Methods For Improving Braincomputer Interface Using
Methods For Improving Braincomputer Interface Using
Research Article
Abstract
Background: The brain-computer interface (BCI) is gaining much
attention to treat neurological disorders and improve brain-dependent
functions. Significant achievements over the last decade have focused
on engineering and computation technology to enhance the recording of
signals and the generation of output stimuli. Nevertheless, many challenges
remain for the translation of BCIs to clinical applications.
Methods: We review the relevant data on the four significant gaps in
enhancing BCI's clinical implementation and effectiveness.
Results: The paper describes three methods to bridge the current gaps in
the clinical application of BCI. The first is using a brain-directed adjuvant
with a high safety profile, which can improve the accuracy of brain
signaling, summing of information, and production of stimuli. The second
is implementing a second-generation artificial intelligence system that is
outcome-oriented for improving data streaming, recording individualized
brain-variability patterns into the algorithm, and improving closed-loop
learning at the level of the brain and with the target organ. The system
overcomes the compensatory mechanisms that underlie the loss of stimuli'
effectiveness for ensuring sustainable effects. Finally, we use inherent
brain parameters relevant to consciousness and brain function to bridge
some of the described gaps.
Conclusions: Combined with the currently developed techniques for
enhancing effectiveness and ensuring a sustainable response, these Affiliation:
methods can potentially improve the clinical outcome of BCI techniques.
1
Dearpartment of Medicine and Hebrew University,
Faculty of Medicine, Hadassah Medical Center, Ein-
Kerem, Jerusalem, Israel
2
Department of Neurology, Hebrew University,
Faculty of Medicine, and Hadassah Medical Center,
Keywords: Brain-Computer Interface; Digital health; colchicine; Department of Medicine, Jerusalem, Israel
consciousness; brain variability;
*Corresponding author:
Abbreviations: BCI: Brain-Computer Interface; AI: artificial intelligence; Yaron Ilan, Dearpartment of Medicine and Hebrew
EEG: electroencephalography; fNIRS: functional near-infrared spectroscopy; University, Faculty of Medicine, Hadassah Medical
EMG: electromyography; EOG: electrooculography; SSVEPs: steady- Center, Ein-Kerem, Jerusalem, Israel.
state visually evoked potentials; SSSEP: steady-state somatosensory Citation: Hillel Lehmann, David Arkadir, Yaron
evoked potential; MTs: Microtubules; JNK: Jun N-terminal kinase; Con A: Ilan. Methods for Improving Brain-Computer
concanavalin A; AD: Alzheimer's disease; BSV: Brain signal variability; Interface: Using A Brain-Directed Adjuvant and A
fMRI: functional magnetic resonance imaging; GAD: generalized anxiety Second-Generation Artificial Intelligence System to
Enhance Information Streaming and Effectiveness
disorder; RSV: Regional signal variability; SMR: sensorimotor rhythm; VR: of Stimuli. International Journal of Applied Biology
virtual reality; and Pharmaceutical Technology. 14 (2023): 42-52.
few years. BCI is a communication system of brain signals in understanding neural decoders, systems for neural feature
to control malfunctioning organs or external devices [1]. It extraction, and brain recording modalities [8]. Nevertheless,
enables control of an external output device by interpreting there remain multiple challenges to the clinical use of BCIs.
the neural activity. The generation of such systems may be Improved engineering and computation overcome some of
independent of the nervous system, such as in Passive BCI, these gaps. However, there are significant challenges in the
assisting patients with motor disabilities [2]. Motor BCI clinical implementation of these systems. The low reliability
comprises electrical recordings from the motor cortex of of some techniques used today contributes to the end-users'
paralyzed humans. The computer decodes the signals and low adaption rate.
can drive robotic arms or restore movement in a paralyzed
Table 1 summarizes some challenges currently faced
hand by stimulating the muscles in the forearm [3]. Cognitive
in implementing BCI in clinical practice, including the
assessment and training can use BCI. Verbal-motor-free
technological and computation barriers BCI systems depend
BCI-based tests assessed cognitive domains in patients with
on sensors and associated hardware that acquire brain signals.
Amyotrophic Lateral Sclerosis were developed [2]. Integrating
Improvements in this hardware are critical to the future of
a BCI with the sensory cortex can augment dexterity for
BCIs. Traditional BCI platforms involve recording brain
improved fine control. BCIs can restore vision in people with
signals via Electroencephalography (EEG). These systems
acquired blindness and control epileptic seizures [3]. BCI-
comprise a rule-based translation algorithm that produces
based cognitive training is part of neurofeedback therapy
the control commands [1]. Non-invasive procedures based
for neurological developmental disorders, including autism,
on EEG lack the spatial resolution to record detailed activity
attention-deficit/hyperactivity disorder, stroke patients, and
at the neuronal circuit level [9]. Signals travel a distance
elderly subjects [2]. Brain's plasticity and Hebbian-based
before being acquired by the EEG machine, and the noise and
motor recovery use BCI for rewarding cortical activity. These
artifacts are causing fundamental problems. EEG requires
are associated with sensory-motor rhythms using self-guided
good performance in different environments and reliability
and assistive modalities [4]. Non-invasive BCIs comprise
despite the noise generated by devices. Many BCI targets
proprioceptive feedback loops, which include numerous
patients surrounded by many electronic pieces of equipment
sensory variables. It allows the modulation of brain signals to
[10].
improve the hand's function. Based on BCI, applications are
developed for improving learning, communication, social, Wireless recording, machine learning analysis, and real-
memory, attention, visuospatial, creative, collaboration, and time temporal resolution can improve EEG-based BCI [11].
emotional skills [5]. Placing electrodes on the cortical surface is less invasive
In the present paper, we describe several of the gaps in Table 1: Several challenges for implementing BCI in clinical
clinical implementation and improving the effectiveness of practice
BCI. We present using brain adjuvants and second-generation a. Low accuracy
artificial intelligence (AI) methods to enhance the signals b. Low reliability
non-
stream and ensure an improved sustainable response. c. Isolation of targeted structures
invasive
d. Lowered accuracy of using non-
Current gaps in the development and implementation invasive measures
Hardware /
of BCI Software
e. Safety – infections, rejection
f. Recharged in situ
BCIs typically consist of three components: a sensor that g. Replacement of probes following
invasive
records brain neural activity; a decoder that processes the a failure
signal input by extracting predictive features and classifying h. Space limitations
the intended movement based on signal features; and an i. High cost
j. High variability of signal features
effector, an external device, typically a robotic limb or a
and continuous change
screen cursor, that receives instructions from the decoder to Decoding
k. Reading and data extraction from
execute an order [6]. BCI's clinical application rests on the recorded data
premise that activity in at least one cortical region associated l. Low reliability
with motor or sensory functioning is intact. BCI can bypass m. Low accuracy of information
transfer rate
brain lesions in the cortex or spine by linking cerebral activity
n. Sophisticated
to the effector [6]. The first-in-human implanted, wireless, Validation and cost
o. Small user population
motor neuroprosthesis used an endovascular stent-electrode. p. Delivery of nanomaterials and
The electrode transmitted signals from the motor cortex for processing Reading and data
numerous command control digital devices in two patients extraction from recorded data
q. Patient expectations
with flaccid upper limb paralysis [7]. Improvement in the
Ethical r. Concept of personal identity
development of BCI-based systems occurred due to progress s. Validity of informed consent
Citation: Hillel Lehmann, David Arkadir, Yaron Ilan. Methods for Improving Brain-Computer Interface: Using A Brain-Directed Adjuvant and A
Second-Generation Artificial Intelligence System to Enhance Information Streaming and Effectiveness of Stimuli. International Journal
of Applied Biology and Pharmaceutical Technology. 14 (2023): 42-52.
Volume 14 • Issue 1 44
Lehmann H., Int J Appl Biol Pharm 2023
DOI:10.26502/ijabpt.202124
but less precise and associated with decreased accuracy [3]. also necessary for improving BCI. A significant challenge
Several challenges include space limitations, replacement for both invasive and non-invasive BCI is decoding the
of probes following failure, isolation of targeted structures, signal. The requirement for months of training, and the
delivery of nanomaterials, and processing of the recorded marked inter-person differences, make it hard to achieve
data [12]. Functional near-infrared spectroscopy (fNIRS), standardization. Inconsistency of signal features affected
electromyography (EMG), electrooculography (EOG), by multiple variables, including the users' mental state and
and eye tracker combine with EEG [13]. Implementation circumstances, requires adaptive BCI algorithms and deep
of multi-sensor data fusion and machine learning-based learning for proper function [17]. It is unclear why some
translation algorithms improves the accuracy of such systems BCI paradigms or features are effective with some patients
[1]. Artificial intelligence and deep learning algorithms can and some are not [18]. Establishing systems using BCIs for
lead to faster and more accurate sensory input classifications. subjects with disabilities involves validating their value in
Neural engineering improved neural recording techniques improving quality of life and cost-effectiveness [19-20].
and clinical translation of neural interfaces.
The validation of BCIs for rehabilitation after strokes
The electronics used are smaller and faster than neurons. or other disorders requires careful comparisons with
However, challenges of decoding the neural circuits are yet conventional methods. Current BCIs, with their incomplete
to be overcome [12]. Visual-based BCIs that use P300 or abilities, are potentially helpful, mainly for people with
steady-state visually evoked potentials (SSVEPs) improve very severe disabilities and relatively small populations.
functionality. The steady-state somatosensory evoked Commercial interests have no adequate incentive to produce
potential (SSSEP) BCIs enhance the visual fatigue that occurs or promote their widespread dissemination [21]. Ethical
with these BCIs. These are based on selective tactile attention issues of using BCI are significant concerns. These include
and can overcome motor activity's reduced reliability of motor managing patient expectations, the concept of personal
activity [14]. Invasive BCI systems use implanted electrodes identity, and the validity of informed consent [22]. Privacy
and face a range of complex issues. These systems must be is a vital issue as the captured neural signals enable access to
safe and remain intact, functional, and reliable for decades private data. There are concerns about how BCI data is stored
[15]. Long-term safety is of concern as the implant could be and protected [23]. Current methods for overcoming these
associated with infections. These systems must be recharged gaps focus on improving technology, including computation
in situ or have batteries that last for years or decades; they barriers. Beyond the technological challenges described
have robust, comfortable, convenient, and discreet external above, several inherent gaps in the brain function itself
elements that could easily interface with high-performance remain to improve BCI clinical effectiveness.
applications [15].
Using brain-targeted adjuvants for improving BCI
Motor imagination/movement tasks using functional
and reactive tasks combined with cognitive tasks for brain There are multiple engineering and neurological
signals increase BCI accuracy [13]. These include using challenges to the clinical application of BCI [12]. Using BCI,
targeting brain-relevant mechanisms provides a new venue for
motor imagination with steady-state evoked visual potentials
improved clinical outcomes. We describe three methods for
(SSVEP) and motor imagination with P300. SSVEP is
improving BCI by targeting several brain pathways. Figure
most widely combined with P300 to increase the number
1 presents several gaps that challenge BCI's implementation
of commands [13]. Combining more than two modalities
and improve its efficacy. It shows a schematic presentation of
is developed for improved brain imaging and prosthesis
these methods for bridging the current BCI gaps for improving
control. Hybridizing several modalities can augment the
information streaming and the effectiveness of output stimuli.
number of control commands, improve classification
accuracy and reduce the signal detection time. Hybrid BCI Microtubules (MTs) are dynamic cytoplasmic tubular
systems with multimodal sensory can improve functions [6]. polymers that form the cell cytoskeleton [24]. MTs provide
Neurofeedback uses BCI systems to enable the real-time the intracellular transport of secretory vesicles, organelles,
display of subjects' brain activity while performing a task. and intracellular macromolecular assemblies. MTs are
BCI in this setting allows patients to control their cortical involved in cell mitosis and meiosis [25, 26]. MTs are
activity. Neurofeedback has improved BCI classification associated with the innate and adaptive arms of the immune
enhancing user control over BCI output [6]. New interface system and determine the dynamics of inflammatory cells
designs may enhance discomfort from daily, long-term use of [27-31]. Polarized CD4 Th1, Th17, CD8 T cells, and NK
BCI by ergonomic approaches [16]. cells induce MTs destabilization within neurons in multiple
sclerosis. Lymphocytes with cytolytic activity drive MTs'
High-fidelity connectivity with minor groups of neurons
axonal destabilization independent of neuronal death [31].
requires the placement of microelectrodes in the cortex
[3]. A better understanding of the sensory components is Bidirectional communication between the brain and the
Citation: Hillel Lehmann, David Arkadir, Yaron Ilan. Methods for Improving Brain-Computer Interface: Using A Brain-Directed Adjuvant and A
Second-Generation Artificial Intelligence System to Enhance Information Streaming and Effectiveness of Stimuli. International Journal
of Applied Biology and Pharmaceutical Technology. 14 (2023): 42-52.
Volume 14 • Issue 1 45
Lehmann H., Int J Appl Biol Pharm 2023
DOI:10.26502/ijabpt.202124
Figure 1: Several potential solutions for improved information streaming and effectiveness of stimuli in brain-computer
interface (BCI).
intestine occurs in health and disease. Gut-based therapy is a the gut-brain connection by impacting the microbiome [63].
method for affecting systemic systems by generating signals
Applying brain-targeted adjuvant to BCI, using non-
in the intestine and was shown effective in pre-clinical models
absorbable low-dose colchicine, which has a high safety
[32-42]. Preliminary data support the use of this method in
profile and targets the gut, can bridge several BCI gaps. The
humans [33, 36, 43-47]. MTs play a role in gut functions.
use of a brain adjuvant can improve the intent signals. It may
Jun N-terminal kinase (JNK) is necessary for the elongation
be related to the potential role of MTs in consciousness or
of the gut tube and regulates MTs architecture, preserving
other yet-to-be-explored mechanisms [64-66]. The adjuvant
adhesive contacts between cells in the intestine [48]. Tao-
can improve the cortex-generated signals and may enhance
1 destabilizes MTs at the actin-rich cortex, and its loss is
associations between the relevant brain area with other areas,
associated with the disordered migration of germ cells out of
leading to a better sum of the inputs received from the cortex.
the gut epithelium and subsequent cell death [49].
At the output stage, adjuvants can improve both the generated
Methods for altering microglial function by targeting stimuli and the closed-loop regulation back to the cortex, thus
the gut-brain axis carry less toxicity and are easier to improving the effectiveness of BCI.
control. Targeting the gut MTs using low-dose colchicine Implementing second-generation artificial
exerts a potent anti-inflammatory effect on target organs. intelligence-based variability for improving and
Oral administration of non-absorbable low-dose colchicine sustaining BCI effectiveness
alleviated immune-mediated hepatitis in mice injected with
concanavalin A (Con A). Similarly, it eased the inflammation First-generation AI systems analyze large datasets and
associated with the metabolic syndrome in the high-fat diet predict prognoses. At the same time, these systems aid
model of type 2 diabetes and fatty liver disease (unpublished). end-users, patients, and healthcare providers; their overall
Microglial cells constitute 5-12% of the cells in the brain and penetration and everyday use are lower than anticipated [67].
are involved in brain homeostasis and its response to triggers Second-generation systems can improve clinical outcomes and
[50-52, 53]. Homeostatic dysregulation of the brain's immune adherence by patients and physicians [67]. These platforms
system regulated by microglia plays a role in neurodegenerative can improve organ function and response to therapies while
disorders, including Alzheimer's disease (AD) [54-57]. controlling for the dynamic nature of the host and disease.
During disease, the microglia become inflammatory while They overcome the "big data" challenges by implementing
losing their homeostatic molecular functions [58-62]. In the an n=1 concept, directing the results toward a single subject
brain, gut MTs using low-dose colchicine was beneficial providing a method for personalizing the therapy in a clinically
in a mouse model of acute neurodegeneration mediated by meaningful way [67]. Second-generation systems provide a
microglia. The beneficial effect was associated with altering platform for generating clinically significant databases, thus
gene expression in genes linked with AD, showing that enabling better use of the data generated [67].
targeting gut MTs can modulate APOE-regulated genes in Variability characterizes multiple functions in nature
microglia in AD (unpublished). This effect may be related to and can serve as a method for improving biological systems
Citation: Hillel Lehmann, David Arkadir, Yaron Ilan. Methods for Improving Brain-Computer Interface: Using A Brain-Directed Adjuvant and A
Second-Generation Artificial Intelligence System to Enhance Information Streaming and Effectiveness of Stimuli. International Journal
of Applied Biology and Pharmaceutical Technology. 14 (2023): 42-52.
Volume 14 • Issue 1 46
Lehmann H., Int J Appl Biol Pharm 2023
DOI:10.26502/ijabpt.202124
[68-84]. The dynamicity of biological processes determines inter-and intra-subject variabilities impacted the performance
disease progression, manifestations, and response to stimuli measured by EEG signals [114].
and drugs. Variability characterizes the normal function
Second-generation AI includes methods to compensate for
of many organs, such as the variability in heart rate, gait,
inter and intra-subject variabilities [67, 113]. The dynamicity
breathing, and others [85-88], and is inherent to multiple
of the system enables it to adapt to constant changes in
brain functions [69, 72, 76, 89]. Brain signal variability
the host, the disease, the response to intervention, and the
(BSV) characterizes brain function and reflects the capacity
environment. As many of these parameters differ between
for state transition of neural activities. Prenatal fMRI defines subjects and change over time in the same subject, the system
variability patterns of the brain networks and shows the spatial continuously adapts itself to improve the patient's outcome
distribution and individual variability in network architecture. [79, 115]. Variability in brain signals can be quantified
Individual variability manifests by decreasing sensorimotor, and implemented into the second-generation algorithm to
visual, subcortical, dorsal, and ventral attention networks [90]. improve accuracy. Organ variability is personalized and
Structural brain development covariance may underlie brain
serves as a basis for subject-tailored platforms, improving
variability concerning cognition and disease vulnerability
information streaming and output stimuli [115]. Second-
[91]. Genetic variation is associated with altered response to
generation systems can solve the intra-subject and inter-
deep brain stimulation in Parkinson's disease, suggesting that
subject variability in the generated signals and the response to
variability in brain function is linked to genotypes [92]. The
stimuli. These systems can improve the response to therapies
diurnal physiological variability in neuro-metabolite levels
by implementing signatures of disease-related variabilities
suggests a link between chronobiology in brain variability
into the treatment regimens [68, 70, 73, 77, 80, 82, 98-111].
[93].
Implementing a system that controls changes adaptively
Patients with a generalized anxiety disorder (GAD) show provides a means for better translation of information into
decreased BSV in widespread regions, including the visual, improved personalized stimuli in a dynamic way [115, 116].
sensorimotor, frontoparietal, limbic, and thalamus. These The system provides an enhanced platform for a closed loop
systems have decreased BSV associated with an inflexible between brain areas, enabling better summing of the signals
brain state transfer pattern. A correlation between BSV and between the target organ and the brain.
trait anxiety score was positive in patients [94]. Differences in
Examples include systems that follow eye movements that
cognitive modulation of brain signal variability are associated
may precede the cortex and quantify and implement into the
with subject differences in motor expertise. This process
algorithm eye movement variability [117]. It collects EEG/
underlies differences in information-processing capacity
ECoG data from multiple attempts to quantify personalized
and information integration during cognitive processing
variability patterns and add them to cortex-derived data [118,
[95]. Regional signal variability (RSV) measures efficiency
119]. It quantifies signal variability by adding stimuli to
and modulatory capacity within brain regions and indicates
"relevant" and "irrelevant" brain areas and brain autonomic
endogenous pain modulatory system responsivity to training
signals, including temperature alterations in different brain
following repeated bouts of pain [96]. The second-generation
areas. It uses intra-brain nano-robots to measure electrical
AI system implements personalized variability parameters
or metabolic activity alteration before cortex-derived signals
into treatment algorithms to improve response to chronic
[120].
interventions in various diseases, including brain disorders
[68, 70, 73, 77-82, 97-112]. Implementing second-generation Decoy of the effect of stimuli due to compensatory
AI in BCI can enhance the accuracy of recording brain inputs. mechanisms and tolerance at different levels of the targets
As brain signals are not regular and are dynamic by nature, a is a significant problem for BCI interventions [79]. Second-
system that continuously adapts to changes can improve the generation AI systems overcome these mechanisms, enabling
accuracy of the information. a sustainable long-term response [115]. The use of low-
dose colchicine under the control of the second-generation
The variability in brain networks underlies subject
artificial intelligence system can further improve the drug's
differences in cognition and behaviors [90]. The EEG's
effectiveness, overcome the loss of response, and reduce side
sensorimotor rhythms (SMR) used for BCI to rehabilitate
effects [29, 30, 75, 81].
motor impairments varies over time and across subjects. The
intra- and inter-subject variabilities cause covariate shifts Implementing inherent brain platforms for
in data distributions that alter the transferability of model overcoming gaps in BCI
parameters among subjects. Machine learning-based methods Like other complex biological systems, the brain carries
compensate for inter-and intra-subject variability manifested information but does not necessarily have perfect structure
in EEG-derived feature distributions [113]. Determining or symmetry. The irregularity that characterizes some of its
the response under a threatening situation showed that both pathways provides an opportunity to apply notions of physics
Citation: Hillel Lehmann, David Arkadir, Yaron Ilan. Methods for Improving Brain-Computer Interface: Using A Brain-Directed Adjuvant and A
Second-Generation Artificial Intelligence System to Enhance Information Streaming and Effectiveness of Stimuli. International Journal
of Applied Biology and Pharmaceutical Technology. 14 (2023): 42-52.
Volume 14 • Issue 1 47
Lehmann H., Int J Appl Biol Pharm 2023
DOI:10.26502/ijabpt.202124
to this biological system [69, 72, 76, 83 79, 121]. An alliance spine disorders. It provides a platform for treating numerous
between classical and correlative brain function improves non-neurological diseases by improving brain-target organ
BCI. regulation. Technological challenges involving engineering
and computation are being worked on and continuously
A direct association mediates correlations between
improved. However, multiple barriers evolve from the
components of complex systems between different elements
inherent brain function. The suggested venues of using brain
of this system [122]. Direct contact or the transfer of mediators
adjuvants, second-generation AI in enhancing the stream
facilitates the effect [123-125]. Recently a system was
of information and stimuli, and implementing brain-linked
developed that correlates between two parts of the immune
methods for improving brain inputs and outputs to targets,
system without direct interaction or a transfer of mediators
set the basis for improving the clinical effectiveness of BCI.
between them [126]. The associated states may be present
within the system and involve a specific correlation between Declaration section:
donors and recipients. Learning and memory capabilities
are required for such correlations to occur. A "wave type of Ethics approval and consent to participate: not
memory" means continuous feedback from multiple brain applicable
areas, and the target organ or device for transmitting and Consent for publication: Yes
receiving signals are mandatory for efficient correlations to
Availability of data and materials: Upon request
occur [126, 127].
Competing interests: YI is the founder of Oberon
BCI can benefit from indirect correlations between
Sciences; other authors have nothing to disclose
different brain areas, which can implement various energy
transfer types by recording or using signals and producing Funding: not applicable
stimuli that are not measured using current technologies.
Authors' contributions: YI DA and HL wrote the
Other kinds of energies may be involved. Recording signals
manuscript and approved the final version
from multiple brain areas that affect or result from these
energies can improve the summing of inputs and outputs Acknowledgements: not applicable
at various levels. The technology can expand closed-loop Authors' information (optional)
inputs and outputs in the brain and target device by recording
"unmeasured responses." Implementing methods based Disclosure: YI is the founder of Oberon Sciences
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Citation: Hillel Lehmann, David Arkadir, Yaron Ilan. Methods for Improving Brain-Computer Interface: Using A Brain-Directed Adjuvant and A
Second-Generation Artificial Intelligence System to Enhance Information Streaming and Effectiveness of Stimuli. International Journal
of Applied Biology and Pharmaceutical Technology. 14 (2023): 42-52.
Volume 14 • Issue 1 48
Lehmann H., Int J Appl Biol Pharm 2023
DOI:10.26502/ijabpt.202124
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Second-Generation Artificial Intelligence System to Enhance Information Streaming and Effectiveness of Stimuli. International Journal
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of Applied Biology and Pharmaceutical Technology. 14 (2023): 42-52.