EEG-Based Auditory BCI for Communication in a Completely Locked-In Patient Using Volitional Frequency Band Modulation

Patients with amyotrophic lateral sclerosis (ALS) in the completely locked-in state (CLIS) can lose all reliable motor control and are left without any means of communication. It remains unknown whether non-invasive electroencephalogram (EEG) based brain-computer interfaces (BCIs) can support volitional communication in CLIS. Here, we show that a CLIS patient was able to operate an EEG-based BCI across multiple online sessions to respond to both general knowledge and personally relevant assistive questions. The patient delivered "Yes"/"No" responses by volitionally modulating alpha and beta band power at different channels, guided by real-time auditory feedback from the BCI. The patient communicated assistive needs above chance in all sessions, achieving a perfect score in the final session. Performance on general knowledge questions varied across sessions, with two sessions showing accurate and above-chance responses, while the first and last sessions remained at chance level. The patient also showed consistent modulation patterns over time. These findings suggest that non-invasive BCIs may offer a potential pathway for restoring basic communication in CLIS.