lose all voluntary muscle control. Although recent studies have demonstrated the feasibility of functional near-infrared spectroscopy (fNIRS) to successfully control BCIs primarily for healthy cohorts, these systems are yet inefficient for people with severe motor disabilities like ALS. In this study, we developed a new fNIRS-based BCI system in concert with a single-trial Visuo-Mental (VM) paradigm to investigate the feasibility of enhanced communication for ALS patients, particularly those in the later stages of the disease.</p><p><b>METHODS: </b>In the first part of the study, we recorded data from six ALS patients using our proposed protocol (fNIRS-VM) and compared the results with the conventional electroencephalography (EEG)-based multi-trial P3Speller (P3S). In the second part, we recorded longitudinal data from one patient in the late locked-in state (LIS) who had fully lost eye-gaze control. Using statistical parametric mapping (SPM) and correlation analysis, the optimal channels and hemodynamic features were selected and used in linear discriminant analysis (LDA).</p><p><b>RESULTS: </b>Over all the subjects, we obtained an average accuracy of 81.3%±5.7% within comparatively short times (< 4 sec) in the fNIRS-VM protocol relative to an average accuracy of 74.0%±8.9% in the P3S, though not competitive in patients with no substantial visual problems. Our longitudinal analysis showed substantially superior accuracy using the proposed fNIRS-VM protocol (73.2%±2.0%) over the P3S (61.8%±1.5%).</p><p><b>SIGNIFICANCE: </b>Our findings indicate the potential efficacy of our proposed system for communication and control for late-stage ALS patients.</p>10aAmyotrophic Lateral Sclerosis10abrain-computer interfaces10aCommunication10aElectroencephalography10aHumans10aSpectroscopy, Near-Infrared1 aBorgheai, Seyyed, Bahram1 aMcLinden, John1 aZisk, Alyssa, Hillary1 aHosni, Sarah, Ismail1 aDeligani, Roohollah, Jafari1 aAbtahi, Mohammadreza1 aMankodiya, Kunal1 aShahriari, Yalda  uhttps://neurotechcenter.org/publications/2020/enhancing-communication-people-late-stage-als-using-fnirs-based-bci02595nas a2200421   4500008004100000022001400041245009200055210006900147260001200216300001100228490000700239520137400246653001001620653000901630653003401639653002801673653003001701653002801731653002701759653003501786653001101821653001101832653000901843653001601852653001901868653002301887653002801910653001801938100002001956700002101976700002601997700001902023700001902042700001902061700002102080700002402101856004802125       2014                        eng d  a2167-922300aBrain-computer interface (BCI) evaluation in people with amyotrophic lateral sclerosis.0 aBraincomputer interface BCI evaluation in people with amyotrophi  c06/2014  a207-150 v153 aBrain-computer interfaces (BCIs) might restore communication to people severely disabled by amyotrophic lateral sclerosis (ALS) or other disorders. We sought to: 1) define a protocol for determining whether a person with ALS can use a visual P300-based BCI; 2) determine what proportion of this population can use the BCI; and 3) identify factors affecting BCI performance. Twenty-five individuals with ALS completed an evaluation protocol using a standard 6 × 6 matrix and parameters selected by stepwise linear discrimination. With an 8-channel EEG montage, the subjects fell into two groups in BCI accuracy (chance accuracy 3%). Seventeen averaged 92 (± 3)% (range 71-100%), which is adequate for communication (G70 group). Eight averaged 12 (± 6)% (range 0-36%), inadequate for communication (L40 subject group). Performance did not correlate with disability: 11/17 (65%) of G70 subjects were severely disabled (i.e. ALSFRS-R < 5). All L40 subjects had visual impairments (e.g. nystagmus, diplopia, ptosis). P300 was larger and more anterior in G70 subjects. A 16-channel montage did not significantly improve accuracy. In conclusion, most people severely disabled by ALS could use a visual P300-based BCI for communication. In those who could not, visual impairment was the principal obstacle. For these individuals, auditory P300-based BCIs might be effective.10aAdult10aAged10aAmyotrophic Lateral Sclerosis10aBiofeedback, Psychology10abrain-computer interfaces10aCommunication Disorders10aElectroencephalography10aEvent-Related Potentials, P30010aFemale10aHumans10aMale10aMiddle Aged10aOnline Systems10aPhotic Stimulation10aPsychomotor Performance10aReaction Time1 aMcCane, Lynn, M1 aSellers, Eric, W1 aMcFarland, Dennis, J.1 aMak, Joseph, N1 aCarmack, Steve1 aZeitlin, Debra1 aWolpaw, Jonathan1 aVaughan, Theresa, M  uhttp://www.ncbi.nlm.nih.gov/pubmed/2455584304388nas a2200385   4500008004100000022001400041245009500055210006900150260001200219300001100231490000800242520325500250653001003505653003403515653002103549653001003570653003603580653002403616653002703640653002103667653001103688653000903699653004103708653002803749100002603777700002503803700001403828700001903842700001403861700001503875700002503890700002103915700001803936856004803954       2011                        eng d  a1872-895200aTransition from the locked in to the completely locked-in state: a physiological analysis.0 aTransition from the locked in to the completely lockedin state a  c06/2011  a925-330 v1223 a<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17px;">OBJECTIVE:&nbsp;</h4>
<p style="margin: 0px 0px 0.5em; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">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&nbsp;<span class="highlight">brain-computer-interface</span>&nbsp;(<span class="highlight">BCI</span>) communication.</p>
<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17px;">METHODS:&nbsp;</h4>
<p style="margin: 0px 0px 0.5em; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">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.</p>
<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17px;">RESULTS:&nbsp;</h4>
<p style="margin: 0px 0px 0.5em; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">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&nbsp;<span class="highlight">brain</span>potentials (ERP) to passive limb movements and auditory stimuli were recorded, vibrotactile stimulation of different body parts resulted in no ERP response.</p>
<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17px;">CONCLUSIONS:&nbsp;</h4>
<p style="margin: 0px 0px 0.5em; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">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.</p>
<h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif; line-height: 17px;">SIGNIFICANCE:&nbsp;</h4>
<p style="margin: 0px 0px 0.5em; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">Auditory and proprioceptive&nbsp;<span class="highlight">brain-computer-interface</span>&nbsp;(<span class="highlight">BCI</span>) systems are the only remaining communication channels in CLIS.</p>10aAdult10aAmyotrophic Lateral Sclerosis10aArea Under Curve10aBrain10aCommunication Aids for Disabled10aDisease Progression10aElectroencephalography10aElectromyography10aHumans10aMale10aSignal Processing, Computer-Assisted10aUser-Computer Interface1 aMurguialday, Ramos, A1 aHill, Jeremy, Jeremy1 aBensch, M1 aMartens, S M M1 aHalder, S1 aNijboer, F1 aSchoelkopf, Bernhard1 aBirbaumer, Niels1 aGharabaghi, A  uhttp://www.ncbi.nlm.nih.gov/pubmed/2088829202392nas a2200361   4500008004100000022001400041245008900055210006900144260001200213300001600225490000800241520135100249653003401600653002901634653002501663653002901688653000901717653001901726100001601745700002001761700001701781700001901798700001301817700001901830700001401849700001501863700002301878700002401901700002101925700002101946700001501967856004801982       2008                        eng d  a1388-245700aA P300-based brain-computer interface for people with amyotrophic lateral sclerosis.0 aP300based braincomputer interface for people with amyotrophic la  c08/2008  a1909–19160 v1193 aOBJECTIVE:
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.10aAmyotrophic Lateral Sclerosis10abrain-computer interface10aelectroencephalogram10aevent-related potentials10aP30010aRehabilitation1 aNijboer, F.1 aSellers, E., W.1 aMellinger, J1 aJordan, M., A.1 aMatuz, T1 aFurdea, Adrian1 aHalder, S1 aMochty, U.1 aKrusienski, D., J.1 aVaughan, Theresa, M1 aWolpaw, Jonathan1 aBirbaumer, Niels1 aKübler, A  uhttp://www.ncbi.nlm.nih.gov/pubmed/1857198402016nas a2200265   4500008004100000022001400041245013800055210006900193260001200262300001400274490000700288520114400295653003401439653002901473653002501502653002901527653000901556653001901565100002201584700002501606700002601631700002401657700002101681856004801702       2006                        eng d  a0301-051100aA P300 event-related potential brain-computer interface (BCI): the effects of matrix size and inter stimulus interval on performance.0 aP300 eventrelated potential braincomputer interface BCI the effe  c10/2006  a242–2520 v733 aWe describe a study designed to assess properties of a P300 brain-computer interface (BCI). The BCI presents the user with a matrix containing letters and numbers. The user attends to a character to be communicated and the rows and columns of the matrix briefly intensify. Each time the attended character is intensified it serves as a rare event in an oddball sequence and it elicits a P300 response. The BCI works by detecting which character elicited a P300 response. We manipulated the size of the character matrix (either 3 x 3 or 6 x 6) and the duration of the inter stimulus interval (ISI) between intensifications (either 175 or 350 ms). Online accuracy was highest for the 3 x 3 matrix 175-ms ISI condition, while bit rate was highest for the 6 x 6 matrix 175-ms ISI condition. Average accuracy in the best condition for each subject was 88%. P300 amplitude was significantly greater for the attended stimulus and for the 6 x 6 matrix. This work demonstrates that matrix size and ISI are important variables to consider when optimizing a BCI system for individual users and that a P300-BCI can be used for effective communication.10aAmyotrophic Lateral Sclerosis10abrain-computer interface10aelectroencephalogram10aevent-related potentials10aP30010aRehabilitation1 aSellers, Eric, W.1 aKrusienski, Dean, J.1 aMcFarland, Dennis, J.1 aVaughan, Theresa, M1 aWolpaw, Jonathan  uhttp://www.ncbi.nlm.nih.gov/pubmed/1686092002332nas a2200457   4500008004100000022001400041245009000055210006900145260001200214300001100226490000700237520103300244653000901277653003401286653002701320653002901347653003701376653001101413653001101424653001601435653000901451653001601460653001701476653001301493653001401506653002301520653002801543653002501571653002201596653002801618100001501646700001501661700002301676700002401699700001601723700001901739700002601758700002101784700002101805856004801826       2005                        eng d  a1526-632X00aPatients with ALS can use sensorimotor rhythms to operate a brain-computer interface.0 aPatients with ALS can use sensorimotor rhythms to operate a brai  c05/2005  a1775-70 v643 a<p><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">People with severe motor disabilities can maintain an acceptable quality of life if they can communicate.&nbsp;</span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">Brain-computer interfaces</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">&nbsp;(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-</span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">based</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">&nbsp;BCI could help maintain quality of life for people with ALS.</span></p>10aAged10aAmyotrophic Lateral Sclerosis10aElectroencephalography10aEvoked Potentials, Motor10aEvoked Potentials, Somatosensory10aFemale10aHumans10aImagination10aMale10aMiddle Aged10aMotor Cortex10aMovement10aParalysis10aPhotic Stimulation10aProstheses and Implants10aSomatosensory Cortex10aTreatment Outcome10aUser-Computer Interface1 aKübler, A1 aNijboer, F1 aMellinger, Jürgen1 aVaughan, Theresa, M1 aPawelzik, H1 aSchalk, Gerwin1 aMcFarland, Dennis, J.1 aBirbaumer, Niels1 aWolpaw, Jonathan  uhttp://www.ncbi.nlm.nih.gov/pubmed/1591180902756nas a2200433   4500008004100000022001400041245011000055210006900165260001200234300001200246490000700258520140000265653001001665653001501675653003401690653002801724653001001752653001401762653002301776653002701799653002201826653001101848653003101859653003201890653002801922100002401950700002601974700001902000700002402019700001902043700002102062700002002083700002002103700002402123700002002147700002302167700002102190856011102211       2004                        eng d  a0018-929400aThe BCI Competition 2003: Progress and perspectives in detection and discrimination of EEG single trials.0 aBCI Competition 2003 Progress and perspectives in detection and   c06/2004  a1044-510 v513 aInterest in developing a new method of man-to-machine communication--a brain-computer interface (BCI)--has grown steadily over the past few decades. BCIs create a new communication channel between the brain and an output device by bypassing conventional motor output pathways of nerves and muscles. These systems use signals recorded from the scalp, the surface of the cortex, or from inside the brain to enable users to control a variety of applications including simple word-processing software and orthotics. BCI technology could therefore provide a new communication and control option for individuals who cannot otherwise express their wishes to the outside world. Signal processing and classification methods are essential tools in the development of improved BCI technology. We organized the BCI Competition 2003 to evaluate the current state of the art of these tools. Four laboratories well versed in EEG-based BCI research provided six data sets in a documented format. We made these data sets (i.e., labeled training sets and unlabeled test sets) and their descriptions available on the Internet. The goal in the competition was to maximize the performance measure for the test labels. Researchers worldwide tested their algorithms and competed for the best classification results. This paper describes the six data sets and the results and function of the most successful algorithms.10aAdult10aAlgorithms10aAmyotrophic Lateral Sclerosis10aArtificial Intelligence10aBrain10aCognition10aDatabases, Factual10aElectroencephalography10aEvoked Potentials10aHumans10aReproducibility of Results10aSensitivity and Specificity10aUser-Computer Interface1 aBlankertz, Benjamin1 aMüller, Klaus-Robert1 aCurio, Gabriel1 aVaughan, Theresa, M1 aSchalk, Gerwin1 aWolpaw, Jonathan1 aSchlögl, Alois1 aNeuper, Christa1 aPfurtscheller, Gert1 aHinterberger, T1 aSchröder, Michael1 aBirbaumer, Niels  uhttps://neurotechcenter.org/publications/2004/bci-competition-2003-progress-and-perspectives-detection-and