**5. Conclusions and discussions**

ALS is a progressive disease that affects the control of muscle movement by damaging motor neurons. ALS kills the pyramidal neurons of the motor cortex as a corollary muscular functions deteriorate rapidly. For the present, there is no known cure for ALS. Because of these movement and muscular disabilities, these patients need an efficient alternative channel to communicate with their environment or to control devices. In this chapter, HCIs especially BCI technology focused on ALS patients, are presented.

The EEG-based BCI systems represent the only technology for severely paralyzed patients to increase or maintain their communication and control needs. The P300 paradigm for the EEG-based BCI systems is due to the fact that such waveform occurs spontaneously for many of the subjects without need of particular training, which is be useful for increasing the quality of life for the patients. EEG is still the most attractive and popular technology for clinical BCI.

The EOG-based side of the system seems more accurate and fast when compared to the EEG-based systems. It must be noted that the solution for the EOG system is cheaper when compared to the EEG solution and can be used as a first step for the hybrid device for all users. The general idea of a hybrid device is to familiarize the patient with a unique interface, while the user can switch the bioelectric signal for the communication/control of the external devices.

NIRS is a non-invasive optical technique, suitable to assess functional activity by measuring cortical oxygenation (HbO2) and deoxygenation (Hb). This technology is also a promising and cheap technology for establishing efficient alternative channel, however needs more study on this field to prove ability of efficiency.

In order to increase the usefulness and improve performance, hybrid approaches and multimodal designs should be investigated. For EEG based BCI systems two or more signal of: P300 response, steady state visual evoked potential, event related desynchronisation, slow cortical potential, sensorimotor rhythms and error-related potentials can be used for an efficient hybrid system. There is no sufficient study in the literature concerning multi-modal system designs. Combination of several bio-signals such as: EEG, EOG, NIRS, HR and GSR, etc offer an improved performance results. The usage of this two or several signals combination may be used depends on the situation of the disability.

### **6. References**

696 Amyotrophic Lateral Sclerosis

The novel system is microcontroller based and battery powered. Data is transferred via optic fiber. To remove the dc level and 50-Hz power line noise, differentiating approach is used. This approach is more successful and practical than the classical methods in the application. After signal conditioning; including filtering and amplification, the analog signal is digitized (at least 12 effective bits) at variable sampling rates and then transferred to the PC via optic fiber. To classify bio-signals, feature extraction with the fractal approach (Usakli, 2010) and wavelet transformed data is applied to artificial neural networks for classification. By using a user-friendly interface, the virtual keyboard and controlling pad allows messages to be given, and some other needs such as cleanup or

The integrated HCI system provides with high 1) efficiency, 2) usefulness, 3) robustness 4) accurate and reliable output, 5) fast response, 6) user friendly, 7) flexibility, 8) cheap, and 9)

ALS is a progressive disease that affects the control of muscle movement by damaging motor neurons. ALS kills the pyramidal neurons of the motor cortex as a corollary muscular functions deteriorate rapidly. For the present, there is no known cure for ALS. Because of these movement and muscular disabilities, these patients need an efficient alternative channel to communicate with their environment or to control devices. In this chapter, HCIs

The EEG-based BCI systems represent the only technology for severely paralyzed patients to increase or maintain their communication and control needs. The P300 paradigm for the EEG-based BCI systems is due to the fact that such waveform occurs spontaneously for many of the subjects without need of particular training, which is be useful for increasing the quality of life for the patients. EEG is still the most attractive and popular technology for

The EOG-based side of the system seems more accurate and fast when compared to the EEG-based systems. It must be noted that the solution for the EOG system is cheaper when compared to the EEG solution and can be used as a first step for the hybrid device for all users. The general idea of a hybrid device is to familiarize the patient with a unique interface, while the user can switch the bioelectric signal for the communication/control of

NIRS is a non-invasive optical technique, suitable to assess functional activity by measuring cortical oxygenation (HbO2) and deoxygenation (Hb). This technology is also a promising and cheap technology for establishing efficient alternative channel, however needs more

In order to increase the usefulness and improve performance, hybrid approaches and multimodal designs should be investigated. For EEG based BCI systems two or more signal of: P300 response, steady state visual evoked potential, event related desynchronisation, slow cortical potential, sensorimotor rhythms and error-related potentials can be used for an efficient hybrid system. There is no sufficient study in the literature concerning multi-modal system designs. Combination of several bio-signals such as: EEG, EOG, NIRS, HR and GSR, etc offer an improved performance results. The usage of this two or several signals

especially BCI technology focused on ALS patients, are presented.

combination may be used depends on the situation of the disability.

**4.2 Design rationale** 

medical assistance can be selected.

designed available components.

clinical BCI.

the external devices.

study on this field to prove ability of efficiency.

**5. Conclusions and discussions** 


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**31** 

*1Baylor* 

*USA* 

*2Veterans Hospital* 

*4University of Texas* 

*3Ruan Neuroscience Center* 

**Overview of Cognitive Function in ALS, with** 

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder that affects upper and lower motor neurons and is more recently known to be associated with declines in cognitive and behavioral functions for a subset of patients (Strong, et al., 1996; Strong et al., 2009). The cognitive changes associated with ALS can vary from mild impairments that may or may not affect the individual's daily functioning to more severe cognitive and behavioral changes that meet criteria for a diagnosis of frontotemporal dementia (ALS-FTD). There are at least mild cognitive changes in 40 to 60% of sporadic and familial ALS patients (Massman et al., 1996; Phukan et al., 1996; Ringholz et al., 2005; Wheaton et al., 2007). The cognitive and behavioral changes associated with ALS follow a pattern consistent with involvement of the frontal and temporal lobes (Strong et al., 2009, Hodges et al., 2004), presenting as difficulties with attention, working memory, verbal fluency, and semantic abilities (Abe et al., 1997; Ringholz et al., 2005; Rippon et al., 2006, Schmolck et al., 2007; Strong et al, 1999; Strong et al., 2009). Furthermore, 15% of ALS patients demonstrate more severe cognitive and behavioral changes consistent with ALS-FTD (Lomen-Hoeth et al., 2002; Ringholz et al., 2005; Wheaton et al., 2007), presenting as declines in judgment, problem solving, and reasoning, which are more frontally mediated cognitive functions. In addition to cognitive changes, up to 25% of patients with ALS may also experience significant changes in their behavior, mood, and personality characteristics (Hodges et al., 2004; Kertesz et al., 2005), including a loss of empathy, problems with organization and planning, changes in social behavior and personality, difficulties with

The temporal lobes are purported to be involved in auditory perception, language comprehension, naming, processing of semantic knowledge and long-term memory storage, high-level visual processing of complex stimuli such as faces and scenes, and episodic memory (Lezak, 1995). In addition, they contain the amygdala and associated limbic areas, which are key structures for processing emotional stimuli and detecting threat from the environment, and are of particular interest for ALS patients. ALS patients show a lack of

**1. Introduction** 

impulse control, and apathy.

**Special Attention to the Temporal Lobe:** 

**Semantic Fluency and Rating the** 

Heike Schmolck1,3, Paul Schulz1,2,4 and Michele York1,2

**Approachability of Faces** 

