Sensorimotor Modulation Assessment and Brain-Computer Interface Training in Disorders of Consciousness

• We assessed awareness in subjects who are in a minimally conscious state by using electroencephalography.
• We assessed whether subjects could learn to operate a brain-computer interface (BCI).
• Awareness detection was determined from modulation in sensorimotor activity.
• All subjects demonstrated significant and appropriate brain activations.
• All subjects may have the capacity to operate a BCI without volitional movement.

ObjectivesTo assess awareness in subjects who are in a minimally conscious state by using an electroencephalogram-based brain-computer interface (BCI), and to determine whether these patients may learn to modulate sensorimotor rhythms with visual feedback, stereo auditory feedback, or both.DesignInitial assessment included imagined hand movement or toe wiggling to activate sensorimotor areas and modulate brain rhythms in 90 trials (4 subjects). Within-subject and within-group analyses were performed to evaluate significant activations. A within-subject analysis was performed involving multiple BCI technology training sessions to improve the capacity of the user to modulate sensorimotor rhythms through visual and auditory feedback.SettingHospital, homes of subjects, and a primary care facility.ParticipantsSubjects (N=4; 3 men, 1 woman) who were in a minimally conscious state (age range, 27–53y; 1–12y after brain injury).InterventionsNot applicable.Main Outcome MeasuresAwareness detection was determined from sensorimotor patterns that differed for each motor imagery task. BCI performance was determined from the mean classification accuracy of brain patterns by using a BCI signal processing framework and assessment of performance in multiple sessions.ResultsAll subjects demonstrated significant and appropriate brain activation during the initial assessment, and real-time feedback was provided to improve arousal. Consistent activation was observed in multiple sessions.ConclusionsThe electroencephalogram-based assessment showed that patients in a minimally conscious state may have the capacity to operate a simple BCI-based communication system, even without any detectable volitional control of movement.