by Prof. Dr. Stefan Debener, Neuropsychology Lab, University of Oldenburg, Germany
and Dr. Awais Kamboh, Neuroinformatics Group, School of Electrical Engineering and Computer Science, National University of Science and Technology, Islamabad, Pakistan
For decades, Pakistan has been suffering from earthquakes, floods, poverty, political instability, a fragile infrastructure, terrorism and regional violence. Indeed, it has been described as a hard country . Given these circumstances, is Pakistan a good choice for setting up a new research EEG laboratory?
Pakistan has approximately 220 million inhabitants and for many of them, public health care is insufficient particularly in rural areas. Access to proper health care, if there is any, it is often limited to basic primary care. Imagine suffering from a stroke or hypertension, or a mental disorder like depression or schizophrenia. Or imagine your child starts having epileptic seizures. In Pakistan those conditions are frequently fatal. Pakistan has approximately 150 registered neurologists. On average, that is only one neurologist for 1.5 million inhabitants. By comparison, in Germany one neurologist takes care of approximately 12000 people. It is likely that more neurologists are available to treat the citizens of Munich than those that are available to treat the people of the fifth-biggest country in the world.
In 2011, the world health organization (WHO) published an interesting report on mobile Health . Mobile Health, or mHealth, is defined as the use of mobile and wireless technologies for health care. The report argues that mHealth has the potential to transform health care delivery on a global level. Smartphones are now ubiquitous even in developing countries, and mobile cellular networks continue to grow rapidly. So it is natural to try to harvest smartphone technology for health care delivery, particularly in developing countries. Many other organizations working in the field of health care share this vision. The King’s Fund, for instance, is an independent charity working to improve health care services in England. It has identified the smartphone as key technology to transform health and care . Apparently, mHealth is becoming important for developed countries as well.
We define mobile EEG as portable technology that provides reasonable EEG signal quality in non-stationary, mobile situations, such as walking, dancing, driving a car, or being engaged in natural communication. Good mobile EEG technology should be small, wireless, head-mounted, unobtrusive and motion-tolerant . But is mobile EEG just another fancy toy for researchers, or is there a meaningful application of mobile EEG technology in the context of mHealth within reach?
At Oldenburg University we began developing mobile EEG technology in 2012. Aiming towards mobile brain-computer interfaces, we initially explored P300 components on a trial-by-trial basis while participants were naturally walking outdoors . By today’s standards, after a mere 6 years, our initial solutions now seem rather clumsy. We needed a notebook carried in a backpack to collect the EEG signals. Nowadays this is easily possible with off-the-shelf smartphones , which can handle EEG acquisition as well as stimulus delivery and behavioral response capture. By merging our 2012 mobile consumer EEG solution with powerful software , other groups have managed to develop a versatile mobile EEG system. These low cost systems enable clinical EEG recordings in the Himalaya mountains of Bhutan. Here, mobile EEG is used to diagnose seizure disorders . Bhutan is a very poor, small country with hardly any access for patients to neurological care .
The School of Electrical Engineering and Computer Science (SEECS) at the National University of Science and Technology (NUST) in Islamabad, Pakistan, is a highly ranked, very well-respected institution. SEECS is the flagship of NUST and provides excellent education in electrical engineering, computer sciences and related fields . In 2015, Ms Maryam Saeed, a lecturer from NUST-SEECS, applied for an internship in my (Debener) lab in Oldenburg, asking specifically to receive training in mobile EEG recording and analysis. Maryam stayed five months and initiated a fruitful collaboration between our lab in Oldenburg and SEECS.
In September 2016, my friend Maarten De Vos from Oxford University and I gave a 2-day workshop on EEG recording and analysis concepts. We were surprised by the huge interest in EEG; over 120 well educated students attended. We received many questions from students, clinical scientists and researchers, many of whom came from other institutions to talk to us and express interest in state-of-the-art EEG. But what do you do as a scientist or clinician with an interest in EEG research but no access to research EEG facilities?
Discussions with the dean of SEECS, Dr. S.M. Hassan Zaidi and the pro-rector of NUST, Dr. Asif Razi, followed and the idea was born to set up what may well be the very first research EEG laboratory in Pakistan. While the dean organized the required space and reconstruction work, several companies in Europe expressed interest in this endeavour and donated the necessary hardware.
A few weeks ago we met at SEECS again. It was great to see that the building work is completed and the newly set up EEG lab is now ready for use. We are very grateful to the companies Brain Products, EASYCAP and mBrainTrain for supporting our wild, ambitious idea. Special thanks go to the members of the Neuroinformatics Group at SEECS and members of the Neuropsychology Lab in Oldenburg. We are all confident that this new EEG lab will soon be successful in providing optimal EEG education for SEECS students. In our opinion, excellence in engineering and computer sciences is urgently needed to unleash the full potential of mobile EEG for advancing health and care, in developing as well as developed countries.
 A. Lieven, “Pakistan: A Hard country” Penguin Press, 529 pages, 2011. ISBN: 9781610390217
  https://www.kingsfund.org.uk/publications/eight-technologies-will-change-health-and-care
 M. G. Bleichner and S. Debener, “Concealed, Unobtrusive Ear-Centered EEG Acquisition : cEEGrids for Transparent EEG,” Front Hum Neurosci vol. 11, no. April, pp. 1–14, 2017.
 S. Debener, F. Minow, R. Emkes, K. Gandras, and M. De Vos, “How about taking a low-cost, small, and wireless EEG for a walk?,” Psychophysiology, vol. 49, no. 11, pp. 1617–1621, Sep. 2012.
 S. Debener, R. Emkes, M. De Vos, and M. Bleichner, “Unobtrusive ambulatory EEG using a smartphone and flexible printed electrodes around the ear.,” Scientific Reports, vol. 5, no. 1, p. 16743, Jan. 2015.
 A. Stopczynski, C. Stahlhut, J. E. Larsen, M. K. Petersen, and L. K. Hansen, “The smartphone brain scanner: A portable real-time neuroimaging system,” PLoS One, vol. 9, no. 2, 2014.
 A. Burton, “Brainwaves from Bhutan Could a mobile phone and an electrode cap derived from a video game headset be used in the,” Lancet Neurol., vol. 14, no. 12, pp. 1154–1155, 2015.
  http://seecs.nust.edu.pk/
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