Foundations of Patient-Oriented AAC Access for Children: Evaluating Picture-Based P300-Brain-Computer Interface Control and Design Preferences - Project Summary/Abstract The broad, long-term goal of the proposed work is to provide children with severe speech and physical impair- ments (SSPI) access to effective augmentative and alternative communication (AAC). AAC devices provide a means of communication for those who find speech communication inefficient or ineffective due to disability. For children with SSPI, the lack of AAC access options has a devastating impact on quality of life, well-being, and medical care. By translating brain activity into communication device control, brain-computer interfaces (BCIs) for AAC (BCI-AAC) can support access to communication for those with SSPI who find existing methods of AAC inaccessible, fatiguing, or difficult to learn, and expand AAC options to facilitate multimodal device control. P300- based BCI-AAC devices use brain activity associated with attention to a target item and provide an encouraging avenue for children's AAC access due to the simple control task and short training times. However, P300-BCI- AAC research primarily focuses on developing spelling-based interfaces for adults, with limited research on chil- dren largely focusing on adolescents (aged ≥13 years), even though cortical maturation impacts the P300 brain signal. Recent works that employ implementation science frameworks and AAC experts have identified a para- mount need to build on prior foundational research and extend P300-BCI-AAC access to those in middle child- hood who may be unable to spell. Problematically, the development of picture-based P300-BCI-AAC systems for children aged 8–12 years remains largely unexplored. Thus, this project will break new ground in (a) picture- based P300-BCI-AAC development and (b) clinical translation, by determining initial levels of picture-P300-BCI- AAC performance for both healthy children and those with SSPI in middle childhood. Further, it will establish factors impacting BCI-AAC accuracy and children's design preferences. Project outcomes will be vital to achieve accelerated BCI-AAC success for individuals and the NIDCD's plan for patient-oriented implementation. Aim 1 will determine initial picture-based P300-BCI-AAC performance across two sessions, which will promote comfort, as BCI-AAC equipment may seem unfamiliar. Aim 2 will provide new knowledge of brain activity underlying P300-BCI-AAC access and how a range of patient-oriented factors impact accuracy to inform the development of assessment tools that can accelerate training times. Finally, to promote engagement, Aim 3 will evaluate and establish the P300-BCI-AAC design preferences of children via the use of a novel BCI-AAC design creation application. Project findings will have potential to improve communication abilities of children with SSPI via BCI- AAC and help decrease the impact of disability and risk of preventable adverse medical events (e.g., incorrect drug administration) while promoting quality of life and social participation. Outcomes will inform larger-scale investigations to develop assessment materials and inform future research to elucidate how children with SSPI learn BCI-AAC control in natural environments, alongside how display designs impact performance.
