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      Development of a brain-computer interface for patients in the critical care setting

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          Abstract

          Objective

          Behaviorally unresponsive patients in intensive care units (ICU) are unable to consistently and effectively communicate their most fundamental physical needs. Brain-Computer Interface (BCI) technology has been established in the clinical context, but faces challenges in the critical care environment. Contrary to cue-based BCIs, which allow activation only during pre-determined periods of time, self-paced BCI systems empower patients to interact with others at any time. The study aims to develop a self-paced BCI for patients in the intensive care unit.

          Methods

          BCI experiments were conducted in 18 ICU patients and 5 healthy volunteers. The proposed self-paced BCI system analyzes EEG activity from patients while these are asked to control a beeping tone by performing a motor task (i.e., opening and closing a hand). Signal decoding is performed in real time and auditory feedback given via headphones. Performance of the BCI system was judged based on correlation between the optimal and the observed performance.

          Results

          All 5 healthy volunteers were able to successfully perform the BCI task, compared to chance alone ( p<0.001). 5 of 14 (36%) conscious ICU patients were able to perform the BCI task. One of these 5 patients was quadriplegic and controlled the BCI system without any hand movements. None of the 4 unconscious patients were able to perform the BCI task.

          Conclusions

          More than one third of conscious ICU patients and all healthy volunteers were able to gain control over the self-paced BCI system. The initial 4 unconscious patients were not. Future studies will focus on studying the ability of behaviorally unresponsive patients with cognitive motor dissociation to control the self-paced BCI system.

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          Most cited references23

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          Brain–computer interfaces for communication and control

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            Brain function in coma, vegetative state, and related disorders.

            We review the nosological criteria and functional neuroanatomical basis for brain death, coma, vegetative state, minimally conscious state, and the locked-in state. Functional neuroimaging is providing new insights into cerebral activity in patients with severe brain damage. Measurements of cerebral metabolism and brain activations in response to sensory stimuli with PET, fMRI, and electrophysiological methods can provide information on the presence, degree, and location of any residual brain function. However, use of these techniques in people with severe brain damage is methodologically complex and needs careful quantitative analysis and interpretation. In addition, ethical frameworks to guide research in these patients must be further developed. At present, clinical examinations identify nosological distinctions needed for accurate diagnosis and prognosis. Neuroimaging techniques remain important tools for clinical research that will extend our understanding of the underlying mechanisms of these disorders.
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              Detection of Brain Activation in Unresponsive Patients with Acute Brain Injury

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SoftwareRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: Project administrationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: Writing – original draft
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                22 January 2021
                2021
                : 16
                : 1
                : e0245540
                Affiliations
                [1 ] Department of Neurology, Columbia University Medical Center, New York, NY, United States of America
                [2 ] Department of Neurosurgery, Columbia University Medical Center, New York, NY, United States of America
                University of California Irvine, UNITED STATES
                Author notes

                Competing Interests: Jan Claassen is a minority shareholder at iCE Neurosystems. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                https://orcid.org/0000-0002-0312-889X
                https://orcid.org/0000-0002-3688-7307
                https://orcid.org/0000-0002-5893-8531
                Article
                PONE-D-20-24486
                10.1371/journal.pone.0245540
                7822274
                33481888
                255d3ba2-1e4d-44ef-92ab-ce35ec350bbd
                © 2021 Eliseyev et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 5 August 2020
                : 30 December 2020
                Page count
                Figures: 6, Tables: 2, Pages: 13
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000065, National Institute of Neurological Disorders and Stroke;
                Award ID: R03 NS112760
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000065, National Institute of Neurological Disorders and Stroke;
                Award ID: R01 NS106014
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100001068, Dana Foundation;
                Award Recipient :
                Jan Claassen is supported by grant funding from the NIH R01 NS106014 and R03 NS112760, and the DANA Foundation.
                Categories
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                Engineering and Technology
                Electronics Engineering
                Computer Engineering
                Man-Computer Interface
                Research and Analysis Methods
                Bioassays and Physiological Analysis
                Electrophysiological Techniques
                Brain Electrophysiology
                Electroencephalography
                Biology and Life Sciences
                Physiology
                Electrophysiology
                Neurophysiology
                Brain Electrophysiology
                Electroencephalography
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                The shared data can be found at https://doi.org/10.6084/m9.figshare.13138367.v1.

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