Critical issues using brain-computer interfaces for augmentative and alternative communication.

Brain-computer interfaces (BCIs) may potentially be of significant practical value to patients in advanced stages of amyotrophic lateral sclerosis and locked-in syndrome for whom conventional augmentative and alternative communication (AAC) systems, which require some measure of consistent voluntary muscle control, are not satisfactory options. However, BCIs have primarily been used for communication in laboratory research settings. This article discusses 4 critical issues that should be addressed as BCIs are translated out of laboratory settings to become fully functional BCI/AAC systems that may be implemented clinically. These issues include (1) identification of primary, secondary, and tertiary system features; (2) integrating BCI/AAC systems in the World Health Organization's International Classification of Functioning, Disability and Health framework; (3) implementing language-based assessment and intervention; and (4) performance measurement. A clinical demonstration project is presented as an example of research beginning to address these critical issues.