People with severe neurological impairments face many challenges in sensorimotor functions and communication with the environment; therefore they have increased demand for advanced, adaptive and personalized rehabilitation. During the last several decades, numerous studies have developed brain–computer interfaces (BCIs) with the goals ranging from providing means of communication to functional rehabilitation. Here we review the research on non-invasive, electroencephalography (EEG)-based BCI systems for communication and rehabilitation. We focus on the approaches intended to help severely paralyzed and locked-in patients regain communication using three different BCI modalities: slow cortical potentials, sensorimotor rhythms and P300 potentials, as operational mechanisms. We also review BCI systems for restoration of motor function in patients with spinal cord injury and chronic stroke. We discuss the advantages and limitations of these approaches and the challenges that need to be addressed in the future.
Vidal (1973, p. 157), in his seminal work, raised the question: “Can observable electrical brain signals be put to work as carriers of information in person–computer communication or for the purpose of controlling devices such as prostheses?”. Since then, we have come a long way investigating whether people with motor disabilities can repurpose brain activity from inner neural signals to tangible controls that attribute the user’s intent to interact with devices or adjust their environment (Shih et al., 2012; Lebedev and Nicolelis, 2017). Nowadays, several advancements in the fields of clinical neurophysiology and computational neuroscience have led to the development of promising approaches based on non-invasive BCIs that pave the way for reliable communication and effective rehabilitation of people with disabilities.
In this review, we focus on non-invasive BCI applications geared toward alternative communication and restoration of movement to paralyzed patients. We consider several milestone studies on EEG-based BCIs that contributed to the systems that improve everyday life and activity of people with motor disabilities in the 21st century. We review EEG-based BCI technologies for communication and control based on three different EEG signals (SCP, SMR and P300), and discuss their limitations and advantages. In addition, we examine and analyze the BCI methods for inducing brain plasticity and restoring functions in impaired patients. An overview of the study framework is presented in Figure 1.
FIGURE 1. Overview of the review framework.
The paper is structured as follows. We firstly review the advantages of the BCI approach compared to other strategies for communication in people with motor impairment. In section 3, we present BCI realizations based on different approaches for brain activity recording, and elaborate on three EEG-based modalities: SCP, SMR, and P300. Subsequently, we provide an elaborate overview of the milestone studies, published mainly during the last two decades, on the BCI systems for communication and rehabilitation in patients with motor-impairments. Finally, we discuss advantages and shortfalls of these BCIs, point out their limitations and comment on the future perspectives in this field.[…]
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