An audiovisual BCI system for assisting clinical communication assessment in patients with disorders of consciousness: A case study

The JFK Coma Recovery Scale-Revised (JFK CRS-R), a behavioral scale, is often used for clinical assessments of patients with disorders of consciousness (DOC), such as patients in a vegetative state. However, there has been a high rate of clinical misdiagnosis with the JFK CRS-R because patients with severe brain injures cannot provide sufficient behavioral responses. It is particularly difficult to evaluate the communication function in DOC patients using the JFK CRS-R because a higher level of behavioral responses is needed for communication assessments than for many other assessments, such as an auditory startle assessment. Brain-computer interfaces (BCIs), which provide control and communication by detecting changes in brain signals, can be used to evaluate patients with DOC without the need of behavioral expressions. In this paper, we proposed an audiovisual BCI system to supplement the JFK CRS-R in assessing the communication ability of patients with DOC. In the graphic user interface of the BCI system, two word buttons (“Yes” and “No” in Chinese) were randomly displayed in the left and right sides and flashed in an alternating manner. When a word button flashed, its corresponding spoken word was broadcast from an ipsilateral headphone. The use of semantically congruent audiovisual stimuli improves the detection performance of the BCI system. Similar to the JFK CRS-R, several situation-orientation questions were presented one by one to patients with DOC. For each question, the patient was required to provide his/her answer by selectively focusing on an audiovisual stimulus (audiovisual “Yes” or “No”). As a case study, we applied our BCI system in a patient with DOC who was clinically diagnosed as being in a minimally conscious state (MCS). According to the JFK CRS-R assessment, this patient was unable to communicate consistently. However, he achieved a high accuracy of 86.5% in our BCI experiment. This result indicates his reliable communication ability and demonstrates the effectiveness of our system.