ELECTROPALATOGRAPHY AS AN ADJUNCT TO NONSPEECH OROFACIAL MYOFUNCTIONAL DISORDER ASSESSMENTS: A FEASIBILITY STUDY

The purpose of this study was to determine if electropalatography (EPG) would be a useful adjunct and feasible option for those conducting clinical assessments of individuals with suspected nonspeech orofacial myofunctional disorders (NSOMD). Three females (two adults, one child) were referred by their orthodontist for assessment of suspected NSOMD. Three adults and one child without NSOMD were recruited for the purpose of evaluating methodological construct, and to provide comparisons for participants with NSOMD. Using EPG, lingual-palatal timing and contact patterns of 105 saliva swallows (45 with NSOMD, 60 without NSOMD) were analyzed by compartmentalizing the sensor display and tracking the order and duration of activation. Lingual-palatal contact patterns were compared in terms of four stages: prepropulsion, propulsion, postpropulsion, release. Coding the lingual-palatal activation in an operationalized manner was a valuable adjunct for describing lingual-palatal timing and contact patterns. Participants with NSOMD showed unique lingual-palatal contact patterns that differed from the patterns of the participants without NSOMD, and from each other. EPG is a potential adjunct to the non-instrumental assessment of NSOMD. Larger scale investigations using EPG should proceed

A screening protocol incorporating brain-computer interface feature matching considerations for augmentative and alternative communication

Purpose: The use of standardized screening protocols may inform brain-computer interface (BCI) research procedures to help maximize BCI performance outcomes and provide foundational information for clinical translation. Therefore, in this study we developed and evaluated a new BCI screening protocol incorporating cognitive, sensory, motor and motor imagery tasks. Methods: Following development, BCI screener outcomes were compared to the Amyotrophic Lateral Sclerosis Cognitive Behavioral Screen (ALS-CBS), and ALS Functional Rating Scale (ALS-FRS) for twelve individuals with a neuromotor disorder. Results: Scores on the cognitive portion of the BCI screener demonstrated limited variability, indicating all participants possessed core BCI-related skills. When compared to the ALS-CBS, the BCI screener was able to modestly discriminate possible cognitive difficulties that are likely to influence BCI performance. In addition, correlations between the motor imagery section of the screener and ALS-CBS and ALS-FRS were non-significant, suggesting the BCI screener may provide information not captured on other assessment tools. Additional differences were found between motor imagery tasks, with greater self-ratings on first-person explicit imagery of familiar tasks compared to unfamiliar/ generic BCI tasks. Conclusion: The BCI screener captures factors likely relevant for BCI, which has value for guiding person-centered BCI assessment across different devices to help inform BCI trials. Includes supplemental data

ELECTROPALATOGRAPHY AS AN ADJUNCT TO NONSPEECH OROFACIAL MYOFUNCTIONAL DISORDER ASSESSMENTS: A FEASIBILITY STUDY

The purpose of this study was to determine if electropalatography (EPG) would be a useful adjunct and feasible option for those conducting clinical assessments of individuals with suspected nonspeech orofacial myofunctional disorders (NSOMD). Three females (two adults, one child) were referred by their orthodontist for assessment of suspected NSOMD. Three adults and one child without NSOMD were recruited for the purpose of evaluating methodological construct, and to provide comparisons for participants with NSOMD. Using EPG, lingual-palatal timing and contact patterns of 105 saliva swallows (45 with NSOMD, 60 without NSOMD) were analyzed by compartmentalizing the sensor display and tracking the order and duration of activation. Lingual-palatal contact patterns were compared in terms of four stages: prepropulsion, propulsion, postpropulsion, release. Coding the lingual-palatal activation in an operationalized manner was a valuable adjunct for describing lingual-palatal timing and contact patterns. Participants with NSOMD showed unique lingual-palatal contact patterns that differed from the patterns of the participants without NSOMD, and from each other. EPG is a potential adjunct to the non-instrumental assessment of NSOMD. Larger scale investigations using EPG should proceed

Treating Myofunctional Disorders: A Multiple-Baseline Study of a New Treatment Using Electropalatography

Purpose: This study assessed the benefit of using electropalatography (EPG) in treatment aimed at habilitating individuals with nonspeech orofacial myofunctional disorders (NSOMD). Method: The study used a multiple-baseline design across 3 female participants who were referred for an evaluation and possible treatment of their NSOMD. Treatment sessions were 30 min and provided twice weekly. Participant 1 received 8 treatments, Participant 2 received 6 treatments, and Participant 3 received 4 treatments. The patterns of sensor activation produced when participants’ tongues made contact with the electropalate during saliva swallows were compared with the patterns of age-matched peers. Individualized goals were developed on the basis of these comparisons. Results: Treatment was generally effective for the established goals. Of the 3 participants, 2 met all their goals, and the 3rd participant made gains across 1 of 2 goals. Participants continued to perform above baseline levels for most targeted goals during testing 5–8 weeks posttreatment. Conclusion: When used in skilled treatment, EPG has potential as a means of habilitating NSOMD. It may serve as a valuable tool, providing the clinician and client with information that allows for individualized treatment planning

Motor-Induced Suppression of the N100 Event-Related Potential During Motor Imagery Control of a Speech Synthesizer Brain–Computer Interface

Purpose: Speech motor control relies on neural processes for generating sensory expectations using an efference copy mechanism to maintain accurate productions. The N100 auditory event-related potential (ERP) has been identified as a possible neural marker of the efference copy with a reduced amplitude during active listening while speaking when compared to passive listening. This study investigates N100 suppression while controlling a motor imagery speech synthesizer brain–computer interface (BCI) with instantaneous auditory feedback to determine whether similar mechanisms are used for monitoring BCI-based speech output that may both support BCI learning through existing speech motor networks and be used as a clinical marker for the speech network integrity in individuals without severe speech and physical impairments. Method: The motor-induced N100 suppression is examined based on data from 10 participants who controlled a BCI speech synthesizer using limb motor imagery. We considered listening to auditory target stimuli (without motor imagery) in the BCI study as passive listening and listening to BCI-controlled speech output (with motor imagery) as active listening since audio output depends on imagined movements. The resulting ERP was assessed for statistical significance using a mixed-effects general linear model. Results: Statistically significant N100 ERP amplitude differences were observed between active and passive listening during the BCI task. Post hoc analyses confirm the N100 amplitude was suppressed during active listening. Conclusion: Observation of the N100 suppression suggests motor planning brain networks are active as participants control the BCI synthesizer, which may aid speech BCI mastery

Guidelines for Feature Matching Assessment of Brain–Computer Interfaces for Augmentative and Alternative Communication

Purpose--Brain–computer interfaces (BCIs) can provide access to augmentative and alternative communication (AAC) devices using neurological activity alone without voluntary movements. As with traditional AAC access methods, BCI performance may be influenced by the cognitive–sensory–motor and motor imagery profiles of those who use these devices. Therefore, we propose a person-centered, feature matching framework consistent with clinical AAC best practices to ensure selection of the most appropriate BCI technology to meet individuals\u27 communication needs. Method--The proposed feature matching procedure is based on the current state of the art in BCI technology and published reports on cognitive, sensory, motor, and motor imagery factors important for successful operation of BCI devices. Results--Considerations for successful selection of BCI for accessing AAC are summarized based on interpretation from a multidisciplinary team with experience in AAC, BCI, neuromotor disorders, and cognitive assessment. The set of features that support each BCI option are discussed in a hypothetical case format to model possible transition of BCI research from the laboratory into clinical AAC applications. Conclusions--This procedure is an initial step toward consideration of feature matching assessment for the full range of BCI devices. Future investigations are needed to fully examine how person-centered factors influence BCI performance across devices

A Noninvasive Brain-Computer Interface for Real-Time Speech Synthesis: The Importance of Multimodal Feedback.

We conducted a study of a motor imagery brain-computer interface (BCI) using electroencephalography to continuously control a formant frequency speech synthesizer with instantaneous auditory and visual feedback. Over a three-session training period, sixteen participants learned to control the BCI for production of three vowel sounds (/ textipa i/ [heed], / textipa A/ [hot], and / textipa u/ [who'd]) and were split into three groups: those receiving unimodal auditory feedback of synthesized speech, those receiving unimodal visual feedback of formant frequencies, and those receiving multimodal, audio-visual (AV) feedback. Audio feedback was provided by a formant frequency artificial speech synthesizer, and visual feedback was given as a 2-D cursor on a graphical representation of the plane defined by the first two formant frequencies. We found that combined AV feedback led to the greatest performance in terms of percent accuracy, distance to target, and movement time to target compared with either unimodal feedback of auditory or visual information. These results indicate that performance is enhanced when multimodal feedback is meaningful for the BCI task goals, rather than as a generic biofeedback signal of BCI progress

Examining sensory ability, feature matching, and assessment-based adaptation for a brain-computer interface using the steady-state visually evoked potential

This is an Accepted Manuscript of an article published by Taylor & Francis in Disability and Rehabilitation: Assistive Technology on 01/31/2018, available online: http://www.tandfonline.com/10.1080/17483107.2018.1428369.PURPOSE:We investigated how overt visual attention and oculomotor control influence successful use of a visual feedback brain-computer interface (BCI) for accessing augmentative and alternative communication (AAC) devices in a heterogeneous population of individuals with profound neuromotor impairments. BCIs are often tested within a single patient population limiting generalization of results. This study focuses on examining individual sensory abilities with an eye toward possible interface adaptations to improve device performance. METHODS: Five individuals with a range of neuromotor disorders participated in four-choice BCI control task involving the steady state visually evoked potential. The BCI graphical interface was designed to simulate a commercial AAC device to examine whether an integrated device could be used successfully by individuals with neuromotor impairment. RESULTS: All participants were able to interact with the BCI and highest performance was found for participants able to employ an overt visual attention strategy. For participants with visual deficits to due to impaired oculomotor control, effective performance increased after accounting for mismatches between the graphical layout and participant visual capabilities. CONCLUSION: As BCIs are translated from research environments to clinical applications, the assessment of BCI-related skills will help facilitate proper device selection and provide individuals who use BCI the greatest likelihood of immediate and long term communicative success. Overall, our results indicate that adaptations can be an effective strategy to reduce barriers and increase access to BCI technology. These efforts should be directed by comprehensive assessments for matching individuals to the most appropriate device to support their complex communication needs. Implications for Rehabilitation Brain computer interfaces using the steady state visually evoked potential can be integrated with an augmentative and alternative communication device to provide access to language and literacy for individuals with neuromotor impairment. Comprehensive assessments are needed to fully understand the sensory, motor, and cognitive abilities of individuals who may use brain-computer interfaces for proper feature matching as selection of the most appropriate device including optimization device layouts and control paradigms. Oculomotor impairments negatively impact brain-computer interfaces that use the steady state visually evoked potential, but modifications to place interface stimuli and communication items in the intact visual field can improve successful outcomes

Cell morphology drives spatial patterning in microbial communities

The clearest phenotypic characteristic of microbial cells is their shape, but we do not understand how cell shape affects the dense communities, known as biofilms, where many microbes live. Here, we use individual-based modeling to systematically vary cell shape and study its impact in simulated communities. We compete cells with different cell morphologies under a range of conditions and ask how shape affects the patterning and evolutionary fitness of cells within a community. Our models predict that cell shape will strongly influence the fate of a cell lineage: we describe a mechanism through which coccal (round) cells rise to the upper surface of a community, leading to a strong spatial structuring that can be critical for fitness. We test our predictions experimentally using strains of Escherichia coli that grow at a similar rate but differ in cell shape due to single amino acid changes in the actin homolog MreB. As predicted by our model, cell types strongly sort by shape, with round cells at the top of the colony and rod cells dominating the basal surface and edges. Our work suggests that cell morphology has a strong impact within microbial communities and may offer new ways to engineer the structure of synthetic communities

The burden of proof: the current state of atrial fibrillation prevention and treatment trials

Atrial fibrillation (AF) is an age-related arrhythmia of enormous socioeconomic significance. In recent years, our understanding of the basic mechanisms that initiate and perpetuate AF has evolved rapidly, catheter ablation of AF has progressed from concept to reality, and recent studies suggest lifestyle modification may help prevent AF recurrence. Emerging developments in genetics, imaging, and informatics also present new opportunities for personalized care. However, considerable challenges remain. These include a paucity of studies examining AF prevention, modest efficacy of existing antiarrhythmic therapies, diverse ablation technologies and practice, and limited evidence to guide management of high-risk patients with multiple comorbidities. Studies examining the long-term effects of AF catheter ablation on morbidity and mortality outcomes are not yet completed. In many ways, further progress in the field is heavily contingent on the feasibility, capacity, and efficiency of clinical trials to incorporate the rapidly evolving knowledge base and to provide substantive evidence for novel AF therapeutic strategies. This review outlines the current state of AF prevention and treatment trials, including the foreseeable challenges, as discussed by a unique forum of clinical trialists, scientists, and regulatory representatives in a session endorsed by the Heart Rhythm Society at the 12th Global CardioVascular Clinical Trialists Forum in Washington, DC, December 3–5, 2015