BCI controlled robotic arm as assistance to the rehabilitation of neurologically disabled patients

Purpose: Brain–computer interface (BCI)-controlled assistive robotic systems have been developed with increasing success with the aim to rehabilitation of patients after brain injury to increase independence and quality of life. While such systems may use surgically implanted invasive sensors, non-invasive alternatives can be better suited due to the ease of use, reduced cost, improvements in accuracy and reliability with the advancement of the technology and practicality of use. The consumer-grade BCI devices are often capable of integrating multiple types of signals, including Electroencephalogram (EEG) and Electromyogram (EMG) signals. Materials and Methods: This paper summarizes the development of a portable and cost-efficient BCI-controlled assistive technology using a non-invasive BCI headset “OpenBCI” and an open source robotic arm, U-Arm, to accomplish tasks related to rehabilitation, such as access to resources, adaptability or home use. The resulting system used a combination of EEG and EMG sensor readings to control the arm. To avoid risks of injury while the device is being used in clinical settings, appropriate measures were incorporated into the software control of the arm. A short survey was used following the system usability scale (SUS), to measure the usability of the technology to be trialed in clinical settings. Results: From the experimental results, it was found that EMG is a very reliable method for assistive technology control, provided that the user specific EMG calibration is done. With the EEG, even though the results were promising, due to insufficient detection of the signal, the controller was not adequate to be used within a neurorehabilitation environment. The survey indicated that the usability of the system is not a barrier for moving the system into clinical trials. Implication on rehabilitation For the rehabilitation of patients suffering from neurological disabilities (particularly those suffering from varying degrees of paralysis), it is necessary to develop technology that bypasses the limitations of their condition. For example, if a patient is unable to walk due to the unresponsiveness in their motor neurons, technology can be developed that used an alternate input to move an exoskeleton, which enables the patient to walk again with the assistance of the exoskeleton. This research focuses on neuro-rehabilitation within the framework of the NHS at the Kent and Canterbury Hospital in UK. The hospital currently does not have any system in place for self-driven rehabilitation and instead relies on traditional rehabilitation methods through assistance from physicians and exercise regimens to maintain muscle movement. This paper summarises the development of a portable and cost-efficient BCI controlled assistive technology using a non-invasive BCI headset “OpenBCI” and an open source robotic arm, U-Arm, to accomplish tasks related to rehabilitation, such as access to resources, adaptability or home use. The resulting system used a combination of EEG and EMG sensor readings to control the arm, which could perform a number of different tasks such as picking/placing objects or assist users in eating

Co‐creating system‐wide improvement for people with traumatic brain injury across one integrated care system in the United Kingdom to initiate a transformation journey through co‐production

Background and Objective There is a need for better integration of services across communities and sectors for people living with traumatic brain injury (TBI) to meet their complex needs. Building on insights gained from earlier pilot work, here we report the outcomes of a participatory workshop that sought to better understand the challenges, barriers and opportunities that currently exist within the care pathway for survivors of TBI. Methods A diverse range of stakeholders from the acute and rehabilitation care pathway and the health and social care system were invited to participate in a 3-h workshop. The participants worked in four mixed subgroups using practice development methodology, which promotes person-centred, inclusive and participatory action. Results Thematic analysis identified shared purposes and values that were used to produce a detailed implementation and impact framework for application at both the level of the care interface and the overarching integrated care system. A variety of enablers were identified that related to collective values and behaviours, case management, team leadership and integrated team working, workforce capability, evidence-based practice and resourcing. The clinical, economic, cultural and social outcomes associated with these enablers were also identified, and included patient safety, independence and well-being, reduced waiting times, re-admission rates, staff retention and professional development. Conclusion The co-produced recommendations made within the implementation and impact framework described here provide a means by which the culture and delivery of health and social care services can be better tailored to meet the needs of people living with TBI. We believe that the recommendations will help shape the formation of new services as well as the development of existing ones. Patient or Public Contribution Patient and public involvement have been established over a 10-year history of relationship building through a joint forum and events involving three charities representing people with TBI, carers, family members, clinicians, service users, researchers and commissioners, culminating in a politically supported event that identified concerns about the needs of people following TBI. These relationships formed the foundation for the interactive workshop, the focus of this publication

Transforming the NHS through transforming ourselves

Abstract Background: Leadership development impacts on quality of care and workplace cultures for staff. Clinical Leadership embracing transformational and other collective leadership approaches are key enablers to developing effective workplace cultures at the micro-systems level. Following the development of a shared purpose and values framework, an internal, inter-professional clinical leadership programme was set up to grow a critical community of transformational leaders across one NHS organisation in England. This programme had previously been unsuccessful in engaging medical doctors. Aims and Objectives: This paper shares how a dedicated practice development based clinical leadership programme set out to support medical doctors across one organisation with their leadership journey, equipping them to become both transformational and collective leaders and facilitators with the skills to begin to develop and sustain effective workplace cultures, that are person centred, safe and effective. Methods: Practice development methodology with its collaborative, inclusive and participative approach for developing person centred cultures combined with clinical leadership strategies, formed the basis of the programme which emphasised the use of active and action learning drawing on the workplace as the main resource for learning, development and improvement. Self-assessment and co-creation of insights about clinical leadership together with collaborative analysis of evaluation data led to the syntheses of insights through the use of reflection and action planning. Findings/Results: Findings are presented at two levels: 1) Five individual authentic reflections by authors to illustrate their leadership journeys which also demonstrate how a range of tools were used and their impact from reflections. Insights and learning include recognition of the benefits of peer support and networking; development of a disciplined approach to learning and self-management; 2) A collaborative reflection and critique that embraced the feeling of a sense of team ethos and community cohesion, for the first time in a safe environment; as well as, a sense of collective shared purpose and values. Conclusions: We conclude that the programme helped to identify the impact of leadership on workplace cultures and to begin to embed ways of working that are collaborative, inclusive, participative and celebratory. This unique approach by one organisation to leadership development has enabled a journey of self-transformation for medical clinical leaders to commence. Practical implications arising from our learning: • An internal model grows clinical leadership capacity across the organisation through peer support and networking and collective leadership. • Investing in a safe confidential space for clinical leads and other staff groups is a strategy for leadership development practice. • There is need to develop more skilled critical companions to support leadership, improvement and development activities • Clinical leadership development, informed by practice development methodology, demonstrates potential for enabling transformative and collective leadership for achieving person-centred cultures in the workplace. Keywords: Clinical leadership, collective leadership, critical companionship, micro-systems, transformational leadership, workplace cultur

Obstructive Sleep Apnea Syndrome Is Less Frequent in Patients With Well-Controlled Acromegaly Treated With Somatostatin Analogues, Pegvisomant or in Combination

Background: Obstructive sleep apnea (OSA) often occurs in patients with active acromegaly and improves after treatment. Less is known about the development of OSA in patients after a longer period of control treated with somatostatin analogues (SSA) and pegvisomant. Methods: Seventy-nine patients (12 females, 17 males; age 49 +/- 14 years; body mass index 29.9 +/- 5.4 kg/m(2); IGF-1 184 +/- 73 mu g/L; disease duration 13 +/- 8 years (mean +/- standard deviation)) with wellcontrolled acromegaly treated with SSA (38%), pegvisomant (38%) or in combination (24%) who underwent ambulatory polygraphy were included in a prospective multicenter cross-sectional study. Results: Fourteen percent had OSA (range of apnea-hypopnea index (AHI) 5 -15). Patients with OSA (AHI >= 5 vs. < 5) had a longer disease duration (16 +/- 1 vs. 12 +/- 8 years; P = 0.01) and were older (61 +/- 9 vs. 47 +/- 13 years; P = 0.037). The AHI of all patients correlated with age (P = 0.01; r = 0.44). No differences were seen in terms of BMI and Epworth sleepiness scale score. Previous transsphenoidal surgery and radiation had no impact of the detection of OSA. The duration of well-controlled acromegaly was 7 +/- 3 years. Conclusion: OSA in patients with well-controlled acromegaly treated with SSA, pegvisomant or in combination is less frequent (14%) than previously described. Early treatment to reduce the active disease period should be aimed to prevent OSA

Usability and performance measure of a consumer-grade brain computer interface system for environmental control by neurological patients

With the increasing incidence and prevalence of chronic brain injury patients and the current financial constraints in healthcare budgets, there is a need for a more intelligent way to realise the current practice of neuro-rehabilitation service provision. Brain-computer Interface (BCI) systems have the potential to address this issue to a certain extent only if carefully designed research can demonstrate that these systems are accurate, safe, cost-effective, are able to increase patient/carer satisfaction and enhance their quality of life. Therefore, one of the objectives of the proposed study was to examine whether participants (patients with brain injury and a sample of reference population) were able to use a low cost BCI system (Emotiv EPOC) to interact with a computer and to communicate via spelling words. Patients participated in the study did not have prior experience in using BCI headsets so as to measure the user experience in the first-exposure to BCI training. To measure emotional arousal of participants we used an ElectroDermal Activity Sensor (Qsensor by Affectiva). For the signal processing and feature extraction of imagery controls the Cognitive Suite of Emotiv's Control Panel was used. Our study reports the key findings based on data obtained from a group of patients and a sample reference population and presents the implications for the design and development of a BCI system for communication and control. The study also evaluates the performance of the system when used practically in context of an acute clinical environment

Concordance between a neuroradiologist, a consultant radiologist and trained reporting radiographers interpreting MRI head examinations: An empirical study

Introduction: This study assessed agreement between MRI reporting radiographers and a consultant radiologist compared with an index neuroradiologist when reporting MRI head (brain/internal auditory meati [IAMs]) examinations. The effect on patient management of any discordant reports was also examined. Methods: Two trained MRI reporting radiographers (RRs), a consultant radiologist (CR) and an index neuroradiologist (INR) reported on a random sample of 210 MRI examinations. The radiographers reported during clinical practice and the radiologists in clinical practice conditions. Two independent consultant physicians (neuro-rehabilitation and neuropsychiatry) compared these reports with the index neuroradiologist report for agreement and the clinical importance of discrepant reports. Results: Overall observer agreement between the RRs and CR was comparable in relation to agreement with the INR: RR; 93/210 (44.3%); and the CR; 83/210 (39.4%) for all head MRI examinations (p = 0.32). For brain examinations the difference was similar: RR; 64/180 (35.6%); and CR; 54/190 (30.0%), p = 0.26. Agreement rates for the IAMs examinations were identical, 29/30 (97.7%). For all head MRI examinations (n = 210) there was a very small observed difference of <0.5% in mean agreement between the reporting radiographers and the consultant radiologist (p = 0.92) for examinations where a major disagreement would have been likely to have led to a change in patient management. Conclusion: MRI reporting radiographers reported during clinical practice on MRI head examinations to a level of agreement comparable with a consultant radiologist. Implications for practice: This is an area in which radiographers could provide additional reporting roles to the reporting service to increase capacity. Wider potential benefits include cost-effectiveness and role development/retention of radiographers

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

Primary objective: To assess the relationship between disability, length of stay (LOS) and anticholinergic burden (ACB) with people following acquired brain or spinal cord injury. Research design: A retrospective case note review assessed total rehabilitation unit admission. Methods and procedures: Assessment of 52 consecutive patients with acquired brain/spinal injury and neuropathy in an in-patient neuro-rehabilitation unit of a UK university hospital. Data analysed included: Northwick Park Dependency Score (NPDS), Rehabilitation complexity Scale (RCS), Functional Independence Measure and Functional Assessment Measure FIM-FAM (UK version 2.2), LOS and ACB. Outcome was different in RCS, NPDS and FIM-FAM between admission and discharge. Main outcomes and results: A positive change was reported in ACB results in a positive change in NPDS, with no significant effect on FIM-FAM, either Motor or Cognitive, or on the RCS. Change in ACB correlated to the length of hospital stay (regression correlation = −6.64; SE = 3.89). There was a significant harmful impact of increase in ACB score during hospital stay, from low to high ACB on NPDS (OR = 9.65; 95% CI = 1.36–68.64) and FIM-FAM Total scores (OR = 0.03; 95% CI = 0.002–0.35). Conclusions: There was a statistically significant correlation of ACB and neuro-disability measures and LOS amongst this patient cohort

Migration Intravésicale du Dispositif Intra-Utérin à Propos de Cinq Cas

La migration intravésicale du dispositif intra-utérin (DIU) par perforation utérine est une complication rare. Dans cette étude rétrospective monocentrique, nous présentons notre expérience de 5 cas colligés au sein de notre établissement entre 2004 et 2009. L’âge moyen de nos patientes est de 39 ans (32-48 ans). La symptomatologie clinique révélatrice était dominée par le syndrome irritatif vésical. Le diagnostic a été évoqué sur le couple écho/AUSP, puis confirmé par la cystoscopie. Le traitement a consisté en une lithotritie balistique du calcul avec extraction du stérilet par voie endoscopique chez 4 patientes et extraction chirurgicale chez une seule.Mots clés : Calcul vésical, dispositif intra-utérin, lithotritie balistique, migration

Ethnic Association in Primary Systemic Vasculitis: A Systematic Review

Background: Literature described wide disparities in incidence and prevalence between different types of vasculitis. There were no comprehensive studies on ethnic or racial associations in all types of primary systemic vasculitis (PSV) in any published article, until this review commenced in 2020. The purpose of the review is to synthesize the evidence regarding the relation of ethnicity and the incidence and/or prevalence of different types of PSV. Methods: A total of 52 selected articles which include Clinical trials, cohorts, cross-sectional studies, case series, and case studies and have been published within the last 10 years in the human population, were reviewed by searching The Medline, PubMed, and Google Scholars databases using predefined keywords. The PRISMA diagrams were followed to identify relevant articles. The methodological qualities of the studies were assessed using the EPHPP tool. Finally, a summary of the evidence on the association between ethnic origin and PSV was painstakingly compiled. Results: The connection between ethnicity and different types of PSV has been found to be significantly diverse in this research such as vasculitis is more common in Asians and Scandinavians, Kawasaki disease and periarteritis nodules are more prevalent in Japanese and Alaska-natives, ANCA-associated vasculitis is more frequent in Caucasians, whereas Henoch-Schonlein purpura and Cogan syndrome more usual in Caucasians and Asians. Furthermore, Behçet's disease more commonly occurs on the "Silk Road", especially in Turkey. Conclusion: Genetic susceptibility and environmental elements could be the contributing factors to the global variation in the incidence and prevalence of primary systemic vasculitis