Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke.

Brain-computer interfaces (BCI) are used in stroke rehabilitation to translate brain signals into intended movements of the paralyzed limb. However, the efficacy and mechanisms of BCI-based therapies remain unclear. Here we show that BCI coupled to functional electrical stimulation (FES) elicits significant, clinically relevant, and lasting motor recovery in chronic stroke survivors more effectively than sham FES. Such recovery is associated to quantitative signatures of functional neuroplasticity. BCI patients exhibit a significant functional recovery after the intervention, which remains 6-12 months after the end of therapy. Electroencephalography analysis pinpoints significant differences in favor of the BCI group, mainly consisting in an increase in functional connectivity between motor areas in the affected hemisphere. This increase is significantly correlated with functional improvement. Results illustrate how a BCI-FES therapy can drive significant functional recovery and purposeful plasticity thanks to contingent activation of body natural efferent and afferent pathways.

The effect of multimodal and enriched feedback on SMR-BCI performance.

OBJECTIVE: This study investigated the effect of multimodal (visual and auditory) continuous feedback with information about the uncertainty of the input signal on motor imagery based BCI performance. A liquid floating through a visualization of a funnel (funnel feedback) provided enriched visual or enriched multimodal feedback. METHODS: In a between subject design 30 healthy SMR-BCI naive participants were provided with either conventional bar feedback (CB), or visual funnel feedback (UF), or multimodal (visual and auditory) funnel feedback (MF). Subjects were required to imagine left and right hand movement and were trained to control the SMR based BCI for five sessions on separate days. RESULTS: Feedback accuracy varied largely between participants. The MF feedback lead to a significantly better performance in session 1 as compared to the CB feedback and could significantly enhance motivation and minimize frustration in BCI use across the five training sessions. CONCLUSION: The present study demonstrates that the BCI funnel feedback allows participants to modulate sensorimotor EEG rhythms. Participants were able to control the BCI with the funnel feedback with better performance during the initial session and less frustration compared to the CB feedback. SIGNIFICANCE: The multimodal funnel feedback provides an alternative to the conventional cursorbar feedback for training subjects to modulate their sensorimotor rhythms.

An online EEG BCI based on covert visuospatial attention in absence of exogenous stimulation.

OBJECTIVE: In this work we present--for the first time--the online operation of an electroencephalogram (EEG) brain-computer interface (BCI) system based on covert visuospatial attention (CVSA), without relying on any evoked responses. Electrophysiological correlates of pure top-down CVSA have only recently been proposed as a control signal for BCI. Such systems are expected to share the ease of use of stimulus-driven BCIs (e.g. P300, steady state visually evoked potential) with the autonomy afforded by decoding voluntary modulations of ongoing activity (e.g. motor imagery). APPROACH: Eight healthy subjects participated in the study. EEG signals were acquired with an active 64-channel system. The classification method was based on a time-dependent approach tuned to capture the most discriminant spectral features of the temporal evolution of attentional processes. The system was used by all subjects over two days without retraining, to verify its robustness and reliability. MAIN RESULTS: We report a mean online accuracy across the group of 70.6 ± 1.5%, and 88.8 ± 5.8% for the best subject. Half of the participants produced stable features over the entire duration of the study. Additionally, we explain drops in performance in subjects showing stable features in terms of known electrophysiological correlates of fatigue, suggesting the prospect of online monitoring of mental states in BCI systems. SIGNIFICANCE: This work represents the first demonstration of the feasibility of an online EEG BCI based on CVSA. The results achieved suggest the CVSA BCI as a promising alternative to standard BCI modalities.

Toward smarter BCIs: extending BCIs through hybridization and intelligent control.

This paper summarizes two novel ways to extend brain-computer interface (BCI) systems. One way involves hybrid BCIs. A hybrid BCI is a system that combines a BCI with another device to help people send information. Different types of hybrid BCIs are discussed, along with challenges and issues. BCIs are also being extended through intelligent systems. Software that allows high-level control, incorporates context and the environment and/or uses virtual reality can substantially improve BCI systems. Throughout the paper, we critically address the real benefits of these improvements relative to existing technology and practices. We also present new challenges that are likely to emerge as these novel BCI directions become more widespread.

Centrally controlled heart rate changes during mental practice in immersive virtual environment: a case study with a tetraplegic.

A tetraplegic patient was able to induce midcentral localized beta oscillations in the electroencephalogram (EEG) after extensive mental practice of foot motor imagery. This beta oscillation was used to simulate a wheel chair movement in a virtual environment (VE). The analysis of electrocardiogram (ECG) data revealed that the induced beta oscillations were accompanied by a characteristic heart rate (HR) change in form of a preparatory HR acceleration followed by a short-lasting deceleration in the order of 10-20 bpm (beats-per-minute). This provides evidence that mental practice of motor performance is accompanied not only by activation of cortical structures but also by central commands into the cardiovascular system with its nuclei in the brain stem.

Cardiac responses induced during thought-based control of a virtual environment.

Cardiac responses induced by motor imagery were investigated in 3 subjects in a series of experiments with a synchronous (cue-based) Brain-Computer Interface (BCI). The cue specified right hand vs. leg/foot motor imagery. After a number of BCI training sessions reaching a classification accuracy of at least 80%, the BCI experiments were carried out in an immersive virtual environment (VE), commonly referred as a "CAVE". In this VE, the subjects were able to move along a virtual street by motor imagery alone. The thought-based control of VE resulted in an acceleration of the heart rate in 2 subjects and a heart rate deceleration in the other subject. In control experiments in front of a PC, all 3 subjects displayed a significant heart rate deceleration of the order of about 3-5%. This heart rate decrease during motor imagery in a normal environment is similar to that observed during preparation for a voluntary movement. The heart rate acceleration in the VE is interpreted as effect of an increased mental effort to walk as far as possible in VE.