Brain-computer interfaces: communication and restoration of movement in paralysis
Brain-computer interfaces: communication and restoration of movement in paralysis
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DOI：
10.1113/jphysiol.2006.125633
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发表时间：
2007-03-15
影响因子：
5.5
通讯作者：
Cohen, Leonardo G.
中科院分区：
文献类型：
--
作者：
Birbaumer, Niels;Cohen, Leonardo G.
本文综述了脑-机或脑-机接口的研究现状。我们的重点是无创脑-计算机接口(BCI)及其在中风瘫痪和运动恢复中的直接脑通信的临床应用。侵入性动物和人类BCI制剂的前景与临床现实之间的巨大差距是这些文献的特点：虽然完好无损的猴子通常在经过广泛训练后，只学会执行或多或少复杂的上肢动作，带有运动脑区的尖峰图案，但通常没有伴随的外周运动活动，但临床应用于人类疾病，如肌萎缩侧索硬化症和中风或脊髓病变导致的瘫痪，只显示出有限的成功，瘫痪和闭锁患者的语言交流除外。基于脑电电位或振荡的BCI已经准备好进行大规模的临床研究和商业生产，作为瘫痪和闭锁患者的辅助或主要辅助通讯设备。然而，在进入完全锁定状态而没有剩余眼球运动后，训练完全锁定的BCI通信患者的尝试失败了。我们认为，目标导向的思想和意图之间缺乏偶然性可能是这个问题的核心。对慢性弯曲的大鼠进行的实验支持了我们的假设；在这种准备过程中，操作性条件反射和自主神经生理功能的自愿控制被证明是不可能的。除了辅助沟通外，脑机接口包括脑电慢皮质电位的可操作性学习和感觉运动节律，被证明在治疗耐药性局灶性癫痫和注意缺陷障碍方面是成功的。首次研究了使用脑电和脑磁图的感觉运动节律的非侵入性BCI在恢复慢性中风和单一病例高位脊髓病变瘫痪手运动中的前景，但需要在良好的对照实验中进行广泛的评估。基于神经元棘波模式、局部场电位或皮层脑电图的侵入性BMI可能构成中风和脊髓瘫痪严重病例的首选策略。脑-机接口未来的研究方向应包括脑代谢和血流的调节以及对人脑的电刺激和磁刺激(有创和无创)。一系列使用功能磁共振成像(FMRI)和近红外光谱的BOLD反应调节研究表明，大脑新陈代谢的自愿变化与行为之间存在密切关联。
The review describes the status of brain-computer or brain-machine interface research. We focus on non-invasive brain-computer interfaces (BCIs) and their clinical utility for direct brain communication in paralysis and motor restoration in stroke. A large gap between the promises of invasive animal and human BCI preparations and the clinical reality characterizes the literature: while intact monkeys learn to execute more or less complex upper limb movements with spike patterns from motor brain regions alone without concomitant peripheral motor activity usually after extensive training, clinical applications in human diseases such as amyotrophic lateral sclerosis and paralysis from stroke or spinal cord lesions show only limited success, with the exception of verbal communication in paralysed and locked-in patients. BCIs based on electroencephalographic potentials or oscillations are ready to undergo large clinical studies and commercial production as an adjunct or a major assisted communication device for paralysed and locked-in patients. However, attempts to train completely locked-in patients with BCI communication after entering the complete locked-in state with no remaining eye movement failed. We propose that a lack of contingencies between goal directed thoughts and intentions may be at the heart of this problem. Experiments with chronically curarized rats support our hypothesis; operant conditioning and voluntary control of autonomic physiological functions turned out to be impossible in this preparation. In addition to assisted communication, BCIs consisting of operant learning of EEG slow cortical potentials and sensorimotor rhythm were demonstrated to be successful in drug resistant focal epilepsy and attention deficit disorder. First studies of non-invasive BCIs using sensorimotor rhythm of the EEG and MEG in restoration of paralysed hand movements in chronic stroke and single cases of high spinal cord lesions show some promise, but need extensive evaluation in well-controlled experiments. Invasive BMIs based on neuronal spike patterns, local field potentials or electrocorticogram may constitute the strategy of choice in severe cases of stroke and spinal cord paralysis. Future directions of BCI research should include the regulation of brain metabolism and blood flow and electrical and magnetic stimulation of the human brain (invasive and non-invasive). A series of studies using BOLD response regulation with functional magnetic resonance imaging (fMRI) and near infrared spectroscopy demonstrated a tight correlation between voluntary changes in brain metabolism and behaviour.