title: BCI in patients with disorders of consciousness: clinical perspectives.
abstract: The reestablishment of communication is one of the main goals for patients with disorders of consciousness (DOC). It is now established that many DOC patients retain the ability to process stimuli of varying complexity even in the absence of behavioural response. Motor impairment, fatigue, attention disorders might contribute to the difficulty of communication in this population. Brain-computer interfaces (BCI) might be helpful in restoring some communication ability in these patients. After a definition of the different disorders of consciousness that might benefit from BCI, brain markers able to detect cognitive processes and awareness in the absence of behavioural manifestation are described. Can these markers be willfully modulated and used to restore communication in DOC patients? In order to answer this question, three paradigmatic articles using either functional imaging or electrophysiology are critically analysed with regard to clinical applications. It appears that the use of fMRI is limited from a clinical point of view, whereas the EEG seems more feasible with possible BCI applications at the patient's bedside. However, at this stage, several limitations are pointed out: the lack of awareness in itself, the lack of sensitivity of the technique, atypical pattern of brain activity in brain damaged patients. The challenge is now to select the best candidates, to improve the efficiency, portability and cost of these techniques. Although this innovative technology may concern a minority of DOC patients, it might offer the possibility to restore or improve communication to heavily disabled patients and meanwhile detect a signature of awareness.
authors.affiliation: Hospices civils de Lyon, hôpital Henry-Gabrielle, Mouvement et Handicap, Saint-Genis Laval 69230, France; Integrative, Multisensory, Perception, Action and Cognition Team, Lyon Neuroscience Research Center, Inserm U1028-CNRS UMR5292, Lyon 69000, France; Université de Lyon, université Lyon 1, Villeurbanne 69100, France. Electronic address: jacques.luaute@chu-lyon.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Luauté
authors.affiliation: Université de Lyon, université Lyon 1, Villeurbanne 69100, France; Brain Dynamics and Cognition Team, Lyon Neuroscience Research Center, Inserm U1028-CNRS UMR5292, Lyon 69000, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Morlet
authors.affiliation: Université de Lyon, université Lyon 1, Villeurbanne 69100, France; Brain Dynamics and Cognition Team, Lyon Neuroscience Research Center, Inserm U1028-CNRS UMR5292, Lyon 69000, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Mattout
mesh_terms: D001364:Awareness; D001930:Brain Injuries / Q000503:physiopathology / Q000534:rehabilitation; D062207:Brain-Computer Interfaces / Q000639:trends*; D003143:Communication Devices for People with Disabilities; D003244:Consciousness Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D004569:Electroencephalography; D006801:Humans; D008279:Magnetic Resonance Imaging; D000066530:Neurological Rehabilitation / Q000295:instrumentation*
keywords: BCI; Brain-computer interface; DOC; Disorders of consciousness; FMRI; Minimally conscious state; Neurophysiology; Vegetative state