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Technology and Health Care 00 (2015) 1–4 DOI 10.3233/THC-150909 IOS Press 1

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Technical Note

Brain computer interface technology: Usability and applications in psychiatry R. Gregory Lande∗ and Miriam Pourzand

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Psychiatry Continuity Service, Walter Reed National Military Medical Center, Bethesda, MD, USA

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Received 13 November 2014 Accepted 28 February 2015

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Keywords:

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1. Introduction

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Commercially available electroencephalogram (EEG) devices suitable for brain computer interface (BCI) research are now widely available. In varying degrees these devices provide reliable signal acquisition and processing which permits researchers to now focus less on the electronics and ergonomics and more on the potential applications of the devices in heath care [1–3].

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Abstract. BACKGROUND: Commercially available electroencephalogram devices suitable for brain computer interface research are now widely available for neurofeedback applications. OBJECTIVE: The authors of this study were interested in exploring the usability and acceptance of a commercially available electroencephalogram as a first step in introducing the technology, assessing patient receptivity, and acquiring preliminary clinical outcome data. METHODS: The study was conducted among active duty military service members referred for psychiatric treatment to the Walter Reed National Military Medical Center’s Psychiatry Continuity Service in Bethesda, MD. The investigators used a commercially available single channel dry electrode electroencephalogram device paired with software programs that focused on promoting mediation and attention. A satisfaction survey was completed at the completion of each session. RESULTS: One hundred and one (101) military patients completed a total of 273 brain computer interface sessions from May 2012 through June 2014. Participants overwhelmingly found the single channel electroencephalogram device easy to use (n = 265/271, 97.8%). Following completion of the session participants most frequently reported “more focus” (n = 85/271, 31.4%) followed by “more relaxed” (n = 71/271, 26.2 %), and “a sense of accomplishment” (n = 44/271, 16.2%). DISCUSSION: Based on survey results gleaned from 273 sessions completed during the two year study, brain computer interface using a single channel electroencephalogram was overwhelming rated as user friendly. Over two-thirds of the individual sessions were rated as improving the person’s focus, relaxation, or sense of accomplishment.

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Corresponding author: R. Gregory Lande, Director of Psychiatry Continuity Service, Walter Reed National Military Medical Center, Building 8, 4th Floor, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600, USA. Tel.: +1 301 400 2110; E-mail: [email protected]. c 2015 – IOS Press and the authors. All rights reserved 0928-7329/15/$35.00 

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2. Methods

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The study was conducted at the Walter Reed National Military Medical Center’s Psychiatry Continuity Service (PCS) in Bethesda, MD. The Psychiatry Continuity Service is a partial hospital program which offers evidenced based care for active duty service members [6]. Although the Service can provide care for all psychiatric disorders needing this level of care, the predominant diagnoses include combat related post traumatic stress disorder, depression, anxiety, and alcohol use disorders. The project was submitted to Walter Reed National Military Medical Center’s Department of Research/Institutional Review Board and after review it was determined that since this since study consisted of a clinical practice evaluation through a satisfaction survey it would constitute a clinical performance improvement project and not human subject research. The authors selected a commercially available single channel dry electrode EEG device as opposed to other devices which had multiple sensors, a choice favoring the user’s comfort and procedural setup. As part of the general orientation to the PCS all newly admitted patients were provided the opportunity to use the EEG device. Those that agreed were provided general information about the use of BCI technology for neurofeedback purposes. During this tutorial the participant leaned about the basic operation of the EEG device, the relationships between brain wave activity and human behaviors, and how various software programs that interacted with the EEG device could help the participant improve mental meditation or concentration. At the conclusion of the tutorial, trained clinicians provided the patients appropriate instructions on how to use the EEG device, and after ensuring signal acquisition, introduced the patient to a software program that promoted mental meditation through a game like environment. Subsequent sessions introduced the patients to alternating meditation and attention oriented programs. Each session lasted about twenty minutes and all were conducted in the morning. Patients completed a satisfaction survey at the end of each session. The satisfaction survey was modeled after previously published studies that explored the usability of an EEG device. The survey consisted of ten questions which addressed the equipment’s ease of use, the patient’s attitude, and factors effecting performance. For example, patients rated the equipment’s overall comfort, speed in acquiring a signal, and the session’s success in the patient’s achieving improved mental focus or meditation.

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With researchers increasingly reassured that commercially available EEG units can satisfactorily operate in the BCI environment, studies are taking advantage of the technology for neurofeedback purposes. For children with attention deficit hyperactivity researchers employed a BCI based treatment which consisted of an 8 week intervention with participants significantly improving their focus upon completion [4]. In another study, researchers explored the usability and acceptance of BCI in an elderly sample as a prelude to a future proposal examining the technology to improve memory and cognition. Each participant in the study completed a questionnaire which demonstrated an overall satisfaction with the BCI environment [5]. The authors of this study were interested in exploring the usability and acceptance of commercially available EEGs among military psychiatric patients as a similar step towards future studies using BCI to improve mental focus and relaxation. This study was considered an important first step introducing the technology, assessing patient receptivity, and acquiring preliminary clinical outcome data.

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Table 1 Characteristics of military subjects (n = 100) Age 18–20 21–25 26–30 31–35 36–40 > 41 Gender Male Female Rank∗ E1-E4 E5-E9 O1-O3 O4-O6 Service Army Navy Air force Marine corps

n (%) 0 (0) 13 (13) 36 (36) 21 (21.0) 7 (7) 23 (23) 62 (62) 38 (38)



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E1-E4 = junior enlisted rank; E5-E9 = noncommissioned officers; O1-O3 = junior commissioned officers; 04-O6 = senior commissioned officers.

3. Results

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Data were collected from May 2012 through June 2014 during which time 101 military psychiatric patients participated in BCI. These 101 patients collectively completed 273 BCI sessions with the average participant completing three sessions (Mean 3.0, SD 2.3). The patient group consisted of roughly two-thirds men (n = 62/100, 62%), half in the US Army (n = 46/100, 46%) and slightly more than half aged 26–35 (n = 57/100, 57%). One participant did not complete the demographic questionnaire. (See Table 1) The 273 BCI sessions were split between only concentration or attention exercises (n = 114/273, 41.8%) those that involved meditation (n = 102/273, 37.4%) and the remainder devoted to exercises that involved both attention and mediation (n = 57/273, 20.8%). In terms of usability the participants overwhelmingly found the single channel EEG device easy to use (n = 265/271, 97.8%). In over three-quarters (n = 214/271, 79%) of the sessions the patients did not find the physical environment fully conducive for BCI. The principle factor associated with this complaint centered on distracting noises from nearby rooms. Other factors contributing to complaints about the physical environment were less infrequent and focused on the equipment (9/264, 3.3%) and were fairly evenly divided among the EEG device (n = 3), the computer (n = 2), and the software applications (n = 4). Following completion of a BCI session participants most frequently reported “more focus” (n = 85/271, 31.4%) followed by “more relaxed” (n = 71/271, 26.2%), and “a sense of accomplishment” (n = 44/271, 16.2%). A smaller number of sessions were reported as “no change” (n = 24/271, 8.9%), “more distracted” (n = 15/271, 5.5%) and “more anxious” (n = 6/271, 2.2%). In terms of gender men attended more total sessions (n = 171/273, Mean 3.09 SD 2.55 p = 0.03) but found the 20 minute session length too short (n = 167/262, Mean 1.07 SD 1.01 p = 0.00) when compared to women’s responses. Men did not judge the equipment as less user friendly (n = 170/270,

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R.G. Lande and M. Pourzand / Brain computer interface technology: Usability and applications in psychiatry

Mean 1.02 SD 0.15 p = 0.71 p = 0.71) or rate the physical environment more problematic (n = 170/200, Mean 1.78 SD 0.41 p = 0.49) than women.

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4. Discussion

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BCI is a promising technology that can harness the potential of a user friendly EEG which provides real time neurofeedback. Through brainwave detection and communication with a computer, users can visualize their mental activity and through various software applications learn to associate meditation and concentration with specifics tasks. This was a preliminary study conducted over two years among 101 patients, the chief aim of which was to determine the usability and acceptance of BCI technology among military patients receiving psychiatric care. In the authors’ opinion this is the first study of its kind examining BCI in both a military and psychiatric population. Based on survey results gleaned from 273 sessions completed during the two year study, BCI using a single channel EEG was overwhelming rated as user friendly. Over two-thirds of the sessions were rated as improving the person’s focus, relaxation, or sense of accomplishment. In terms of medical practice, BCI is still in its infancy with improvements in technology continually shaping the field. With an ever increasing tech-savvy society, BCI should find a ready niche. It usefulness in psychiatry is still unproven but the results of this study show a willing acceptance by patients, ease of use, and reliable equipment will not stand in the way of future research.

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Acknowledgement

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The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government.

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References

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Leuthardt EC. The Evolution of Brain-Computer Interfaces. Frontiers of Engineering [Internet]. 2012 [cited 2015 Feb 10]; 42(1): 41–50. Available from: https://nae.edu/File.aspx?id=57879. Nicolas-Alonso LF, Gomez-Gil J. Brain Computer Interfaces, a Review. Sensors [Internet].2012 [cited 2015 Feb 10]; 12 (2): 1211–1279. Available from Medline: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304110/. Ekandem J I, Davis TA, Alvarez I, James MT, Gilbert JE. Evaluating the ergonomics of BCI devices for research and experimentation. Ergonomics [Internet].2012 [cited 2015 Feb 10]; 55(5): 592–8. Available from Medline: http://www. ncbi.nlm.nih.gov/pubmed/22506831. Choon Guan L, Tih Shih l, Cuntai G, Shuen Sheng FD, Yudong Z, Sze Wei TS, et al. A Brain-Computer Interface Based Attention Training Program for Treating Attention Deficit Hyperactivity Disorder. PLoS ONE [Internet]. 2012 [cited 2015 Feb 10] 7(10) Available at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0046692. Tih-Shih L, Juinn Alexa GS, Shin Yi Q, Rachel P, Cuntai G, Yin Bun C, et al. A Brain-Computer Interface Based Cognitive Training System for Healthy Elderly: A Randomized Control Pilot Study for Usability and Preliminary Efficacy. PLoS ONE [Internet]. 2012 [cited 2015 Feb 10] 7(10) Available at: http://journals.plos.org/plosone/ article?id=10.1371/journal.pone.0079419. Lande RG, Banks Williams L, Francis JL, Gragnani C, Morin ML. Characteristics and effectiveness of an intensive military outpatient treatment program for PTSD [Internet]. 2011 [cited 2015 Feb 10] 20(5):530-8. Available at: http://www. tandfonline.com/doi/abs/10.1080/10926771.2011.588149.

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Brain computer interface technology: Usability and applications in psychiatry.

Commercially available electroencephalogram devices suitable for brain computer interface research are now widely available for neurofeedback applicat...
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