Kids use brain-computer-interface for empowerment

TORONTO – Several dozen children at Holland Bloorview Kids Rehabilitation Hospital are using brain computer interface (BCI) technology to interact with their environment. They’re learning how to use their thought patterns to play a favourite song, paint with a robotic ball or race a remote-control car around a small track.

One patient, named Giselle, has a global development delay caused by a rare gene mutation. She has limited speech and physical mobility and is unable to use her hands or voice to control a computer. Using the hospital’s BCI solution, she is able to turn on her favourite song on her laptop computer – via her own brain waves.

And researchers at the hospital say these early stages suggest the remarkable technology holds the promise of one day helping Giselle and children like her find new ways to more fully engage with their world.

Holland Bloorview is the first pediatric hospital to use such technology in a clinical setting. It’s a non-invasive system; a headset and its 16 small, felt sensors sit gently against the scalp. The software, called Mindset, was developed at the Bloorview Research Institute’s PRISM Lab with the goal of helping children with severe neuromotor disabilities learn, communicate and play.

So far, 66 kids and teens have participated in the hospital’s clinical BCI program, which launched before the pandemic in early 2019. Children with cerebral palsy, brain injuries and neurodegenerative conditions have used the technology and the program has recently started offering it to those with autism spectrum disorder and Duchenne muscular dystrophy.

The BCI allows children, who depend on parents, family and caregivers to speak or act for them, the chance to do something on their own. That independence, researchers and clinicians say, fosters a greater sense of autonomy and dignity for children. Soon, the team will launch a trial to investigate whether the technology offers cognitive development benefits to children with disabilities.

“These are kids who require an intermediary to interact with their environment,” Susannah Van Damme, an occupational therapist and the BCI program’s team lead told the Toronto Star. “In a school setting, they might have an educational assistant doing hand-over-hand help with them to contribute to a painting project.

“BCI takes out the intermediary. Children can engage directly with the materials. The benefit is feeling mastery in doing something – and being able to do it independently – which we know is really important for self-determination and development of autonomy.”

As BCI technology advances, the hope is that children with disabilities will be able to use it to communicate independently or help them move on their own using a brain-controlled mobility device, said Tom Chau, a senior scientist and head of the PRISM, or Paediatric Rehabilitation Intelligent Systems Multidisciplinary, Lab.

“The future is completely wide open in terms of the possibilities,” said Chau, an engineer who has been developing the pediatric BCI technology for 17 years. “Kids have shown us that their capacity to learn and to modulate their brain activities is well beyond what we understood.”

Today, Giselle is demonstrating how well she can use the BCI technology in Holland Bloorview’s Creative Arts Studio.

Earlier, she used her thought patterns to activate a bubbler on a sensory cart, smiling in delight as bubbles floated up though the clear, water-filled tube.

Now she’s patiently waiting in her wheelchair, ready to play “C is for Cookie” on the laptop sitting open on a paint-splashed table in front of her.

The BCI technology, which uses non-invasive electroencephalography (EEG), is programmed to respond to changes in brain activity, either from flashing visual stimulus or a motor imagery mental task.

Giselle has learned to quiet her brain to a resting, or neutral, state, which the BCI technology understands to be like the ‘off’ function of a simple on-off switch.

When she wants to turn on the YouTube video, Giselle will think of clapping her hands, and the change in brain activity – going from a neutral state to an active state – will be understood as the ‘on’ function, prompting the song to start.

When Mirusha Ravindran, a life skills coach at Holland Bloorview, signals Giselle to start ‘C is for Cookie,’ Giselle smiles and a moment later the YouTube video starts to play.

Giselle makes joyful noises as Cookie Monster gobbles up a cookie in time with the music. Ravindran, who is dancing, stops when Giselle pauses the song.

Though labs around the world are working on BCI for adults, few are focusing on the pediatric population. Chau, whose lab developed specific software for kids’ brain activity and abilities, hopes that will change.

He said his observations suggest that young children who start learning how to use BCI early in life will adapt to it and will likely develop alongside the technology and could, as adults, use it to live independently and have a profession.

“We may have people driving motor vehicles,” said Chau, whose lab currently has a prototype of a brain-computer mobility device in the pipeline, along with BCI communication software. “We may have politicians on Parliament Hill who are non-verbal who are communicating and participating and setting government policies on national agendas just simply using the power of the mind. This is all possible.”

Van Damme said she never tires of watching children engage with the BCI in the hospital program. She notes that studies are required to fully understand the potential benefits of the technology and that, for some children, BCI doesn’t always work for reasons that are not yet understood.

Of the 66 children who have participated in the BCI program, at least two have not had any success while several others have dropped out because using the technology takes up too much time in already busy schedules or they are bored of the activity options.

But for most children, the BCI has led to feelings of independence and “small moments of joy,” Van Damme said.

“It’s so gratifying to them, that they’ve done something, they were able to do what they wanted to do, and they did it by themselves.”

For some children, using the BCI has encouraged teachers to modify individual education plans to better suit their abilities, she said. And for families, the technology has helped siblings play together, sometimes for the first time.