Competing at the Cybathlon championship for people with disabilities: long-term motor imagery brain-computer interface training of a cybathlete who has tetraplegia.

BACKGROUND: The brain-computer interface (BCI) race at the Cybathlon championship, for people with disabilities, challenges teams (BCI researchers, developers and pilots with spinal cord injury) to control an avatar on a virtual racetrack without movement. Here we describe the training regime and results of the Ulster University BCI Team pilot who has tetraplegia and was trained to use an electroencephalography (EEG)-based BCI intermittently over 10 years, to compete in three Cybathlon events. METHODS: A multi-class, multiple binary classifier framework was used to decode three kinesthetically imagined movements (motor imagery of left arm, right arm, and feet), and relaxed state. Three game paradigms were used for training i.e., NeuroSensi, Triad, and Cybathlon Race: BrainDriver. An evaluation of the pilot's performance is presented for two Cybathlon competition training periods-spanning 20 sessions over 5 weeks prior to the 2019 competition, and 25 sessions over 5 weeks in the run up to the 2020 competition. RESULTS: Having participated in BCI training in 2009 and competed in Cybathlon 2016, the experienced pilot achieved high two-class accuracy on all class pairs when training began in 2019 (decoding accuracy > 90%, resulting in efficient NeuroSensi and Triad game control). The BrainDriver performance (i.e., Cybathlon race completion time) improved significantly during the training period, leading up to the competition day, ranging from 274-156 s (255 ± 24 s to 191 ± 14 s mean ± std), over 17 days (10 sessions) in 2019, and from 230-168 s (214 ± 14 s to 181 ± 4 s), over 18 days (13 sessions) in 2020. However, on both competition occasions, towards the race date, the performance deteriorated significantly. CONCLUSIONS: The training regime and framework applied were highly effective in achieving competitive race completion times. The BCI framework did not cope with significant deviation in electroencephalography (EEG) observed in the sessions occurring shortly before and during the race day. Changes in cognitive state as a result of stress, arousal level, and fatigue, associated with the competition challenge and performance pressure, were likely contributing factors to the non-stationary effects that resulted in the BCI and pilot achieving suboptimal performance on race day. Trial registration not registered.

Sensorimotor modulation assessment and brain-computer interface training in disorders of consciousness.

OBJECTIVES: To assess awareness in subjects who are in a minimally conscious state by using an electroencephalogram-based brain-computer interface (BCI), and to determine whether these patients may learn to modulate sensorimotor rhythms with visual feedback, stereo auditory feedback, or both. DESIGN: Initial assessment included imagined hand movement or toe wiggling to activate sensorimotor areas and modulate brain rhythms in 90 trials (4 subjects). Within-subject and within-group analyses were performed to evaluate significant activations. A within-subject analysis was performed involving multiple BCI technology training sessions to improve the capacity of the user to modulate sensorimotor rhythms through visual and auditory feedback. SETTING: Hospital, homes of subjects, and a primary care facility. PARTICIPANTS: Subjects (N=4; 3 men, 1 woman) who were in a minimally conscious state (age range, 27-53 y; 1-12 y after brain injury). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Awareness detection was determined from sensorimotor patterns that differed for each motor imagery task. BCI performance was determined from the mean classification accuracy of brain patterns by using a BCI signal processing framework and assessment of performance in multiple sessions. RESULTS: All subjects demonstrated significant and appropriate brain activation during the initial assessment, and real-time feedback was provided to improve arousal. Consistent activation was observed in multiple sessions. CONCLUSIONS: The electroencephalogram-based assessment showed that patients in a minimally conscious state may have the capacity to operate a simple BCI-based communication system, even without any detectable volitional control of movement.

A qualitative exploration of how individuals reconstruct their sense of self following acquired brain injury in comparison with spinal cord injury.

PRIMARY OBJECTIVE: The present study aimed to investigate the specific ways in which individuals reconstruct their sense of self following injury to the nervous system, by comparing individuals with acquired brain injury (ABI) and individuals with spinal cord injury (SCI), two groups that have experienced a sudden-onset injury with life-changing repercussions. RESEARCH DESIGN: Phenomenological qualitative research. METHODS AND PROCEDURES: Nine individuals with ABI and 10 individuals with SCI took part in an interview exploring the ways in which individuals reconstruct their sense of self following injury. Data were analysed using interpretative thematic analysis. MAIN OUTCOMES AND RESULTS: Findings showed similar themes identified within the interview data of the ABI and SCI groups. Both groups developed positive and negative self-narratives. Individuals employed strategies that facilitated the reconstruction of positive self-narratives. In addition, individuals described their sense of self as simultaneously continuous and changing. DISCUSSION: Findings are discussed in relation to proposed models of self-reconstruction post-injury to the nervous system.

How gender impacts career development and leadership in rehabilitation medicine: a report from the AAPM&R research committee.

OBJECTIVE: To examine the role that gender plays in meeting the medical academic mission by assessing career development, leadership, and research productivity among rehabilitation researchers. DESIGN: Prospective, cross-sectional cohort study. SETTING: National survey. PARTICIPANTS: Three hundred sixty rehabilitation professionals linked to the American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, and/or the American Congress of Rehabilitation Medicine. INTERVENTION: Online or paper survey. MAIN OUTCOME MEASURES: Research skills, resources and productivity, salary, leadership, and academic advancement. RESULTS: Results suggested that women rated themselves as being less skilled and having fewer resources for research compared with their male counterparts. Additionally, significantly fewer women applied for grant funding and had a lower publication rate compared with men. A proportionally larger number of women remained at lower academic ranks than men, and fewer women achieved senior academic ranks or positions of leadership. Even after adjusting for potential confounding factors, female sex remained a significant variable associated with lower salaries and lower manuscript production. Unlike men, female respondents tended to believe that being a woman was a negative factor with respect to academic advancement, leadership opportunities, salary, and resources. CONCLUSIONS: Female rehabilitation researchers were less developed professionally than their male counterparts and saw themselves as disadvantaged. These findings have potential implications for attracting women into rehabilitation research and the rehabilitation research community's efforts to sustain its academic mission, to improve research capacity, and to meet the needs of the 52 million people in the United States with disabilities.

Measuring rehabilitation research capacity: report from the AAPM&R Research Advisory Committee.

There is considerable concern regarding the paucity of individuals pursuing biomedical research in general and rehabilitation research in particular. The Research Advisory Committee (RAC) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) accepted the task to explore the barriers to biomedical research careers for physicians and rehabilitation scientists and, in particular, those factors pertaining to successfully conducting rehabilitation research. Concurrently, the Foundation for PM&R was also exploring the related issue of building capacity for rehabilitation research and planning a Rehabilitation Research Summit to address this issue for the spring of 2005. The goals of the Research Summit included the identification of barriers to rehabilitation research and development of an active agenda to enhance research capacity. As such, AAPM&R and the Foundation for PM&R worked through the RAC survey to provide some key information that would help the summit leaders achieve their goals. This report presents portions of the survey related to research capacity and outlines the methodology of the data collection and analysis within the context of the capacity taxonomy framework as presented at the Research Summit, "Building Research Capacity," held in the spring of 2005. This survey report provides quantitative information about researchers and academicians, their research environment, as well as their barriers and incentives for conducting rehabilitation research. Observations here provide a platform for future work in understanding the adequacy of the rehabilitation research enterprise, its appropriateness, and ability to meet societal needs for those with disabilities.

Congenital and acquired brain injury. 3. Rehabilitation interventions: cognitive, behavioral, and community reentry.

UNLABELLED: This self-directed learning module highlights the cognitive and psychosocial adjustment aspects of brain injury. It is part of the chapter on congenital and acquired brain injury in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses specifically on evaluation and treatment of mood and behavioral impairments after brain injury, treatment of cognitive impairments, efficacy of cognitive rehabilitation, psychosocial impact of a traumatic brain injury on families, and resources available for community reintegration. OVERALL ARTICLE OBJECTIVE: To summarize the psychosocial and cognitive impact of brain injury in children and adults.

Congenital and acquired brain injury. 5. Outcomes after acquired brain injury.

UNLABELLED: This self-directed learning module highlights several aspects of outcome after acquired brain injury rehabilitation. It is part of the chapter on brain injury rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. In this article, functional measures commonly used in rehabilitation are described, and their potential uses for various populations are discussed. Key physiologic factors that predict outcome for persons with different acquired brain injuries are identified. Variables that affect return to school and work are described, and the studies evaluating the effectiveness of brain injury rehabilitation programs in general, as well as their subcomponents, are also reviewed. OVERALL ARTICLE OBJECTIVES: (a) To describe variables that affect outcome after acquired brain injury and (b) to identify the outcome tools most appropriate for the patient populations and outcomes to be studied.