Evaluating the perspectives of those with severe physical impairments while learning BCI control of a commercial augmentative and alternative communication paradigm.

Augmentative and alternative communication (AAC) techniques can provide access to communication for individuals with severe physical impairments. Brain-computer interface (BCI) access techniques may serve alongside existing AAC access methods to provide communication device control. However, there is limited information available about how individual perspectives change with motor-based BCI-AAC learning. Four individuals with ALS completed 12 BCI-AAC training sessions in which they made letter selections during an automatic row-column scanning pattern via a motor-based BCI-AAC. Recurring measures were taken before and after each BCI-AAC training session to evaluate changes associated with BCI-AAC performance, and included measures of fatigue, frustration, mental effort, physical effort, device satisfaction, and overall ease of device control. Levels of pre- to post-fatigue were low for use of the BCI-AAC system. However, participants indicated different perceptions of the term fatigue, with three participants discussing fatigue to be generally synonymous with physical effort, and one mental effort. Satisfaction with the BCI-AAC system was related to BCI-AAC performance for two participants, and levels of frustration for two participants. Considering a range of person-centered measures in future clinical BCI-AAC applications is important for optimizing and standardizing BCI-AAC assessment procedures.