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.
