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Design Considerations for Long Term Non-invasive Brain Computer Interface Training With Tetraplegic CYBATHLON Pilot.

ABSTRACT: Several studies in the recent past have demonstrated how Brain Computer Interface (BCI) technology can uncover the neural mechanisms underlying various tasks and translate them into control commands. While a multitude of studies have demonstrated the theoretic potential of BCI, a point of concern is that the studies are still confined to lab settings and mostly limited to healthy, able-bodied subjects. The CYBATHLON 2020 BCI race represents an opportunity to further develop BCI design strategies for use in real-time applications with a tetraplegic end user. In this study, as part of the preparation to participate in CYBATHLON 2020 BCI race, we investigate the design aspects of BCI in relation to the choice of its components, in particular, the type of calibration paradigm and its relevance for long-term use. The end goal was to develop a user-friendly and engaging interface suited for long-term use, especially for a spinal-cord injured (SCI) patient. We compared the efficacy of conventional open-loop calibration paradigms with real-time closed-loop paradigms, using pre-trained BCI decoders. Various indicators of performance were analyzed for this study, including the resulting classification performance, game completion time, brain activation maps, and also subjective feedback from the pilot. Our results show that the closed-loop calibration paradigms with real-time feedback is more engaging for the pilot. They also show an indication of achieving better online median classification performance as compared to conventional calibration paradigms (p = 0.0008). We also observe that stronger and more localized brain activation patterns are elicited in the closed-loop paradigm in which the experiment interface closely resembled the end application. Thus, based on this longitudinal evaluation of single-subject data, we demonstrate that BCI-based calibration paradigms with active user-engagement, such as with real-time feedback, could help in achieving better user acceptability and performance.

SUBMITTER: Robinson N

PROVIDER: S-EPMC8239283 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:CYBATHLON is an international championship where people with severe physical disabilities compete with the aid of state-of-the-art assistive technology. In one of the disciplines, the BCI Race, tetraplegic pilots compete in a computer game race by controlling an avatar with a brain-computer interface (BCI). This competition offers a perfect opportunity for BCI researchers to study long-term training effects in potential end-users, and to evaluate BCI performance in a realistic environment. In this work, we describe the BCI system designed by the team Mirage91 for participation in the CYBATHLON BCI Series 2019, as well as in the CYBATHLON 2020 Global Edition. Furthermore, we present the BCI's interface with the game and the main methodological strategies, along with a detailed evaluation of its performance over the course of the training period, which lasted 14 months. The developed system was a 4-class BCI relying on task-specific modulations of brain rhythms. We implemented inter-session transfer learning to reduce calibration time, and to reinforce the stability of the brain patterns. Additionally, in order to compensate for potential intra-session shifts in the features' distribution, normalization parameters were continuously adapted in an unsupervised fashion. Across the aforementioned 14 months, we recorded 26 game-based training sessions. Between the first eight sessions, and the final eight sessions leading up to the CYBATHLON 2020 Global Edition, the runtimes significantly improved from 255 ± 23 s (mean ± std) to 225 ± 22 s, respectively. Moreover, we observed a significant increase in the classifier's accuracy from 46 to 53%, driven by more distinguishable brain patterns. Compared to conventional single session, non-adaptive BCIs, the inter-session transfer learning and unsupervised intra-session adaptation techniques significantly improved the performance. This long-term study demonstrates that regular training helped the pilot to significantly increase the distance between task-specific patterns, which resulted in an improvement of performance, both with respect to class separability in the calibration data, and with respect to the game. Furthermore, it shows that our methodological approaches were beneficial in transferring the performance across sessions, and most importantly to the CYBATHLON competitions.

Project description:BackgroundBrain-computer interfaces (BCIs) are systems capable of translating human brain patterns, measured through electroencephalography (EEG), into commands for an external device. Despite the great advances in machine learning solutions to enhance the performance of BCI decoders, the translational impact of this technology remains elusive. The reliability of BCIs is often unsatisfactory for end-users, limiting their application outside a laboratory environment.MethodsWe present the analysis on the data acquired from an end-user during the preparation for two Cybathlon competitions, where our pilot won the gold medal twice in a row. These data are of particular interest given the mutual learning approach adopted during the longitudinal training phase (8 months), the long training break in between the two events (1 year) and the demanding evaluation scenario. A multifaceted perspective on long-term user learning is proposed: we enriched the information gathered through conventional metrics (e.g., accuracy, application performances) by investigating novel neural correlates of learning in different neural domains.ResultsFirst, we showed that by focusing the training on user learning, the pilot was capable of significantly improving his performance over time even with infrequent decoder re-calibrations. Second, we revealed that the analysis of the within-class modifications of the pilot's neural patterns in the Riemannian domain is more effective in tracking the acquisition and the stabilization of BCI skills, especially after the 1-year break. These results further confirmed the key role of mutual learning in the acquisition of BCI skills, and particularly highlighted the importance of user learning as a key to enhance BCI reliability.ConclusionWe firmly believe that our work may open new perspectives and fuel discussions in the BCI field to shift the focus of future research: not only to the machine learning of the decoder, but also in investigating novel training procedures to boost the user learning and the stability of the BCI skills in the long-term. To this end, the analyses and the metrics proposed could be used to monitor the user learning during training and provide a marker guiding the decoder re-calibration to maximize the mutual adaptation of the user to the BCI system.

Project description:BackgroundThere is growing evidence that cognitive training (CT) can improve the cognitive functioning of the elderly. CT may be influenced by cultural and linguistic factors, but research examining CT programs has mostly been conducted on Western populations. We have developed an innovative electroencephalography (EEG)-based brain-computer interface (BCI) CT program that has shown preliminary efficacy in improving cognition in 32 healthy English-speaking elderly adults in Singapore. In this second pilot trial, we examine the acceptability, safety, and preliminary efficacy of our BCI CT program in healthy Chinese-speaking Singaporean elderly.MethodsThirty-nine elderly participants were randomized into intervention (n=21) and wait-list control (n=18) arms. Intervention consisted of 24 half-hour sessions with our BCI-based CT training system to be completed in 8 weeks; the control arm received the same intervention after an initial 8-week waiting period. At the end of the training, a usability and acceptability questionnaire was administered. Efficacy was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which was translated and culturally adapted for the Chinese-speaking local population. Users were asked about any adverse events experienced after each session as a safety measure.ResultsThe training was deemed easily usable and acceptable by senior users. The median difference in the change scores pre- and post-training of the modified RBANS total score was 8.0 (95% confidence interval [CI]: 0.0-16.0, P=0.042) higher in the intervention arm than waitlist control, while the mean difference was 9.0 (95% CI: 1.7-16.2, P=0.017). Ten (30.3%) participants reported a total of 16 adverse events - all of which were graded "mild" except for one graded "moderate".ConclusionOur BCI training system shows potential in improving cognition in both English- and Chinese-speaking elderly, and deserves further evaluation in a Phase III trial. Overall, participants responded positively on the usability and acceptability questionnaire.

Project description:Introduction: Transcranial direct current stimulation (tDCS) has been shown to modulate cortical plasticity, enhance motor learning and post-stroke upper extremity motor recovery. It has also been demonstrated to facilitate activation of brain-computer interface (BCI) in stroke patients. We had previously demonstrated that BCI-assisted motor imagery (MI-BCI) can improve upper extremity impairment in chronic stroke participants. This study was carried out to investigate the effects of priming with tDCS prior to MI-BCI training in chronic stroke patients with moderate to severe upper extremity paresis and to investigate the cortical activity changes associated with training. Methods: This is a double-blinded randomized clinical trial. Participants were randomized to receive 10 sessions of 20-min 1 mA tDCS or sham-tDCS before MI-BCI, with the anode applied to the ipsilesional, and the cathode to the contralesional primary motor cortex (M1). Upper extremity sub-scale of the Fugl-Meyer Assessment (UE-FM) and corticospinal excitability measured by transcranial magnetic stimulation (TMS) were assessed before, after and 4 weeks after intervention. Results: Ten participants received real tDCS and nine received sham tDCS. UE-FM improved significantly in both groups after intervention. Of those with unrecordable motor evoked potential (MEP-) to the ipsilesional M1, significant improvement in UE-FM was found in the real-tDCS group, but not in the sham group. Resting motor threshold (RMT) of ipsilesional M1 decreased significantly after intervention in the real-tDCS group. Short intra-cortical inhibition (SICI) in the contralesional M1 was reduced significantly following intervention in the sham group. Correlation was found between baseline UE-FM score and changes in the contralesional SICI for all, as well as between changes in UE-FM and changes in contralesional RMT in the MEP- group. Conclusion: MI-BCI improved the motor function of the stroke-affected arm in chronic stroke patients with moderate to severe impairment. tDCS did not confer overall additional benefit although there was a trend toward greater benefit. Cortical activity changes in the contralesional M1 associated with functional improvement suggests a possible role for the contralesional M1 in stroke recovery in more severely affected patients. This has important implications in designing neuromodulatory interventions for future studies and tailoring treatment. Clinical Trial Registration: The study was registered at https://clinicaltrials.gov (NCT01897025).

Project description:UnlabelledCognitive decline in aging is a pressing issue associated with significant healthcare costs and deterioration in quality of life. Previously, we reported the successful use of a novel brain-computer interface (BCI) training system in improving symptoms of attention deficit hyperactivity disorder. Here, we examine the feasibility of the BCI system with a new game that incorporates memory training in improving memory and attention in a pilot sample of healthy elderly. This study investigates the safety, usability and acceptability of our BCI system to elderly, and obtains an efficacy estimate to warrant a phase III trial. Thirty-one healthy elderly were randomized into intervention (n = 15) and waitlist control arms (n = 16). Intervention consisted of an 8-week training comprising 24 half-hour sessions. A usability and acceptability questionnaire was administered at the end of training. Safety was investigated by querying users about adverse events after every session. Efficacy of the system was measured by the change of total score from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) before and after training. Feedback on the usability and acceptability questionnaire was positive. No adverse events were reported for all participants across all sessions. Though the median difference in the RBANS change scores between arms was not statistically significant, an effect size of 0.6SD was obtained, which reflects potential clinical utility according to Simon's randomized phase II trial design. Pooled data from both arms also showed that the median change in total scores pre and post-training was statistically significant (Mdn = 4.0; p<0.001). Specifically, there were significant improvements in immediate memory (p = 0.038), visuospatial/constructional (p = 0.014), attention (p = 0.039), and delayed memory (p<0.001) scores. Our BCI-based system shows promise in improving memory and attention in healthy elderly, and appears to be safe, user-friendly and acceptable to senior users. Given the efficacy signal, a phase III trial is warranted.Trial registrationClinicalTrials.gov NCT01661894.

Project description:ObjectivePilot testing of real time functional magnetic resonance imaging (rt-fMRI) and real time functional near infrared spectroscopy (rt-fNIRS) as brain computer interface (BCI) neural feedback systems combined with motor learning for motor recovery in chronic severely impaired stroke survivors.ApproachWe enrolled a four-case series and administered three sequential rt-fMRI and ten rt-fNIRS neural feedback sessions interleaved with motor learning sessions. Measures were: Arm Motor Assessment Tool, functional domain (AMAT-F; 13 complex functional tasks), Fugl-Meyer arm coordination scale (FM); active wrist extension range of motion (ROM); volume of activation (fMRI); and fNIRS HbO concentration. Performance during neural feedback was assessed, in part, using percent successful brain modulations during rt-fNIRS.Main resultsPre-/post-treatment mean clinically significant improvement in AMAT-F (.49 ± 0.22) and FM (10.0 ± 3.3); active wrist ROM improvement ranged from 20° to 50°. Baseline to follow-up change in brain signal was as follows: fMRI volume of activation was reduced in almost all ROIs for three subjects, and for one subject there was an increase or no change; fNIRS HbO was within normal range, except for one subject who increased beyond normal at post-treatment. During rt-fNIRS neural feedback training, there was successful brain signal modulation (42%-78%).SignificanceSeverely impaired stroke survivors successfully engaged in spatially focused BCI systems, rt-fMRI and rt-fNIRS, to clinically significantly improve motor function. At the least, equivalency in motor recovery was demonstrated with prior long-duration motor learning studies (without neural feedback), indicating that no loss of motor improvement resulted from substituting neural feedback sessions for motor learning sessions. Given that the current neural feedback protocol did not prevent the motor improvements observed in other long duration studies, even in the presence of fewer sessions of motor learning in the current work, the results support further study of neural feedback and its potential for recovery of motor function in stroke survivors. In future work, expanding the sophistication of either or both rt-fMRI and rt-fNIRS could hold the potential for further reducing the number of hours of training needed and/or the degree of recovery. ClinicalTrials.gov ID: NCT02856035.

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Design Considerations for Long Term Non-invasive Brain Computer Interface Training With Tetraplegic CYBATHLON Pilot.

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