Stakeholder’s perspective on Brain-Computer Interfaces for children and adolescents with quadriplegic cerebral palsy

Communication Brain-Computer Interfaces (cBCIs) use neural signals to control a computer and are of interest as a communication tool for people with motor and speech impairment. Whereas the majority of cBCI research focuses on adults, the technology may also benefit children and adolescents with communication impairments, for example as a result of cerebral palsy (CP). Here we aimed to create a solid basis for the user centered design of cBCIs for children and adolescents with CP and complex communication needs by investigating the perspectives of their parents/caregivers and health care professionals on communication and cBCIs. We conducted an online survey on 1) current communication problems and usability of used aids, 2) interest in cBCIs, and 3) preference for specific types of cBCIs. A total of 19 parents/caregivers and 36 health care professionals who live(d) or work(ed) directly with children and adolescents (8-25 years old) with quadriplegic CP participated. Both groups of respondents indicated that, of 12 potential communication-limiting factors, motor impairment occurred the most frequently and also had the greatest impact on communication. The currently used communication aids included mainly no/low- tech aids (e.g., letter card) and high-tech aids (e.g., tablet or computer). Mid-tech aids (e.g., systems with static displays) were less frequently used. The majority of health care professionals and parents/caregivers reported an interest in cBCIs for children and adolescents with severe CP, with a slight preference for implanted electrodes over non-implanted ones, and no preference for either of the two proposed mental BCI control strategies (visual stimuli and imagined/attempted movement). These results indicate that cBCIs should be considered for a subpopulation of children and adolescents with severe CP, and that in the development of cBCIs for this group both P300 and sensorimotor rhythms, as well as the use of implanted electrodes, should be considered. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Dutch Technology Foundation STW (PANDA project, grant 19072, MPB), the Kinderrevalidatiefonds Adriaanstichting/JFK Kinderfonds (OTTER project, grant 20210009, MJV), and the Gravitation program of the Dutch Ministry of Education, Culture, and Science and the Netherlands Organization for Scientific Research (ESDiT project, grant 024.004.031). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of the Utrecht Medical University Center, waived ethical approval for this work under the Dutch Medical Scientific Research Act (non-WMO). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes