Brain-computer interface (BCI) spellers allow severe motor-disabled patients to communicate using their brain activity without muscular mobility. Different visual configurations of the widely studied P300-based BCI speller had been assessed with healthy and motor-disabled users. However, the speller size (in terms of cm) had only been assessed for healthy subjects. We think that the speller size might be limiting for some severely motor-disabled patients with restricted head and eye movements. The usability of three speller sizes was assessed for seven patients diagnosed with amyotrophic lateral sclerosis (ALS) and a participant diagnosed with Duchenne muscular dystrophy (DMD). This is the first usability evaluation of speller size with severely motor-disabled participants. Effectiveness (in the online results) and efficiency (in the workload test) of the medium speller was remarkably better. Satisfaction was significantly the highest with the medium size speller and the lowest with the small size. These results correlate with previously described findings in healthy subjects. In conclusion, the speller size should be considered when designing a speller paradigm, especially for motor-disabled individuals, since it might affect their performance and user experience while controlling a BCI speller.
