AAC should be standard practice for adults with neurodegenerative disease. Patients can maintain effective, functional communication with AAC supports. Individualized communication systems can be implemented ensuring patients remain active participants in daily activities.

Brain-computer interfaces (BCIs) promise to provide a novel access channel for assistive technologies, including augmentative and alternative communication (AAC) systems, to people with severe speech and physical impairments (SSPI). Research on the subject has been accelerating significantly in the last decade and the research community took great strides toward making BCI-AAC a practical reality to individuals with SSPI. Nevertheless, the end goal has still not been reached and there is much work to be done to produce real-world-worthy systems that can be comfortably, conveniently, and reliably used by individuals with SSPI with help from their families and care givers who will need to maintain, setup, and debug the systems at home. This paper reviews reports in the BCI field that aim at AAC as the application domain with a consideration on both technical and clinical aspects.

Background Some non-invasive brain computer interface (BCI) systems are currently available for locked-in syndrome (LIS) but none have incorporated a statistical language model during text generation. Objective To begin to address the communication needs of individuals with LIS using a non-invasive BCI that involves Rapid Serial Visual Presentation (RSVP) of symbols and a unique classifier with EEG and language model fusion. Methods The RSVP Keyboard™ was developed with several unique features. Individual letters are presented at 2.5 per sec. Computer classification of letters as targets or non-targets based on EEG is performed using machine learning that incorporates a language model for letter prediction via Bayesian fusion enabling targets to be presented only 1–4 times. Nine participants with LIS and nine healthy controls were enrolled. After screening, subjects first calibrated the system, and then completed a series of balanced word generation mastery tasks that were designed with five incremental levels of difficulty, that increased by selecting phrases for which the utility of the language model decreased naturally. Results Six participants with LIS and nine controls completed the experiment. All LIS participants successfully mastered spelling at level one and one subject achieved level five. Six of nine control participants achieved level five. Conclusions Individuals who have incomplete LIS may benefit from an EEG-based BCI system, which relies on EEG classification and a statistical language model. Steps to further improve the system are discussed.

Purpose To propose a screening protocol that identifies requisite sensory, motor, cognitive, and communication skills for people with locked-in syndrome (PLIS) to use the RSVP Keyboard™ brain-computer interface (BCI). Method A multidisciplinary clinical team of seven individuals representing five disciplines identified requisite skills for the BCI. They chose questions and subtests from existing standardized instruments for auditory comprehension, reading, and spelling;modified them to accommodate nonverbal response modalities; and developed novel tasks to screen visual perception, sustained visual attention, and working memory. Questions were included about sensory skills, positioning, pain interference, and medications. The result is a compilation of questions, adapted subtests and original tasks designed for this new BCI system. It was administered to 12 PLIS and six healthy controls. Results Administration required one hour or less. Yes/no choices and eye gaze were adequate response modes for PLIS. Healthy controls and 9 PLIS were 100% accurate on all tasks; three PLIS missed single items. Conclusions The RSVP BCI screening protocol is a brief, repeatable technique for patients with different levels of LIS to identify the presence/absence of skills for BCI use. Widespread adoption of screening methods should be a clinical goal and will help standardize BCI implementation for research and intervention.

Over 300 researchers gathered at the 2013 International Brain-Computer Interface (BCI) Meeting to discuss current practice and future goals for BCI research and development. The authors organized the Virtual Users’ Forum at the meeting to provide the BCI community with feedback from users. We report on the Virtual Users’ Forum, including initial results from ongoing research being conducted by two BCI groups. Online surveys and in-person interviews were used to solicit feedback from people with disabilities who are expert and novice BCI users. For the Virtual Users’ Forum, their responses were organized into four major themes: current (non-BCI) communication methods, experiences with BCI research, challenges of current BCIs, and future BCI developments. Two authors with severe disabilities gave presentations during the Virtual Users’ Forum, and their comments are integrated with the other results. While participants’ hopes for BCIs of the future remain high, their comments about available systems mirror those made by consumers about conventional assistive technology. They reflect concerns about reliability (e.g. typing accuracy/speed), utility (e.g. applications and the desire for real-time interactions), ease of use (e.g. portability and system setup), and support (e.g. technical support and caregiver training). People with disabilities, as target users of BCI systems, can provide valuable feedback and input on the development of BCI as an assistive technology. To this end, participatory action research (PAR) should be considered as a valuable methodology for future BCI research.