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.

"Not a whole woman": an interpretative phenomenological analysis of the lived experience of women's body image and sexuality following amputation.

Background: Lower-limb amputations can lead to depression, performance anxiety, altered body image, relationships and sexual well-being. However, there is little published literature investigating how people experience changes to body image and their sexuality post-amputation and minimal literature exploring sexuality specifically from the female perspective post-amputation.Purpose: To gain an in-depth understanding of women's experience of sexuality and body image following amputation of a lower limb to inform rehabilitation and clinical practice.Method: Semi-structured interviews with female amputees (n = 9) were conducted to collect rich contextual data. This qualitative data was analysed using Interpretative Phenomenological Analysis (IPA).Results: Three superordinate themes emerged from IPA data analysis: "I don't like the way I am", which illustrated participants' changed relationship with their embodied selves, "Broken/not wanted" which reflected changes participants experienced in their romantic relationships, and "Same but different" which related to participants' changed societal roles as women.Discussion: Participants' accounts highlighted experiences of decreased sexual well-being, disrupted body image, stigmatisation and resilience. These accounts point to the potential utility of compassion focused approaches in therapeutic intervention, as well as the necessity for health professionals to involve spouses in sexual rehabilitation conversations and encourage patient-led peer support networks.Implications for rehabilitationPsychosexual assessment following limb loss involving open-ended questions will likely capture issues of sexual well-being as well as functioning, ensuring that interventions are comprehensive, targeted and relevant to the individual.Women struggle with reconciling their post-amputation kinetic representations of their selves to new ways of functioning, which may impact body image and prosthesis uptake.Compassion focused psychotherapeutic interventions could be effective in addressing problematic coping strategies post-amputation such as avoidance and disengagement while enhancing more self-compassionate coping styles.Couples distressed about their relationship may not engage in problem-solving discussions around sexuality, highlighting the necessity for health professionals to involve spouses in sexual rehabilitation conversations and interventions.Supporting the creation of gendered, peer-led groups to address issues related to sexual well-being is likely to improve overall quality of life for these individuals.