title: Enhancing clinical communication assessments using an audiovisual BCI for patients with disorders of consciousness.
abstract: The JFK coma recovery scale-revised (JFK CRS-R), a behavioral observation scale, is widely used in the clinical diagnosis/assessment of patients with disorders of consciousness (DOC). However, the JFK CRS-R is associated with a high rate of misdiagnosis (approximately 40%) because DOC patients cannot provide sufficient behavioral responses. A brain-computer interface (BCI) that detects command/intention-specific changes in electroencephalography (EEG) signals without the need for behavioral expression may provide an alternative method.
  
  
  
  In this paper, we proposed an audiovisual BCI communication system based on audiovisual 'yes' and 'no' stimuli to supplement the JFK CRS-R for assessing the communication ability of DOC patients. Specifically, patients were given situation-orientation questions as in the JFK CRS-R and instructed to select the answers using the BCI.
  
  
  
  Thirteen patients (eight vegetative state (VS) and five minimally conscious state (MCS)) participated in our experiments involving both the BCI- and JFK CRS-R-based assessments. One MCS patient who received a score of 1 in the JFK CRS-R achieved an accuracy of 86.5% in the BCI-based assessment. Seven patients (four VS and three MCS) obtained unresponsive results in the JFK CRS-R-based assessment but responsive results in the BCI-based assessment, and 4 of those later improved scores in the JFK CRS-R-based assessment. Five patients (four VS and one MCS) obtained usresponsive results in both assessments.
  
  
  
  The experimental results indicated that the audiovisual BCI could provide more sensitive results than the JFK CRS-R and therefore supplement the JFK CRS-R.
authors.affiliation: School of Automation Science and Engineering, South China University of Technology, Guangzhou 510640, People's Republic of China. Guangzhou Key Laboratory of Brain Computer Interface and Applications, Guangzhou 510640, People's Republic of China.
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.forename: Yanbin
authors.initials: Y
authors.lastname: He
authors.forename: Jun
authors.initials: J
authors.lastname: Qu
authors.forename: Qiuyou
authors.initials: Q
authors.lastname: Xie
authors.forename: Qing
authors.initials: Q
authors.lastname: Lin
authors.forename: Xiaoxiao
authors.initials: X
authors.lastname: Ni
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.forename: Jiahui
authors.initials: J
authors.lastname: Pan
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.forename: Ronghao
authors.initials: R
authors.lastname: Yu
authors.forename: Yuanqing
authors.initials: Y
authors.lastname: Li
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods*; D000293:Adolescent; D000328:Adult; D062207:Brain-Computer Interfaces / Q000706:statistics & numerical data*; D003142:Communication; D003244:Consciousness Disorders / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000379:methods*; D011897:Random Allocation; D055815:Young Adult