Designing a flexible tool for rapid implementation of brain-computer interfaces (BCI) in game development.

Early neurological injury or disease can lead to severe life-long physical impairments, despite normal cognitive function. For such individuals, brain-computer interfaces (BCI) may provide a means to regain access to the world by offering control of systems through directly processing brain patterns. However, current BCI applications are often research driven and consequently seen as uninteresting, particularly for prolonged use and younger BCI-users. To help mitigate this concern, this paper establishes a tool for researchers and game developers alike to rapidly incorporate a BCI control scheme (the P300 oddball response) into a gaming environment. Preliminary results indicate the proposed P300 Dynamic Cube (PDC) asset works in online BCI environments (n=20, healthy adult participants), resulting in median classification accuracy of 75 ± 3.28%. Additionally, the PDC tool can be rapidly adapted for a variety of game designs, evidenced by its incorporation into submissions to the Brain-Computer Interface (BCI) Game Jam 2019 competition. These findings support the PDC as a useful asset in the design and development of BCI-based games.

A Child's Right to Play: Results from the Brain-Computer Interface Game Jam 2019 (Calgary Competition).

Children with severe neurological disabilities may be unable to communicate or interact with their environments, depriving them of their right to play. Brain-computer interfaces (BCI) offer a means for such children to control external devices using only their brain signals, thereby introducing new opportunities for interaction. We organized the first North American BCI Game Jam to incite the development of BCI-compatible games for children. Nine games were submitted by 30 participants across North America. Games were judged by researchers and disabled children currently using BCI. Preliminary results demonstrate variety in game criteria preferences amongst the children who judged the games. The BCI Game Jam demonstrated promising potential for the creation of enjoyable games to suit the individual needs and preferences of children with severe neurological disabilities.

Safety and tolerability of transcranial magnetic and direct current stimulation in children: Prospective single center evidence from 3.5 million stimulations.

BACKGROUND: Non-invasive brain stimulation is being increasingly used to interrogate neurophysiology and modulate brain function. Despite the high scientific and therapeutic potential of non-invasive brain stimulation, experience in the developing brain has been limited. OBJECTIVE: To determine the safety and tolerability of non-invasive neurostimulation in children across diverse modalities of stimulation and pediatric populations. METHODS: A non-invasive brain stimulation program was established in 2008 at our pediatric, academic institution. Multi-disciplinary neurophysiological studies included single- and paired-pulse Transcranial Magnetic Stimulation (TMS) methods. Motor mapping employed robotic TMS. Interventional trials included repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS). Standardized safety and tolerability measures were completed prospectively by all participants. RESULTS: Over 10 years, 384 children underwent brain stimulation (median 13 years, range 0.8-18.0). Populations included typical development (n = 118), perinatal stroke/cerebral palsy (n = 101), mild traumatic brain injury (n = 121) neuropsychiatric disorders (n = 37), and other (n = 7). No serious adverse events occurred. Drop-outs were rare (<1%). No seizures were reported despite >100 participants having brain injuries and/or epilepsy. Tolerability between single and paired-pulse TMS (542340 stimulations) and rTMS (3.0 million stimulations) was comparable and favourable. TMS-related headache was more common in perinatal stroke (40%) than healthy participants (13%) but was mild and self-limiting. Tolerability improved over time with side-effect frequency decreasing by >50%. Robotic TMS motor mapping was well-tolerated though neck pain was more common than with manual TMS (33% vs 3%). Across 612 tDCS sessions including 92 children, tolerability was favourable with mild itching/tingling reported in 37%. CONCLUSIONS: Standard non-invasive brain stimulation paradigms are safe and well-tolerated in children and should be considered minimal risk. Advancement of applications in the developing brain are warranted. A new and improved pediatric NIBS safety and tolerability form is included.

Robotic TMS mapping of motor cortex in the developing brain.

BACKGROUND: The human motor cortex can be mapped safely and painlessly with transcranial magnetic stimulation (TMS) to explore neurophysiology in health and disease. Human error likely contributes to heterogeneity of such TMS measures. Here, we aimed to use recently pioneered robotic TMS technology to develop an efficient, reproducible protocol to characterize cortical motor maps in a pediatric population. NEW METHOD: Magnetic resonance imaging was performed on 12 typically developing children and brain reconstructions were paired with the robotic TMS system. The system automatically aligned the TMS coil to target sites in 3 dimensions with near-perfect coil orientation and real-time head motion correction. Motor maps of 4 forelimb muscles were derived bilaterally by delivering single-pulse TMS at predefined, uniformly spaced trajectories across a 10 × 10 grid (7 mm spacing) customized to the participant's MRI. RESULTS: Procedures were well tolerated with no adverse events. Two male, eight-year-old participants had high resting motor thresholds that precluded mapping. The mean hotspot coordinate and centre of gravity coordinate were determined in each hemisphere for four forelimb muscles bilaterally. Average mapping time was 14.25 min per hemisphere. COMPARISON WITH EXISTING METHODS: Traditional manual TMS methods of motor mapping are time intensive, technically challenging, prone to human error, and arduous for use in pediatrics. This novel TMS robot approach facilitates improved efficiency, tolerability, and precision in derived, high-fidelity motor maps. CONCLUSIONS: Robotic TMS opens new avenues to explore motor map neurophysiology and its influence on developmental plasticity and therapeutic neuromodulation. Our findings provide evidence that TMS robotic motor mapping is feasible in young participants.