A user-centred approach to unlock the potential of non-invasive BCIs: an unprecedented international translational effort

Non-invasive Mental Task-based Brain-Computer Interfaces (MT-BCIs) enable their users to interact with the environment through their brain activity alone (measured using electroencephalography for example), by performing mental tasks such as mental calculation or motor imagery. Current developments in technology hint at a wide range of possible applications, both in the clinical and non-clinical domains. MT-BCIs can be used to control (neuro)prostheses or interact with video games, among many other applications. They can also be used to restore cognitive and motor abilities for stroke rehabilitation, or even improve athletic performance.Nonetheless, the expected transfer of MT-BCIs from the lab to the marketplace will be greatly impeded if all resources are allocated to technological aspects alone. We cannot neglect the Human End-User that sits in the centre of the loop. Indeed, self-regulating one’s brain activity through mental tasks to interact is an acquired skill that requires appropriate training. Yet several studies have shown that current training procedures do not enable MT-BCI users to reach adequate levels of performance. Therefore, one significant challenge for the community is that of improving end-user training.To do so, another fundamental challenge must be taken into account: we need to understand the processes that underlie MT-BCI performance and user learning. It is currently estimated that 10 to 30% of people cannot control an MT-BCI. These people are often referred to as “BCI inefficient”. But the concept of “BCI inefficiency” is debated. Does it really exist? Or, are low performances due to insufficient training, training procedures that are unsuited to these users or is the BCI data processing not sensitive enough? The currently available literature does not allow for a definitive answer to these questions as most published studies either include a limited number of participants (i.e., 10 to 20 participants) and/or training sessions (i.e., 1 or 2). We still have very little insight into what the MT-BCI learning curve looks like, and into which factors (including both user-related and machine-related factors) influence this learning curve. Finding answers will require a large number of experiments, involving a large number of participants taking part in multiple training sessions. It is not feasible for one research lab or even a small consortium to undertake such experiments alone. Therefore, an unprecedented coordinated effort from the research community is necessary.We are convinced that combining forces will allow us to characterise in detail MT-BCI user learning, and thereby provide a mandatory step toward transferring BCIs “out of the lab”. This is why we gathered an international, interdisciplinary consortium of BCI researchers from more than 20 different labs across Europe and Japan, including pioneers in the field. This collaboration will enable us to collect considerable amounts of data (at least 100 participants for 20 training sessions each) and establish a large open database. Based on this precious resource, we could then lead sound analyses to answer the previously mentioned questions. Using this data, our consortium could offer solutions on how to improve MT-BCI training procedures using innovative approaches (e.g., personalisation using intelligent tutoring systems) and technologies (e.g., virtual reality). The CHIST-ERA programme represents a unique opportunity to conduct this ambitious project, which will foster innovation in our field and strengthen our community

Integrated treatment of first episode psychosis with online training (e-learning): study protocol for a randomised controlled trial

BackgroundThe integrated treatment of first episode psychosis has been shown to improve functionality and negative symptoms in previous studies. In this paper, we describe a study of integrated treatment (individual psychoeducation complementary to pharmacotherapy) versus treatment as usual, comparing results at baseline with those at 6-month re-assessment (at the end of the study) for these patients, and online training of professionals to provide this complementary treatment, with the following objectives: 1) to compare the efficacy of individual psychoeducation as add-on treatment versus treatment as usual in improving psychotic and mood symptoms; 2) to compare adherence to medication, functioning, insight, social response, quality of life, and brain-derived neurotrophic factor, between both groups; and 3) to analyse the efficacy of online training of psychotherapists.Methods/designThis is a single-blind randomised clinical trial including patients with first episode psychosis from hospitals across Spain, randomly assigned to either a control group with pharmacotherapy and regular sessions with their psychiatrist (treatment as usual) or an intervention group with integrated care including treatment as usual plus a psychoeducational intervention (14 sessions). Training for professionals involved at each participating centre was provided by the coordinating centre (University Hospital of Álava) through video conferences. Patients are evaluated with an extensive battery of tests assessing clinical and sociodemographic characteristics (Positive and Negative Syndrome Scale, State-Trait Anxiety Inventory, Liebowitz Social Anxiety Scale, Hamilton Rating Scale for Depression, Scale to Assess Unawareness of Mental Disorders, Strauss and Carpenter Prognostic Scale, Global Assessment of Functioning Scale, Morisky Green Adherence Scale, Functioning Assessment Short Test, World Health Organization Quality of Life instrument WHOQOL-BREF (an abbreviated version of the WHOQOL-100), and EuroQoL questionnaire), and brain-derived neurotrophic factor levels are measured in peripheral blood at baseline and at 6 months. The statistical analysis, including bivariate analysis, linear and logistic regression models, will be performed using SPSS.DiscussionThis is an innovative study that includes the assessment of an integrated intervention for patients with first episode psychosis provided by professionals who are trained online, potentially making it possible to offer the intervention to more patients.Trial registrationNCT01783457 clinical trials.gov. Date of registration in primary registry 23 January 2013