User-centered design in brain–computer interfaces — a case study

The array of available brain–computer interface (BCI) paradigms has continued to grow, and so has the corresponding set of machine learning methods which are at the core of BCI systems. The latter have evolved to provide more robust data analysis solutions, and as a consequence the proportion of healthy BCI users who can use a BCI successfully is growing. With this development the chances have increased that the needs and abilities of specific patients, the end-users, can be covered by an existing BCI approach. However, most end-users who have experienced the use of a BCI system at all have encountered a single paradigm only. This paradigm is typically the one that is being tested in the study that the end-user happens to be enrolled in, along with other end-users. Though this corresponds to the preferred study arrangement for basic research, it does not ensure that the end-user experiences a working BCI. In this study, a different approach was taken; that of a user-centered design. It is the prevailing process in traditional assistive technology. Given an individual user with a particular clinical profile, several available BCI approaches are tested and – if necessary – adapted to him/her until a suitable BCI system is found

Does the Preparticipation Examination Aid in Identifying Future Risk of Concussion?

Context: A pre-participation examination (PPE) has become standard practice among the athletic community. This examination commonly includes a multifaceted baseline concussion assessment and an injury history survey. Recent evidence suggests that neuropsychological testing can aid in predicting individuals at an increased risk of lower extremity injury. However, no known previous study has investigated the relationship between neuropsychological function and potential risk of sustaining a concussion. Objective: This study sought to identify a relationship between components of a standard PPE and an elevated risk of concussion. Design: All data was extracted from the institution concussion database. Setting: A large university in Southeast Georgia. Participants: One hundred and sixty-six participants were recruited for this study, of these participants eighty-two were in the concussed experimental group and eighty-two were in the matched healthy control group, with two excluded for invalid or incomplete ImPACT data. Main Outcome Measurements: Statistics included a descriptive analyses of gender, sport, and concussion history, a frequency analysis of the four ImPACT composites, total BESS score, total SAC score, gender, sport, and injury history, a series of one-way ANOVAs, a ROC analysis, and a discriminant function analysis. Results: The frequency analysis determined that there was some missing data, the descriptive analysis determined the following group means, verbal memory composite: 85.7 +/- 11, visual memory composite: 73.1 +/- 16.3, reaction time composite: 0.577 +/- 0.080, processing speed composite: 39.8 +/- 7.7, BESS: 13.1 +/- 6.1, SAC: 27+/- 2. The series of nine one-way ANOVAs showed no significant group differences. The ROC analysis determined the following cut off values for each PPE component, verbal memory composite: 83.5, visual memory composite: 81.5, reaction time composite: 0.63, processing speed composite: 33.05, BESS: 13, and SAC: 26. The discriminant function analysis revealed no significant predictors. Discussion: This study began to show that the basic components of the PPE may not be clinical predictors of concussions. This is clinically significant because it rules out the baseline assessment approach as something that could help identify individuals at an increased risk

Choice Response Time Differences between Recently Recovered Concussed and Healthy Student-Athletes

Some 1.6 to 3.8 million sports-related concussions occur annually in the United States. Utilization of test batteries and exercise protocols are recommended to ensure athletes recover completely. Many batteries involve response time (RT) tests, which show response time increases post concussion. A major limitation of RT tests is that all are done in static position. Additionally, many studies show a lingering effect on RT. The addition of RT tests to check for lingering symptoms could be beneficial. The purpose of this study was to see if significant differences could be found in RT tests involving dynamic movement between healthy studentathletes and those recently recovered from a concussion. Sixteen student athletes from a major southeastern university were recruited; half were healthy studentathletes (HSA), and half were recently recovered student-athletes (RRSA) from a concussion. Both groups were tested on two random choice response time tasks with dynamic movement using Quickboard (LLC, Memphis, TN). The first task, a delayed choice response time task was done with a 3-5 s delay after each stimulus; the second task was a continuous choice response time task. There were no significant differences between the two groups for either test. In the delayed choice response time task, (U=31, p=0.916), RRSA mean time was 0.68 ± 0.067 s; HSA mean time was 0.70 ± 0.068 s. In the continuous choice response time task (U=25, p=0.401), RRSA mean time was 21.63 ± 2.46 s and HSA mean time was 20.86 ± 2.92 s. There were no errors in the delayed choice response time task. Errors were made in the continuous choice response time task, but with no significant differences (U=27, p=0.765). RRSA mean error rate was 0.75 + 1.43 s; HSA mean error rate was 0.875 ± 0.99 s. This study tested RRSA when deemed fully recovered. One reason RT may be similar is that university officials didn’t allow RRSA to be tested until recovered, therefore response times could have recovered. Previous studies were done within a week of their concussions. Another reason was the low statistical power. It’s possible a larger sample size could lead to a statistical difference

Feasibility and preliminary efficacy of remotely delivering cognitive training to people with schizophrenia using tablets.

Limited access to Cognitive Training (CT) for people with schizophrenia (SZ) prevents widespread adoption of this intervention. Delivering CT remotely via tablets may increase accessibility, improve scheduling flexibility, and diminish patient burden.In this reanalysis of data from a larger trial of CT, we compared two samples of individuals with SZ who chose to complete 40 h of CT either on desktop computers in the laboratory (N = 33) or remotely via iPads (N = 41). We examined attrition rates and adherence to training, and investigated whether remote iPad-based CT and in-person desktop-based CT induced significantly different improvements in cognitive and real-world functioning.The attrition rate was 36.6%. On average, participants completed 3.06 h of CT per week. There were no significant between-group differences in attrition and adherence to CT requirements. Participants who completed iPad-based CT were significantly younger and had lower symptoms at baseline compared to participants who completed CT on the lab desktops. Controlling for age and symptom severity, rANCOVA showed that iPad-based and desktop-based CT similarly and significantly improved verbal learning and problem solving. Main effects of time, at trend level significance, were evident in global cognition, verbal memory, quality of life, and social functioning. All group by time interactions were non-significant except for verbal memory, where iPad users showed greater gains. Within-group effect sizes for changes in outcomes were in the small range.Although underpowered and not randomized, this study demonstrates that delivering CT remotely to people with SZ using tablets is feasible and results in retention rates, adherence, and cognitive and functional outcome improvements that are comparable to those observed when CT is delivered in the laboratory. This has important implications in terms of scalability and dissemination of CT. These results require confirmation in larger samples

Clinical outcome measures in dementia with Lewy bodies trials: critique and recommendations.

The selection of appropriate outcome measures is fundamental to the design of any successful clinical trial. Although dementia with Lewy bodies (DLB) is one of the most common neurodegenerative conditions, assessment of therapeutic benefit in clinical trials often relies on tools developed for other conditions, such as Alzheimer's or Parkinson's disease. These may not be sufficiently valid or sensitive to treatment changes in DLB, decreasing their utility. In this review, we discuss the limitations and strengths of selected available tools used to measure DLB-associated outcomes in clinical trials and highlight the potential roles for more specific objective measures. We emphasize that the existing outcome measures require validation in the DLB population and that DLB-specific outcomes need to be developed. Finally, we highlight how the selection of outcome measures may vary between symptomatic and disease-modifying therapy trials

Momentum Volume 5: Full Issue

Welcome to Momentum, the University of Pennsylvania’s Science, Technology, and Society (STSC) Academic Journal. The Spring 2018 Edition presents a revival of the former journal (inactive since 2015) with an accessible and diverse spirit. In today’s world, technology often becomes synonymous with billion dollar startup companies or the newest iPhone applications. Our goal for this journal is to demonstrate how pervasive and multifaceted technology can be, and the various, if not unexpected ways, we encounter it. The subsequent collection of essays and art works will touch on a few of the many exchanges we share with technology. From the 2015 viral blue-and-black-or-white-and-gold dress to cinematic depictions of dogs, we aim to highlight the vast array of technologies and our interactions. We hope to inspire you to reflect on more of your own experiences and to internalize the expansive role technology has played in history, society, and your own individual life

Clinical outcome measures in dementia with Lewy bodies trials: critique and recommendations

The selection of appropriate outcome measures is fundamental to the design of any successful clinical trial. Although dementia with Lewy bodies (DLB) is one of the most common neurodegenerative conditions, assessment of therapeutic benefit in clinical trials often relies on tools developed for other conditions, such as Alzheimer's or Parkinson's disease. These may not be sufficiently valid or sensitive to treatment changes in DLB, decreasing their utility. In this review, we discuss the limitations and strengths of selected available tools used to measure DLB-associated outcomes in clinical trials and highlight the potential roles for more specific objective measures. We emphasize that the existing outcome measures require validation in the DLB population and that DLB-specific outcomes need to be developed. Finally, we highlight how the selection of outcome measures may vary between symptomatic and disease-modifying therapy trials

How Anxiety in Adolescent Athletes May Affect Baseline Neuropsychological Test Scores

Background: Anxiety is highly prevalent in the adolescent population and can affect performance on cognitive tasks. As part of a concussion protocol, measuring cognitive ability through the use of baseline neuropsychological testing is recommended in the high school setting. Because of the cognitive nature of baseline testing, there is potential for anxiety to influence scores. Purpose: To examine the effects of varying levels of state and trait anxiety on a baseline computerized neurocognitive assessment in the adolescent population. Methods: 75 adolescent athletes (age:15.91±1.33, height (cm): 168.72±9.07, weight (kg): 62.97±12.04) participated in the study. Cognitive ability was measured utilizing the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), while the anxiety screen utilized was the State Trait Anxiety Inventory. Data collection took place during preseason, and measures were administered within five minutes of each other. Participants were split into high and low groups based upon their level of state and trait anxiety. Statistical Analyses: Descriptive statistics were run on all demographic variables and outcome measures. Two one-way ANOVAs were conducted to compare ImPACT composite scores across high and low anxiety groups. Results: Significant differences were found between the high and low state anxiety groups for reaction time (LS 0.60±0.10, HS 0.69±0.09, F(1, 73) = 6.28, p =.01, r = -0.43, Cohen’s d = -0.95). No significant differences were found between the state and trait anxiety groups for any other composite score (p \u3e 0.05). Summary: Adolescent athletes consistently perceive situations as stressful, and those in the high state anxiety group have slower reaction times during baseline concussion assessment. Concussion is highly covered in media leading to a change in public perception and awareness. This heightened awareness potentially creates an environment where adolescent athletes do not assess baseline testing as stressful, thereby reducing the overall effect of anxiety on performance. The current concussion paradigm places substantial weight on neuropsychological testing, however post-injury testing may be more stress provoking. Therefore, future research should examine how anxiety affects the post-injury examination

Neuropsychological and neurophysiological correlates of fatigue in post-acute patients with neurological manifestations of COVID-19: Insights into a challenging symptom

More than half of patients who recover from COVID-19 experience fatigue. We studied fatigue using neuropsychological and neurophysiological investigations in post-COVID-19 patients and healthy subjects. Neuropsychological assessment included: Fatigue Severity Scale (FSS), Fatigue Rating Scale, Beck Depression Inventory, Apathy Evaluation Scale, cognitive tests, and computerized tasks. Neurophysiological examination was assessed before (PRE) and 2 min after (POST) a 1-min fatiguing isometric pinching task and included: maximum compound muscle action potential (CMAP) amplitude in first dorsal interosseous muscle (FDI) following ulnar nerve stimulation, resting motor threshold, motor evoked potential (MEP) amplitude and silent period (SP) duration in right FDI following transcranial magnetic stimulation of the left motor cortex. Maximum pinch strength was measured. Perceived exertion was assessed with the Borg-Category-Ratio scale. Patients manifested fatigue, apathy, executive deficits, impaired cognitive control, and reduction in global cognition. Perceived exertion was higher in patients. CMAP and MEP were smaller in patients both PRE and POST. CMAP did not change in either group from PRE to POST, while MEP amplitudes declined in controls POST. SP duration did not differ between groups PRE, increased in controls but decreased in patients POST. Patients' change of SP duration from PRE to POST was negatively correlated to FSS. Abnormal SP shortening and lack of MEP depression concur with a reduction in post-exhaustion corticomotor inhibition, suggesting a possible GABAB-ergic dysfunction. This impairment might be related to the neuropsychological alterations. COVID-19-associated inflammation might lead to GABAergic impairment, possibly representing the basis of fatigue and explaining apathy and executive deficits