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Objective: We investigated neurophysiological brain responses elicited by a tactile event-related potential paradigm in a sample of ALS patients. Underlying cognitive processes and neurophysiological signatures for brain-computer interface (BCI) are addressed., Methods: We stimulated the palm of the hand in a group of fourteen ALS patients and a control group of ten healthy participants and recorded electroencephalographic signals in eyes-closed condition. Target and non-target brain responses were analyzed and classified offline. Classification errors served as the basis for neurophysiological brain response sub-grouping., Results: A combined behavioral and quantitative neurophysiological analysis of sub-grouped data showed neither significant between-group differences, nor significant correlations between classification performance and the ALS patients' clinical state. Taking sequential effects of stimuli presentation into account, analyses revealed mean classification errors of 19.4% and 24.3% in healthy participants and ALS patients respectively., Conclusions: Neurophysiological correlates of tactile stimuli presentation are not altered by ALS. Tactile event-related potentials can be used to monitor attention level and task performance in ALS and may constitute a viable basis for future BCIs., Significance: Implications for brain-computer interface implementation of the proposed method for patients in critical conditions, such as the late stage of ALS and the (completely) locked-in state, are discussed., (Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective of this study was to evaluate attentional control mechanisms in amyotrophic lateral sclerosis (ALS) using an auditory event-related potentials (ERPs) paradigm. Fifteen mild to moderate ALS patients and 15 healthy controls were administered a brief neuropsychological test battery and an ERPs paradigm assessing selective attention. Four types of auditory stimuli were presented in random order: short standard (200 Hz, 200 ms), long standard (200 Hz, 500 ms), short deviant (1000 Hz, 200 ms) and long deviant (1000 Hz, 500 ms). Participants had to respond to the long deviant stimuli only. During the task the electroencephalogram (EEG) was recorded. The N200, P300 and re-orienting negativity (RON) ERP components were analysed. Compared to controls ALS patients showed reduced amplitudes and delayed latencies of N200, P300 and RON. These results could be attributable to both an alteration in change detection resulting in a reduction of the allocation and re-orientation of attentional resources or a general slowing or reduction of neural processing efficiency in the same system. The ERPs results support the hypothesis that ALS involves extramotor cognitive functions including auditory attentional processing at all processing stages, early (200 ms) and late (300-600 ms). These data prove the usefulness and sensitivity of the auditory ERPs in detection of cognitive functions in ALS patients.

A major clinical goal of brain-computer interfaces (BCIs) is to allow severely paralyzed patients to communicate their needs and thoughts during their everyday lives. Among others, P300-based BCIs, which resort to EEG measurements, have been successfully operated by people with severe neuromuscular disabilities. Besides reducing the number of stimuli repetitions needed to detect the P300, a current challenge in P300-based BCI research is the simplification of system's setup and maintenance by lowering the number N of recording channels. By using offline data collected in 30 subjects (21 amyotrophic lateral sclerosis patients and 9 controls) through a clinical BCI with N = 5 channels, in the present paper we show that a preprocessing approach based on a Bayesian single-trial ERP estimation technique allows reducing N to 1 without affecting the system's accuracy. The potentially great benefit for the practical usability of BCI devices (including patient acceptance) that would be given by the reduction of the number N of channels encourages further development of the present study, for example, in an online setting.

Our objective was to investigate the relationship between brain-computer interface (BCI) communication skill and disease progression in amyotrophic lateral sclerosis (ALS). We sought also to assess stability of BCI communication performance over time and whether it is related to the progression of neurological impairment before entering the locked-in state. A three years follow-up, BCI evaluation in a group of ALS patients (n = 24) was conducted. For a variety of reasons only three patients completed the three years follow-up. BCI communication skill and disability level, using the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised, were assessed at admission and at each of the three follow-ups. Multiple non-parametric statistical methods were used to ensure reliability of the dependent variables: correlations, paired test and factor analysis of variance. Results demonstrated no significant relationship between BCI communication skill (BCI-CS) and disease evolution. The patients who performed the follow-up evaluations preserved their BCI-CS over time. Patients' age at admission correlated positively with the ability to achieve control over a BCI. In conclusion, disease evolution in ALS does not affect the ability to control a BCI for communication. BCI performance can be maintained in the different stages of the illness.

Background: Brain-computer interfaces (BCIs) allow people to control devices by translating brain signals into commands. BCIs represent a concrete solution with regard to communication and motor control disabilities of patients with amyotrophic lateral sclerosis (ALS). Most of the BCIs rely on visual interfaces in which patients must move their eyes to achieve efficient BCI control. This fact represents a limitation of BCI use in ALS patients who are in the final stages of the disease., Objective: We aimed to improve visual interfaces for ALS patients to control the movement of a cursor on a monitor by orienting their covert visuospatial attention (i.e., orienting without eye movements)., Methods: A total of 10 ALS patients with different levels of impairment used 2 new visual interfaces in an event-related potential (ERP)-based BCI. In the first interface, they were required to use exogenous visuospatial attention orienting (VAO), whereas in the second interface, they were required to use endogenous VAO., Results: . ALS patients were able to use the 2 interfaces for controlling the ERP-based BCI system in real time. Nevertheless, better target classification and information transfer rate were associated with the interface that was based on endogenous VAO., Conclusions: ALS patients can exploit their covert VAO to control a BCI that does not require eye movements. The implementation of endogenous VAO in the design of covert visuospatial attention-based interfaces seems to be suitable for designing more ergonomic and efficient BCIs for ALS patients with impaired eye movements.

Aim of this study is to investigate working memory functions in nondemented patients with amyotrophic lateral sclerosis (ALS) using neuropsychological testing and auditory event-related potentials. Twenty-four patients with ALS and 17 age- and education-matched controls underwent a comprehensive neuropsychological assessment, with particular emphasis on working memory functions. Event-related potentials were assessed with an active auditory oddball paradigm. In a subsample (67%) of patients with ALS, the neuropsychological assessment revealed impaired performance on working memory tests (semantic and letter verbal fluency, modified card sorting test, trail making test, digit span, Corsi blocks tapping test, and prose memory). The analysis of event-related potentials showed a significant delay of the N100, P200, and N200 latency in ALS compared with controls. Correlation analysis showed a relation between clinical parameters (disease duration and functional rating scale) and neuropsychological test results (letter fluency and trail making test) and between disease duration and P300 amplitude. The neuropsychological and event-related potentials profile of patients with ALS at an average is consistent with a mild dysfunction of the central executive component of working memory. In conclusion, the results support previously published reports that indicate the involvement of the extramotor functions in a significant subsample of ALS.