Establishing a Clinical Brain-Computer Interface Program for Children With Severe Neurological Disabilities

Background: Children with severe motor impairment but intact cognition are deprived of fundamental human rights. Quadriplegic cerebral palsy is the most common scenario where rehabilitation options remain limited. Brain-computer interfaces (BCI) represent a potential solution, but pediatric populations have been neglected. Direct engagement of children and families could provide meaningful opportunities while informing program development. We describe a patient-centered, clinical, non-invasive pediatric BCI program. Methods: Eligible children were identified within a population-based, tertiary care children’s hospital. Criteria included 1) age six to 18 years, 2) severe physical disability (non-ambulatory, minimal hand use), 3) severely limited speech, and 4) evidence of grade 1 cognitive capacity. After initial screening for BCI competency, participants attended regular sessions, attempting commercially available and customized systems to play computer games, control devices, and attempt communication. Results: We report the first 10 participants (median 11 years, range 6-16, 60% male). Over 334 hours of participation, there were no serious adverse events. BCI training was well tolerated, with favorable feedback from children and parents. All but one participant demonstrated the ability to perform BCI tasks. The majority performed well, using motor imagery based tasks for games and entertainment. Difficulties were most significant using P300, visual evoked potential based paradigms where maintenance of attention was challenging. Children and families expressed interest in continuing and informing program development. Conclusions: Patient-centered clinical BCI programs are feasible for children with severe disabilities. Carefully selected participants can often learn quickly to perform meaningful tasks on readily available systems. Patient and family motivation and engagement appear high.