Despite partial success, communication has remained impossible for persons suffering from complete motor paralysis but intact cognitive and emotional processing, a state called complete locked-in state (CLIS). Based on a motor learning theoretical context and on the failure of neuroelectric brain–computer interface (BCI) communication attempts in CLIS, we here report BCI communication using functional near-infrared spectroscopy (fNIRS) and an implicit attentional processing procedure. Four patients suffering from advanced amyotrophic lateral sclerosis (ALS)—two of them in permanent CLIS and two entering the CLIS without reliable means of communication—learned to answer personal questions with known answers and open questions all requiring a “yes” or “no” thought using frontocentral oxygenation changes measured with fNIRS. Three patients completed more than 46 sessions spread over several weeks, and one patient (patient W) completed 20 sessions. Online fNIRS classification of personal questions with known answers and open questions using linear support vector machine (SVM) resulted in an above-chance-level correct response rate over 70%. Electroencephalographic oscillations and electrooculographic signals did not exceed the chance-level threshold for correct communication despite occasional differences between the physiological signals representing a “yes” or “no” response. However, electroencephalogram (EEG) changes in the theta-frequency band correlated with inferior communication performance, probably because of decreased vigilance and attention. If replicated with ALS patients in CLIS, these positive results could indicate the first step towards abolition of complete locked-in states, at least for ALS.

There have been many attempts to design brain-computer interfaces (BCIs) for wheelchair control based on steady state visual evoked potential (SSVEP), event-related desynchronization/synchronization (ERD/ERS) during motor imagery (MI) tasks, P300 evoked potential, and some hybrid signals. However, those BCI systems cannot implement the wheelchair navigation flexibly and effectively. In this paper, we propose a hybrid BCI scheme based on two-class MI and four-class SSVEP tasks. It cannot only provide multi-degree control for its user, but also allow the user implement the different types of commands in parallel. In order for the subject to learn the hybrid mental strategies effectively, we design a visual and auditory cues and feedback-based training paradigm. Furthermore, an algorithm based on entropy of classification probabilities is proposed to detect intentional control (IC) state for hybrid tasks, and ensure that multi-degree control commands are accurately and quickly generated. The experiment results attest to the efficiency and flexibility of the hybrid BCI for wheelchair control in the real-world.

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