Translational refinement of adaptive communication system for locked-in patients

描述(申请人提供)：脑机接口(BCI)技术的激增为被锁住的患者提供了成功沟通的潜在途径。大多数BCI系统要么涉及从一组同时呈现的刺激中进行选择，需要对界面进行广泛的控制；要么使用二元刺激选择机制，由于缓慢的意图检测或固定的(与上下文无关的)刺激排序而无法实现高通信速率。我们提出了一种新的界面，通过自然语言组件的快速连续可视化呈现，使用文本输入的二进制选择。由获得性神经疾病(肌萎缩侧索硬化症、脑干中风、帕金森病、多发性硬化症、脊髓损伤)和神经发育障碍(脑瘫、肌肉营养不良)导致的严重言语和身体障碍(SSPI)的个人推动了拟议的研究。四个实验室组成了这一翻译研究项目的联盟：基础研究(Erdogmus，工程学；Roark，计算机科学和自然语言处理)和临床研究(Oken，神经学/神经生理学；Fry-Oken，增强沟通/神经源性沟通障碍)。我们的目标是(1)开发一种创新的基于EEG的BCI，以实现更高的通信速率，错误更少，对目标SSPI人群更满意；(2)在实验室中反复改进该系统，利用来自健康受试者和上市AAC系统的LIS专家的用户反馈；(3)在SSPI患者的自然临床环境中评估该系统的性能。创新的BCI是RSVP键盘，具有三个基本特征：(1)从字母到单词再到短语的语言成分的快速连续视觉呈现(RSVP)；(2)采用多通道脑电(EEG)和/或其他合适的反应机制的检测机制，可以可靠地指示用户的二元意图，并根据用户的个性化神经生理数据进行调整；(3)开放词汇的自然语言模型，能够准确预测即将到来的文本。理论框架基于坚实的贝叶斯基础；临床可用性基于世卫组织ICF(WHO，2001)和增强和替代沟通(AAC)参与模式。将在临床实验室和自然环境中对健全的受试者和SSPI患者进行严格的实验审查。对36名健康受试者进行假设驱动的交叉设计，对40名SSPI患者进行交替治疗随机设计，获得不同迭代RSVP键盘的学习率、消息产生速度、错误率和用户满意度的测量结果。对在自然环境中使用新系统的LIS患者的运动、认知和语言技能的描述将为临床指南和功能设备的适应提供信息，以更好地对患有SSPI的儿童和成人进行个性化治疗。拟议的转译研究的合作性质预计将为BCI开发和临床AAC使用产生新的知识。 相关性：随着医疗技术的进步和成功地维持生命，闭锁综合征患者的人数正在增加。如果这些人有更快、更可靠的方式与通信系统交互，这些限制为不动的人可能会对他们的医疗决策、知情同意和日常护理做出贡献。RSVP键盘和拟议的语言模型是创新的技术发现，正在应用于临床增强交流工具，使患者及其家人能够参与日常活动，并倡导改善标准的临床护理。拟议的项目强调将基础计算机科学转化为临床护理，支持拟议的NIH路线图和公共卫生倡议。

DESCRIPTION (provided by applicant): The proliferation of brain-computer interface (BCI) technology promises locked-in patients potential ways to communicate successfully. Most BCI systems either involve selection from among a set of simultaneously presented stimuli, requiring extensive control of the interface; or use binary stimulus selection mechanisms that fail to achieve high communication rates because of slow intent detection or a fixed (context independent) ordering of stimuli. We propose a new interface using binary selection of text input via rapid serial visual presentation of natural language components. Individuals with severe speech and physical impairments (SSPI) resulting from acquired neurological disorders (amyotrophic lateral sclerosis, brainstem stroke, Parkinson's disease, multiple sclerosis, spinal cord injury) and neurodevelopmental disorders (cerebral palsy, muscular dystrophy) drive the proposed research. Four laboratories form an alliance for this translational research project: basic research (Erdogmus, engineering; Roark, computer science and natural language processing), and clinical research (Oken, neurology/neurophysiology; Fried-Oken, augmentative communication/neurogenic communication disorders). Our aims are (1) to develop an innovative EEG-based BCI that achieves increased communication rates with fewer errors and greater satisfaction for the target SSPI populations; (2) to iteratively refine the system in the laboratory with user feedback from healthy subjects and expert LIS users of marketed AAC systems; (3) to evaluate the performance of the system within the natural clinical settings of SSPI patients. The innovative BCI is the RSVP Keyboard with three essential features: (1) rapid serial visual presentation (RSVP) of linguistic components ranging from letters to words to phrases; (2) a detection mechanism that employs multichannel electroencephalography (EEG) and/or other suitable response mechanisms that can reliably indicate the binary intent of the user and adapt based on individualized neurophysiologic data of the user; and (3) an open-vocabulary natural language model with a capability for accurate predictions of upcoming text. Theoretical framework is based on a solid Bayesian foundation; clinical usability is based on the WHO ICF (WHO, 2001) and an Augmentative and Alternative Communication (AAC) model of participation. Rigorous experimental scrutiny in both clinical laboratory and natural settings will be obtained with able-bodied subjects and SSPI patients. Measures of learning rate, speed of message production, error rate and user satisfaction for different iterations of the RSVP keyboard will be obtained using an hypothesis-driven crossover design for 36 healthy subjects, and alternating treatment randomization design for 40 patients with SSPI. Descriptions of the motor, cognitive, and language skills of LIS patients using the novel system in their natural environments will inform clinical guidelines and functional device adaptations to better individualize treatment for children and adults with SSPI. The collaborative nature of the proposed translational research is expected to yield new knowledge for both BCI development and clinical AAC use. Relevance: The populations of patients with locked-in syndrome are increasing as medical technologies advance and successfully support life. These individuals with limited to no movement could potentially contribute to their medical decision making, informed consent, and daily care giving if they had faster, more reliable means to interface with communication systems. The RSVP keyboard and proposed language models are innovative technological discoveries that are being applied to clinical augmentative communication tools so that patients and their families can participate in daily activities and advocate for improvements in standard clinical care. The proposed project stresses the translation of basic computer science into clinical care, supporting the proposed NIH Roadmap and public health initiatives.