Tilt/Recline Adjustment by Subjects with ALS using Brain Computer Interfaces

描述(申请人提供)：许多神经性疾病会导致严重的残疾，并限制个人独立操作技术的选择。脑机接口(BCI)可以使完全瘫痪的人独立控制辅助设备。肌萎缩侧索硬化症(ALS)患者非常适合参与BCI的临床应用开发，因为他们经常可以从当前BCI提供的有限能力中受益。患有肌萎缩侧索硬化症的人通常会收到电动轮椅，这些轮椅上有重新定位和缓解压力的动力系统，比如空间倾斜。不幸的是，随着肌萎缩侧索硬化症的进展，肌萎缩侧索硬化症患者往往无法控制这些倾斜/倾斜系统，从而增加了他们的不适和对护理的依赖。BCI有可能为这些人提供独立的动力倾斜/倾斜控制，以缓解压力、舒适和改善呼吸。这项实验/开发拨款(R21)应用程序将支持BCI的原型开发，以控制倾斜/倾斜，以及ALS受试者的初步测试。这项拟议的工作将解决总体研究问题：“ALS患者在家中使用基于脑电(EEG)P300反应的脑机接口来操作电动轮椅倾斜/倾斜系统的效果如何？”项目假设包括：1.基于NIH资助的BCI2000的BCI可以取代标准控制来调整轮椅倾斜/倾斜系统。2.患有肌萎缩侧索硬化症的人会发现，能够独立控制轮椅倾斜/倾斜的脑机接口非常有用，以至于他们将平均每周在家里使用该系统至少10个小时。这项拟议的工作将包括开发基于大脑对古怪范例的P300反应的脑机接口，以取代电动轮椅倾斜/倾斜系统上的标准控制。在拟议的工作过程中，BCI将在家庭环境中接受至少6名患有肌萎缩侧索硬化的受试者数月的测试。将在受试者家中安装远程监测系统，以提供技术支持。受试者的技能和感知将定期进行衡量，以获得BCI效用的客观和主观衡量标准。受试者的损害程度也将被定期测量，以用于在疾病进展过程中评估脑机接口。肌萎缩侧索硬化症患者相对长期使用脑机接口在家庭环境中操作倾斜/倾斜系统，这将是对脑机接口效用的重大测试，收集的信息将指导未来的脑机接口发展。随着在家庭环境中成功使用所需的脑机接口设计的创新，收集关于使用、实用、能力和损伤的初步数据，以及这些数据揭示的趋势和相关性，应该为未来涉及更多对象的研究奠定基础。总体而言，这将使BCI更接近成为各种严重残疾人士的临床可用选择。与公共健康相关：脑机接口(BCI)是一项新技术，可以为完全瘫痪的人提供独立操作辅助设备的能力。这项拟议的工作将测试BCI作为肌萎缩侧索硬化症(ALS，又名Lou Gehrig病)患者的临床管理工具，以便在他们的家庭环境中独立调整倾斜/倾斜以获得舒适和改善呼吸。通过研究受试者在使用脑机接口时的实际努力/利益权衡，拟议的工作将为因各种疾病和损伤(如ALS、肌肉营养不良、脊髓损伤和脑干中风)而导致身体障碍的人的临床应用奠定基础，并将为脑机接口进一步发展为实用的临床工具提供信息。

DESCRIPTION (provided by applicant): Many neurological disorders cause severe disabilities and limit a person's options for independent operation of technology. Brain computer interfaces (BCIs) can enable people with complete paralysis to control assistive devices independently. People with amyotrophic lateral sclerosis (ALS) are uniquely suited to participate in the development of clinical applications of BCIs because they can often benefit from the limited capabilities offered by current BCIs. People with ALS routinely receive power wheelchairs that have powered systems for repositioning and pressure relief, such as tilt-in-space. Unfortunately, with ALS progression, the controls for these tilt/recline systems often become inaccessible to people with ALS, increasing their discomfort and dependence on attendant care. BCIs have the potential to provide such people with independent control of power tilt/recline for pressure relief, comfort, and improved respiration. This experimental/development grant (R21) application will support the prototype development of a BCI to control tilt/recline along with initial testing by subjects with ALS. The proposed work will address the overall research question: "How well can subjects with ALS use a BCI based on the P300 response in electroencephalogram (EEG) to operate a power wheelchair tilt/recline system in their home environments?" Project hypotheses include: 1. A BCI based on the NIH-funded BCI2000 can replace standard controls to adjust a wheelchair tilt/recline system. 2. People with ALS will find a BCI that provides independent control of wheelchair tilt/recline sufficiently useful so that they will use the system in their homes an average of at least 10 hours per week. The proposed work will include the development of a BCI based on the brain's P300 response to the oddball paradigm to replace the standard controls found on power wheelchair tilt/recline systems. Over the course of the proposed work, the BCI will be tested for many months in the home environment by at least 6 subjects with ALS. A telemonitoring system will be installed in subjects' homes for technical support. Subjects' skills and perceptions will be measured on a regular basis to obtain objective and subjective measures of BCI utility. Subjects' levels of impairment will also be measured regularly to use in the evaluation of the BCI over the course of disease progression. This relatively long-term use of BCIs by people with ALS to operate a tilt/recline system in a home environment will be a significant test of BCI utility and the information gathered will guide future BCI development. Along with the innovations in BCI design required for successful use in the home environment, the collection of preliminary data on usage, utility, ability and impairment, and the trends and correlations that this data reveal should lay the groundwork for future studies involving larger numbers of subjects. Overall, this will bring BCIs closer to becoming a clinically available option for people with a variety of severe disabilities. PUBLIC HEALTH RELEVANCE: Brain Computer Interfaces (BCIs) are a new technology that could provide people with complete paralysis with the ability to operate assistive devices independently. The proposed work will test a BCI as a clinical management tool for people with amyotrophic lateral sclerosis (ALS, aka Lou Gehrig's Disease) to independently adjust tilt/recline for comfort and improved respiration in their home environments. By examining the realistic effort/benefit trade-offs the subjects' experience while using a BCI, the proposed work will lay a foundation for the clinical use of BCIs by people with physical impairments resulting from a variety of diseases and injuries, such as ALS, muscular dystrophy, spinal cord injury, and brainstem stroke, and it will inform the further development of BCIs into practical clinical tools.