MindBEAGLE — A new system for the assessment and communication with patients with disorders of consciousness and complete locked-in syndrom

Patients with disorders of consciousness (DOC) cannot reply to questions or clinical assessments using voluntary motor control, and therefore it is very difficult to assess their cognitive capabilities and conscious awareness. Patients who are locked-in (LIS) are instead fully conscious, and they can communicate with their preserved eye movements. However, when the residual oculomotor activity is also lost (e.g., patients with amyotrophic lateral sclerosis disease of very long duration), the locked-in status becomes complete (CLIS). In CLIS patients, detection of conscious awareness may become very challenging, similarly to the subjects with DOC. mindBEAGLE has a physiological testing battery that uses auditory, vibro-tactile and motor imagery paradigms and brain-computer interface (BCI) technology to assess these patients and even provide communication for some of them. The current study presents results from 5 DOC and 3 LIS patients. The auditory evoked potential (AEP) assessement led to classification accuracies between 0 and 90 %, the vibro-tactile P300 paradigms led to 0 % to 100 % accuracy and the motor imagery paradigms led to accuracies up to 83.3 %. Three of the eight patients could succcessfully establish communication with the mindBEAGLE system. The results show that an assessment battery with auditory, vibro-tactile and motor imagery paradigms is able to identify cognitive functions of DOC and LIS patients. Patients showed substantial fluctuations in EEG measures, assessment results and communication reliability across different days and runs. Therefore, it is important to have a system available that can quickly and easily determine the status of a patient. Successful communication with these patients is also important.