Abstract
During the last years, several studies have suggested that Brain-Computer Interface (BCI) can play a critical role in the field of motor rehabilitation. In this case report, we aim to investigate the feasibility of a covert visuospatial attention (CVSA) driven BCI in three patients with left spatial neglect (SN). We hypothesize that such a BCI is able to detect attention task-specific brain patterns in SN patients and can induce significant changes in their abnormal cortical activity (α-power modulation, feature recruitment, and connectivity). The three patients were asked to control online a CVSA BCI by focusing their attention at different spatial locations, including their neglected (left) space. As primary outcome, results show a significant improvement of the reaction time in the neglected space between calibration and online modalities (p < 0.01) for the two out of three patients that had the slowest initial behavioral response. Such an evolution of reaction time negatively correlates (p < 0.05) with an increment of the Individual α-Power computed in the pre-cue interval. Furthermore, all patients exhibited a significant reduction of the inter-hemispheric imbalance (p < 0.05) over time in the parieto-occipital regions. Finally, analysis on the inter-hemispheric functional connectivity suggests an increment across modalities for regions in the affected (right) hemisphere and decrement for those in the healthy. Although preliminary, this feasibility study suggests a possible role of BCI in the therapeutic treatment of lateralized, attention-based visuospatial deficits.
Highlights
Spatial neglect (SN) is one of the most frequent and disabling neuropsychological syndromes following right-hemisphere damage (Heilman et al, 2003; Buxbaum et al, 2004; Adair and Barrett, 2008)
Patients’ Brain-Computer Interface (BCI) performance was low, it was above random for most sessions with an individual maximum accuracy of 76.6, 70, and 70% in their best runs. Such a level of BCI accuracy is similar to that achieved by stroke patients during BCI-based motor rehabilitation (Prasad et al, 2010; Ramos-Murguialday et al, 2013; Pichiorri et al, 2015)
To the best of our knowledge, for the first time cortical effects in EEG patterns have been monitored during online covert visuospatial attention (CVSA) BCI operations performed by spatial neglect (SN) patients
Summary
Spatial neglect (SN) is one of the most frequent and disabling neuropsychological syndromes following right-hemisphere damage (Heilman et al, 2003; Buxbaum et al, 2004; Adair and Barrett, 2008). Brain-Computer Interface in Spatial Neglect occurs in the majority of patients after stroke, SN might remain severe in the chronic phase, limiting considerably the effectiveness of rehabilitation interventions (Katz et al, 1999; Battelli et al, 2001; Jehkonen et al, 2006; Kerkhoff and Schenk, 2012; Bowen et al, 2013; Riestra and Barrett, 2013). It has been demonstrated that the normalization of the inter-hemispheric connectivity is a physiological signature of recovery from SN (Baldassarre et al, 2014; Ramsey et al, 2016)
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