Face stimuli effectively prevent brain-computer interface inefficiency in patients with neurodegenerative disease

Objectives: Recently, we proposed a new stimulation paradigm for brain computer interfaces (BCI) based on event-related potentials (ERP), i.e. flashing characters with superimposed pictures of well-known faces. This new face flashing (FF) paradigm significantly outperformed the commonly used character flashing (CF) approach, i.e. simply highlighting characters. Methods: In the current study we assessed the impact of face stimuli on BCI inefficiency in patients with neurodegenerative disease, i.e. on their inability to communicate by means of a BCI. Healthy participants (N = 16) and those with neurodegenerative disease (N = 9) performed spelling tasks using CF and FF paradigms. Results: Online performance with FF was significantly increased as compared to CF in both, healthy and impaired users. Importantly, two patients who were classified highly inefficient with the classic CF stimulation were able to spell with high accuracy using FF. Our results particularly emphasize great benefit of the FF paradigm for those users displaying low signal-to-noise ratio of the recorded ERPs in the classic stimulation approach. Conclusion: In conclusion, we confirm previously reported results now systematically validated in an online setting and display specifically beneficial effects of FF for motor-impaired users. Significance: The FF paradigm thus constitutes a big step forward against the BCI inefficiency phenomenon. (C) 2012 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.