Brain-Computer Interface for Clinical Purposes: Cognitive Assessment and Rehabilitation.

Alongside the best-known applications of brain-computer interface (BCI) technology for restoring communication abilities and controlling external devices, we present the state of the art of BCI use for cognitive assessment and training purposes. We first describe some preliminary attempts to develop verbal-motor free BCI-based tests for evaluating specific or multiple cognitive domains in patients with Amyotrophic Lateral Sclerosis, disorders of consciousness, and other neurological diseases. Then we present the more heterogeneous and advanced field of BCI-based cognitive training, which has its roots in the context of neurofeedback therapy and addresses patients with neurological developmental disorders (autism spectrum disorder and attention-deficit/hyperactivity disorder), stroke patients, and elderly subjects. We discuss some advantages of BCI for both assessment and training purposes, the former concerning the possibility of longitudinally and reliably evaluating cognitive functions in patients with severe motor disabilities, the latter regarding the possibility of enhancing patients' motivation and engagement for improving neural plasticity. Finally, we discuss some present and future challenges in the BCI use for the described purposes.

An eye-tracking controlled neuropsychological battery for cognitive assessment in neurological diseases.

Traditional cognitive assessment in neurological conditions involving physical disability is often prevented by the presence of verbal-motor impairment; to date, an extensive motor-verbal-free neuropsychological battery is not available for such purposes. We adapted a set of neuropsychological tests, assessing language, attentional abilities, executive functions and social cognition, for eye-tracking (ET) control, and explored its feasibility in a sample of healthy participants. Thirty healthy subjects performed a neuropsychological assessment, using an ET-based neuropsychological battery, together with standard "paper and pencil" cognitive measures for frontal (Frontal Assessment Battery-FAB) and working memory abilities (Digit Sequencing Task) and for global cognitive efficiency (Montreal Cognitive Assessment-MoCA). Psychological measures of anxiety (State-Trait Anxiety Inventory-Y-STAI-Y) and depression (Beck Depression Inventory-BDI) were also collected, and a usability questionnaire was administered. Significant correlations were observed between the "paper and pencil" screening of working memory abilities and the ET-based neuropsychological measures. The ET-based battery also correlated with the MoCA, while poor correlations were observed with the FAB. Usability aspects were found to be influenced by both working memory abilities and psychological components. The ET-based neuropsychological battery developed could provide an extensive assessment of cognitive functions, allowing participants to perform tasks independently from the integrity of motor or verbal channels. Further studies will be aimed at investigating validity and usability components in neurological populations with motor-verbal impairments.

Cognitive assessment in Amyotrophic Lateral Sclerosis by means of P300-Brain Computer Interface: a preliminary study.

OBJECTIVE: To investigate the use of P300-based Brain Computer Interface (BCI) technology for the administration of motor-verbal free cognitive tests in Amyotrophic Lateral Sclerosis (ALS). METHODS: We recruited 15 ALS patients and 15 age- and education-matched healthy subjects. All participants underwent a BCI-based neuropsychological assessment, together with two standard cognitive screening tools (FAB, MoCA), two psychological questionnaires (BDI, STAI-Y) and a usability questionnaire. For patients, clinical and respiratory examinations were also performed, together with a behavioural assessment (FBI). RESULTS: Correlations were observed between standard cognitive and BCI-based neuropsychological assessment, mainly concerning execution times in the ALS group. Moreover, patients provided positive rates concerning the BCI perceived usability and subjective experience. Finally, execution times at the BCI-based neuropsychological assessment were useful to discriminate patients from controls, with patients achieving lower processing speed than controls regarding executive functions. CONCLUSIONS: The developed motor-verbal free neuropsychological battery represents an innovative approach, that could provide relevant information for clinical practice and ethical issues. Its use for cognitive evaluation throughout the course of ALS, currently not available by means of standard assessment, must be addressed in further longitudinal validation studies. Further work will be aimed at refining the developed system and enlarging the cognitive spectrum investigated.

A textile-based wearable system for the prolonged assessment of cardiac mechanics in daily life.

Seismocardiogram, SCG, can be detected over the 24 hours in ambulant subjects by a textile-based wearable system together with the electrocardiogram, ECG and respiration. In this pilot study we explored the possibility to derive 24 h profiles of cardiac time intervals, i.e. indexes of heart mechanical function, from the SCG recordings performed in daily life conditions by the above wearable system. Two healthy subjects were recruited for the study. They worn the system for 24 hours during a working day. From each recording, every 30 minutes the following parameters were derived from the ECG and SCG signals: RR interval, RRI, Pre-Ejection Period, PEP, Isovolumic Contraction Time, ICT, Left Ventricular Ejection Time, LVET, Isovolumic Relaxation Time, IRT. From the analysis it appears that 1) all parameters are characterized by a coefficient of variation in the same order of magnitude, and 2) 24 h LVET time profiles mirrors the long term RRI behavior. Common trends in PEP and ICT profiles were observed in one subject. This study indicates that indexes of cardiac mechanics can be derived from SCG recordings performed over the 24 hours. The obtained positive results encourage further studies to refine this methodology and confirm the present findings.

Wearable seismocardiography for the beat-to-beat assessment of cardiac intervals during sleep.

Seismocardiogram (SCG) can be detected during sleep by a textile-based wearable system. This pilot study preliminarily explores the feasibility of a beat-to-beat estimation of cardiac mechanical features (RR interval, RRI, Pre-Ejection Period, PEP, Isovolumic Contraction Time, ICT, Left Ventricular Ejection Time, LVET, Isovolumic Relaxation Time, IRT) from the joint ECG and SCG assessment during sleep. The analysis of two 30-min sleep data segments from one healthy subject, indicated that 1) respiration largely influence the dynamics of most of the parameters; 2) variability of cardiac intervals is only marginally influenced by the RRI variability; 3) appreciable spectral power at frequencies ≤ 0.1 is only observed in the RRI spectrum and not in the spectra of the other indexes; 4) IRT has a broadband variability, that is clearly different from the dynamics of the other indexes. These findings represent the very first description of the beat-to-beat variability of cardiac mechanical indexes. Further investigations on a larger population are in progress to confirm the present results.

The use of P300-based BCIs in amyotrophic lateral sclerosis: from augmentative and alternative communication to cognitive assessment.

The use of augmentative and alternative communication (AAC) tools in patients with amyotrophic lateral sclerosis (ALS), as effective means to compensate for the progressive loss of verbal and gestural communication, has been deeply investigated in the recent literature. The development of advanced AAC systems, such as eye-tracking (ET) and brain-computer interface (BCI) devices, allowed to bypass the important motor difficulties present in ALS patients. In particular, BCIs could be used in moderate to severe stages of the disease, since they do not require preserved ocular-motor ability, which is necessary for ET applications. Furthermore, some studies have proved the reliability of BCIs, regardless of the severity of the disease and the level of physical decline. However, the use of BCI in ALS patients still shows some limitations, related to both technical and neuropsychological issues. In particular, a range of cognitive deficits in most ALS patients have been observed. At the moment, no effective verbal-motor free measures are available for the evaluation of ALS patients' cognitive integrity; BCIs could offer a new possibility to administer cognitive tasks without the need of verbal or motor responses, as highlighted by preliminary studies in this field. In this review, we outline the essential features of BCIs systems, considering advantages and challenges of these tools with regard to ALS patients and the main applications developed in this field. We then outline the main findings with regard to cognitive deficits observed in ALS and some preliminary attempts to evaluate them by means of BCIs. The definition of specific cognitive profiles could help to draw flexible approaches tailored on patients' needs. It could improve BCIs efficacy and reduce patients' efforts. Finally, we handle the open question, represented by the use of BCIs with totally locked in patients, who seem unable to reliably learn to use such tool.

A wearable system for the seismocardiogram assessment in daily life conditions.

Seismocardiogram (SCG) is the recording of the minute body accelerations induced by the heart activity, and reflects mechanical aspects of heart contraction and blood ejection. So far, most of the available systems for the SCG assessment are designed to be used in a laboratory or in controlled behavioral and environmental conditions. In this paper we propose a modified version of a textile-based wearable device for the unobtrusive recording of ECG, respiration and accelerometric data (the MagIC system), to assess the 3d sternal SCG in daily life. SCG is characterized by an extremely low magnitude of the accelerations (in the order of g × 10(-3)), and is masked by major body accelerations induced by locomotion. Thus in daily life recordings, SCG can be measured whenever the subject is still. We observed that about 30 seconds of motionless behavior are sufficient for a stable estimate of the average SCG waveform, independently from the subject's posture. Since it is likely that during spontaneous behavior the subject may stay still for at least 30 seconds several times in a day, it is expected that the SCG could be repeatedly estimated and tracked over time through a prolonged data recording. These observations represent the first testing of the system in the assessment of SCG out of a laboratory environment, and open the possibility to perform SCG studies in a wide range of everyday conditions without interfering with the subject's activity tasks.

Assessment of gravitational stress on heart rate variability during maneuvers on high performance jet flights.

The Push-Pull Effect (PPE) is a physiological phenomenon defined as a reduction of +Gz tolerance induced by a previous exposure to a -Gz acceleration, that may lead to loss of consciousness. Aim of this study was to evaluate, for the first time, the cardiac rhythm changes associated with PPE during real flights. Data were collected in 3 pilots during flights on the Aermacchi MB- 339-CD aircraft. In each flight, lasting about 60 minutes, ECG, respiration and 3D accelerations were recorded by a new smart garment (the MagIC System). The flight protocol included a maneuver eliciting a reference +5Gz acceleration for 15 seconds (Ref+5G), followed, after a while, by a push-pull maneuver with a profile characterized by a 5-s acceleration at -1Gz (PP-1G) and, with a 1G/s onset, by 15 seconds at +5Gz (PP+5G), so to induce the push-pull gravitational stress. From each ECG recording, a beat-by-beat RR Interval (RRI) series was derived. RRI mean, standard deviation (SDNN) and the RRI Root Mean Square of Successive Difference (RMSSD) were estimated in each pilot during the Ref+5G and the PP+5G maneuvers. As compared with Ref+5G, all pilots displayed significant reductions in RRI mean, SDNN and RMSSD during PP+5G. These findings are compatible with a PP-induced enhancement in the sympathetic drive to the heart -as shown by the reduction in RRI mean and SDNN- and a concomitant deactivation of the parasympathetic control as shown by the reduction in RMSSD.