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Institute
Brain-computer interfaces (BCIs) are devices that translate signals from the brain into control commands for applications. Within the last twenty years, BCI applications have been developed for communication, environmental control, entertainment, and substitution of motor functions. Since BCIs provide muscle independent communication and control of the environment by circumventing motor pathways, they are considered as assistive technologies for persons with neurological and neurodegenerative diseases leading to motor paralysis, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal muscular atrophy and stroke (Kübler, Kotchoubey, Kaiser, Wolpaw, & Birbaumer, 2001). Although most researcher mention persons with severe motor impairment as target group for their BCI systems, most studies include healthy participants and studies including potential BCI end-users are sparse. Thus, there is a substantial lack of studies that investigate whether results obtained in healthy participants can be transferred to patients with neurodegenerative diseases. This clearly shows that BCI research faces a translational gap between intense BCI research and bringing BCI applications to end-users outside the lab (Kübler, Mattia, Rupp, & Tangermann, 2013). Translational studies are needed that investigate whether BCIs can be successfully used by severely disabled end-users and whether those end-users would accept BCIs as assistive devices. Another obvious discrepancy exists between a plethora of short-term studies and a sparse number of long-term studies. BCI research thus also faces a reliability gap (Kübler, Mattia, et al., 2013). Most studies present only one BCI session, however the few studies that include several testing sessions indicate high inter- and intra-individual variance in the end-users’ performance due to non-stationarity of signals. Long-term studies, however, are needed to demonstrate whether a BCI can be reliably used as assistive device over a longer period of time in the daily-life of a person. Therefore there is also a great need for reliability studies.
The purpose of the present thesis was to address these research gaps and to bring BCIs closer to end-users in need, especially into their daily-lives, following a user-centred design (UCD). The UCD was suggested as theoretical framework for bringing BCIs to end-users by Kübler and colleagues (Kübler et al., 2014; Zickler et al., 2011). This approach aims at the close and iterative interaction between BCI developers and end-users with the final goal to develop BCI systems that are accepted as assistive devices by end-users. The UCD focuses on usability, that is, how well a BCI technology matches the purpose and meets the needs and requirements of the targeted end-users and was standardized with the ISO 9241-210.
Within the UCD framework, usability of a device can be defined with regard to its effectiveness, efficiency and satisfaction. These aspects were operationalized by Kübler and colleagues to evaluate BCI-controlled applications. As suggested by Vaughan and colleagues, the number of BCI sessions, the total usage duration and the impact of the BCI on the life of the person can be considered as indicators of usefulness of the BCI in long-term daily-life use (Vaughan, Sellers, & Wolpaw, 2012). These definitions and metrics for usability and usefulness were applied for evaluating BCI applications as assistive devices in controlled settings and independent use. Three different BCI applications were tested and evaluated by in total N=10 end-users: In study 1 a motor-imagery (MI) based BCI for gaming was tested by four end-users with severe motor impairment. In study 2, a hybrid P300 event-related (ERP) based BCI for communication was tested by four severely motor restricted end-users with severe motor impairment. Study 1 and 2 are short-term studies conducted in a controlled-setting. In study 3 a P300-ERP BCI for creative expression was installed for long-term independent use at the homes of two end-users in the locked-in state. Both end-users are artists who had gradually lost the ability to paint after being diagnosed with ALS.
Results reveal that BCI controlled devices are accepted as assistive devices. Main obstacles for daily-life use were the not very aesthetic design of the EEG-cap and electrodes (cap is eye-catching and looks medical), low comfort (cables disturb, immobility, electrodes press against head if lying on a head cushion), complicated and time-consuming adjustment, low efficiency and low effectiveness, and not very high reliability (many influencing factors). While effectiveness and efficiency in the MI based BCI were lower compared to applications using the P300-ERP as input channel, the MI controlled gaming application was nevertheless better accepted by the end-users and end-users would rather like to use it compared to the communication applications. Thus, malfunctioning and errors, low speed, and the EEG cap are rather tolerated in gaming applications, compared to communication devices. Since communication is essential for daily-life, it has to be fast and reliable. BCIs for communication, at the current state of the art, are not considered competitive with other assistive devices, if other devices, such as eye-gaze, are still an option. However BCIs might be an option when controlling an application for entertainment in daily-life, if communication is still available. Results demonstrate that BCI is adopted in daily-life if it matches the end-users needs and requirements. Brain Painting serves as best representative, as it matches the artists’ need for creative expression. Caveats such as uncomfortable cap, dependence on others for set-up, and experienced low control are tolerated and do not prevent BCI use on a daily basis. Also end-users in real need of means for communication, such as persons in the locked-in state with unreliable eye-movement or no means for independent communication, do accept obstacles of the BCI, as it is the last or only solution to communicate or control devices. Thus, these aspects are “no real obstacles” but rather “challenges” that do not prevent end-users to use the BCI in their daily-lives. For instance, one end-user, who uses a BCI in her daily-life, stated: “I don’t care about aesthetic design of EEG cap and electrodes nor amplifier”. Thus, the question is not which system is superior to the other, but which system is best for an individual user with specific symptoms, needs, requirements, existing assistive solutions, support by caregivers/family etc.; it is thereby a question of indication. These factors seem to be better “predictors” for adoption of a BCI in daily-life, than common usability criterions such as effectiveness or efficiency. The face valid measures of daily-life demonstrate that BCI-controlled applications can be used in daily-life for more than 3 years, with high satisfaction for the end-users, without experts being present and despite a decrease in the amplitude of the P300 signal. Brain Painting re-enabled both artists to be creatively active in their home environment and thus improved their feelings of happiness, usefulness, self-esteem, well-being, and consequently quality of life and supports social inclusion. This thesis suggests that BCIs are valuable tools for people in the locked-in state.
Brain-Computer Interfaces (BCIs) strive to decode brain signals into control commands for severely handicapped people with no means of muscular control. These potential users of noninvasive BCIs display a large range of physical and mental conditions. Prior studies have shown the general applicability of BCI with patients, with the conflict of either using many training sessions or studying only moderately restricted patients. We present a BCI system designed to establish external control for severely motor-impaired patients within a very short time. Within only six experimental sessions, three out of four patients were able to gain significant control over the BCI, which was based on motor imagery or attempted execution. For the most affected patient, we found evidence that the BCI could outperform the best assistive technology (AT) of the patient in terms of control accuracy, reaction time and information transfer rate. We credit this success to the applied user-centered design approach and to a highly flexible technical setup. State-of-the art machine learning methods allowed the exploitation and combination of multiple relevant features contained in the EEG, which rapidly enabled the patients to gain substantial BCI control. Thus, we could show the feasibility of a flexible and tailorable BCI application in severely disabled users. This can be considered a significant success for two reasons: Firstly, the results were obtained within a short period of time, matching the tight clinical requirements. Secondly, the participating patients showed, compared to most other studies, very severe communication deficits. They were dependent on everyday use of AT and two patients were in a locked-in state. For the most affected patient a reliable communication was rarely possible with existing AT.
Albeit research on brain-computer interfaces (BCI) for controlling applications has expanded tremendously, we still face a translational gap when bringing BCI to end-users. To bridge this gap, we adapted the user-centered design (UCD) to BCI research and development which implies a shift from focusing on single aspects, such as accuracy and information transfer rate (ITR), to a more holistic user experience. The UCD implements an iterative process between end-users and developers based on a valid evaluation procedure. Within the UCD framework usability of a device can be defined with regard to its effectiveness, efficiency, and satisfaction. We operationalized these aspects to evaluate BCI-controlled applications. Effectiveness was regarded equivalent to accuracy of selections and efficiency to the amount of information transferred per time unit and the effort invested (workload). Satisfaction was assessed with questionnaires and visual-analogue scales. These metrics have been successfully applied to several BCI-controlled applications for communication and entertainment, which were evaluated by end-users with severe motor impairment. Results of four studies, involving a total of N = 19 end-users revealed: effectiveness was moderate to high; efficiency in terms of ITR was low to high and workload low to medium; depending on the match between user and technology, and type of application satisfaction was moderate to high. The here suggested evaluation metrics within the framework of the UCD proved to be an applicable and informative approach to evaluate BCI controlled applications, and end-users with severe impairment and in the locked-in state were able to participate in this process.
This paper describes a case study with a patient in the classic locked-in state, who currently has no means of independent communication. Following a user-centered approach, we investigated event-related potentials (ERP) elicited in different modalities for use in brain-computer interface (BCI) systems. Such systems could provide her with an alternative communication channel. To investigate the most viable modality for achieving BCI based communication, classic oddball paradigms (1 rare and 1 frequent stimulus, ratio 1:5) in the visual, auditory and tactile modality were conducted (2 runs per modality). Classifiers were built on one run and tested offline on another run (and vice versa). In these paradigms, the tactile modality was clearly superior to other modalities, displaying high offline accuracy even when classification was performed on single trials only. Consequently, we tested the tactile paradigm online and the patient successfully selected targets without any error. Furthermore, we investigated use of the visual or tactile modality for different BCI systems with more than two selection options. In the visual modality, several BCI paradigms were tested offline. Neither matrix-based nor so-called gaze-independent paradigms constituted a means of control. These results may thus question the gaze-independence of current gaze-independent approaches to BCI. A tactile four-choice BCI resulted in high offline classification accuracies. Yet, online use raised various issues. Although performance was clearly above chance, practical daily life use appeared unlikely when compared to other communication approaches (e.g., partner scanning). Our results emphasize the need for user-centered design in BCI development including identification of the best stimulus modality for a particular user. Finally, the paper discusses feasibility of EEG-based BCI systems for patients in classic locked-in state and compares BCI to other AT solutions that we also tested during the study.