Advanced Augmentative and Alternative Communication System Based in Physiological Control

Dyskinetic Cerebral Palsy (DCP) is mainly characterized by alterations in muscle tone and involuntary movements. Therefore, these people present with difficulties in coordination and movement control, which makes walking difficult and affects their posture when seated. Additionally, their cognitive performance varies between being completely normal and severe mental retardation. People with DCP were selected as the objective of this thesis due to their multiple and complex limitations (speech problems and motor control) and because their capabilities have a great margin for improvement thanks to physiological control systems. Given their communication difficulties, some people with DCP have good motor con-trol and can communicate with written language. However, most have difficulty using Augmentative and Alternative Communication (AAC) systems. People with DCP gen-erally use concept boards to indicate the idea they want to communicate. However, most communication solutions available today are based on proprietary software that makes it difficult to customize the concept board and this type of control system. This is the motivation behind this thesis, with the aim of creating an interface with characteristics, able to be adapted to the user needs and limitations. Thus, this thesis proposes an Augmentative and Alternative Communication System for people with DCP based on physiological control. In addition, an innovative system for direct con-trol of concept boards with EMG is proposed. This control system is based on a physi-cal model that reproduces the muscular mechanical response (stiffness, inertia and viscosity). It allows for a selection of elements thanks to small pulses of EMG signal with sensors on a muscle with motor control. Its main advantage is the possibility of correcting errors during selection associated with uncontrolled muscle impulses, avoid-ing sustained muscle effort and thus reduced fatigue.La Parálisis Cerebral de tipo Discinésica (DCP) se caracteriza principalmente por las alteraciones del tono muscular y los movimientos involuntarios. Por ello, estos pacientes presentan dificultades en la coordinación y en el control de movimientos, lo cual les dificulta el caminar y afecta su postura cuando están sentados. Cabe resaltar que la capacidad cognitiva de las personas con DCP puede variar desde completamente normal, hasta un retraso mental severo. Las personas con DCP han sido seleccionadas como objetivo de esta tesis ya el margen de mejora de sus capacidades es amplio gracias a sistemas de control fisiológico, debido a sus múltiples y complejas limitaciones (problemas de habla y control motor). Debido a sus dificultades de comunicación, algunas personas con DCP se pueden comunicar con lenguaje escrito, siempre y cuando tenga un buen control motor. Sin embargo, la mayoría tienen dificultades para usar sistemas de Comunicación Aumentativos y Alternativos (AAC). De hecho, las personas con DCP utilizan generalmente tableros de conceptos para indicar la idea que quieren transmitir. Sin embargo, la mayoría las soluciones de comunicación disponibles en la actualidad están basadas en software propietario que hacen difícil la personalización del tablero de conceptos y el tipo de sistema de control. Es aquí donde surge esta tesis, con el objetivo de crear una interfaz con esas características, capaz de adaptarse a las necesidades y limitaciones del usuario. De esta forma, esta tesis propone un sistema de comunicación aumentativo y alternativo para personas con DCP basado en control fisiológico. Además, se propone un Sistema innovador de control directo sobre tableros de conceptos basado en EMG. Este Sistema de control se basa en un modelo físico que reproduce la respuesta mecánica muscular (basado en parámetros como Rigidez, Inercia y Viscosidad), permitiendo la selección de elementos gracias a pequeños pulsos de señal EMG con sensores sobre un músculo con control motor. Sus principales ventajas son la posibilidad de corregir errores durante la selección asociado a los impulsos musculares no controlados, evitar el esfuerzo muscular mantenido para alcanzar un nivel y reducir la fatiga.La Paràlisi Cerebral de tipus Discinèsica (DCP) es caracteritza principalment per les alteracions del to muscular i els moviments involuntaris. Per açò, aquests pacients presenten dificultats en la coordinació i en el control de moviments, la qual cosa els dificulta el caminar i afecta la seua postura quan estan asseguts. Cal ressaltar que la capacitat cognitiva de les persones amb DCP pot variar des de completament normal, fins a un retard mental sever. Les persones amb DCP han sigut seleccionades com a objectiu d'aquesta tesi ja el marge de millora de les seues capacitats és ampli gràcies a sistemes de control fisiològic, a causa dels seus múltiples i complexes limitacions (problemes de parla i control motor). A causa de les seues dificultats de comunicació, algunes persones amb DCP es poden comunicar amb llenguatge escrit, sempre que tinga un bon control motor. No obstant açò, la majoria tenen dificultats per a usar sistemes de Comunicació Augmentatius i Alternatius (AAC). De fet, les persones amb DCP utilitzen generalment taulers de conceptes per a indicar la idea que volen transmetre. No obstant açò, la majoria les solucions de comunicació disponibles en l'actualitat estan basades en programari propietari que fan difícil la personalització del tauler de conceptes i el tipus de sistema de control. És ací on sorgeix aquesta tesi, amb l'objectiu de crear una interfície amb aqueixes característiques, capaç d'adaptar-se a les necessitats i limitacions de l'usuari. D'aquesta forma, aquesta tesi proposa un sistema de comunicació augmentatiu i alternatiu per a persones amb DCP basat en control fisiològic. A més, es proposa un sistema innovador de control directe sobre taulers de conceptes basat en EMG. Aquest sistema de control es basa en un model físic que reprodueix la resposta mecànica muscular (basat en paràmetres com a Rigidesa, Inèrcia i Viscositat), permetent la selecció d'elements gràcies a xicotets polsos de senyal EMG amb sensors sobre un múscul amb control motor. Els seus principals avantatges són la possibilitat de corregir errors durant la selecció associat als impulsos musculars no controlats, evitar l'esforç muscular mantingut per a aconseguir un nivell i reduir la fatiga.Díaz Pineda, JA. (2017). Advanced Augmentative and Alternative Communication System Based in Physiological Control [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/90418TESI

The Affective Perceptual Model: Enhancing Communication Quality for Persons with PIMD

Methods for prolonged compassionate care for persons with Profound Intellectual and Multiple Disabilities (PIMD) require a rotating cast of import people in the subjects life in order to facilitate interaction with the external environment. As subjects continue to age, dependency on these people increases with complexity of communications while the quality of communication decreases. It is theorized that a machine learning (ML) system could replicate the attuning process and replace these people to promote independence. This thesis extends this idea to develop a conceptual and formal model and system prototype. The main contributions of this thesis are: (1) proposal of a conceptual and formal model for using machine learning to attune to unique communications from subjects with PIMD, (2) implementation of the system with both hardware and software components, and (3) modeling affect recognition in individuals based on the sensors from the hardware implementation

The BciAi4SLA Project: Towards a User-Centered BCI

The brain–computer interfaces (BCI) are interfaces that put the user in communication with an electronic device based on signals originating from the brain. In this paper, we describe a proof of concept that took place within the context of BciAi4Sla, a multidisciplinary project involving computer scientists, physiologists, biomedical engineers, neurologists, and psychologists with the aim of designing and developing a BCI system following a user-centered approach, involving domain experts and users since initial prototyping steps in a design–test–redesign development cycle. The project intends to develop a software platform able to restore a communication channel in patients who have compromised their communication possibilities due to illness or accidents. The most common case is the patients with amyotrophic lateral sclerosis (ALS). In this paper, we describe the background and the main development steps of the project, also reporting some initial and promising user evaluation results, including real-time performance classification and a proof-of-concept prototype

Reliability of brain-computer interface language sample transcription procedures

We tested the reliability of transcribing language samples of daily brain-computer interface (BCI) communication recorded as language activity monitoring (LAM) logfiles. This study determined interrater reliability and interjudgeagreement for transcription of communication of veterans with amyotrophic lateral sclerosis using a P300-based BCI as an augmentative and alternative communication (AAC) system. KeyLAM software recorded logfiles in a universal logfile format during use of BCI-controlled email and word processing applications. These logfiles were encrypted and sent to our laboratory for decryption, transcription, and analysis. The study reports reliability results on transcription of 345 daily logfile samples. The procedure was found to be accurate across transcribers/raters. Frequency of agreement ratios of 97.6% for total number of words and 93.5% for total utterances were found as measures of interrater reliability. Interjudge agreement was 100% for both measures. The results indicated that transcribing language samples using LAM data is highly reliable and the fidelity of the process can be maintained. LAM data supported the transcription of a large number of samples that could not have been completed using audio and video recordings of AAC speakers. This demonstrated efficiency of LAM tools to measure language performance benefits to BCI research and clinical communities

Response to mental health calls: The frontline perspectives of police officers, communicators and administrators

Abstract OBJECTIVES: The purpose of this study was to examine the lived experiences of frontline police personnel of a mid-sized police service in Southern Ontario. As the prevalence of mental illness increases, so do the calls for assistance to police services. Police officers often find themselves on the frontline and are often the first responders to mental health calls when an individual is in crisis (Wells & Schafer, 2006). With the majority of current research being quantitative in nature, this qualitative study allowed the voice of frontline police personnel to be heard in order to provide a complete picture of police response to mental health calls for service. Furthermore, this study included communications personnel, which are an important group that has often been overlooked in previous studies, but are instrumental in police response to all calls for service. METHODS: The lived experiences of fourteen participants were examined using in-depth, semi-structured interviews with heuristic phenomenology as a guiding theoretical orientation. The participants were placed into one of three groups based on his/her current role within the police service with the total number of participants within the groups as follows: police officers (n = 7), administrators (n = 3) and communicators (n = 4). Four research questions were examined through fifteen interview questions. RESULTS: Upon detailed analysis of the interviews, several themes and subthemes emerged from the data across all groups of participants. Each theme was found to play an important role in in responding to mental health calls. The themes included: (1) Interaction of roles on mental health calls; (2) Challenges relating to mental health calls; (3) Strategies for responding to mental health calls; and (4) Coping and aftermath. Four subthemes emerged relating to challenges when responding to mental health calls: (i) Perceived increase in mental health calls for service; (ii) Lack of training; (iii) Type of training; (iv) The broken system. CONCLUSIONS: Officers and communicators often find themselves as the first responders to individuals suffering from a mental illness who are in crisis. Hopefully this study has created an increased awareness of the role that frontline police personnel play when responding to mental health calls for service, some of the challenges that they face, and their voices will continue to be heard as policy makers and stakeholders make improvements and adjustments to the current system in the future

M-health review: joining up healthcare in a wireless world

In recent years, there has been a huge increase in the use of information and communication technologies (ICT) to deliver health and social care. This trend is bound to continue as providers (whether public or private) strive to deliver better care to more people under conditions of severe budgetary constraint

Servant Leadership Characteristics and Empathic Care: Developing a Culture of Empathy in the Healthcare Setting

The purpose of this study was to assess the degree to which servant leadership characteristics are exhibited in medical group practices, and the degree to which servant leadership characteristics correlated with measures of empathic care. This study featured an explanatory mixed methods research design embedded in appreciative inquiry. A total of 189 mid-level practitioners consisting of nurse practitioners, physician assistants, and practice mangers responded to a 32-item scale survey that featured a six-point Likert scale to measure servant leadership items and a 10-point continuous scale to assess measures of empathic care. The servant leadership items were based on the seven pillars of servant leadership. Data analyses included assessing means, standard deviations, and percentage distributions for servant leadership statements and empathic care statements. Additionally, bivariate correlation analysis and standard multiple regression analysis were conducted to assess the degree of influence of servant leadership characteristics on measures of empathic care. Findings from this study identified Pillar 1 (Persons of Character) as the servant leadership pillar most strongly exhibited in the medical group practices. Furthermore, Pillar 5 (Has Foresight) was the strongest correlate of reported empathic care within medical group practices as well as team members’ proclivity to practice servant leadership behaviors with patients more than with each other. The study also found that clinicians and non-clinicians significantly differed in their endorsement of all of the servant leadership pillars except Pillar 1 (Persons of Character). The findings of this dissertation point to strategies for promoting an environment of empathic care, and team building and organizational development and training in the medical group practices. This dissertation is available in open access at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu

The psychological experience of acquiring a communication impairment and the therapeutic implications

There is little research exploring the psychological experience of acquiring a CI(communication impairment) in adulthood, possibly due to a perception that people with a CI are unable to participate in an interview (Bronken, Kirkecold, Martinsen, Wyller and Kvigne 2012). This study seeks to challenge this perception and explore the experiences of adults who have had to adjust to a change in their communication due to a stroke or head injury. Five participants were interviewed (3 face to face and 2 by email) about their experience from the moment they realised their communication had changed until the current day. All of the participants were 2 years or more post acquiring their CI. The data was analysed using Interpretative Phenomenological Analysis. Results indicate the levels of fear, anxiety and confusion triggered at the time of acquiring the CI and a need for more awareness of CIs within hospital environments. The importance of compassionate communication and psychological support within healthcare services was noted. Aninstinctual drive or motivation to find an alternative way to communicate and adetermination to keep communicating were also highlighted, as well the challenges of living with a CI; including a lack of awareness within society. The study also highlights the significance of expressive writing, singing, humour, laughter and finding the positive to support recovery, adjustment to living with the CI and psychological well-being in the longer term. Considerations for what could be offered therapeutically by counselling psychologists are discussed throughout. Gaps in the literature and further areas for research are identified, such as attachment history and acquiring a CI and the impact of a CI on the family homeostasis