Patients In Locked-in State Research Articles

Bioelectricity Buzz.

Bioelectricity Buzz.

A dataset of EEG and EOG from an auditory EOG-based communication system for patients in locked-in state

The dataset presented here contains recordings of electroencephalogram (EEG) and electrooculogram (EOG) from four advanced locked-in state (LIS) patients suffering from ALS (amyotrophic lateral sclerosis). These patients could no longer use commercial eye-trackers, but they could still move their eyes and used the remnant oculomotor activity to select letters to form words and sentences using a novel auditory communication system. Data were recorded from four patients during a variable range of visits (from 2 to 10), each visit comprised of 3.22 ± 1.21 days and consisted of 5.57 ± 2.61 sessions recorded per day. The patients performed a succession of different sessions, namely, Training, Feedback, Copy spelling, and Free spelling. The dataset provides an insight into the progression of ALS and presents a valuable opportunity to design and improve assistive and alternative communication technologies and brain-computer interfaces. It might also help redefine the course of progression in ALS, thereby improving clinical judgement and treatment.

EEG power spectral density in locked-in and completely locked-in state patients: a longitudinal study

Persons with their eye closed and without any means of communication is said to be in a completely locked-in state (CLIS) while when they could still open their eyes actively or passively and have some means of communication are said to be in locked-in state (LIS). Two patients in CLIS without any means of communication, and one patient in the transition from LIS to CLIS with means of communication, who have Amyotrophic Lateral Sclerosis were followed at a regular interval for more than 1 year. During each visit, resting-state EEG was recorded before the brain–computer interface (BCI) based communication sessions. The resting-state EEG of the patients was analyzed to elucidate the evolution of their EEG spectrum over time with the disease’s progression to provide future BCI-research with the relevant information to classify changes in EEG evolution. Comparison of power spectral density (PSD) of these patients revealed a significant difference in the PSD’s of patients in CLIS without any means of communication and the patient in the transition from LIS to CLIS with means of communication. The EEG of patients without any means of communication is devoid of alpha, beta, and higher frequencies than the patient in transition who still had means of communication. The results show that the change in the EEG frequency spectrum may serve as an indicator of the communication ability of such patients.

A Dataset of EEG and EOG recordings from an Auditory EOG-based Communication System for Patients in Locked-In State

A Dataset of EEG and EOG recordings from an Auditory EOG-based Communication System for Patients in Locked-In State

Editors' note: An observational study on quality of life and preferences to sustain life in locked-in state

It is well-established that for many patients with chronic neurologic conditions—even in patients in a locked-in state (LIS)—they may experience a good personal quality of life. In their retrospective cohort of 19 patients with amyotrophic lateral sclerosis (ALS) in LIS; Drs. Kuzma-Kozakiewicz et al. corroborated previous findings that most patients in LIS are generally satisfied with their quality of life and do not wish for a hastened death. This study may have been subject to selection bias given the low response rate (76% of caregivers who were contacted did not respond or chose not to participate), but the results add to our understanding of despondency in LIS among patients with ALS. In response, Drs. Hermann and Aust comment on the importance of the caregiver and next of kin perspective. Although data from this study and others indicate caregivers frequently overestimate depressive symptoms in patients with LIS, other social factors and the caregiver-patient dynamic ought to be explored in future studies. It is well-established that for many patients with chronic neurologic conditions—even in patients in a locked-in state (LIS)—they may experience a good personal quality of life. In their retrospective cohort of 19 patients with amyotrophic lateral sclerosis (ALS) in LIS; Drs. Kuzma-Kozakiewicz et al. corroborated previous findings that most patients in LIS are generally satisfied with their quality of life and do not wish for a hastened death. This study may have been subject to selection bias given the low response rate (76% of caregivers who were contacted did not respond or chose not to participate), but the results add to our understanding of despondency in LIS among patients with ALS. In response, Drs. Hermann and Aust comment on the importance of the caregiver and next of kin perspective. Although data from this study and others indicate caregivers frequently overestimate depressive symptoms in patients with LIS, other social factors and the caregiver-patient dynamic ought to be explored in future studies.

Electroencephalography of completely locked-in state patients with amyotrophic lateral sclerosis

Patients in completely locked-in state (CLIS) due to amyotrophic lateral sclerosis (ALS) lose the control of each and every muscle of their body rendering them motionless and without any means of communication. Though some studies have attempted to develop brain-computer interface (BCI)-based communication methods with CLIS patients, little information is available of the neuroelectric brain activity of CLIS patients. However, because of the difficulties with and often loss of communication, the neuroelectric signature may provide some indications of the state of consciousness in these patients. We recorded electroencephalography (EEG) signals from 10 CLIS patients during resting state and compared their power spectral densities with those of healthy participants in fronto-central, central, and centro-parietal channels. The results showed significant power reduction in the high alpha, beta, and gamma bands in CLIS patients, indicating the dominance of slower EEG frequencies in their oscillatory activity. This is the first study showing group-level EEG change of CLIS patients, though the reason for the observed EEG change cannot be concluded without any reliable communication methods with this population.

Development of an electrooculogram-based human-computer interface using involuntary eye movement by spatially rotating sound for communication of locked-in patients

Individuals who have lost normal pathways for communication need augmentative and alternative communication (AAC) devices. In this study, we propose a new electrooculogram (EOG)-based human-computer interface (HCI) paradigm for AAC that does not require a user’s voluntary eye movement for binary yes/no communication by patients in locked-in state (LIS). The proposed HCI uses a horizontal EOG elicited by involuntary auditory oculogyric reflex, in response to a rotating sound source. In the proposed HCI paradigm, a user was asked to selectively attend to one of two sound sources rotating in directions opposite to each other, based on the user’s intention. The user’s intentions could then be recognised by quantifying EOGs. To validate its performance, a series of experiments was conducted with ten healthy subjects, and two patients with amyotrophic lateral sclerosis (ALS). The online experimental results exhibited high-classification accuracies of 94% in both healthy subjects and ALS patients in cases where decisions were made every six seconds. The ALS patients also participated in a practical yes/no communication experiment with 26 or 30 questions with known answers. The accuracy of the experiments with questionnaires was 94%, demonstrating that our paradigm could constitute an auxiliary AAC system for some LIS patients.

An emergency call system for patients in locked‐in state using an SSVEP‐based brain switch

Patients in a locked-in state (LIS) due to severe neurological disorders such as amyotrophic lateral sclerosis (ALS) require seamless emergency care by their caregivers or guardians. However, it is a difficult job for the guardians to continuously monitor the patients' state, especially when direct communication is not possible. In the present study, we developed an emergency call system for such patients using a steady-state visual evoked potential (SSVEP)-based brain switch. Although there have been previous studies to implement SSVEP-based brain switch system, they have not been applied to patients in LIS, and thus their clinical value has not been validated. In this study, we verified whether the SSVEP-based brain switch system can be practically used as an emergency call system for patients in LIS. The brain switch used for our system adopted a chromatic visual stimulus, which proved to be visually less stimulating than conventional checkerboard-type stimuli but could generate SSVEP responses strong enough to be used for brain-computer interface (BCI) applications. To verify the feasibility of our emergency call system, 14 healthy participants and 3 patients with severe ALS took part in online experiments. All three ALS patients successfully called their guardians to their bedsides in about 6.56 seconds. Furthermore, additional experiments with one of these patients demonstrated that our emergency call system maintains fairly good performance even up to 4 weeks after the first experiment without renewing initial calibration data. Our results suggest that our SSVEP-based emergency call system might be successfully used in practical scenarios.

Toward a reliable gaze-independent hybrid BCI combining visual and natural auditory stimuli

BackgroundBrain computer interfaces (BCIs) are one of the last communication options for patients in the locked-in state (LIS). For complete LIS patients, interfaces must be gaze-independent due to their eye impairment. However, unimodal gaze-independent approaches typically present levels of performance substantially lower than gaze-dependent approaches. The combination of multimodal stimuli has been pointed as a viable way to increase users’ performance.New method: A hybrid visual and auditory (HVA) P300-based BCI combining simultaneously visual and auditory stimulation is proposed. Auditory stimuli are based on natural meaningful spoken words, increasing stimuli discrimination and decreasing user's mental effort in associating stimuli to the symbols. The visual part of the interface is covertly controlled ensuring gaze-independency. ResultsFour conditions were experimentally tested by 10 healthy participants: visual overt (VO), visual covert (VC), auditory (AU) and covert HVA. Average online accuracy for the hybrid approach was 85.3%, which is more than 32% over VC and AU approaches. Questionnaires’ results indicate that the HVA approach was the less demanding gaze-independent interface. Interestingly, the P300 grand average for HVA approach coincides with an almost perfect sum of P300 evoked separately by VC and AU tasks.Comparison with existing methods: The proposed HVA–BCI is the first solution simultaneously embedding natural spoken words and visual words to provide a communication lexicon. Online accuracy and task demand of the approach compare favorably with state-of-the-art. ConclusionsThe proposed approach shows that the simultaneous combination of visual covert control and auditory modalities can effectively improve the performance of gaze-independent BCIs.

Communication in locked-in state after brainstem stroke: a brain-computer-interface approach.

In a recent study by Sellers et al. (1) a patient in locked-in state after brainstem stroke was able to successfully communicate via electroencephalography (EEG) based brain computer interface (BCI) employing a P300 speller paradigm.

Comparison of tactile, auditory, and visual modality for brain-computer interface use: a case study with a patient in the locked-in state

This paper describes a case study with a patient in the classic locked-in state, who currently has no means of independent communication. Following a user-centered approach, we investigated event-related potentials (ERP) elicited in different modalities for use in brain-computer interface (BCI) systems. Such systems could provide her with an alternative communication channel. To investigate the most viable modality for achieving BCI based communication, classic oddball paradigms (1 rare and 1 frequent stimulus, ratio 1:5) in the visual, auditory and tactile modality were conducted (2 runs per modality). Classifiers were built on one run and tested offline on another run (and vice versa). In these paradigms, the tactile modality was clearly superior to other modalities, displaying high offline accuracy even when classification was performed on single trials only. Consequently, we tested the tactile paradigm online and the patient successfully selected targets without any error. Furthermore, we investigated use of the visual or tactile modality for different BCI systems with more than two selection options. In the visual modality, several BCI paradigms were tested offline. Neither matrix-based nor so-called gaze-independent paradigms constituted a means of control. These results may thus question the gaze-independence of current gaze-independent approaches to BCI. A tactile four-choice BCI resulted in high offline classification accuracies. Yet, online use raised various issues. Although performance was clearly above chance, practical daily life use appeared unlikely when compared to other communication approaches (e.g., partner scanning). Our results emphasize the need for user-centered design in BCI development including identification of the best stimulus modality for a particular user. Finally, the paper discusses feasibility of EEG-based BCI systems for patients in classic locked-in state and compares BCI to other AT solutions that we also tested during the study.