Original article
Long-Term Independent Brain-Computer Interface Home Use Improves Quality of Life of a Patient in the Locked-In State: A Case Study

https://doi.org/10.1016/j.apmr.2014.03.035Get rights and content

Abstract

Objective

Despite intense brain-computer interface (BCI) research for >2 decades, BCIs have hardly been established at patients' homes. The current study aimed at demonstrating expert independent BCI home use by a patient in the locked-in state and the effect it has on quality of life.

Design

In this case study, the P300 BCI-controlled application Brain Painting was facilitated and installed at the patient's home. Family and caregivers were trained in setting up the BCI system. After every BCI session, the end user indicated subjective level of control, loss of control, level of exhaustion, satisfaction, frustration, and enjoyment. To monitor BCI home use, evaluation data of every session were automatically sent and stored on a remote server. Satisfaction with the BCI as an assistive device and subjective workload was indicated by the patient. In accordance with the user-centered design, usability of the BCI was evaluated in terms of its effectiveness, efficiency, and satisfaction. The influence of the BCI on quality of life of the end user was assessed.

Setting

At the patient's home.

Participant

A 73-year-old patient with amyotrophic lateral sclerosis in the locked-in state.

Interventions

Not applicable.

Main Outcome Measure

The BCI has been used by the patient independent of experts for >14 months. The patient painted in about 200 BCI sessions (1–3 times per week) with a mean painting duration of 81.86 minutes (SD=52.15, maximum: 230.41). BCI improved quality of life of the patient.

Results

In most of the BCI sessions the end user's satisfaction was high (mean=7.4, SD=3.24; range, 0–10). Dissatisfaction occurred mostly because of technical problems at the beginning of the study or varying BCI control. The subjective workload was moderate (mean=40.61; range, 0–100). The end user was highy satisfied with all components of the BCI (mean 4.42–5.0; range, 1–5). A perfect match between the user and the BCI technology was achieved (mean: 4.8; range, 1–5). Brain Painting had a positive impact on the patient's life on all three dimensions: competence (1.5), adaptability (2.17) and self-esteem (1.5); (range: –3 = maximum negative impact; 3 maximum positive impact). The patient had her first public art exhibition in July 2013; future exhibitions are in preparation.

Conclusions

Independent BCI home use is possible with high satisfaction for the end user. The BCI indeed positively influenced quality of life of the patient and supports social inclusion. Results demonstrate that visual P300 BCIs can be valuable for patients in the locked-in state even if other means of communication are still available (eye tracker).

Section snippets

Participant

The participant is a 73-year-old woman with ALS (spinal form) in the locked-in state with only residual eye movement. She is artificially ventilated and fed and is able to communicate with eye movements in the partner-scanning mode or with an eye tracker. She lives with her family and full-time caregivers. Painting had been her favorite hobby. Because she has had no application for creative expression, Brain Painting awoke her interest, and her family contacted the Brain Painting team of the

Event-related potentials

The P300 signal was more pronounced in calibration 2 and again increased in calibration 3 with initiation of the Einstein-face stimuli. ERPs from calibrations 1, 2, and 3 are depicted in figure 3.

Face valid measures of BCI use in daily life

The end user painted in about 200 sessions (at the date of data analysis). Mostly the end user opened 1 session per day (139 of 200). The mean total painting time was 81.86±52.15 minutes (range, .34–230.41) (fig 4A). The total painting time was positively correlated with session number (r=.60, P<.001).

Effectiveness

Discussion

In this study, Brain Painting was implemented at the home of 1 patient in the locked-in state because of ALS. Within 14 months the end user painted with the BCI several times per week resulting in 200 sessions. BCI sessions were evaluated in terms of effectiveness, efficiency, and satisfaction. Indicators of use in daily life and effect of the BCI-controlled Brain Painting on the patient's quality of life were assessed.

Conclusions

The current case study demonstrated that independent home use of a BCI-controlled painting application is possible and can be continued for >14 months. Provided that there is a perfect match between the user and technology and sufficient support by significant others, BCI-controlled applications can be used in daily life and contribute to quality of life. BCIs can support social inclusion and have come of age.

Suppliers

  • a.

    Gerwin Schalk, Ph.D. Center For Medical Sciences.

  • b.

    Python Software Foundation.

  • c.

    g.tec medical engineering GmbH.

  • d.

    The MathWorks GmbH.

Acknowledgments

We thank Christoph Guger, PhD, and g.tec for providing the BCI equipment.

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    Presented to the National Institutes of Health, National Science Foundation, and other organizations (for a full list, see http://bcimeeting.org/2013/sponsors.html), June 3-7, 2013, Asilomar Conference Grounds, Pacific Grove, CA.

    Supported by the European Information and Communication Technologies Program Project FP7-288566 (BackHome).

    This article only reflects the authors' views, and funding agencies are not liable for any use that may be made of the information contained herein.

    Disclosures: none.

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