Brain–computer interface–based communication in the completely locked-in State
Open accessAbstract
Despite partial success, communication has remained impossible for persons suffering from complete motor paralysis but intact cognitive and emotional processing, a state called complete locked-in state (CLIS). Based on a motor learning theoretical context and on the failure of neuroelectric brain-computer interface (BCI) communication attempts in CLIS, we here report BCI communication using functional near-infrared spectroscopy (fNIRS) and an implicit attentional processing procedure. Four patients suffering from advanced amyotrophic lateral sclerosis (ALS)-two of them in permanent CLIS and two entering the CLIS without reliable means of communication-learned to answer personal questions with known answers and open questions all requiring a "yes" or "no" thought using frontocentral oxygenation changes measured with fNIRS. Three patients completed more than 46 sessions spread over several weeks, and one patient (patient W) completed 20 sessions. Online fNIRS classification of personal questions with known answers and open questions using linear support vector machine (SVM) resulted in an above-chance-level correct response rate over 70%. Electroencephalographic oscillations and electrooculographic signals did not exceed the chance-level threshold for correct communication despite occasional differences between the physiological signals representing a "yes" or "no" response. However, electroencephalogram (EEG) changes in the theta-frequency band correlated with inferior communication performance, probably because of decreased vigilance and attention. If replicated with ALS patients in CLIS, these positive results could indicate the first step towards abolition of complete locked-in states, at least for ALS.
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It may be hard to obtain sufficiently large patient populations for concrete and statistically significant conclusions.
“Additionally, it is apparent from previous work that access to sufficiently large patient populations for concrete and statistically significant conclusions may be difficult to obtain (1–5, 8, 11, 29, 39).”
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- Authors
- Chaudhary, U., Xia, B., Silvoni, S., Cohen, L. G., & Birbaumer, N.
- Affiliations
- University of Tübingen (DE)
- Shanghai Maritime University (CN)
- Central Institute of Mental Health (DE)
- National Institutes of Health (US)
- IRCCS San Camillo Hospital (IT)
- Corresponding author
- Chaudhary, Ujwal
- Birbaumer, Niels
- Venue
- PLOS Biology
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-01-31
- Volume
- 15
- Issue
- 1
- Pages
- e1002593
- ISSN
- 1544-9173 (ISSN-L)
- 1545-7885
- PMC
- PMC5283652
- OpenAlex
- W2584955774
- Cited by
- 235
- References
- 63
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 16 · 2023: 6 · 2022: 17 · 2021: 44 · 2020: 30 · 2019: 40 · 2018: 50 · 2017: 20
- FWCI
- 21.98
- Type
- journal article
- Language
- en
- Status
- Retracted
- Update notices
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/publicdomain/zero/1.0/ (vor)
- Locations
- PLoS Biology (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Deutsche Forschungsgemeinschaft (DFG, Bi195, Kosellek)
- Stiftung Volkswagenwerk
- Bundesministerium für Bildung und Forschung (MOTOR-BIC (FKZ 136W0053))
- Baden-Württemberg Stiftung (524-4013-16SV7196)
- National Natural Science Foundation of China (61550110252)
- EU grant LUMINOUS (686764)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › EEG and Brain-Computer Interfaces
- Physical Sciences › Computer Science › Human-Computer Interaction › Gaze Tracking and Assistive Technology
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- brain-computer interface, amyotrophic lateral sclerosis, functional near-infrared spectroscopy, motor learning, theta oscillations, EEG, electrooculography, support vector machine classification, motor paralysis
- MeSH terms
- Communication, Electroencephalography, Humans, Oxyhemoglobins, Quadriplegia, ROC Curve, Signal Processing, Computer-Assisted, Spectroscopy, Near-Infrared, Brain-Computer Interfaces
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