急性脑损伤后临床无反应的患者能够控制脑机接口
Clinically unresponsive patients with acute brain injury activate a brain-computer interface
在临床无反应患者中，可通过脑电图（EEG）检测到对言语指令的脑激活。这些存在认知运动分离（CMD）的患者尽管意识保留，却无法与环境交流。先进的脑机接口（BCI）有望支持运动神经元疾病或脊髓损伤患者的运动功能。我们的主要目标是确定临床无反应患者在急性脑损伤后早期能否控制一个自定节奏的单向BCI。其次，我们评估了BCI控制与短期和长期结局的关联。我们在41名临床无反应、病情危重且急性脑损伤的患者中开展了一项前瞻性单中心队列研究，同时纳入8名健康志愿者和22名有意识的危重患者作为便利样本。该自定节奏BCI实时分析EEG，并调节音调的频率和音高，患者通过尝试完成一项运动任务来控制该音调：向患者提供指令“让哔声变快，持续张开和闭合你的右手”，并与“让哔声变慢，停止张开和闭合你的右手”交替呈现。通过对患者聆听运动指令时记录的EEG应用机器学习来检测CMD。临床结局为出院时意识恢复（采用修订版昏迷恢复量表评估）以及12个月时功能独立恢复（定义为扩展版格拉斯哥结局量表评分4分或更高，表示能够独立活动8小时或以上）。此外，我们邀请有意识患者以及有意识和临床无反应患者的家属完成一项调查，内容涉及对BCI的感知效用和相关挑战。在本研究中，13名临床无反应患者（32%）实现了BCI控制，41名中有8名（20%）为CMD阳性。所有健康志愿者和9名有意识患者（41%）能够
在急性脑损伤后临床无反应的患者中检验自定步调脑机接口控制，并追踪其与意识恢复和功能结局的关联。
Brain activation to verbal commands can be detected by EEG in clinically unresponsive patients. These patients with cognitive motor dissociation (CMD) are unable to communicate with the environment despite preserved consciousness. Advanced brain-computer interfaces (BCI) are promising to support motor function in patients with motor neuron disease or spinal cord injury. Our primary objective was to determine if clinically unresponsive patients can control a self-paced, one-way BCI early after acute brain injury. Secondarily, we assessed the association of BCI control with short- and long-term outcomes.We conducted a prospective single-centre cohort study in 41 clinically unresponsive, critically ill and acutely brain injured patients, as well as in a convenience sample of 8 healthy volunteers and 22 conscious critically ill patients. The self-paced BCI analysed EEG in real time and modulated frequency and pitch of a tone that patients controlled by attempting a motor task: patients were provided with instructions ‘to make the beep sound faster, keep opening and closing your right hand’ alternating with ‘to make the beep sound slower, stop opening and closing your right hand’. CMD was detected by applying machine learning to EEG recorded while patients listened to motor commands. Clinical outcomes were recovery of consciousness by hospital discharge, assessed with the Coma Recovery Scale–Revised, and recovery of functional independence at 12 months, defined as a Glasgow Outcome Scale–Extended score of 4 or higher (denoting the ability to function independently for 8 h or more). Additionally, we invited conscious patients as well as family members of conscious and clinically unresponsive patients to complete a survey on perceived utility and challenges associated with the BCI.In this study, 13 clinically unresponsive patients (32%) achieved BCI control and 8 of 41 (20%) were CMD-positive. All healthy volunteers and nine conscious patients (41%) were able to c
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来源：Brain · academic.oup.com