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Background Action research (AR) is an established research framework to introduce change in a community following a cyclical approach and involving stakeholders as coresearchers in the process. In recent years, it has also been used for eHealth development. However, little is known about the best practices and lessons learned from using AR for eHealth development. Objective This literature review aims to provide more knowledge on the best practices and lessons learned from eHealth AR studies. Additionally, an overview of the context in which AR eHealth studies take place is given. Methods A semisystematic review of 44 papers reporting on 40 different AR projects was conducted to identify the best practices and lessons learned in the research studies while accounting for the particular contextual setting and used AR approach. Results Recommendations include paying attention to the training of stakeholders’ academic skills, as well as the various roles and tasks of action researchers. The studies also highlight the need for constant reflection and accessible dissemination suiting the target group. Conclusions This literature review identified room for improvements regarding communicating and specifying the particular AR definition and applied approach.

Background Brain-computer interfaces (BCIs) have been proposed as an assistive technology (AT) allowing people with locked-in syndrome (LIS) to use neural signals to communicate. To design a communication BCI (cBCI) that is fully accepted by the users, their opinion should be taken into consideration during the research and development process. Objective We assessed the preferences of prospective cBCI users regarding (1) the applications they would like to control with a cBCI, (2) the mental strategies they would prefer to use to control the cBCI, and (3) when during their clinical trajectory they would like to be informed about AT and cBCIs. Furthermore, we investigated if individuals diagnosed with progressive and sudden onset (SO) disorders differ in their opinion. Methods We interviewed 28 Dutch individuals with LIS during a 3-hour home visit using multiple-choice, ranking, and open questions. During the interview, participants were informed about BCIs and the possible mental strategies. Results Participants rated (in)direct forms of communication, computer use, and environmental control as the most desired cBCI applications. In addition, active cBCI control strategies were preferred over reactive strategies. Furthermore, individuals with progressive and SO disorders preferred to be informed about AT and cBCIs at the moment they would need it. Conclusions We show that individuals diagnosed with progressive and SO disorders preferred, in general, the same applications, mental strategies, and time of information. By collecting the opinion of a large sample of individuals with LIS, this study provides valuable information to stakeholders in cBCI and other AT development.

In the past 10 years, brain-computer interfaces (BCIs) for controlling assistive devices have seen tremendous progress with respect to reliability and learnability, and numerous exemplary applications were demonstrated to be controllable by a BCI. Yet, BCI-controlled applications are hardly used for patients with neurologic or neurodegenerative disease. Such patient groups are considered potential end-users of BCI, specifically for replacing or improving lost function. We argue that BCI research and development still faces a translational gap, i.e., the knowledge of how to bring BCIs from the laboratory to the field is insufficient. BCI-controlled applications lack usability and accessibility; both constitute two sides of one coin, which is the key to use in daily life and to prevent nonuse. To increase usability, we suggest rigorously adopting the user-centered design in applied BCI research and development. To provide accessibility, assistive technology (AT) experts, providers, and other stakeholders have to be included in the user-centered process. BCI experts have to ensure the transfer of knowledge to AT professionals, and listen to the needs of primary, secondary, and tertiary end-users of BCI technology. Addressing both, usability and accessibility, in applied BCI research and development will bridge the translational gap and ensure that the needs of clinical end-users are heard, understood, addressed, and fulfilled.

This paper provides an analysis of perspectives from different stakeholders on the state-of-the-art of BCI. Three barriers for technology transfer of BCIs as access technologies are identified. First, BCIs are developed with a narrow focus on creating a reliable technology, while a broader focus on creating a usable technology is needed. Second, the potential target group, which could benefit from BCIs as access technologies is expected to be very small. Development costs are therefore high, while reimbursements are expected to be low, which challenges the commercial viability. Third, potential target users should be much more included in the design process of BCIs to ensure that the end-products meet technical, ethical, legal and social requirements. These three issues need to be urgently addressed so that target users may benefit from this promising technology.

Item does not contain fulltext The steadily growing field of brain–computer interfacing (BCI) may develop useful technologies, with a potential impact not only on individuals, but also on society as a whole. At the same time, the development of BCI presents significant ethical and legal challenges. In a workshop during the 4th International BCI meeting (Asilomar, California, 2010), six panel members from various BCI laboratories and companies set out to identify and disentangle ethical issues related to BCI use in four case scenarios, which were inspired by current experiences in BCI laboratories. Results of the discussion are reported in this article, touching on topics such as the representation of persons with communication impairments, dealing with technological complexity and moral responsibility in multidisciplinary teams, and managing expectations, ranging from an individual user to the general public. Furthermore, we illustrate that where treatment and research interests conflict, ethical concerns arise. On the basis of the four case scenarios, we discuss salient, practical ethical issues that may confront any member of a typical multidisciplinary BCI team. We encourage the BCI and rehabilitation communities to engage in a dialogue, and to further identify and address pressing ethical issues as they occur in the practice of BCI research and its commercial applications. 6 p.

Objective: This study examined the effect of motivation as a possible psychological influencing variable on P300 amplitude and performance in a brain–computer interface (BCI) controlled by event-related potentials (ERP). Methods: Participants were instructed to copy spell a sentence by attending to cells of a randomly flashing 7 � 7 matrix. Motivation was manipulated by monetary reward. In two experimental groups participants received 25 (N = 11) or 50 (N = 11) Euro cent for each correctly selected character; the control group (N = 11) was not rewarded. BCI performance was defined as the overall percentage of correctly selected characters (correct response rate = CRR). Results: Participants performed at an average of 99%. At electrode location Cz the P300 amplitude was positively correlated to self-rated motivation. The P300 amplitude of the most motivated participants was significantly higher than that of the least motivated participants. Highly motivated participants were able to communicate correctly faster with the ERP-BCI than less motivated participants. Conclusions: Motivation modulates the P300 amplitude in an ERP-BCI. Significance: Motivation may contribute to variance in BCI performance and should be monitored in BCI settings.

Objective Brain–computer interfaces (BCIs) provide non-muscular communication for individuals diagnosed with late-stage motoneuron disease (e.g., amyotrophic lateral sclerosis (ALS)). In the final stages of the disease, a BCI cannot rely on the visual modality. This study examined a method to achieve high accuracies using auditory stimuli only. Methods We propose an auditory BCI based on a three-stimulus paradigm. This paradigm is similar to the standard oddball but includes an additional target (i.e. two target stimuli, one frequent stimulus). Three versions of the task were evaluated in which the target stimuli differed in loudness, pitch or direction. Results Twenty healthy participants achieved an average information transfer rate (ITR) of up to 2.46 bits/min and accuracies of 78.5%. Most subjects (14 of 20) achieved their best performance with targets differing in pitch. Conclusions With this study, the viability of the paradigm was shown for healthy participants and will next be evaluated with individuals diagnosed with ALS or locked-in syndrome (LIS) after stroke. Significance The here presented BCI offers communication with binary choices (yes/no) independent of vision. As it requires only little time per selection, it may constitute a reliable means of communication for patients who lost all motor function and have a short attention span.

Objective: The current study evaluates the efficacy of a P300-based brain–computer interface (BCI) communication device for individuals with advanced ALS. Methods: Participants attended to one cell of a N N matrix while the N rows and N columns flashed randomly. Each cell of the matrix contained one character. Every flash of an attended character served as a rare event in an oddball sequence and elicited a P300 response. Classification coefficients derived using a stepwise linear discriminant function were applied to the data after each set of flashes. The character receiving the highest discriminant score was presented as feedback. Results: In Phase I, six participants used a 6 6 matrix on 12 separate days with a mean rate of 1.2 selections/min and mean online and offline accuracies of 62% and 82%, respectively. In Phase II, four participants used either a 6 6o r a7 7 matrix to produce novel and spontaneous statements with a mean online rate of 2.1 selections/min and online accuracy of 79%. The amplitude and latency of the P300 remained stable over 40 weeks. Conclusions: Participants could communicate with the P300-based BCI and performance was stable over many months. Significance: BCIs could provide an alternative communication and control technology in the daily lives of people severely disabled by ALS.

Brain-computer interfaces (BCIs) translate brain activity into signals controlling external devices. BCIs based on visual stimuli can maintain communication in severely paralyzed patients, but only if intact vision is available. Debilitating neurological disorders however, may lead to loss of intact vision. The current study explores the feasibility of an auditory BCI. Sixteen healthy volunteers participated in three training sessions consisting of 30 2-3 min runs in which they learned to increase or decrease the amplitude of sensorimotor rhythms (SMR) of the EEG. Half of the participants were presented with visual and half with auditory feedback. Mood and motivation were assessed prior to each session. Although BCI performance in the visual feedback group was superior to the auditory feedback group there was no difference in performance at the end of the third session. Participants in the auditory feedback group learned slower, but four out of eight reached an accuracy of over 70% correct in the last session comparable to the visual feedback group. Decreasing performance of some participants in the visual feedback group is related to mood and motivation. We conclude that with sufficient training time an auditory BCI may be as efficient as a visual BCI. Mood and motivation play a role in learning to use a BCI.

Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease with no curative treatment. Considering the devastating nature of the disease, a high prevalence of depression and anxiety in affected patients would be expected. A review of the literature shows prevalence rates for depression in ALS patients ranging from 0% to 44%, but studies using the structured interview according to DSM-IV criteria find highly consistent rates of 9-11%. Prevalence rates for anxiety in ALS range from 0% to 30%. Depression and anxiety appear to be not always properly addressed aspects of ALS, as there are only a few references in the literature about psychological and pharmacological interventions. Additionally, pharmacological antidepressant therapy is often not continuously monitored and its effectiveness remains unevaluated. A review of the literature and our own experiences show that there is a lack of psychological care and, to our knowledge, there is no specific psychological intervention method for ALS patients. Concerning pharmacological treatment of depression in patients with ALS, there is broad consensus among clinical experts that SSRIs and TCAs are helpful, but there have been no controlled clinical studies of these medications in ALS patients. TCAs can be prescribed if anticholinergic effects are desired simultaneously for treating pseudohypersalivation or insomnia. Anxiety is usually treated with anxiolytics, but again there have been no systematic studies of these drugs in patients with ALS. For psychological intervention we suggest a cognitive behavioural approach, which has to be integrated into an intervention programme that includes teaching of appropriate coping strategies and reappraisal skills and encourages engagement in activities that are still practicable and pleasant. We propose that the treatment of depression and anxiety should involve both cognitive behavioural therapy and pharmacological intervention. Pharmacological treatment should be strictly monitored for effectiveness. To date, no clinical trials are available that would allow us to recommend pharmacotherapy over psychotherapy or vice versa; however, evidence from other patient groups, such as elderly patients diagnosed with major depressive disorder, suggests that a combination of both therapies has the potential to also improve depression and anxiety in patients with ALS.

We summarize results from a series of related studies that aim to develop a motor-imagery-based brain-computer interface using a single recording session of electroencephalogram (EEG) or electrocorticogram (ECoG) signals for each subject. We apply the same experimental and analytical methods to 11 nonparalysed subjects (eight EEG, three ECoG), and to five paralyzed subjects (four EEG, one ECoG) who had been unable to communicate for some time. While it was relatively easy to obtain classifiable signals quickly from most of the nonparalyzed subjects, it proved impossible to classify the signals obtained from the paralyzed patients by the same methods. This highlights the fact that though certain BCI paradigms may work well with healthy subjects, this does not necessarily indicate success with the target user group. We outline possible reasons for this failure to transfer.

Locked-in syndrome (LIS) as a result of brainstem lesions or progressive neurodegenerative disorders, such as amyotrophic lateral sclerosis (ALS), is a severe medical condition in which a person is fully conscious but unable to move or talk. LIS can transition into complete locked-in syndrome (CLIS) in which residual abilities to communicate through muscle twitches are entirely lost. It is unknown how CLIS affects circadian rhythm and sleep/wake patterns. Here we report a 39-year-old ALS patient who transitioned from LIS to CLIS while brain activity was continuously recorded using electrocorticography (ECoG) over one month. While we found no circadian rhythm in heart rate and body temperature, transition into CLIS was associated with increased fragmentation of slow wave sleep (SWS) across the day. Total time in SWS did not change. SWS fragmentation might reflect progressive circadian system impairment and should be considered as a factor further limiting communication capabilities in these patients.

People with severe motor disabilities can maintain an acceptable quality of life if they can communicate. Brain-computer interfaces (BCIs), which do not depend on muscle control, can provide communication. Four people severely disabled by ALS learned to operate a BCI with EEG rhythms recorded over sensorimotor cortex. These results suggest that a sensorimotor rhythm-based BCI could help maintain quality of life for people with ALS.

This study was designed to develop and test an auditory event-related potential (ERP) based spelling system for a brain-computer interface (BCI) and to compare user's performance between the auditory and visual modality. The spelling system, where letters in a matrix were coded with acoustically presented numbers, was tested on a group of healthy volunteers. The results were compared with a visual spelling system. Nine of the 13 participants presented with the auditory ERP spelling system scored above a predefined criterion level control for communication. Compared to the visual spelling system, users' performance was lower and the peak latencies of the auditorily evoked ERPs were delayed. It was concluded that auditorily evoked ERPs from the majority of the users could be reliably classified. High accuracies were achieved in these users, rendering item selection with a BCI based on auditory stimulation feasible for communication.

Contains fulltext : 77533.pdf (Publisher’s version ) (Closed access) This paper focuses on ethical aspects of BCI, as a research and a clinical tool, that are challenging for practitioners currently working in the field. Specifically, the difficulties involved in acquiring informed consent from locked-in patients are investigated, in combination with an analysis of the shared moral responsibility in BCI teams, and the complications encountered in establishing effective communication with media. 6 p.

This paper describes the highlights of presentations and discussions during the Third International BCI Meeting in a workshop that evaluated potential brain-computer interface (BCI) signals and currently available recording methods. It defined the main potential user populations and their needs, addressed the relative advantages and disadvantages of noninvasive and implanted (i.e., invasive) methodologies, considered ethical issues, and focused on the challenges involved in translating BCI systems from the laboratory to widespread clinical use. The workshop stressed the critical importance of developing useful applications that establish the practical value of BCI technology.

Objective: Patients in the completely locked-in state (CLIS), due to, for example, amyotrophic lateral sclerosis (ALS), no longer possess voluntary muscle control. Assessing attention and cognitive function in these patients during the course of the disease is a challenging but essential task for both nursing staff and physicians. Approach: An electrophysiological cognition test battery, including auditory and semantic stimuli, was applied in a late-stage ALS patient at four different time points during a six-month epidural electrocorticography (ECoG) recording period. Event-related cortical potentials (ERP), together with changes in the ECoG signal spectrum, were recorded via 128 channels that partially covered the left frontal, temporal and parietal cortex. Main results: Auditory but not semantic stimuli induced significant and reproducible ERP projecting to specific temporal and parietal cortical areas. N1/P2 responses could be detected throughout the whole study period. The highest P3 ERP was measured immediately after the patient's last communication through voluntary muscle control, which was paralleled by low theta and high gamma spectral power. Three months after the patient's last communication, i.e., in the CLIS, P3 responses could no longer be detected. At the same time, increased activity in low-frequency bands and a sharp drop of gamma spectral power were recorded. Significance: Cortical electrophysiological measures indicate at least partially intact attention and cognitive function during sparse volitional motor control for communication. Although the P3 ERP and frequency-specific changes in the ECoG spectrum may serve as indicators for CLIS, a close-meshed monitoring will be required to define the exact time point of the transition.