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iNature As motor neuron degeneration progresses, patients with amyotrophic lateral sclerosis (ALS) may lose all muscle-based communication pathways, and eventually they may lose any communication
.
While communication where muscle control remains has been assessed, it is unclear whether neural-based communication is still possible in a state of complete atresia
.
On March 22, 2022, the team of Niels Birbaumer of the University of Tübingen in Germany published a research paper titled "Spelling interface using intracortical signals in a completely locked-in patient enabled via auditory neurofeedback training" online in Nature Communications.
64 microelectrode arrays were implanted in the auxiliary and primary motor cortex of ALS patients in a fully atretic state
.
The patient modulates neural firing rates based on auditory feedback, and he uses this strategy to select one letter at a time to form words and phrases to convey his needs and experiences
.
This case study provides evidence that brain-based volitional communication is possible even in a completely locked-down state
.
It is understood that in 2019, Niels Birbaumer was identified as academic misconduct due to incomplete research data, and his research paper on PLOS Biology (who once claimed to have developed a brain monitoring technology capable of reading the mind of paralyzed patients) was withdrawn, but Niels Birbaumer etc.
refused to sign the retraction agreement because they stood by their data, analysis and conclusions, and said they intended to pursue legal proceedings to challenge the findings of the investigative report, which they claim was in error
.
The DFG (Deutsches Research Federation) prohibits Niels Birbaumer from applying for his grants or serving on the DFG's grant jury for five years
.
DFG also said it would ask it to return funds used in the study
.
Birbaumer left Germany for Italy following an incident of academic misconduct
.
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that causes the body to gradually lose muscle function
.
As the disease progresses, affected individuals lose the ability to breathe due to paralysis of the diaphragm
.
Following artificial ventilation and orofacial muscle paralysis, in most cases the individual is no longer able to speak and becomes dependent on assistive and augmented communication (AAC) devices, and may enter a locked-in state (LIS) with intact eye movement or gaze control
.
Several invasive and non-invasive brain-computer interfaces (BCIs) provide communication for individuals in LIS by controlling residual eye movements or (facial) muscle or nerve signals
.
Once the affected individual loses control of this reliable communication or can no longer open his eyes voluntarily, none of the existing assistive technologies are able to provide voluntary communication in this completely locked-out state (CLIS)
.
Non-invasive and invasive BCIs developed for communication have demonstrated successful cursor control and sentence formation in individuals up to the LIS stage
.
Based on past BCI failures, several hypotheses have been developed to explain the inability of ALS patients in CLIS to choose letters to form words and sentences, ranging from loss of intent associated with prolonged loss of sensory input and motor output, cognitive dysfunction, particularly is when it is associated with frontotemporal degeneration
.
A successful demonstration of any BCI enabling individuals without reliable eye movement control and eye closure (CLIS) to form a complete sentence would upend these assumptions and open the door to investigations of communication and psychological processes in fully paralyzed ALS patients
.
Here, the study identifies a person in CLIS and demonstrates that sentence-level communication can be achieved using BCI without relying on the patient's vision
.
This person lacks reliable voluntary eye movement control and is therefore unable to communicate using an eye tracker
.
Patients also ended up losing access to non-invasive computer communication systems based on eye movements
.
To restore communication in CLIS, the participant had intracortical microelectrode arrays implanted in two areas of the motor cortex
.
The legally responsible family member provided informed written consent for the implantation according to procedures established by the regulatory agency
.
Setup and Neurofeedback Paradigm (figure from Nature Communications) The patient was in home care and then an auditory-guided neurofeedback-based strategy was employed to modulate neural firing rates to select letters and form words and sentences using custom software
.
Before implantation, the person was unable to express his needs and desires through non-invasive methods, including eye tracking, visual classification of eye movements, or eye movement-based BCI systems
.
Patients started voluntary verbal communication using the intracortical BCI system three months after implantation
.
As ALS progressed, the patient lost the ability to open his eyes voluntarily, as well as his vision, but he still used a neurofeedback strategy based on auditory guidance, closing his eyes to select letters and form words and sentences
.
Therefore, CLIS patients who are unable to express their wishes and wishes are using the BCI system to express their ability independently of sight
.
In addition, it must not be mentioned that on January 31, 2017, Niels Birbaumer's team published a research paper titled "Brain–Computer Interface–Based Communication in the Completely Locked-In State" online in PLOS Biology, which reports the use of functional Near-infrared spectroscopy (fNIRS) and BCI communication for implicit attention processors
.
Four patients with advanced amyotrophic lateral sclerosis (ALS) -- two in permanent CLIS and two in CLIS without a reliable means of communication -- learn to use known answers and open-ended questions Answer personal questions
.
Three patients completed more than 46 courses over several weeks, and one patient (patient W) completed 20 courses
.
Online fNIRS classification of individual questions with known answers and unsolved questions using a linear support vector machine (SVM) resulted in a correct response rate above 70%
.
These results may be a first step towards eliminating the state of complete atresia, at least for ALS patients
.
On December 16, 2019, the editor withdrew the publication after two investigations into the issue that the whistleblower originally brought to the author's agency's attention
.
During the investigation, committees at both agencies concluded that the study's authors were at fault in data collection, processing and analysis
.
However, they did not comment on the methodology on which the findings were based
.
Following guidelines provided by the Publication Ethics Committee, the editors retracted this manuscript because Eberhard Karls Universität Tübingen and Deutsche Forschungsgemeinschaft found that the authors were involved in academic misconduct
.
The authors refuse to sign this retraction agreement because they stand by their data, analysis, and conclusions, and say they intend to pursue legal proceedings to challenge the findings of the investigative report, which they claim are in error
.
The DFG (German Research Federation) forbids Niels Birbaumer from applying for its grants or serving on the DFG's grant jury for five years
.
DFG also said it would ask it to return funds used in the study
.
Birbaumer left Germany for Italy following an incident of academic misconduct
.
Reference information: https:// .
org/plosbiology/article?id=10.
1371/journal.
pbio.
1002593
.
While communication where muscle control remains has been assessed, it is unclear whether neural-based communication is still possible in a state of complete atresia
.
On March 22, 2022, the team of Niels Birbaumer of the University of Tübingen in Germany published a research paper titled "Spelling interface using intracortical signals in a completely locked-in patient enabled via auditory neurofeedback training" online in Nature Communications.
64 microelectrode arrays were implanted in the auxiliary and primary motor cortex of ALS patients in a fully atretic state
.
The patient modulates neural firing rates based on auditory feedback, and he uses this strategy to select one letter at a time to form words and phrases to convey his needs and experiences
.
This case study provides evidence that brain-based volitional communication is possible even in a completely locked-down state
.
It is understood that in 2019, Niels Birbaumer was identified as academic misconduct due to incomplete research data, and his research paper on PLOS Biology (who once claimed to have developed a brain monitoring technology capable of reading the mind of paralyzed patients) was withdrawn, but Niels Birbaumer etc.
refused to sign the retraction agreement because they stood by their data, analysis and conclusions, and said they intended to pursue legal proceedings to challenge the findings of the investigative report, which they claim was in error
.
The DFG (Deutsches Research Federation) prohibits Niels Birbaumer from applying for his grants or serving on the DFG's grant jury for five years
.
DFG also said it would ask it to return funds used in the study
.
Birbaumer left Germany for Italy following an incident of academic misconduct
.
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that causes the body to gradually lose muscle function
.
As the disease progresses, affected individuals lose the ability to breathe due to paralysis of the diaphragm
.
Following artificial ventilation and orofacial muscle paralysis, in most cases the individual is no longer able to speak and becomes dependent on assistive and augmented communication (AAC) devices, and may enter a locked-in state (LIS) with intact eye movement or gaze control
.
Several invasive and non-invasive brain-computer interfaces (BCIs) provide communication for individuals in LIS by controlling residual eye movements or (facial) muscle or nerve signals
.
Once the affected individual loses control of this reliable communication or can no longer open his eyes voluntarily, none of the existing assistive technologies are able to provide voluntary communication in this completely locked-out state (CLIS)
.
Non-invasive and invasive BCIs developed for communication have demonstrated successful cursor control and sentence formation in individuals up to the LIS stage
.
Based on past BCI failures, several hypotheses have been developed to explain the inability of ALS patients in CLIS to choose letters to form words and sentences, ranging from loss of intent associated with prolonged loss of sensory input and motor output, cognitive dysfunction, particularly is when it is associated with frontotemporal degeneration
.
A successful demonstration of any BCI enabling individuals without reliable eye movement control and eye closure (CLIS) to form a complete sentence would upend these assumptions and open the door to investigations of communication and psychological processes in fully paralyzed ALS patients
.
Here, the study identifies a person in CLIS and demonstrates that sentence-level communication can be achieved using BCI without relying on the patient's vision
.
This person lacks reliable voluntary eye movement control and is therefore unable to communicate using an eye tracker
.
Patients also ended up losing access to non-invasive computer communication systems based on eye movements
.
To restore communication in CLIS, the participant had intracortical microelectrode arrays implanted in two areas of the motor cortex
.
The legally responsible family member provided informed written consent for the implantation according to procedures established by the regulatory agency
.
Setup and Neurofeedback Paradigm (figure from Nature Communications) The patient was in home care and then an auditory-guided neurofeedback-based strategy was employed to modulate neural firing rates to select letters and form words and sentences using custom software
.
Before implantation, the person was unable to express his needs and desires through non-invasive methods, including eye tracking, visual classification of eye movements, or eye movement-based BCI systems
.
Patients started voluntary verbal communication using the intracortical BCI system three months after implantation
.
As ALS progressed, the patient lost the ability to open his eyes voluntarily, as well as his vision, but he still used a neurofeedback strategy based on auditory guidance, closing his eyes to select letters and form words and sentences
.
Therefore, CLIS patients who are unable to express their wishes and wishes are using the BCI system to express their ability independently of sight
.
In addition, it must not be mentioned that on January 31, 2017, Niels Birbaumer's team published a research paper titled "Brain–Computer Interface–Based Communication in the Completely Locked-In State" online in PLOS Biology, which reports the use of functional Near-infrared spectroscopy (fNIRS) and BCI communication for implicit attention processors
.
Four patients with advanced amyotrophic lateral sclerosis (ALS) -- two in permanent CLIS and two in CLIS without a reliable means of communication -- learn to use known answers and open-ended questions Answer personal questions
.
Three patients completed more than 46 courses over several weeks, and one patient (patient W) completed 20 courses
.
Online fNIRS classification of individual questions with known answers and unsolved questions using a linear support vector machine (SVM) resulted in a correct response rate above 70%
.
These results may be a first step towards eliminating the state of complete atresia, at least for ALS patients
.
On December 16, 2019, the editor withdrew the publication after two investigations into the issue that the whistleblower originally brought to the author's agency's attention
.
During the investigation, committees at both agencies concluded that the study's authors were at fault in data collection, processing and analysis
.
However, they did not comment on the methodology on which the findings were based
.
Following guidelines provided by the Publication Ethics Committee, the editors retracted this manuscript because Eberhard Karls Universität Tübingen and Deutsche Forschungsgemeinschaft found that the authors were involved in academic misconduct
.
The authors refuse to sign this retraction agreement because they stand by their data, analysis, and conclusions, and say they intend to pursue legal proceedings to challenge the findings of the investigative report, which they claim are in error
.
The DFG (German Research Federation) forbids Niels Birbaumer from applying for its grants or serving on the DFG's grant jury for five years
.
DFG also said it would ask it to return funds used in the study
.
Birbaumer left Germany for Italy following an incident of academic misconduct
.
Reference information: https:// .
org/plosbiology/article?id=10.
1371/journal.
pbio.
1002593
