Severe Motor Disabilities Research Articles

A deep neural network approach for P300 detection-based BCI using single-channel EEG scalogram images

Brain-computer interfaces (BCIs) acquire electroencephalogram (EEG) signals and interpret them into a command that helps people with severe motor disabilities using single channel. The goal of BCI is to achieve a prototype that supports disabled people to develop the relevant function. Various studies have been implemented in the literature to achieve a superior design using multi-channel EEG signals. This paper proposed a novel framework for the automatic P300 detection-based BCI model using a single EEG electrode. In the present study, we introduced a denoising approach using the bandpass filter technique followed by the transformation of scalogram images using continuous wavelet transform. The derived images were trained and validated using a deep neural network based on the transfer learning approach. This paper presents a BCI model based on the deep network that delivers higher performance in terms of classification accuracy and bitrate for disabled subjects using a single-channel EEG signal. The proposed P300 based BCI model has the highest average information transfer rates of 13.23 to 26.48 bits/min for disabled subjects. The classification performance has shown that the deep network based on the transfer learning approach can offer comparable performance with other state-of-the-art-method.

The Assessments of Psychological Dynamics in Daily Life of Individual With Severe Motor and Intellectual Disabilities (SMID): Relationship Between the Inter-Stimulus Interval on Communications and the SMID’s Heart Rate

Central fatigue in Parkinson’s disease (PD) is a common and disabling symptom that further worsens the patients’ quality of life. A deficit in the serotonergic system may be implicated in the occurrence of fatigue in patients with PD as well as in those with other chronic conditions characterized by fatigue. The loudness dependence of auditory evoked potentials (LDAEP) is a neurophysiological tool that has proved to be effective in measuring the serotonergic central function in vivo. The aim of the present study was to assess central serotonergic activity in PD patients and to explore its possible association with the presence of fatigue. LDAEP was recorded in 38 PD patients (26 without fatigue – PDnF and 12 with fatigue – PDF) and 34 healthy controls. A significant difference between parkinsonian patients and controls emerged, with patients displaying stronger LDAEP values (which reflect a lower serotonergic central tone) than controls. By contrast, no differences in LDAEP emerged between PDF and PDnF. Our electrophysiological data confirmed the presence of a deficit in serotonergic central transmission in PD. An association between this deficit and fatigue was not demonstrated. It is likely that an altered dopamine/serotonin balance, rather than a serotonin deficit alone, is involved in the genesis of central fatigue. This complex and multifaceted symptom is related above all to a dysfunction in the striato-thalamo-cortical loop that connects the neostriatum to the frontal lobe and is strongly affected by motivation.

障がい者・重症心身障がい者の外出を伴う余暇活動に関する基礎的研究

障がい者・重症心身障がい者の外出を伴う余暇活動に関する基礎的研究

Monitoring of Gait Parameters in Post-Stroke Individuals: A Feasibility Study Using RGB-D Sensors.

Stroke is one of the most significant causes of permanent functional impairment and severe motor disability. Hemiplegia or hemiparesis are common consequences of the acute event, which negatively impacts daily life and requires continuous rehabilitation treatments to favor partial or complete recovery and, consequently, to regain autonomy, independence, and safety in daily activities. Gait impairments are frequent in stroke survivors. The accurate assessment of gait anomalies is therefore crucial and a major focus of neurorehabilitation programs to prevent falls or injuries. This study aims to estimate, using a single RGB-D sensor, gait patterns and parameters on a short walkway. This solution may be suitable for monitoring the improvement or worsening of gait disorders, including in domestic and unsupervised scenarios. For this purpose, some of the most relevant spatiotemporal parameters, estimated by the proposed solution on a cohort of post-stroke individuals, were compared with those estimated by a gold standard system for a simultaneous instrumented 3D gait analysis. Preliminary results indicate good agreement, accuracy, and correlation between the gait parameters estimated by the two systems. This suggests that the proposed solution may be employed as an intermediate tool for gait analysis in environments where gold standard systems are impractical, such as home and ecological settings in real-life contexts.

Neurological involvement in secondary hemophagocytic lymphohistiocytosis in children.

To describe neurological characteristics and CNS involvement on MRI in secondary hemophagocytic lymphohistiocytosis (sHLH) and differentiate it from primary hemophagocytic lymphohistiocytosis (pHLH) and acute disseminated encephalomyelitis (ADEM). Nine children with sHLH who had neurological symptoms were retrospectively included. Characteristics of brain MRI were compared to those of 15 children with pHLH and neurological involvement and 44 children with ADEM. Three children (33%) presented with isolated neurological symptoms. Neurological signs occurred within one month following Epstein-Barr virus primary infection or systemic juvenile arthritis exacerbation in 8 patients (89%). Eight children (89%) had MRI lesions. sHLH MRI lesions were distinct of those of pHLH by morphology and signal with more frequent hyposignal intensities on T1-weighted sequences (p=0.01) and well-defined and less fuzzy lesions (p=0.03). All patients survived and one patient presented severe motor and cognitive disability. Neurological symptoms of sHLH are non-specific and their outcome is favorable in most of the children. MRI at onset may help to differentiate this condition from pHLH.

Monocarboxylate Transporter 8 Deficiency: From Pathophysiological Understanding to Therapy Development.

Genetic defects in the thyroid hormone transporter monocarboxylate transporter 8 (MCT8) result in MCT8 deficiency. This disorder is characterized by a combination of severe intellectual and motor disability, caused by decreased cerebral thyroid hormone signalling, and a chronic thyrotoxic state in peripheral tissues, caused by exposure to elevated serum T3 concentrations. In particular, MCT8 plays a crucial role in the transport of thyroid hormone across the blood-brain-barrier. The life expectancy of patients with MCT8 deficiency is strongly impaired. Absence of head control and being underweight at a young age, which are considered proxies of the severity of the neurocognitive and peripheral phenotype, respectively, are associated with higher mortality rate. The thyroid hormone analogue triiodothyroacetic acid is able to effectively and safely ameliorate the peripheral thyrotoxicosis; its effect on the neurocognitive phenotype is currently under investigation. Other possible therapies are at a pre-clinical stage. This review provides an overview of the current understanding of the physiological role of MCT8 and the pathophysiology, key clinical characteristics and developing treatment options for MCT8 deficiency.

Outcomes After Living Donor Liver Transplantation in Pediatric Patients with Inherited Metabolic Diseases.

BackgroundThere is no consensus about the long-term prognosis of pediatric patients with a variety of rare liver diseases but with inherited metabolic diseases (IMDs). We retrospectively reviewed the developmental outcomes of patients with IMDs undergoing living donor liver transplantation (LDLT).Material/MethodsBetween May 2001 and December 2020, of 314 pediatric patients who underwent LDLT, 44 (14%) had IMDs. The median age at LDLT was 3.0 years old (range 0–15.0 years). Associations between the post-transplant complications and graft survival rate in patients with IMDs and biliary atresia (BA) were calculated. We evaluated the safety of LDLT from heterozygous carrier donors, the prognosis of patients with IMDs who have metabolic defects expressed in other organs, and developmental outcomes of patients with IMDs.ResultsThe 10-year graft survival rates in patients with IMDs and BA were 87% and 94%, respectively (P=0.041), and the causes of graft failure included pneumocystis pneumonia, acute lung failure, hemophagocytic syndrome, hepatic vein thrombosis, portal vein thrombosis, and sepsis. The rate of post-transplant cytomegalovirus viremia in patients with IMDs was higher than that of patients with BA (P=0.039). Of 39 patients with IMDs, 15 patients (38%) had severe motor and intellectual disabilities in 4 patients, intellectual developmental disorders including epilepsy in 2, and attention-deficit hyperactivity disorder in 2. Of 28 patients with IMDs, 13 (46%) needed special education.ConclusionsThe long-term outcomes of LDLT in patients with IMDs are good. However, further long-term social and educational follow-up regarding intellectual developmental disorders is needed.

Inverse T-shaped sternotomy as novel thoracoplasty for severe chest deformation and tracheal stenosis

BackgroundPatients with severe motor and intellectual disabilities often suffer from tracheal stenosis due to chest deformation and brachiocephalic artery compression, which sometimes leads to serious complications, such as dying spell and tracheobrachiocephalic artery fistula. We herein described our experience of performing a novel and simple thoracoplastic procedure combined with brachiocephalic artery transection in two patients with severe chest deformation and tracheal stenosis.Case presentationThe patients were a 12-year-old female with cerebral palsy due to periventricular leukomalacia and a 21-year-old male with subacute sclerosing panencephalitis stage IV in the Jabbour classification following a laryngotracheal separation. Both patients showed severe chest deformation and symptoms of airway stenosis resulting in dying spells. The sternum was laterally transected between the manubrium and the sternal body, and a manubriotomy was performed longitudinally, ending with an inverse T-shaped sternotomy. Since the clavicle and the first rib remained attached to the halves of the divided manubrium, the sternum was allowed to be left open, resulting in improvement of the mediastinal narrowing and tracheal stenosis. Postoperative computed tomography (CT) showed that the distance between the halves of the manubrium was maintained at 10–11 mm, and that the mediastinal narrowing in both patients improved; the sternocervical spine distance increased from 20 mm to 22 and 13 mm to 16 mm, respectively. The patients’ tracheal stenosis below the sternal end of the clavicle and the manubrium and respiratory symptoms improved, and the patients are currently at home in a stable condition with no chest fragility and no upper limb movement disorder 1 year after surgery.ConclusionsOur observations suggested that the inverse T-shaped sternotomy combined with brachiocephalic artery transection may relieve symptoms of tracheal stenosis due to severe chest deformation in patients with severe motor and intellectual disabilities.

Serum fractalkine and 3-nitrotyrosine levels correlate with disease severity in Parkinson's disease: a pilot study.

Parkinson's disease (PD) and Parkinsonian syndromes; Progressive supranuclear palsy (PSP), and Multiple system atrophy (MSA) are debilitating neurodegenerative disorders. Fractalkine is a chemokine involved in neuroinflammation, whereas, 3-nitrotyrosine (3-NT) is a marker of early neurodegenerative cellular-damage. We measured Fractalkine and 3-NT levels in the serum of these patients to examine the neuroinflammation hypothesis and also to decipher the propensity of these biologics to be used as early (5years from onset) biochemical markers in neurodegenerative Parkinsonism. The diagnoses of PD, PSP and MSA were performed as per the respective clinical criteria. 21 PD, 9 PSP and 8 MSA patients along with controls participated in this study. Serum concentrations of Fractalkine and 3-NT were measured by ELISA. Fractalkine levels were increased in PD, PSP and MSA cohorts in comparison with controls with p < 0.001, p < 0.05 and p < 0.05 respectively. Levels of 3-NT also showed elevation in PD (p < 0.01) vs. controls. However, Pearson plot showed that Fractalkine levels were high in the patients with unified Parkinson's disease rating scale (UPDRS) part III motor score of 1, meaning slight disability, but gradually dropped in patients with motor score of 4, which is a measure of severe motor disability. This negative correlation (- .565, p < .0.01) also accentuates the neuroprotectant/anti-inflammatory nature of Fractalkine in PD. Continuous rise of 3-NT in PD, positively correlating (.512, p < 0.05) with worsening motor symptoms points to deleterious consequences of nitrosative stress. To our knowledge, this is the first report providing evidence that serum Fractalkine and 3-NT have early diagnostic/prognostic significance as PD biomarkers.

Intussusception Caused by Percutaneous Endoscopic Gastrostomy With Jejunal Extension in Patients With Severe Motor and Intellectual Disabilities

The risk of intussusception related to percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in patients with severe motor and intellectual disabilities (SMID) remains unknown. In a cross-sectional study, a review of 26 patients (mean age, 11.6 ± 6.4 years) with SMID who underwent PEG-J was performed. During the follow-up period, 6 of 26 (23%) patients developed intussusception. The median period from PEG-J to the onset of intussusception was 364 (range, 8–1344) days. No significant difference was observed in the Cobb angle between the intussusception and nonintussusception groups; however, body mass index at the time of PEG-J was significantly lower in the intussusception group. Intussusception related to PEG-J occurs relatively frequently in patients, and it is possibly attributable to factors such as deformity caused by undernutrition and weight loss. If enteral nutrition via PEG-J has been established, earlier enterostomy can be recommended because of the high risk of intussusception in patients with SMID.

Noninvasive Electroencephalography Equipment for Assistive, Adaptive, and Rehabilitative Brain-Computer Interfaces: A Systematic Literature Review.

Humans interact with computers through various devices. Such interactions may not require any physical movement, thus aiding people with severe motor disabilities in communicating with external devices. The brain–computer interface (BCI) has turned into a field involving new elements for assistive and rehabilitative technologies. This systematic literature review (SLR) aims to help BCI investigator and investors to decide which devices to select or which studies to support based on the current market examination. This examination of noninvasive EEG devices is based on published BCI studies in different research areas. In this SLR, the research area of noninvasive BCIs using electroencephalography (EEG) was analyzed by examining the types of equipment used for assistive, adaptive, and rehabilitative BCIs. For this SLR, candidate studies were selected from the IEEE digital library, PubMed, Scopus, and ScienceDirect. The inclusion criteria (IC) were limited to studies focusing on applications and devices of the BCI technology. The data used herein were selected using IC and exclusion criteria to ensure quality assessment. The selected articles were divided into four main research areas: education, engineering, entertainment, and medicine. Overall, 238 papers were selected based on IC. Moreover, 28 companies were identified that developed wired and wireless equipment as means of BCI assistive technology. The findings of this review indicate that the implications of using BCIs for assistive, adaptive, and rehabilitative technologies are encouraging for people with severe motor disabilities and healthy people. With an increasing number of healthy people using BCIs, other research areas, such as the motivation of players when participating in games or the security of soldiers when observing certain areas, can be studied and collaborated using the BCI technology. However, such BCI systems must be simple (wearable), convenient (sensor fabrics and self-adjusting abilities), and inexpensive.

A pH-eQTL Interaction at the RIT2-SYT4 Parkinson's Disease Risk Locus in the Substantia Nigra.

Parkinson’s disease causes severe motor and cognitive disabilities that result from the progressive loss of dopamine neurons in the substantia nigra. The rs12456492 variant in the RIT2 gene has been repeatedly associated with increased risk for Parkinson’s disease. From a transcriptomic perspective, a meta-analysis found that RIT2 gene expression is correlated with pH in the human brain. To assess these pH associations in relation to Parkinson’s disease risk, we examined the two datasets that assayed rs12456492, gene expression, and pH in the postmortem human brain. Using the BrainEAC dataset, we replicate the positive correlation between RIT2 gene expression and pH in the human brain (n = 100). Furthermore, we found that the relationship between expression and pH is influenced by rs12456492. When tested across ten brain regions, this interaction is specifically found in the substantia nigra. A similar association was found for the co-localized SYT4 gene. In addition, SYT4 associations are stronger in a combined model with both genes, and the SYT4 interaction appears to be specific to males. In the Genotype-Tissue Expression (GTEx) dataset, the pH associations involving rs12456492 and expression of either SYT4 and RIT2 were not seen. This null finding may be due to the short postmortem intervals of the GTEx tissue samples. In the BrainEAC data, we tested the effect of postmortem interval and only observed the interactions in samples with the longer intervals. These previously unknown associations suggest novel roles for rs12456492, RIT2, and SYT4 in the regulation and response to pH in the substantia nigra.

Embedded Brain Computer Interface: State-of-the-Art in Research.

There is a wide area of application that uses cerebral activity to restore capabilities for people with severe motor disabilities, and actually the number of such systems keeps growing. Most of the current BCI systems are based on a personal computer. However, there is a tremendous interest in the implementation of BCIs on a portable platform, which has a small size, faster to load, much lower price, lower resources, and lower power consumption than those for full PCs. Depending on the complexity of the signal processing algorithms, it may be more suitable to work with slow processors because there is no need to allow excess capacity of more demanding tasks. So, in this review, we provide an overview of the BCIs development and the current available technology before discussing experimental studies of BCIs.

Integrating Behavior of Children with Profound Intellectual, Multiple, or Severe Motor Disabilities With Location and Environment Data Sensors for Independent Communication and Mobility: App Development and Pilot Testing.

BackgroundChildren with profound intellectual and multiple disabilities (PIMD) or severe motor and intellectual disabilities (SMID) only communicate through movements, vocalizations, body postures, muscle tensions, or facial expressions on a pre- or protosymbolic level. Yet, to the best of our knowledge, there are few systems developed to specifically aid in categorizing and interpreting behaviors of children with PIMD or SMID to facilitate independent communication and mobility. Further, environmental data such as weather variables were found to have associations with human affects and behaviors among typically developing children; however, studies involving children with neurological functioning impairments that affect communication or those who have physical and/or motor disabilities are unexpectedly scarce.ObjectiveThis paper describes the design and development of the ChildSIDE app, which collects and transmits data associated with children’s behaviors, and linked location and environment information collected from data sources (GPS, iBeacon device, ALPS Sensor, and OpenWeatherMap application programming interface [API]) to the database. The aims of this study were to measure and compare the server/API performance of the app in detecting and transmitting environment data from the data sources to the database, and to categorize the movements associated with each behavior data as the basis for future development and analyses.MethodsThis study utilized a cross-sectional observational design by performing multiple single-subject face-to-face and video-recorded sessions among purposively sampled child-caregiver dyads (children diagnosed with PIMD/SMID, or severe or profound intellectual disability and their primary caregivers) from September 2019 to February 2020. To measure the server/API performance of the app in detecting and transmitting data from data sources to the database, frequency distribution and percentages of 31 location and environment data parameters were computed and compared. To categorize which body parts or movements were involved in each behavior, the interrater agreement κ statistic was used.ResultsThe study comprised 150 sessions involving 20 child-caregiver dyads. The app collected 371 individual behavior data, 327 of which had associated location and environment data from data collection sources. The analyses revealed that ChildSIDE had a server/API performance >93% in detecting and transmitting outdoor location (GPS) and environment data (ALPS sensors, OpenWeatherMap API), whereas the performance with iBeacon data was lower (82.3%). Behaviors were manifested mainly through hand (22.8%) and body movements (27.7%), and vocalizations (21.6%).ConclusionsThe ChildSIDE app is an effective tool in collecting the behavior data of children with PIMD/SMID. The app showed high server/API performance in detecting outdoor location and environment data from sensors and an online API to the database with a performance rate above 93%. The results of the analysis and categorization of behaviors suggest a need for a system that uses motion capture and trajectory analyses for developing machine- or deep-learning algorithms to predict the needs of children with PIMD/SMID in the future.

Efficient Quadcopter Flight Control Using Hybrid SSVEP + P300 Visual Brain Computer Interface

ABSTRACT The objective of this study was to assess the feasibility of hybrid SSVEP + P300 visual BCI systems for quad-copter flight control in physical world. Existing BCI-based quad-copter flight control has limitations of slow navigation, lower system accuracy, rigorous user training requirement and lesser number of independent control commands. So, there is need of hybrid BCI design that combines evoked SSVEP and P300 potentials to control flight direction of quad-copter movement. GUI design is developed such that user can effectively control quad-copter flight by gazing at visual stimuli buttons that produce SSVEP & P300 potentials simultaneously in human cortex. We compare the performance metrics of the proposed flight control systems with other existing BCI-based flight control as conventional SSVEP BCI and P300 BCI and commercially available keyboard flight control systems. Results proved that the proposed system outperforms the existing BCI-based flight control systems but has slightly lower performance efficiency than the commercial keyboard flight control systems. Further, the proposed quad-copter flight control system proved its suitability for patients with severe motor disabilities.

重症心身障害児（者）に対する看護師の共感の程度とその関連要因

重症心身障害児（者）に対する看護師の共感の程度とその関連要因

An integrated deep learning model for motor intention recognition of multi-class EEG Signals in upper limb amputees

Background and objectiveRecognition of motor intention based on electroencephalogram (EEG) signals has attracted considerable research interest in the field of pattern recognition due to its notable application of non-muscular communication and control for those with severe motor disabilities. In analysis of EEG data, achieving a higher classification performance is dependent on the appropriate representation of EEG features which is mostly characterized by one unique frequency before applying a learning model. Neglecting other frequencies of EEG signals could deteriorate the recognition performance of the model because each frequency has its unique advantages. Motivated by this idea, we propose to obtain distinguishable features with different frequencies by introducing an integrated deep learning model to accurately classify multiple classes of upper limb movement intentions. MethodsThe proposed model is a combination of long short-term memory (LSTM) and stacked autoencoder (SAE). To validate the method, four high-level amputees were recruited to perform five motor intention tasks. The acquired EEG signals were first preprocessed before exploring the consequence of input representation on the performance of LSTM-SAE by feeding four frequency bands related to the tasks into the model. The learning model was further improved by t-distributed stochastic neighbor embedding (t-SNE) to eliminate feature redundancy, and to enhance the motor intention recognition. ResultsThe experimental results of the classification performance showed that the proposed model achieves an average performance of 99.01% for accuracy, 99.10% for precision, 99.09% for recall, 99.09% for f1_score, 99.77% for specificity, and 99.0% for Cohen's kappa, across multi-subject and multi-class scenarios. Further evaluation with 2-dimensional t-SNE revealed that the signal decomposition has a distinct multi-class separability in the feature space. ConclusionThis study demonstrated the predominance of the proposed model in its ability to accurately classify upper limb movements from multiple classes of EEG signals, and its potential application in the development of a more intuitive and naturalistic prosthetic control.

Gross Motor Functioning in Children with Cerebral Palsy after Stem Cell Transplantation

Background Cerebral palsy (CP) is a non-progressive motor disability that mostly results from perinatal complications. It demands extensive and multidisciplinary care, which poses a burden for patients and their families and a challenge to health systems. We aimed to evaluate the effect of stem cells transplantation on gross motor functioning of CP patients. Patients and Methods: It is a prospective study conducted on 20 children diagnosed with cerebral palsy with severe motor disability (GMFC 5) further classified into two groups according to age. The study was carried out from January 2018 to January 2020. Follow up of the patients was done before injection of stem cells and 3, 6, 9 and 12 months after injection of stem cells using Gross motor function classification scale (GMFC). Results: The study revealed that GMFC scores in pre-injection and 3,6,9and 12 months evaluations were not statistically significant when compared among the two groups while significant improvement was found in gross motor scale from pre-injection to final injection score in each group. Median GMFC changed from 5 to 2 among all cases. Conclusion: Gross motor function in children with CP remarkably improved after stem cell transplantation.

A 9-year-old boy with severe motor and intellectual disabilities and prolonged abdominal distension.

Journal of Paediatrics and Child HealthEarly View Image of the Month A 9-year-old boy with severe motor and intellectual disabilities and prolonged abdominal distension Yousuke Higuchi, Corresponding Author yhiguchi218@gmail.com orcid.org/0000-0001-5253-6569 Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan Correspondence:Dr Yousuke Higuchi, MD, Department of Pediatrics, National Hospital Organization Okayama Medical Center, 1711-1, Tamasu, Kita-ku, Okayama 701-1192, Japan. Fax: +81 86 294 9255; email: yhiguchi218@gmail.comSearch for more papers by this authorTakahiro Namba, Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, JapanSearch for more papers by this authorYuki Ebuchi, Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, JapanSearch for more papers by this authorYasuo Nakahara, Department of Pediatric Surgery, National Hospital Organization Okayama Medical Center, Okayama, JapanSearch for more papers by this authorAkihito Takeuchi, Department of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, JapanSearch for more papers by this author Yousuke Higuchi, Corresponding Author yhiguchi218@gmail.com orcid.org/0000-0001-5253-6569 Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, Japan Correspondence:Dr Yousuke Higuchi, MD, Department of Pediatrics, National Hospital Organization Okayama Medical Center, 1711-1, Tamasu, Kita-ku, Okayama 701-1192, Japan. Fax: +81 86 294 9255; email: yhiguchi218@gmail.comSearch for more papers by this authorTakahiro Namba, Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, JapanSearch for more papers by this authorYuki Ebuchi, Department of Pediatrics, National Hospital Organization Okayama Medical Center, Okayama, JapanSearch for more papers by this authorYasuo Nakahara, Department of Pediatric Surgery, National Hospital Organization Okayama Medical Center, Okayama, JapanSearch for more papers by this authorAkihito Takeuchi, Department of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, JapanSearch for more papers by this author First published: 26 March 2021 https://doi.org/10.1111/jpc.15459Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Long Multi-Stage Training for a Motor-Impaired User in a BCI Competition

In a Mental Imagery Brain-Computer Interface the user has to perform a specific mental task that generates electroencephalography (EEG) components, which can be translated in commands to control a BCI system. The development of a high-performance MI-BCI requires a long training, lasting several weeks or months, in order to improve the ability of the user to manage his/her mental tasks. This works aims to present the design of a MI-BCI combining mental imaginary and cognitive tasks for a severely motor impaired user, involved in the BCI race of the Cybathlon event, a competition of people with severe motor disability. In the BCI-race, the user becomes a pilot in a virtual race game against up to three other pilots, in which each pilot has to control his/her virtual car by his/her mental tasks. We present all the procedures followed to realize an effective MI-BCI, from the user's first contact with a BCI technology to actually controlling a video-game through her EEG. We defined a multi-stage user-centered training protocol in order to successfully control a BCI, even in a stressful situation, such as that of a competition. We put a specific focus on the human aspects that influenced the long training phase of the system and the participation to the competition.