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Summary

People with Locked-In Syndrome (LIS) are severely paralyzed and impaired in their ability to communicate, due to for instance late-stage ALS or brainstem stroke. Brain-Computer Interface (BCI) technology could allow these people to control communication devices with their brain activity. As part of the Utrecht NeuroProsthesis study, I investigated whether people with LIS can use a fully implanted BCI at home, without the presence of research personnel. 

Three participants were implanted with a BCI comprising electrodes placed directly on the brain surface (sensorimotor cortex and the dorsolateral prefrontal cortex, DLPFC). Brief periods of increased brain activity were converted into simple computer actions, allowing for control over assistive communication software. 
In this thesis, I show the usefulness of pre-surgical functional MRI for the localization of BCI control areas. I also demonstrate that signals from the sensorimotor cortex and the DLPFC can be used for BCI control. All participants were able to use the BCI for basic communication purposes and feasibility tests for independent home-use were successful. One participant with late-stage ALS used the system at home for almost seven years. For that participant, I implemented a call-caregiver functionality and the world’s first BCI nighttime mode allowing for 24/7 communication capability. Finally, I present longitudinal decreases in BCI-relevant brain signals in two participants with late-stage ALS. 
Taken together, independent home-use by people with LIS of a BCI implant is possible and can be of great benefit, allowing for sustained communication when traditional assistive devices can no longer be reliably controlled.