Probing command following in patients with disorders of consciousness using a brain-computer interface

Area of Science:

• Neuroscience
• Biomedical Engineering
• Clinical Neurology

Background:

• Disorders of consciousness (DoC) present diagnostic challenges.
• Assessing covert awareness and communication in DoC is crucial for patient care.
• Brain-computer interfaces (BCIs) offer a potential avenue for communication.

Purpose of the Study:

• To evaluate electroencephalography (EEG)-based BCIs for detecting command following and communication in patients with DoC.
• To assess the feasibility of BCIs in identifying consciousness in non-responsive individuals.

Main Methods:

• An auditory oddball EEG-BCI paradigm was employed.
• 16 healthy subjects and 18 patients (vegetative state/unresponsive wakefulness syndrome, minimally conscious state (MCS), locked-in syndrome (LIS)) participated.
• Participants underwent training and responded to questions via the BCI.

Main Results:

• Healthy subjects and one LIS patient successfully communicated using the BCI.
• One MCS patient demonstrated command following via BCI, undetected clinically.
• Other patients did not respond or communicate via the BCI.

Conclusions:

• EEG-based BCIs can detect command following in altered consciousness states and enable communication in LIS.
• BCI approaches require simplification to enhance sensitivity and clinical utility.
• BCIs may offer "yes-no" communication for severely impaired patients, providing hope for interaction.