Invasive Brain-Computer Interface for Communication: A Scoping Review.

Brain–Computer Interface

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that causes progressive loss of voluntary movement, including the ability to speak. As the disease rapidly progresses, there is a need for augmented and alternative communication that removes physical barriers required for engagement. Brain-Computer Interfaces (BCI) are a technology that allow for communication using only brain signals in response to visual stimuli. This project aimed to design an accessible and practical BCI for continuous, at-home use, and to increase BCI usability by using familiar facial stimuli to elicit a stronger brain response. The overall goal for enhancement of BCI usability is to maximize ease of use for individuals with ALS and their caregivers so that BCI technologies can make a useful impact and improve the everyday lives of people with ALS. In this project, a new miniaturized and low-cost P300 BCI system was designed using wireless and battery-operated EEG neuroimaging, modular software, and the use of an individualized BCI presentation stimuli. A 3-dimensional virtual environment platform was integrated as a navigational control output mechanism that executes commands received from the BCI to move a user's avatar in a virtual maze. Together, these form the virtual environment BCI (veBCI). The BCI stimuli presentation consisted of a custom approach of integrating different human face images with the aim of increasing user engagement and elicited brain activity, and therefore improving BCI online accuracy. The impact and effectiveness of the approach was tested via a verification BCI study in which 6 different stimuli conditions were utilized: male celebrity face, female celebrity face, male stranger face, female stranger face, a family member/close friend of the participant, and blank/no face as a control. A total of 16 volunteers (average age 56.5 and eight diagnosed with ALS) used the BCI system with all 6 face conditions in ecologically valid settings. Results indicate that this new miniaturized BCI is usable for both people with ALS and healthy controls. Significant differences existed in the amplitude of the P300 response in ALS and healthy controls. Additionally, differences between male and female participants demonstrated the potential role of personalization to optimize the visually evoked potential response and further increase BCI online accuracy. In conclusion, a home-use P300 BCI system was developed with a new generation of miniaturized, low-cost, and mobile neuroimaging running on an embedded computational platform. BCI stimuli with human face inclusion could help personalization of the BCI. Furthermore, virtual environments provide unique new ways to implement BCI output beyond typical spelling tasks and communication. Future work could focus on developing dedicated online signal processing to eliminate noise and improve online accuracy during home use.

Neuromuscular physical therapy, also known as neurological physical therapy, focuses on assessing and treating individuals with conditions affecting the nervous system and muscles. It is crucial in promoting recovery, improving function, and enhancing the quality of life for individuals with neurological disorders. As the field continues to evolve, several new frontiers and advancements have emerged in neuromuscular physical therapy. Some of the recent trends in neuromuscular physical trends include the following. Technology-assisted rehabilitation: The integration of technology has revolutionized neuromuscular physical therapy. Various devices, such as robotic exoskeletons, virtual reality systems, and wearable sensors, are being utilized to enhance treatment outcomes. These technologies provide interactive and engaging platforms for therapy, facilitate repetitive practice, and offer real-time feedback on movement performance. They can be particularly beneficial in promoting motor recovery and functional improvements in individuals with stroke, spinal cord injury, and traumatic brain injury. Motor learning principles: There is an increased focus on incorporating motor learning principles into neuromuscular physical therapy interventions. Motor learning involves acquiring and retaining new motor skills through practice and feedback. By tailoring therapy sessions to optimize motor learning, therapists can facilitate more effective skill acquisition and long-term retention. This may involve techniques such as task-specific training, variable practice, and contextual interference. Brain-computer interfaces (BCIs): BCIs are systems that establish direct communication pathways between the brain and external devices. In the context of neuromuscular physical therapy, BCIs hold promise in neurorehabilitation. They enable individuals with severe motor impairments to control external devices or robotic exoskeletons using brain signals. BCIs can provide opportunities for functional restoration, promote neuroplasticity, and enhance the rehabilitation process for individuals with conditions like spinal cord injury or amyotrophic lateral sclerosis (ALS). Telerehabilitation: With the advancement of telehealth technology, telerehabilitation has gained momentum in neuromuscular physical therapy. Telerehabilitation allows therapists to deliver assessment and treatment remotely, overcoming barriers of geographical distance and accessibility. It enables real-time video consultations, remote exercise monitoring, education, and support. Telerehabilitation has the potential to increase access to care, improve convenience for patients, and enhance the continuity of therapy. Personalized and precision rehabilitation: The concept of personalized and precision medicine is increasingly applied to neuromuscular physical therapy. By considering individual characteristics, such as genetics, biomechanics, and neurophysiology, therapists can tailor interventions to meet specific needs and optimize outcomes. Advanced assessment tools like motion analysis systems and genetic testing can provide valuable insights for personalized treatment planning and targeted interventions. These new frontiers in neuromuscular physical therapy hold great promise in advancing the field and improving outcomes for individuals with neurological conditions. Integrating technology, motor learning principles, brain-computer interfaces, telerehabilitation, and personalized approaches can enhance the effectiveness, accessibility, and individualization of neuromuscular rehabilitation programs.

The paper provides a comprehensive exploration of brain-computer interfaces (BCIs) and their application in addressing communication and control challenges in neurological disorders like Amyotrophic Lateral Sclerosis (ALS), locked-in syndrome, Parkinson’s disease, and Spinal Cord Injury. It traces BCI advancements from foundational information theory principles to their current state. Neurological disorders severely impact communication and control abilities, with ALS causing muscle weakness and paralysis, and locked-in syndrome confining individuals within paralyzed bodies while maintaining cognitive functions. BCIs decode brain signals, enabling control of external devices like computers, offering hope for restoring communication and control in affected individuals. Employing data analysis and visualization techniques, this study evaluates BCI performance in improving communication and control across various disorders. Matplotlib generates informative graphs and performance metrics, quantifying BCI efficacy for users with differing motor impairments. The findings highlight BCI transformative potential, guiding clinicians and researchers toward personalized solutions for diverse patient populations. This research underscores the necessity for continued innovation and exploration in BCI technology, envisioning a more inclusive and adaptive future for individuals with neurological disorders

Objective. Brain–machine interfaces (BMI) are an emerging therapeutic option that can allow paralyzed patients to gain control over assistive technology devices (ATDs). BMI approaches can be broadly classified into invasive (based on intracranially implanted electrodes) and noninvasive (based on skin electrodes or extracorporeal sensors). Invasive BMIs have a favorable signal-to-noise ratio, and thus allow for the extraction of more information than noninvasive BMIs, but they are also associated with the risks related to neurosurgical device implantation. Current noninvasive BMI approaches are typically concerned, among other issues, with long setup times and/or intensive training. Recent studies have investigated the attitudes of paralyzed patients eligible for BMIs, particularly patients affected by amyotrophic lateral sclerosis (ALS). These studies indicate that paralyzed patients are indeed interested in BMIs. Little is known, however, about the degree of knowledge among paralyzed patients concerning BMI approaches or about how patients retrieve information on ATDs. Furthermore, it is not yet clear if paralyzed patients would accept intracranial implantation of BMI electrodes with the premise of decoding improvements, and what the attitudes of a broader range of patients with diseases such as stroke or spinal cord injury are towards this new kind of treatment. Approach. Using a questionnaire, we surveyed 131 paralyzed patients for their opinions on invasive BMIs and their attitude toward invasive BMI treatment options. Main results. The majority of the patients knew about and had a positive attitude toward invasive BMI approaches. The group of ALS patients was especially open to the concept of BMIs. The acceptance of invasive BMI technology depended on the improvements expected from the technology. Furthermore, the survey revealed that for paralyzed patients, the Internet is an important source of information on ATDs. Significance. Websites tailored to prospective BMI users should be further developed to provide reliable information to patients, and also to help to link prospective BMI users with researchers involved in the development of BMI technology.

Intracortical electrodes are important tools, with applications ranging from fundamental laboratory studies to potential solutions to intractable clinical applications. However, the longevity and reliability of the interfaces remain their major limitation to the wider implementation and adoption of this technology, especially in broader translational work. Accordingly, this review summarizes the most significant biological and technical factors influencing the long-term performance of intracortical electrodes. In a laboratory setting, intracortical electrodes have been used to study the normal and abnormal function of the brain. This improved understanding has led to valuable insights regarding many neurological conditions. Likewise, clinical applications of intracortical brain-machine interfaces offer the ability to improve the quality of life of many patients afflicted with high-level paralysis from spinal cord injury, brain stem stroke, amyotrophic lateral sclerosis, or other conditions. It is widely hypothesized that the tissue response to the electrodes, including inflammation, limits their longevity. Many studies have examined and modified the tissue response to intracortical electrodes to improve future intracortical electrode technologies. Overall, the relationship between biological, mechanical, and technological considerations are crucial for the fidelity of chronic electrode recordings and represent a presently active area of investigation in the field of neural engineering.

Respiratory compromise due to phrenic motor neuron loss is a debilitating consequence of a large proportion of human traumatic spinal cord injury (SCI) cases (1) and is the ultimate cause of death in patients with the motor neuron disorder, amyotrophic laterals sclerosis (ALS) (2). ALS is a devastating neurological disorder that is characterized by relatively rapid degeneration of upper and lower motor neurons. Patients ultimately succumb to the disease on average 2-5 years following diagnosis because of respiratory paralysis due to loss of phrenic motor neuron innnervation of the diaphragm (3). The vast majority of cases are sporadic, while 10% are of the familial form. Approximately twenty percent of familial cases are linked to various point mutations in the Cu/Zn superoxide dismutase 1 (SOD1) gene on chromosome 21 (4). Transgenic mice (4,5) and rats (6) carrying mutant human SOD1 genes ((G93A, G37R, G86R, G85R)) have been generated, and, despite the existence of other animal models of motor neuron loss, are currently the most highly used models of the disease. Spinal cord injury (SCI) is a heterogeneous set of conditions resulting from physical trauma to the spinal cord, with functional outcome varying according to the type, location and severity of the injury (7). Nevertheless, approximately half of human SCI cases affect cervical regions, resulting in debilitating respiratory dysfunction due to phrenic motor neuron loss and injury to descending bulbospinal respiratory axons (1). A number of animal models of SCI have been developed, with the most commonly used and clinically-relevant being the contusion (8). Transplantation of various classes of neural precursor cells (NPCs) is a promising therapeutic strategy for treatment of traumatic CNS injuries and neurodegeneration, including ALS and SCI, because of the ability to replace lost or dysfunctional CNS cell types, provide neuroprotection, and deliver gene factors of interest (9). Animal models of both ALS and SCI can model many clinically-relevant aspects of these diseases, including phrenic motor neuron loss and consequent respiratory compromise (10,11). In order to evaluate the efficacy of NPC-based strategies on respiratory function in these animal models of ALS and SCI, cellular interventions must be specifically directed to regions containing therapeutically relevant targets such as phrenic motor neurons. We provide a detailed protocol for multi-segmental, intraspinal transplantation of NPCs into the cervical spinal cord ventral gray matter of neurodegenerative models such as SOD1(G93A) mice and rats, as well as spinal cord injured rats and mice (11).

Epidural Anesthesia and Pulmonary Function in a Patient with Amyotrophic Lateral Sclerosis

Neurological disorders represent a significant category of diseases that profoundly affect human health, accounting for the second leading cause of global mortality. This group of conditions includes stroke, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), spinal cord injury, Parkinson's disease, and cerebral palsy, among others. These disorders are highly susceptible to sequelae and profoundly impact individuals' daily lives. In this context, Brain-Computer Interface (BCI) technology has demonstrated considerable potential in the domain of neurorehabilitation, although numerous challenges remain. The manuscript provides a comprehensive review of recent advancements in research and clinical applications, highlighting current limitations and outlining future directions. It elucidates the applicability and constraints of Brain-Computer Interface (BCI) technology across various diseases and patient populations. To facilitate insights across different conditions, comparative tables are presented, aligning BCI strategies with therapeutic targets, outcomes, advantages, limitations, and existing evidence gaps. The scope extends beyond motor restoration to include under-explored domains, such as neuropathic pain, with a focus on real-world translation, including home and community feasibility and the distinction between assistive and rehabilitative applications. The review distills overarching limitations within the field, such as small sample sizes, protocol heterogeneity, and limited longitudinal evidence, while synthesizing the most recent studies. An actionable research and development roadmap is proposed to guide next-generation BCI rehabilitation, incorporating individualized cortical-network simulators, self-architecting decoders, adaptive therapy approaches akin to game seasons, and proprioceptive "write-back" mechanisms via peripheral interfaces. Moreover, the review reveals significant research focal points and critical issues that warrant further investigation in the context of neurological rehabilitation utilizing BCI technology.

Many disorders, like spinal cord injury, stroke or amyotrophic lateral sclerosis (ALS), can impair or even completely disable the usual communication channels a person needs to communicate and interact with his or her environment. In such severe cases, a brain-computer interface (BCI) might be the only remaining way to communicate [1]. In a BCI, the brain’s electrical activity during predefined mental tasks is analyzed and translated into corresponding actions intend‐ ed by the user. But even for less severe disabilities, a BCI can improve quality of life by allow‐ ing users to control a computer or specially prepared electronic devices, or to stay in contact with friends through social networks and games. P300 evoked potential [2, 3, 4] based BCIs can provide goal-oriented control as needed to operating spelling devices [5] or control computer games [6]. For navigating in space e.g. moving a computer mouse [7]), controlling the motion and move‐ ment of a robot or a wheelchair, steady state visual evoked potential (SSVEP) [8, 9, 10, 10] and motor imagination [12, 13] based BCI paradigms can be used.

Electrocortical and behavioral effects of chronic immobility on word processing

For a long time, researchers have been working on a marriage of human and machine that sounds like something out of science fiction: a brain-computer interface. BCIs read electrical signals or other manifestations of brain activity and translate them into a digital form that computers can understand, process, and convert into actions of some kind, such as moving a cursor or turning on a TV. Several academic and corporate researchers are now working to commercialize the technology, while other projects are taking innovative approaches to BCIs that could create interesting products or services in the not-too-distant future. The technology holds great promise for people who can't use their arms or hands normally because they have had spinal cord injuries or suffer from conditions such as amyotrophic lateral sclerosis (ALS) or cerebral palsy. BCI could help them control computers, wheelchairs, televisions, or other devices with brain activity

Enhancing the Social Impact of Contemporary Music with Neurotechnology

Individuals suffering from a progressive neurodegenerative disease, such as amyotrophic lateral sclerosis (ALS), will lose muscle function over time and become completely paralysed. For some time, people with ALS may retain functional tongue movement, despite losing mobility below the neck. These individuals can benefit from using an inductive tongue control interface (ITCI) to control computers or assistive robotic devices to gain independence in their daily lives. Eventually, when the individual can no longer use their tongue, they can rely on a brain computer interface (BCI). However, these require a lot of data to calibrate and function properly. Recording this data while the individual can still use the ITCI can potentially speed up the training process, allowing for an easier transition between interface technologies. This study investigates whether it is possible to create a background data collector for a BCI based on attempted tongue movement by analyzing brain patterns of two individuals with ALS while using an ITCI. The participants used an inductive ITCI in simple cued movement trials while electroencephalogram (EEG) was collected from the motor cortex. The EEG signal indicated that movement-related cortical potentials (MRCP) were generated after the cued movements. After synchronising the signal to the activations recorded on the ITCI, the MRCP became even more apparent. Therefore, it is concluded that it is possible to record MRCPs from individuals with ALS performing tongue movements, that the ITCI can assist in better extracting synchronized MRCP epochs, and that a background data collector for a tongue movement intention-based BCI is very feasible.

Amyotrophic Lateral Sclerosis (ALS) is a rapidly progressive, life-limiting neurodegenerative disease. Informal carers provide extensive support, significantly impacting their health-related quality of life (HRQoL). Current HRQoL measurement using person-reported outcome measures (PROMs) in ALS carers lacks consistency and comprehensiveness, hindering robust assessment and synthesis. There is evident need for a comprehensive conceptual framework of HRQoL, to fully capture the multidimensional nature of caregiving in ALS. Such a framework is essential to inform research and clinical practice, ensuring relevant measurement and meaningful clinical discussions. This study aimed to develop this evidence-based framework. This study comprised two stages. Firstly, a scoping review was undertaken in March 2024 using Medline, Embase, and CINAHL to identify primary articles exploring HRQoL in ALS carers. Qualitative, mixed methods and quantitative articles using multi-item PROMs to assess HRQoL in informal ALS carers were included. Relevant themes and subthemes were extracted from articles and PROMs and mapped onto an existing conceptual framework for people with ALS (Quality of Life in ALS, QuALS), which covers physical, psychological, and social HRQoL domains in people with ALS. The Carer-QuALS framework was subsequently developed and refined using existing literature and consultation with ALS carers. PROMs within this review were then indexed against the finalised Carer-QuALS framework. From 715 search results, 82 articles and 44 PROMs were eligible for inclusion. One new subtheme 'physical caring activities' emerged, while seven subthemes lacked support from the literature. In three structured consultation sessions, nine ALS carers, reviewed the draft Carer-QuALS framework (consisting of seven themes and 43 subthemes). Based on their input, one new subtheme 'privacy' was added, six subthemes were removed, and one was retained, despite lacking support from review literature. The final Carer-QuALS framework includes 37 subthemes: 8 physical, 6 social, and 23 psychological. This review presents a comprehensive conceptual framework encompassing the multidimensional impact of ALS caregiving on the HRQoL of informal carers. The framework provides a resource that can be used by researchers, clinicians, and patient advocacy groups for multiple purposes (e.g., to support PROM selection to measure HRQoL, to guide future PROM development, and to facilitate discussions between informal carers and clinicians).