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  Transition from the locked in to the completely locked-in state: A physiological analysis

Ramos Murguialday, A., Hill, J., Bensch, M., Martens, S., Halder, S., Nijboer, F., et al. (2011). Transition from the locked in to the completely locked-in state: A physiological analysis. Clinical Neurophysiology, 122(5), 925-933. doi:10.1016/j.clinph.2010.08.019.

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Item Permalink: http://hdl.handle.net/11858/00-001M-0000-0013-BBBC-6 Version Permalink: http://hdl.handle.net/21.11116/0000-0001-B844-3
Genre: Journal Article

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Ramos Murguialday, A, Author
Hill, J1, 2, Author              
Bensch, M, Author
Martens, S1, 2, Author              
Halder, S, Author              
Nijboer, F, Author
Schölkopf, B1, 2, Author              
Birbaumer, N, Author
Gharabaghi, A, Author
Affiliations:
1Department Empirical Inference, Max Planck Institute for Biological Cybernetics, Max Planck Society, ou_1497795              
2Max Planck Institute for Biological Cybernetics, Max Planck Society, ou_1497794              

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 Abstract: Objective To clarify the physiological and behavioral boundaries between locked-in (LIS) and the completely locked-in state (CLIS) (no voluntary eye movements, no communication possible) through electrophysiological data and to secure brain–computer-interface (BCI) communication. Methods Electromyography from facial muscles, external anal sphincter (EAS), electrooculography and electrocorticographic data during different psychophysiological tests were acquired to define electrophysiological differences in an amyotrophic lateral sclerosis (ALS) patient with an intracranially implanted grid of 112 electrodes for nine months while the patient passed from the LIS to the CLIS. Results At the very end of the LIS there was no facial muscle activity, nor external anal sphincter but eye control. Eye movements were slow and lasted for short periods only. During CLIS event related brain potentials (ERP) to passive limb movements and auditory stimuli were recorded, vibrotactile stimulation of different body parts resulted in no ERP response. Conclusions The results presented contradict the commonly accepted assumption that the EAS is the last remaining muscle under voluntary control and demonstrate complete loss of eye movements in CLIS. The eye muscle was shown to be the last muscle group under voluntary control. The findings suggest ALS as a multisystem disorder, even affecting afferent sensory pathways. Significance Auditory and proprioceptive brain–computer-interface (BCI) systems are the only remaining communication channels in CLIS.

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 Dates: 2011-05
 Publication Status: Published in print
 Pages: -
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 Table of Contents: -
 Rev. Method: -
 Identifiers: DOI: 10.1016/j.clinph.2010.08.019
BibTex Citekey: 6784
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Title: Clinical Neurophysiology
  Other : Clin. Neurophysiol.
Source Genre: Journal
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Publ. Info: Amsterdam : Elsevier
Pages: - Volume / Issue: 122 (5) Sequence Number: - Start / End Page: 925 - 933 Identifier: ISSN: 1388-2457
CoNE: https://pure.mpg.de/cone/journals/resource/954926941726