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Brain–computer interfaces for communication and rehabilitation

A Corrigendum to this article was published on 17 February 2017

This article has been updated

Key Points

  • Brain–computer interfaces (BCIs) are starting to prove their efficacy as assistive and rehabilitative technologies in patients with severe motor impairments

  • BCIs can be invasive or noninvasive, and designed to detect and decode a variety of brain signals

  • Assistive BCIs are intended to enable paralyzed patients to communicate or control external robotic devices; rehabilitative BCIs are intended to facilitate neural recovery

  • EEG-based BCIs have enabled some paralyzed patients to communicate, but near-infrared spectroscopy combined with a classical conditioning paradigm is the only successful approach for complete locked-in syndrome

  • The combination of EEG-based BCIs with behavioural physiotherapy is a feasible option for rehabilitation in stroke; the approach is to induce neuroplasticity and restore lost function after stroke

  • There is an urgent need for more large randomized controlled clinical trials using invasive and noninvasive BCIs with long-term follow-ups in patients rather than healthy populations

Abstract

Brain–computer interfaces (BCIs) use brain activity to control external devices, thereby enabling severely disabled patients to interact with the environment. A variety of invasive and noninvasive techniques for controlling BCIs have been explored, most notably EEG, and more recently, near-infrared spectroscopy. Assistive BCIs are designed to enable paralyzed patients to communicate or control external robotic devices, such as prosthetics; rehabilitative BCIs are designed to facilitate recovery of neural function. In this Review, we provide an overview of the development of BCIs and the current technology available before discussing experimental and clinical studies of BCIs. We first consider the use of BCIs for communication in patients who are paralyzed, particularly those with locked-in syndrome or complete locked-in syndrome as a result of amyotrophic lateral sclerosis. We then discuss the use of BCIs for motor rehabilitation after severe stroke and spinal cord injury. We also describe the possible neurophysiological and learning mechanisms that underlie the clinical efficacy of BCIs.

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Figure 1: General framework of brain–computer interface (BCI) systems.
Figure 2: Use of a brain–computer interface in severe chronic stroke.

Change history

  • 17 February 2017

    In the initial version of this article, details of the BrainGate2 study were omitted from Table 1. This error has been corrected in the HTML and PDF versions of the article.

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Acknowledgements

The authors are funded by Deutsche Forschungsgemeinschaft (DFG, Bi195, Kosellek), Stiftung Volkswagenwerk (VW), German Ministry of Education and Research (BMBF, grant number MOTOR-BIC (FKZ 136W0053), Ministry of Science, Research and the Arts of Baden Wüttemberg (Az: 32–729.63-0/5-5), Baden-Württemberg Stiftung (ROB-1), EMOIO from the Federal Ministry of Education and Research (BMBF, 524-4013-16SV7196) and Eva and Horst Köhler-Stiftung, (Berlin), EU (Horizon 2020) grant “Brain Train” and “Luminous”, Brain Products, Munich, Germany, and the Wyss Foundation, Geneva, Switzerland.

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Correspondence to Ujwal Chaudhary or Ander Ramos-Murguialday.

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Glossary

Alpha waves

Neural oscillations in the frequency range of 8–13 Hz, indicating widespread inhibitory activity in neuronal tissue.

Instrumental learning

A type of learning in which the strength of a behaviour or a physiological response is modified by its consequences (reward or punishment).

Local field potentials

Graded neuroelectrical changes in voltage, generated by the summed synaptic currents flowing from multiple nearby neurons within a small volume of nervous tissue, recorded from inserted microelectrodes.

Single-unit acitivity

Action potentials of single neurons, recorded using inserted microelectrodes

Multi-unit activity

Action potentials of multiple neurons,recorded using an array of multiple microelectrodes.

Cortical preparation

Cortical preparation occurs before a cognitive, motor or emotional response, and is detectable with EEG as a negatively polarized voltage shift.

Contingency

Contingency is an associative connection between stimuli or responses that are usually paired within a short time period of milliseconds to seconds.

Classical conditioning

Classical conditioning, also called Pavlovian conditioning, is a learning process in which two stimuli are repeatedly paired until one elicits a reflexive behavioural or physiological response that relates to the other.

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Chaudhary, U., Birbaumer, N. & Ramos-Murguialday, A. Brain–computer interfaces for communication and rehabilitation. Nat Rev Neurol 12, 513–525 (2016). https://doi.org/10.1038/nrneurol.2016.113

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