Brain–Computer Interfaces in Neurorecovery and Neurorehabilitation

Abstract

Recent advances in brain–computer interface technology to restore and rehabilitate neurologic function aim to enable persons with disabling neurologic conditions to communicate, interact with the environment, and achieve other key activities of daily living and personal goals. Here we evaluate the principles, benefits, challenges, and future directions of brain–computer interfaces in the context of neurorehabilitation. We then explore the clinical translation of these technologies and propose an approach to facilitate implementation of brain–computer interfaces for persons with neurologic disease.

Neuroethics across the Disorders of Consciousness Care Continuum

“…259 Persons with DoC might therefore need special accommodations that address disease-specific impairments, similar to those enjoyed by other populations with cognitive disabilities. Interestingly, some ethicists have also argued 260 that, in cases of severe impairments secondary to brain injury, sophisticated brain-computer interfaces might one day be regarded as "auxiliary aids" under the American Disabilities Act (ADA), 261,262 guaranteeing access for people with brain injury much like mobility devices are guaranteed for people with severe spinal-cord injuries. 262,263 Social reintegration of persons with DoC might also be enhanced through functional interaction with others.…”

“…Interestingly, some ethicists have also argued 260 that, in cases of severe impairments secondary to brain injury, sophisticated brain-computer interfaces might one day be regarded as "auxiliary aids" under the American Disabilities Act (ADA), 261,262 guaranteeing access for people with brain injury much like mobility devices are guaranteed for people with severe spinal-cord injuries. 262,263 Social reintegration of persons with DoC might also be enhanced through functional interaction with others. Having conversations, expressing values, and building relationships are core features of being human, but cognitive impairments associated with DoC can limit one's ability to partake in these experiences.…”

“…The U.N. Convention on the Rights of Persons with Disabilities anticipates these concerns by asserting that accommodation is not just about access to physical spaces, but fundamentally about “enjoyment … of all human rights and …freedoms.” 259 Persons with DoC might therefore need special accommodations that address disease-specific impairments, similar to those enjoyed by other populations with cognitive disabilities. Interestingly, some ethicists have also argued 260 that, in cases of severe impairments secondary to brain injury, sophisticated brain–computer interfaces might one day be regarded as “auxiliary aids” under the American Disabilities Act (ADA), 261 262 guaranteeing access for people with brain injury much like mobility devices are guaranteed for people with severe spinal-cord injuries. 262 263…”

“…Interestingly, some ethicists have also argued 260 that, in cases of severe impairments secondary to brain injury, sophisticated brain–computer interfaces might one day be regarded as “auxiliary aids” under the American Disabilities Act (ADA), 261 262 guaranteeing access for people with brain injury much like mobility devices are guaranteed for people with severe spinal-cord injuries. 262 263…”

Ethical Considerations in Clinical Trials for Disorders of Consciousness

“…Empirical neuroethics research is needed to better understand the attitudes of patients and families surrounding the optimal approach to involving research participants with emerging consciousness in the consent process, recognizing the pitfalls of assigning too much or too little weight to surrogate indicators of subjective attitudes ascertained through processed neural correlates. Efforts to restore functional communication through brain–computer interfaces and other assistive technologies in persons with covert consciousness are ongoing, and, in the future, they may aid in safeguarding the autonomy and welfare of these especially vulnerable persons and improve the ethical resilience of longitudinal DoC research programs [ 123 , 124 , 125 , 126 , 127 , 128 ].…”