Objective: Amyotrophic lateral sclerosis (ALS) is a rare disease, but is also one of the most common motor neuron diseases, and people of all races and ethnic backgrounds are affected. There is currently no cure. Brain computer interfaces (BCIs) can establish a communication channel directly between the brain and an external device by recognizing brain activities that reflect user intent. Therefore, this technology could help ALS patients in promoting functional independence through BCI-based speller systems and motor assistive devices. Methods: In this paper, two kinds of ERP-based speller systems were tested on 18 ALS patients to: (1) assess performance when they spelled 42 characters online continuously, without a break; and (2) to compare performance between a matrix-based speller paradigm (MS-P, mean visual angle 6 degree) and a new speller paradigm that used a larger visual angle called the large visual angle speller paradigm (LS-P, mean visual angle 8 degree). Results: Although results showed that there were no significant differences between the two paradigms in accuracy trend over continuous use (p>0.05), the fatigue during the LS-P condition was significantly lower than that of MS-P (p<0.05). Results also showed that continuous use slightly reduced the performance of this ERP-based BCI. Conclusion: 15 subjects obtained higher than 80% feedback accuracy (online output accuracy) and 9 subjects obtained higher than 90% feedback accuracy in one of the two paradigms, thus validating the BCI approaches in this study. Significance: Most ALS subjects in this study could spell effectively after continuous use of an ERP-based BCI. The new LS-P display may be easier for subjects to use, resulting in lower fatigue.
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