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.

Context-aware adaptive spelling in motor imagery BCI.

OBJECTIVE: This work presents a first motor imagery-based, adaptive brain-computer interface (BCI) speller, which is able to exploit application-derived context for improved, simultaneous classifier adaptation and spelling. Online spelling experiments with ten able-bodied users evaluate the ability of our scheme, first, to alleviate non-stationarity of brain signals for restoring the subject's performances, second, to guide naive users into BCI control avoiding initial offline BCI calibration and, third, to outperform regular unsupervised adaptation. APPROACH: Our co-adaptive framework combines the BrainTree speller with smooth-batch linear discriminant analysis adaptation. The latter enjoys contextual assistance through BrainTree's language model to improve online expectation-maximization maximum-likelihood estimation. MAIN RESULTS: Our results verify the possibility to restore single-sample classification and BCI command accuracy, as well as spelling speed for expert users. Most importantly, context-aware adaptation performs significantly better than its unsupervised equivalent and similar to the supervised one. Although no significant differences are found with respect to the state-of-the-art PMean approach, the proposed algorithm is shown to be advantageous for 30% of the users. SIGNIFICANCE: We demonstrate the possibility to circumvent supervised BCI recalibration, saving time without compromising the adaptation quality. On the other hand, we show that this type of classifier adaptation is not as efficient for BCI training purposes.

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.

Clinical evaluation of BrainTree, a motor imagery hybrid BCI speller.

OBJECTIVE: While brain-computer interfaces (BCIs) for communication have reached considerable technical maturity, there is still a great need for state-of-the-art evaluation by the end-users outside laboratory environments. To achieve this primary objective, it is necessary to augment a BCI with a series of components that allow end-users to type text effectively. APPROACH: This work presents the clinical evaluation of a motor imagery (MI) BCI text-speller, called BrainTree, by six severely disabled end-users and ten able-bodied users. Additionally, we define a generic model of code-based BCI applications, which serves as an analytical tool for evaluation and design. MAIN RESULTS: We show that all users achieved remarkable usability and efficiency outcomes in spelling. Furthermore, our model-based analysis highlights the added value of human-computer interaction techniques and hybrid BCI error-handling mechanisms, and reveals the effects of BCI performances on usability and efficiency in code-based applications. SIGNIFICANCE: This study demonstrates the usability potential of code-based MI spellers, with BrainTree being the first to be evaluated by a substantial number of end-users, establishing them as a viable, competitive alternative to other popular BCI spellers. Another major outcome of our model-based analysis is the derivation of a 80% minimum command accuracy requirement for successful code-based application control, revising upwards previous estimates attempted in the literature.