title: Sensorimotor modulation assessment and brain-computer interface training in disorders of consciousness.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  Initial 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.
  
  
  METHODS
  Hospital, homes of subjects, and a primary care facility.
  
  
  METHODS
  Subjects (N=4; 3 men, 1 woman) who were in a minimally conscious state (age range, 27-53 y; 1-12 y after brain injury).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Awareness 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.
  
  
  RESULTS
  All 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Intelligent Systems Research Centre, University of Ulster, Derry, Northern Ireland, United Kingdom. Electronic address: dh.coyle@ulster.ac.uk.
authors.forename: Damien
authors.initials: D
authors.lastname: Coyle
authors.affiliation: National Rehabilitation Hospital, Dun Laoghaire, Republic of Ireland.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Stow
authors.affiliation: Intelligent Systems Research Centre, University of Ulster, Derry, Northern Ireland, United Kingdom.
authors.forename: Karl
authors.initials: K
authors.lastname: McCreadie
authors.affiliation: National Rehabilitation Hospital, Dun Laoghaire, Republic of Ireland.
authors.forename: Jacinta
authors.initials: J
authors.lastname: McElligott
authors.affiliation: National Rehabilitation Hospital, Dun Laoghaire, Republic of Ireland.
authors.forename: Áine
authors.initials: Á
authors.lastname: Carroll
mesh_terms: D000328:Adult; D001364:Awareness; D062207:Brain-Computer Interfaces; D003244:Consciousness Disorders / Q000534:rehabilitation*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D014584:User-Computer Interface
keywords: Brain injuries; Communication; Electroencephalography; Minimally conscious state; Rehabilitation