Research Examines Customization of Brain-Computer Interface (BCI) Technology in Patients with ALS and Cognitive Decline

The novel technology of brain-computer interface (BCI) uses brain activity, as measured by electroencephalogram (EEG) to control external devices, facilitating paralyzed patients’ ability to communicate. This technology¹ can allow patients with amyotrophic lateral sclerosis (ALS) to communicate even after they have lost the gaze control necessary for eye-tracking communication programs.¹ For maximum efficacy, BCI programs must account for aspects of disease heterogeneity, such as cognitive impairment, according to Andrew Geronimo, Ph.D., instructor, Penn State Hershey Neurosurgery.

“Our primary contribution to the ongoing ALS patient research is to account for cognitive impairment as we customize BCI programs for each patient,” says Geronimo, who is conducting ongoing studies in the area. “It represents the future direction of this field.” Cognitive decline is present in 50 percent of patients with ALS, once thought to be a purely motor neuron disease, with 15 percent of patients meeting the clinical criteria for dementia. While most clinicians are aware of this fact, the majority of BCI designers are not, a knowledge gap that Geronimo hopes to bridge with his work.

Brain-Computer Interface System Functions (BCI)

A boxplot of the patients’ interest in using BCI for various tasks.

Geronimo also notes how the behavioral changes common to ALS patients affect their participation and success with BCI technology. He elaborates, “These behavioral changes are independent of the cognitive decline, and affect ALS patients’ outlook on the disease itself, their interest in pursuing therapies that may or may not help them manage their symptoms, and their willingness to utilize advanced technology.” One study led by Geronimo found that behavioral impairment was associated with decreased receptivity to the use of BCI technology.² As a result, much of his research to date has been conducted on patients at an earlier stage of the disease, when cognitive and behavioral changes are minimal. Future studies will examine more closely the applicability of BCI technology to ALS patients with advanced disease.

Brain-Computer Interface System Functions (BCI)

Distribution of those responses is skewed toward the lower interest range for patients with behavioral impairment.2

Although BCI technology comprises an entire field of study, its use in patients with neurological disorders has been limited, and ALS patients have historically made up a small percentage of that study population. In the future, as technology improves, Geronimo envisions BCI becoming as prevalent as eye-tracking communications, with a strong possibility for hybrid systems that combine both eye-tracking and BCI. “It’s about using the available resources—any residual muscles the patient still has available,” he says. Overall, the availability of enhanced communication tools may even change end-of-life directives for ALS patients, making life-extending interventions, such as mechanical ventilation, more desirable.

Andrew Geronimo, Ph.D.Andrew Geronimo, Ph.D.
Instructor, Penn State Hershey Neurosurgery
717-531-0003, x 282576
Penn State Department of Engineering Science and Mechanics, University Park, Pa



  1. Chaudhary U, Birbaumer N, Curado MR. Brain-machine interface (BMI) in paralysis. Ann Phys Rehabil Med. 2015 Feb;58(1):9- 13.
  2. Geronimo A, Stephens HE, Schiff SJ, Simmons Z. Acceptance of brain-computer interfaces in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2014 Nov 5:1-7.

Leave a comment

Filed under Research

Comments are closed.