Submitted by: Bryan DeSouza
Edited by: Rocio Carolina Garcia Santibanez, MD
Wolpaw JR, Bedlack RS, Reda DJ, et al. Independent home use of a brain-computer interface by people with amyotrophic lateral sclerosis. Neurology
Wolpaw et al. report the first prospective, multi-site, clinical trial of a Brain Computer Interface (BCI) to restore communication in patients with ALS.
In this study, Wolpaw and colleagues assessed the reliability and usefulness of the Wadsworth BCI system, an EEG–scalp recorded BCI, as a practical communication device in advanced ALS patients in a home environment for up to 18 months. BCI use included audio books, conversation, copy-spelling/calibration, email, internet newsreader, pictures and YouTube. Outcome measures were extent and nature of BCI use, BCI benefit versus burden, quality of life, technical support and patient attrition.
The study recruited 42 veterans with loss of verbal and/or written communication on the ALSFRS-R (ALS Functional Rating Scale-Revised), but preserved reading and understanding. Of these patients, 28 were able to participate in the study, their caregivers were trained and they had use of the BCI in their homes. 9 patients (21%) dropped out due to death or disease progression, 4 lost interest, and 1 was lost to follow-up. The remaining 14 patients used the BCI for 2-17 months mainly for communication. Technical problems were rare. Patient and caregiver ratings showed BCI benefit surpassed burden. McGill Quality of Life assessments were stable despite disease progression. At the end of the study, 7 of 8 participants chose to keep the BCI for further use indicating that patients felt it was important and useful for communication.
This clinical trial shows that the EEG-based brain computer interface (BCI) operated independently by patients with ALS is a useful and reliable tool for communication in a home setting with proper training and minimal support.
The study is important because it establishes proof of concept that a non-invasive BCI device can improve communication and potentially motor control in a practical way. As technology improves, so will the speed, efficiency, applications and number of the devices that will be available for our patients. Moving forward, it will be important for physicians involved in treating and managing neuromuscular diseases and neurorehabilitation to understand the uses and limitations of this technology.