title: Self-regulation of brain rhythms in the precuneus: a novel BCI paradigm for patients with ALS.
abstract: Electroencephalographic (EEG) brain-computer interfaces (BCIs) hold promise in restoring communication for patients with completely locked-in stage amyotrophic lateral sclerosis (ALS). However, these patients cannot use existing EEG-based BCIs, arguably because such systems rely on brain processes that are impaired in the late stages of ALS. In this work, we introduce a novel BCI designed for patients in late stages of ALS based on high-level cognitive processes that are less likely to be affected by ALS.
  
  
  
  We trained two ALS patients via EEG-based neurofeedback to use self-regulation of theta or gamma oscillations in the precuneus for basic communication. Because there is a tight connection between the precuneus and consciousness, precuneus oscillations are arguably generated by high-level cognitive processes, which are less likely to be affected by ALS than processes linked to the peripheral nervous system.
  
  
  
  Both patients learned to self-regulate their precuneus oscillations and achieved stable online decoding accuracy over the course of disease progression. One patient achieved a mean online decoding accuracy in a binary decision task of 70.55% across 26 training sessions, and the other patient achieved 59.44% across 16 training sessions. We provide empirical evidence that these oscillations were cortical in nature and originated from the intersection of the precuneus, cuneus, and posterior cingulate.
  
  
  
  Our results establish that ALS patients can employ self-regulation of precuneus oscillations for communication. Such a BCI is likely to be available to ALS patients as long as their consciousness supports communication.
authors.affiliation: Department Empirical Inference, Max Planck Institute for Intelligent Systems, Tübingen, Germany. IMPRS for Cognitive and Systems Neuroscience, University of Tübingen, Tübingen, Germany.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Fomina
authors.forename: Gabriele
authors.initials: G
authors.lastname: Lohmann
authors.forename: Michael
authors.initials: M
authors.lastname: Erb
authors.forename: Thomas
authors.initials: T
authors.lastname: Ethofer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schölkopf
authors.forename: Moritz
authors.initials: M
authors.lastname: Grosse-Wentrup
mesh_terms: D000465:Algorithms; D000690:Amyotrophic Lateral Sclerosis / Q000503:physiopathology* / Q000534:rehabilitation*; D016477:Artifacts; D062207:Brain-Computer Interfaces; D003071:Cognition; D003143:Communication Devices for People with Disabilities; D004569:Electroencephalography; D065818:Gamma Rhythm; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058765:Neurofeedback; D010296:Parietal Lobe / Q000503:physiopathology*; D011597:Psychomotor Performance; D013826:Theta Rhythm