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Hybrid Brain–Computer Interfaces and Their Applications
Published in Chang S. Nam, Anton Nijholt, Fabien Lotte, Brain–Computer Interfaces Handbook, 2018
This audio-visual BCI system was applied to detect the awareness of patients with a disorder of consciousness (DOC). Currently, clinical diagnosis and awareness evaluations of patients with a DOC, such as patients in a vegetative state (VS) or a minimally conscious state (MCS), rely mainly on behavioral observation scales, such as the Coma Recovery Scale–Revised. There exists a high misdiagnosis rate (ranging from 37% to 43%) because these patients cannot provide sufficient behavioral responses. Detecting awareness in these patients is extremely challenging. Recently, the potential applications of BCIs in awareness detection and online communication for DOC patients have been explored in several studies (Coyle et al. 2012; Lulé et al. 2012). However, DOC patients with severe brain injuries have a much lower ability to use BCIs than healthy individuals. One possible solution is to apply the aforementioned audio-visual BCI to improve sensitivity in awareness detection. Seven patients with DOC performed a calibration run of 10 trials and a test run of 50 trials. Specifically, the test run contained five blocks, each of which was composed of 10 trials and was conducted on separate days because the patients became easily fatigued. Among the seven patients, the online accuracies for five patients (one VS and four MCS) were significantly higher than the chance level. For each of the five patients, the ERP waveforms measured at the “Fz” and “Oz” electrodes showed robust P300 responses elicited by the target stimuli. The results demonstrated the presence of command following and residual number recognition in the five DOC patients.
The Briggsian Heresy? Should Previously Expressed Wishes Determine Best Interests in Decisions Relating to Withdrawal of Clinically-Assisted Nutrition and Hydration?
Published in The New Bioethics, 2020
The treatment of persons experiencing Prolonged Disorders of Consciousness (‘PDOC’) such as Vegetative State (‘VS’) and Minimally Conscious State (‘MCS’) creates significant ethical and legal issues. Patients frequently require significant care, including Clinically Assisted Nutrition and Hydration (‘CANH’). Few patients recover to any significant extent (Steppacher et al.2014, p. 401), and those that do have lifetime care needs (Lammi et al.2005, p. 753). Over recent years, a body of cases has built up in which Courts have considered circumstances in which it is in the best interest of PDOC patients to have CANH withdrawn. However, the recent case of Briggs v Briggs [2016] EWCOP 53 seems to have pushed aside the concept of sanctity of life as determinative of the Court’s approach, in favour of the previously expressed wishes of CANH patients being decisive.1
Workshops of the eighth international brain–computer interface meeting: BCIs: the next frontier
Published in Brain-Computer Interfaces, 2022
Jane E. Huggins, Dean Krusienski, Mariska J. Vansteensel, Davide Valeriani, Antonia Thelen, Sergey Stavisky, James J.S. Norton, Anton Nijholt, Gernot Müller-Putz, Nataliya Kosmyna, Louis Korczowski, Christoph Kapeller, Christian Herff, Sebastian Halder, Christoph Guger, Moritz Grosse-Wentrup, Robert Gaunt, Aliceson Nicole Dusang, Pierre Clisson, Ricardo Chavarriaga, Charles W. Anderson, Brendan Allison, Tetiana Aksenova, Erik Aarnoutse
Bedside evaluation to assess conscious awareness after coma requires inferences based on patients’ motor responsiveness [209] with limited diagnostic precision and prognostic information, increasing the ethical difficulty of decisions on life-prolonging therapies. Technologies such as functional neuroimaging and BCIs provide objective tools for diagnostic, prognostic, and therapeutic purposes [210]. About two-thirds of patients clinically diagnosed with ‘unresponsive wakefulness syndrome (UWS)’ (or ‘persistent vegetative state’) may show residual brain activity in PET studies [211] and are hence actually in a minimally conscious state (MCS) with a better chance of recovery.
Liminal innovation practices: questioning three common assumptions in responsible innovation
Published in Journal of Responsible Innovation, 2018
Unfortunately, the prognostic tools to predict neurological outcome are limited. Currently, only two indicators for poor prognosis in these patients exist, both focused on the brainstem.2 Death or severe disorders of consciousness like vegetative state or minimally conscious state can be predicted for some patients by testing brainstem reflexes. Yet through these methods, only a fraction of all patients with poor outcome can be identified as such. In addition, these indicators tell us nothing about the likelihood of good outcome.