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          Institute: MPI für Intelligente Systeme (ehemals Max-Planck-Institut für Metallforschung)     Collection: Abt. Schölkopf (Empirical Inference)     Display Documents



  history
ID: 596847.0, MPI für Intelligente Systeme (ehemals Max-Planck-Institut für Metallforschung) / Abt. Schölkopf (Empirical Inference)
Transition from the locked in to the completely locked-in state: A physiological analysis
Authors:Ramos Murguialday, A.; Hill, J.; Bensch, M.; Martens, S.; Halder, S.; Nijboer, F.; Schölkopf, B.; Birbaumer, N.; Gharabaghi, A.
Date of Publication (YYYY-MM-DD):2011-05-01
Title of Journal:Clinical Neurophysiology
Volume:122
Issue / Number:5
Start Page:925
End Page:933
Review Status:not specified
Audience:Not Specified
Intended Educational Use:No
Abstract / Description:Objective

To clarify the physiological and behavioral boundaries between locked-in (LIS) and the completely locked-in state (CLIS) (no voluntary eye movements, no communication possible) through electrophysiological data and to secure brain–computer-interface (BCI) communication.
Methods

Electromyography from facial muscles, external anal sphincter (EAS), electrooculography and electrocorticographic data during different psychophysiological tests were acquired to define electrophysiological differences in an amyotrophic lateral sclerosis (ALS) patient with an intracranially implanted grid of 112 electrodes for nine months while the patient passed from the LIS to the CLIS.
Results

At the very end of the LIS there was no facial muscle activity, nor external anal sphincter but eye control. Eye movements were slow and lasted for short periods only. During CLIS event related brain potentials (ERP) to passive limb movements and auditory stimuli were recorded, vibrotactile stimulation of different body parts resulted in no ERP response.
Conclusions

The results presented contradict the commonly accepted assumption that the EAS is the last remaining muscle under voluntary control and demonstrate complete loss of eye movements in CLIS. The eye muscle was shown to be the last muscle group under voluntary control. The findings suggest ALS as a multisystem disorder, even affecting afferent sensory pathways.
Significance

Auditory and proprioceptive brain–computer-interface (BCI) systems are the only remaining communication channels in CLIS.
External Publication Status:published
Document Type:Article
Communicated by:Heide Klooz
Affiliations:MPI für Intelligente Systeme/Abt. Schölkopf
Identifiers:URL:http://www.kyb.tuebingen.mpg.de/
LOCALID:6784
DOI:10.1016/j.clinph.2010.08.019
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