Brain-Computer Interface-Based Communication in the Completely Locked-In State.
Brain-Computer Interface-Based Communication in the Completely Locked-In State.
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DOI：
10.1371/journal.pbio.1002593
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发表时间：
2017-01
期刊：
影响因子：
9.8
通讯作者：
Birbaumer N
中科院分区：
文献类型：
--
作者：
Chaudhary U;Xia B;Silvoni S;Cohen LG;Birbaumer N
尽管取得了部分成功，但对于患有完全运动瘫痪但认知和情感处理完整的人来说，沟通仍然是不可能的，这种状态称为完全锁定状态（CLIS）。基于运动学习的理论背景和神经电脑机接口（BCI）通信尝试在CLIS的失败，我们在这里报告BCI通信使用功能近红外光谱（fNIRS）和内隐注意力处理程序。四名患有晚期肌萎缩性侧索硬化症（ALS）的患者-其中两人在永久性CLIS中，两人在没有可靠的通信手段的情况下进入CLIS-学会了用已知答案回答个人问题和开放性问题，所有这些问题都需要使用fNIRS测量的额中央氧合变化来思考“是”或“否”。三名患者在几周内完成了超过46个疗程，一名患者（患者W）完成了20个疗程。在线fNIRS分类的个人问题与已知的答案和开放的问题，使用线性支持向量机（SVM），导致以上的机会水平的正确回答率超过70%。脑电图振荡和眼电图信号没有超过正确沟通的机会水平阈值，尽管偶尔的生理信号之间的差异表示“是”或“否”的反应。然而，θ频段的脑电图（EEG）变化与较差的通信性能相关，可能是因为警惕性和注意力下降。如果在CLIS中对ALS患者进行复制，这些积极的结果可能表明朝着废除完全锁定状态迈出了第一步，至少对于ALS来说是这样。患有晚期肌萎缩侧索硬化症的“锁定”患者，没有可靠的交流手段，可以学习回答需要“是”或“否”思考的问题，使用功能性近红外光谱测量的额中枢氧合变化。尽管科学和技术取得了进步，但对于患有完全运动瘫痪但认知和情感处理完好的人来说，沟通仍然是不可能的，这种情况被称为完全锁定状态。基于神经电技术（如脑电图）的脑机接口无法为处于完全锁定状态的患者提供交流手段。因此，在这里，我们探讨了基于功能性近红外光谱（fNIRS）的脑机接口-测量与神经元活动相关的脑血流动力学反应-是否可以克服这一障碍。四名患有晚期肌萎缩侧索硬化症（ALS）的患者，其中两名处于永久完全锁定状态，两名进入完全锁定状态，没有可靠的通信手段，学会了回答个人问题，已知答案和开放性问题，需要一个“是”或“否”，通过使用fNIRS测量的额中央氧合变化。这些结果可能是废除完全锁定状态的第一步，至少对ALS患者来说是这样。
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. "Locked in" patients suffering from advanced amyotrophic lateral sclerosis, with no reliable means of communication, can learn to answer questions requiring a “yes” or “no” thought using frontocentral oxygenation changes measurable by functional near-infrared spectroscopy. Despite scientific and technological advances, communication has remained impossible for persons suffering from complete motor paralysis but intact cognitive and emotional processing, a condition that is called completely locked-in state. Brain–computer interfaces based on neuroelectrical technology (like an electroencephalogram) have failed at providing patients in a completely locked-in state with means to communicate. Therefore, here we explored if a brain–computer interface based on functional near infrared spectroscopy (fNIRS)—which measures brain hemodynamic responses associated with neuronal activity—could overcome this barrier. Four patients suffering from advanced amyotrophic lateral sclerosis (ALS), two of them in permanent completely locked-in state and two entering the completely locked-in state without reliable means of communication, learned to answer personal questions with known answers and open questions requiring a “yes” or “no” by using frontocentral oxygenation changes measured with fNIRS. These results are, potentially, the first step towards abolition of completely locked-in states, at least for patients with ALS.