The Effects of Noise and Simulated Conductive Hearing Loss on Physiological Response Measures During Interactive Conversations.

PURPOSE: The purpose of this work was to study the effects of background noise and hearing attenuation associated with earplugs on three physiological measures, assumed to be markers of effort investment and arousal, during interactive communication. METHOD: Twelve pairs of older people (average age of 63.2 years) with age-adjusted normal hearing took part in a face-to-face communication to solve a Diapix task. Communication was held in different levels of babble noise (0, 60, and 70 dBA) and with two levels of hearing attenuation (0 and 25 dB) in quiet. The physiological measures obtained included pupil size, heart rate variability, and skin conductance. In addition, subjective ratings of perceived communication success, frustration, and effort were obtained. RESULTS: Ratings of perceived success, frustration, and effort confirmed that communication was more difficult in noise and with approximately 25-dB hearing attenuation and suggested that the implemented levels of noise and hearing attenuation resulted in comparable communication difficulties. Background noise at 70 dBA and hearing attenuation both led to an initial increase in pupil size (associated with effort), but only the effect of the background noise was sustained throughout the conversation. The 25-dB hearing attenuation led to a significant decrease of the high-frequency power of heart rate variability and a significant increase of skin conductance level, measured as the average z value of the electrodermal activity amplitude. CONCLUSION: This study demonstrated that several physiological measures appear to be viable indicators of changing communication conditions, with pupillometry and cardiovascular as well as electrodermal measures potentially being markers of communication difficulty.

Participant-specific classifier tuning increases the performance of hand movement detection from EEG in patients with amyotrophic lateral sclerosis.

Objective.Brain-computer interface (BCI) systems can be employed to provide motor and communication assistance to patients suffering from neuromuscular diseases, such as amyotrophic lateral sclerosis (ALS). Movement related cortical potentials (MRCPs), which are naturally generated during movement execution, can be used to implement a BCI triggered by motor attempts. Such BCI could assist impaired motor functions of ALS patients during disease progression, and facilitate the training for the generation of reliable MRCPs. The training aspect is relevant to establish a communication channel in the late stage of the disease. Therefore, the aim of this study was to investigate the possibility of detecting MRCPs associated to movement intention in ALS patients with different levels of disease progression from slight to complete paralysis.Approach.Electroencephalography signals were recorded from nine channels in 30 ALS patients at various stages of the disease while they performed or attempted to perform hand movements timed to a visual cue. The movement detection was implemented using offline classification between movement and rest phase. Temporal and spectral features were extracted using 500 ms sliding windows with 50% overlap. The detection was tested for each individual channel and two surrogate channels by performing feature selection followed by classification using linear and non-linear support vector machine and linear discriminant analysis.Main results.The results demonstrated that the detection performance was high in all patients (accuracy 80.5 ± 5.6%) but that the classification parameters (channel, features and classifier) leading to the best performance varied greatly across patients. When the same channel and classifier were used for all patients (participant-generic analysis), the performance significantly decreased (accuracy 74 ± 8.3%).Significance.The present study demonstrates that to maximize the detection of brain waves across ALS patients at different stages of the disease, the classification pipeline should be tuned to each patient individually.

Online control of an assistive active glove by slow cortical signals in patients with amyotrophic lateral sclerosis.

Objective.A brain-computer interface (BCI) allows users to control external devices using brain signals that can be recorded non-invasively via electroencephalography (EEG). Movement related cortical potentials (MRCPs) are an attractive option for BCI control since they arise naturally during movement execution and imagination, and therefore, do not require an extensive training. This study tested the feasibility of online detection of reaching and grasping using MRCPs for the application in patients suffering from amyotrophic lateral sclerosis (ALS).Approach.A BCI system was developed to trigger closing of a soft assistive glove by detecting a reaching movement. The custom-made software application included data collection, a novel method for collecting the input data for classifier training from the offline recordings based on a sliding window approach, and online control of the glove. Eight healthy subjects and two ALS patients were recruited to test the developed BCI system. They performed assessment blocks without the glove active (NG), in which the movement detection was indicated by a sound feedback, and blocks (G) in which the glove was controlled by the BCI system. The true positive rate (TPR) and the positive predictive value (PPV) were adopted as the outcome measures. Correlation analysis between forehead EEG detecting ocular artifacts and sensorimotor area EEG was conducted to confirm the validity of the results.Main results.The overall median TPR and PPV were >0.75 for online BCI control, in both healthy individuals and patients, with no significant difference across the blocks (NG versus G).Significance.The results demonstrate that cortical activity during reaching can be detected and used to control an external system with a limited amount of training data (30 trials). The developed BCI system can be used to provide grasping assistance to ALS patients.

Real-time neurofeedback is effective in reducing diversion of attention from a motor task in healthy individuals and patients with amyotrophic lateral sclerosis.

OBJECTIVE: The performance of brain-computer interface (BCI) systems is influenced by the user's mental state, such as attention diversion. In this study, we propose a novel online BCI system able to adapt with variations in the users' attention during real-time movement execution. APPROACH: Electroencephalography signals were recorded from healthy participants and patients with Amyotrophic Lateral Sclerosis while attention to the target task (a dorsiflexion movement) was drifted using an auditory oddball task. For each participant, the selected channels, classifiers and features from a training data set were used in the online phase to predict the attention status. MAIN RESULTS: For both healthy controls and patients, feedback to the user on attentional status reduced the amount of attention diversion. SIGNIFICANCE: The findings presented here demonstrate successful monitoring of the users' attention in a fully online BCI system, and further, that real-time neurofeedback on the users' attention state can be implemented to focus the attention of the user back onto the main task.

Classification of Movement Preparation Between Attended and Distracted Self-Paced Motor Tasks.

OBJECTIVE: Brain-computer interface (BCI) systems aim to control external devices by using brain signals. The performance of these systems is influenced by the user's mental state, such as attention. In this study, we classified two attention states to a target task (attended and distracted task level) while attention to the task is altered by one of three types of distractors. METHODS: A total of 27 participants were allocated into three experimental groups and exposed to one type of distractor. An attended condition that was the same across the three groups comprised only the main task execution (self-paced dorsiflexion) while the distracted condition was concurrent execution of the main task and an oddball task (dual-task condition). Electroencephalography signals were recorded from 28 electrodes to classify the two attention states of attended or distracted task conditions by extracting temporal and spectral features. RESULTS: The results showed that the ensemble classification accuracy using the combination of temporal and spectral features (spectro-temporal features, 82.3 ± 2.7%) was greater than using temporal (69 ± 2.2%) and spectral (80.3 ± 2.6%) features separately. The classification accuracy was computed using a combination of different channel locations, and it was demonstrated that a combination of parietal and centrally located channels was superior for classification of two attention states during movement preparation (parietal channels: 84.6 ± 1.3%, central and parietal channels: 87.2 ± 1.5%). CONCLUSION: It is possible to monitor the users' attention to the task for different types of distractors. SIGNIFICANCE: It has implications for online BCI systems where the requirement is for high accuracy of intention detection.

Effectiveness of CRT-D Versus ICD on Prevention of Electrical Storm: Big Data from the USA.

Patients with implantable cardioverter-defibrillator (ICD) are at the risk of electrical storm (ES) occurrence associated with mortality and poor quality of life. Cardiac resynchronization therapy with defibrillator (CRT-D) minimizes inappropriate ICD shocks. However, limited reports exist on the impact of CRT-D versus traditional ICD on ES occurrences in real-life cohorts. We evaluated the implanted-device characteristics associated with ES events in a large data based on daily stored device-summaries obtained from remote monitoring data in US.Between 2004 and 2016, 19,935 US patients were implanted. Survival analyses with Cox regression for device-shock therapy were performed between patients who experienced at least one ES and those without ES. CRT-D devices (bi-ventricular) were implanted in 5522 (28%) patients during this period, and their ES events over time were compared to ICD recipients implanted with RV lead. Primary endpoint was the first ES event.ES occurred with the rate of 7.26% for all patients during the period. Cox regression analyses revealed significantly an increase risk in ES occurrences (the p-value <; 0.05 and hazard ratio >> 1) with shock therapy. CRT-D implant led to lower ES risk comparing with patients received traditional ICD (RV only).

Predicting Electrical Storm Using Episodes' Parameters from ICD Recorded Data.

Electrical storm (ES) is a life-threatening heart condition for patients with implantable cardioverter defibrillators (ICDs). ICD patients experienced episodes are at higher risk for ES. However, predicting ES using previous episodes' parameters recorded by ICDs have never been developed. This study aims to predict ES using machine learning models based on ICD remote monitoring-summaries during episodes in the anonymized large number of patients. Episode ICD-summaries from 16,022 patients were used to construct and evaluate two models, logistic regression and random forest, for predicting the short-term risk of ES. Episode parameters in this study included the total number of sustained episodes, shocks delivered and the cycle length parameters. The models evaluated on the data sections not used for model development. Random forest performed significantly better than logistic regression (P <; 0.01), achieving a test accuracy of 0.99 and an Area Under an ROC Curve (AUC) of 0.93 (vs. an accuracy of 0.98 and an AUC of 0.90). The total number of previous sustained episodes was the most relevant variables in the both models.

Brain state-dependent stimulation boosts functional recovery following stroke.

OBJECTIVE: Adjuvant protocols devised to enhance motor recovery in subacute stroke patients have failed to show benefits with respect to classic therapeutic interventions. Here, we evaluate the efficacy of a novel brain state-dependent intervention based on known mechanisms of memory and learning that is integrated as part of the weekly rehabilitation program in subacute stroke patients. METHODS: Twenty-four hospitalized subacute stroke patients were randomly assigned to 2 intervention groups: (1) the associative group received 30 pairings of a peripheral electrical nerve stimulus (ES) such that the generated afferent volley arrived precisely during the most active phase of the motor cortex as patients attempted to perform a movement; and (2) in the control group, the ES intensity was too low to generate a stimulation of the nerve. Functional (including the lower extremity Fugl-Meyer assessment [LE-FM; primary outcome measure]) and neurophysiological (changes in motor evoked potentials [MEPs]) assessments were performed prior to and following the intervention period. RESULTS: The associative group significantly improved functional recovery with respect to the control group (median [interquartile range] LE-FM improvement = 6.5 [3.5-8.25] and 3 [0.75-3], respectively; p = 0.029). Significant increases in MEP amplitude were seen following all sessions in the associative group only (p ≤ 0.006). INTERPRETATION: This is the first evidence of a clinical effect of a neuromodulatory intervention in the subacute phase of stroke. This was evident with relatively few repetitions in comparison to available techniques, making it a clinically viable approach. The results indicate the potential of the proposed neuromodulation system in daily clinical routine for stroke rehabilitation. ANN NEUROL 2019;85:84-95.

Comparison of the Efficacy of a Real-Time and Offline Associative Brain-Computer-Interface.

An associative brain-computer-interface (BCI) that correlates in time a peripherally generated afferent volley with the peak negativity (PN) of the movement related cortical potential (MRCP) induces plastic changes in the human motor cortex. However, in this associative BCI the movement timed to a cue is not detected in real time. Thus, possible changes in reaction time caused by factors such as attention shifts or fatigue will lead to a decreased accuracy, less pairings, and likely reduced plasticity. The aim of the current study was to compare the effectiveness of this associative BCI intervention on plasticity induction when the MRCP PN time is pre-determined from a training data set (BCIoffline), or detected online (BCIonline). Ten healthy participants completed both interventions in randomized order. The average detection accuracy for the BCIonline intervention was 71 ± 3% with 2.8 ± 0.7 min-1 false detections. For the BCIonline intervention the PN did not differ significantly between the training set and the actual intervention (t9 = 0.87, p = 0.41). The peak-to-peak motor evoked potentials (MEPs) were quantified prior to, immediately following, and 30 min after the cessation of each intervention. MEP results revealed a significant main effect of time, F(2,18) = 4.46, p = 0.027. The mean TA MEP amplitudes were significantly larger 30 min after (277 ± 72 µV) the BCI interventions compared to pre-intervention MEPs (233 ± 64 µV) regardless of intervention type and stimulation intensity (p = 0.029). These results provide further strong support for the associative nature of the associative BCI but also suggest that they likely differ to the associative long-term potentiation protocol they were modeled on in the exact sites of plasticity.

Influence of dual-tasking with different levels of attention diversion on characteristics of the movement-related cortical potential.

Dual tasking is defined as performing two tasks concurrently and has been shown to have a significant effect on attention directed to the performance of the main task. In this study, an attention diversion task with two different levels was administered while participants had to complete a cue-based motor task consisting of foot dorsiflexion. An auditory oddball task with two levels of complexity was implemented to divert the user's attention. Electroencephalographic (EEG) recordings were made from nine single channels. Event-related potentials (ERPs) confirmed that the oddball task of counting a sequence of two tones decreased the auditory P300 amplitude more than the oddball task of counting one target tone among three different tones. Pre-movement features quantified from the movement-related cortical potential (MRCP) were changed significantly between single and dual-task conditions in motor and fronto-central channels. There was a significant delay in movement detection for the case of single tone counting in two motor channels only (237.1-247.4ms). For the task of sequence counting, motor cortex and frontal channels showed a significant delay in MRCP detection (232.1-250.5ms). This study investigated the effect of attention diversion in dual-task conditions by analysing both ERPs and MRCPs in single channels. The higher attention diversion lead to a significant reduction in specific MRCP features of the motor task. These results suggest that attention division in dual-tasking situations plays an important role in movement execution and detection. This has important implications in designing real-time brain-computer interface systems.

Classification of EEG signals to identify variations in attention during motor task execution.

BACKGROUND: Brain-computer interface (BCI) systems in neuro-rehabilitation use brain signals to control external devices. User status such as attention affects BCI performance; thus detecting the user's attention drift due to internal or external factors is essential for high detection accuracy. NEW METHOD: An auditory oddball task was applied to divert the users' attention during a simple ankle dorsiflexion movement. Electroencephalogram signals were recorded from eighteen channels. Temporal and time-frequency features were projected to a lower dimension space and used to analyze the effect of two attention levels on motor tasks in each participant. Then, a global feature distribution was constructed with the projected time-frequency features of all participants from all channels and applied for attention classification during motor movement execution. RESULTS: Time-frequency features led to significantly better classification results with respect to the temporal features, particularly for electrodes located over the motor cortex. Motor cortex channels had a higher accuracy in comparison to other channels in the global discrimination of attention level. COMPARING WITH EXISTING METHODS: Previous methods have used the attention to a task to drive external devices, such as the P300 speller. However, here we focus for the first time on the effect of attention drift while performing a motor task. CONCLUSIONS: It is possible to explore user's attention variation when performing motor tasks in synchronous BCI systems with time-frequency features. This is the first step towards an adaptive real-time BCI with an integrated function to reveal attention shifts from the motor task.

Influence of attention alternation on movement-related cortical potentials in healthy individuals and stroke patients.

OBJECTIVE: In this study, we analyzed the influence of artificially imposed attention variations using the auditory oddball paradigm on the cortical activity associated to motor preparation/execution. METHODS: EEG signals from Cz and its surrounding channels were recorded during three sets of ankle dorsiflexion movements. Each set was interspersed with either a complex or a simple auditory oddball task for healthy participants and a complex auditory oddball task for stroke patients. RESULTS: The amplitude of the movement-related cortical potentials (MRCPs) decreased with the complex oddball paradigm, while MRCP variability increased. Both oddball paradigms increased the detection latency significantly (p<0.05) and the complex paradigm decreased the true positive rate (TPR) (p=0.04). In patients, the negativity of the MRCP decreased while pre-phase variability increased, and the detection latency and accuracy deteriorated with attention diversion. CONCLUSION: Attention diversion has a significant influence on MRCP features and detection parameters, although these changes were counteracted by the application of the laplacian method. SIGNIFICANCE: Brain-computer interfaces for neuromodulation that use the MRCP as the control signal are robust to changes in attention. However, attention must be monitored since it plays a key role in plasticity induction. Here we demonstrate that this can be achieved using the single channel Cz.