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Objective: Amyotrophic lateral sclerosis (ALS) is a rare disease, but is alsoone of the most common motor neuron diseases, and people of all races andethnic backgrounds are affected. There is currently no cure. Brain computerinterfaces (BCIs) can establish a communication channel directly between thebrain and an external device by recognizing brain activities that reflect userintent. Therefore, this technology could help ALS patients in promotingfunctional independence through BCI-based speller systems and motor assistivedevices. Methods: In this paper, two kinds of ERP-based speller systems weretested on 18 ALS patients to: (1) assess performance when they spelled 42characters online continuously, without a break; and (2) to compare performancebetween a matrix-based speller paradigm (MS-P, mean visual angle 6 degree) anda new speller paradigm that used a larger visual angle called the large visualangle speller paradigm (LS-P, mean visual angle 8 degree). Results: Althoughresults showed that there were no significant differences between the twoparadigms in accuracy trend over continuous use (p>0.05), the fatigue duringthe LS-P condition was significantly lower than that of MS-P (p<0.05). Resultsalso showed that continuous use slightly reduced the performance of thisERP-based BCI. Conclusion: 15 subjects obtained higher than 80% feedbackaccuracy (online output accuracy) and 9 subjects obtained higher than 90%feedback accuracy in one of the two paradigms, thus validating the BCIapproaches in this study. Significance: Most ALS subjects in this study couldspell effectively after continuous use of an ERP-based BCI. The new LS-Pdisplay may be easier for subjects to use, resulting in lower fatigue.

Continuous use of ERP-based BCIs with different visual angles in ALS patients