Validation of SuPerSense, a Sensorized Surface for the Evaluation of Posture Perception in Supine Position.

This study aimed to validate a sensorized version of a perceptive surface that may be used for the early assessment of misperception of body midline representation in subjects with right stroke, even when they are not yet able to stand in an upright posture. This device, called SuPerSense, allows testing of the load distribution of the body weight on the back in a supine position. The device was tested in 15 patients with stroke, 15 age-matched healthy subjects, and 15 young healthy adults, assessing three parameters analogous to those conventionally extracted by a baropodometric platform in a standing posture. Subjects were hence tested on SuPerSense in a supine position and on a baropodometric platform in an upright posture in two different conditions: with open eyes and with closed eyes. Significant correlations were found between the lengths of the center of pressure path with the two devices in the open-eyes condition (R = 0.44, p = 0.002). The parameters extracted by SuPerSense were significantly different among groups only when patients were divided into those with right versus left brain damage. This last result is conceivably related to the role of the right hemisphere of the brain in the analysis of spatial information.

New protocol for dissociating visuospatial working memory ability in reaching space and in navigational space.

Several studies have demonstrated that the processing of visuospatial memory for locations in reaching space and in navigational space is supported by independent systems, and that the coding of visuospatial information depends on the modality of the presentation (i.e., sequential or simultaneous). However, these lines of evidence and the most common neuropsychological tests used by clinicians to investigate visuospatial memory have several limitations (e.g., they are unable to analyze all the subcomponents of this function and are not directly comparable). Therefore, we developed a new battery of tests that is able to investigate these subcomponents. We recruited 71 healthy subjects who underwent sequential and simultaneous navigational tests by using an innovative sensorized platform, as well as comparable paper tests to evaluate the same components in reaching space (Exp. 1). Consistent with the literature, the principal-component method of analysis used in this study demonstrated the presence of distinct memory for sequences in different portions of space, but no distinction was found for simultaneous presentation, suggesting that different modalities of eye gaze exploration are used when subjects have to perform different types of tasks. For this purpose, an infrared Tobii Eye-Tracking X50 system was used in both spatial conditions (Exp. 2), showing that a clear effect of the presentation modality was due to the specific strategy used by subjects to explore the stimuli in space. Given these findings, the neuropsychological battery established in the present study allows us to show basic differences in the normal coding of stimuli, which can explain the specific visuospatial deficits found in various neurological conditions.

Hybrid P300-based brain-computer interface to improve usability for people with severe motor disability: electromyographic signals for error correction during a spelling task.

OBJECTIVE: To evaluate the impact of a hybrid control on usability of a P300-based brain-computer interface (BCI) system that was designed to control an assistive technology software and was integrated with an electromyographic channel for error correction. DESIGN: Proof-of-principle study with a convenience sample. SETTING: Neurologic rehabilitation hospital. PARTICIPANTS: Participants (N=11) in this pilot study included healthy (n=8) and severely motor impaired (n=3) persons. The 3 people with severe motor disability were identified as potential candidates to benefit from the proposed hybrid BCI system for communication and environmental interaction. INTERVENTIONS: To eventually investigate the improvement in usability, we compared 2 modalities of BCI system control: a P300-based and a hybrid P300 electromyographic-based mode of control. MAIN OUTCOME MEASURES: System usability was evaluated according to the following outcome measures within 3 domains: (1) effectiveness (overall system accuracy and P300-based BCI accuracy); (2) efficiency (throughput time and users' workload); and (3) satisfaction (users' satisfaction). We also considered the information transfer rate and time for selection. RESULTS: Findings obtained in healthy participants were in favor of a higher usability of the hybrid control as compared with the nonhybrid. A similar trend was indicated by the observational results gathered from each of the 3 potential end-users. CONCLUSIONS: The proposed hybrid BCI control modality could provide end-users with severe motor disability with an option to exploit some residual muscular activity, which could not be fully reliable for properly controlling an assistive technology device. The findings reported in this pilot study encourage the implementation of a clinical trial involving a large cohort of end-users.

A covert attention P300-based brain-computer interface: Geospell.

The Farwell and Donchin P300 speller interface is one of the most widely used brain-computer interface (BCI) paradigms for writing text. Recent studies have shown that the recognition accuracy of the P300 speller decreases significantly when eye movement is impaired. This report introduces the GeoSpell interface (Geometric Speller), which implements a stimulation framework for a P300-based BCI that has been optimised for operation in covert visual attention. We compared the Geospell with the P300 speller interface under overt attention conditions with regard to effectiveness, efficiency and user satisfaction. Ten healthy subjects participated in the study. The performance of the GeoSpell interface in covert attention was comparable with that of the P300 speller in overt attention. As expected, the effectiveness of the spelling decreased with the new interface in covert attention. The NASA task load index (TLX) for workload assessment did not differ significantly between the two modalities. PRACTITIONER SUMMARY: This study introduces and evaluates a gaze-independent, P300-based brain-computer interface, the efficacy and user satisfaction of which were comparable with those off the classical P300 speller. Despite a decrease in effectiveness due to the use of covert attention, the performance of the GeoSpell far exceeded the threshold of accuracy with regard to effective spelling.

Depression disorder in patients with cerebellar damage: Awareness of the mood state.

BACKGROUND: Although depressive symptoms are often reported to be comorbid with degenerative cerebellar diseases, the role of the cerebellum in depressive disorder needs to be elucidated. To address this aim, we investigated self-perception of the negative mood state in patients with cerebellar pathology and depressive symptoms. METHODS: Thirty-eight patients with cerebellar damage (10 with depressive symptoms - CB-DP and 28 with no depressive symptoms - CB-nDP), 11 subjects with depressive disorders without cerebellar damage (DP) and 29 healthy controls (CTs) were enrolled. A device for self-monitoring of the mood state (MoMo) and validated scales such as the Profile of Mood States questionnaire (POMS), the Self-Report Symptom Inventory-Revised (SCL-90-R) and the Hamilton Depression Rating Scale (HDRS) were used to evaluate depressive symptoms. RESULTS: Both CB-DP and DP patients showed higher scores than CTs on the POMS and SCL-90-R for depressive factors and on the HDRS. DP patients showed a lower frequency of 'good' mood and a higher frequency of 'bad' mood than CTs when using the MoMo device. However, although the two depressed populations showed comparable scores on these validated scales, CB-DP patients showed impaired self-awareness of the mood experience in 'the here and now', as evidenced by the absence of significant differences, compared with CTs, in the subjective mood evaluation performed with the MoMo device. LIMITATIONS: The number of CB patients and inhomogeneity across MRI scans were study limitations. CONCLUSION: Cerebellar dysfunction might slow the data integration necessary for mood state awareness, resulting in difficulty of depressed CB patients in explicitly recognizing their mood "in the here and now".

High-resolution EEG techniques for brain-computer interface applications.

High-resolution electroencephalographic (HREEG) techniques allow estimation of cortical activity based on non-invasive scalp potential measurements, using appropriate models of volume conduction and of neuroelectrical sources. In this study we propose an application of this body of technologies, originally developed to obtain functional images of the brain's electrical activity, in the context of brain-computer interfaces (BCI). Our working hypothesis predicted that, since HREEG pre-processing removes spatial correlation introduced by current conduction in the head structures, by providing the BCI with waveforms that are mostly due to the unmixed activity of a small cortical region, a more reliable classification would be obtained, at least when the activity to detect has a limited generator, which is the case in motor related tasks. HREEG techniques employed in this study rely on (i) individual head models derived from anatomical magnetic resonance images, (ii) distributed source model, composed of a layer of current dipoles, geometrically constrained to the cortical mantle, (iii) depth-weighted minimum L(2)-norm constraint and Tikhonov regularization for linear inverse problem solution and (iv) estimation of electrical activity in cortical regions of interest corresponding to relevant Brodmann areas. Six subjects were trained to learn self modulation of sensorimotor EEG rhythms, related to the imagination of limb movements. Off-line EEG data was used to estimate waveforms of cortical activity (cortical current density, CCD) on selected regions of interest. CCD waveforms were fed into the BCI computational pipeline as an alternative to raw EEG signals; spectral features are evaluated through statistical tests (r(2) analysis), to quantify their reliability for BCI control. These results are compared, within subjects, to analogous results obtained without HREEG techniques. The processing procedure was designed in such a way that computations could be split into a setup phase (which includes most of the computational burden) and the actual EEG processing phase, which was limited to a single matrix multiplication. This separation allowed to make the procedure suitable for on-line utilization, and a pilot experiment was performed. Results show that lateralization of electrical activity, which is expected to be contralateral to the imagined movement, is more evident on the estimated CCDs than in the scalp potentials. CCDs produce a pattern of relevant spectral features that is more spatially focused, and has a higher statistical significance (EEG: 0.20+/-0.114 S.D.; CCD: 0.55+/-0.16 S.D.; p=10(-5)). A pilot experiment showed that a trained subject could utilize voluntary modulation of estimated CCDs for accurate (eight targets) on-line control of a cursor. This study showed that it is practically feasible to utilize HREEG techniques for on-line operation of a BCI system; off-line analysis suggests that accuracy of BCI control is enhanced by the proposed method.

Non-invasive brain-computer interface system: towards its application as assistive technology.

The quality of life of people suffering from severe motor disabilities can benefit from the use of current assistive technology capable of ameliorating communication, house-environment management and mobility, according to the user's residual motor abilities. Brain-computer interfaces (BCIs) are systems that can translate brain activity into signals that control external devices. Thus they can represent the only technology for severely paralyzed patients to increase or maintain their communication and control options. Here we report on a pilot study in which a system was implemented and validated to allow disabled persons to improve or recover their mobility (directly or by emulation) and communication within the surrounding environment. The system is based on a software controller that offers to the user a communication interface that is matched with the individual's residual motor abilities. Patients (n=14) with severe motor disabilities due to progressive neurodegenerative disorders were trained to use the system prototype under a rehabilitation program carried out in a house-like furnished space. All users utilized regular assistive control options (e.g., microswitches or head trackers). In addition, four subjects learned to operate the system by means of a non-invasive EEG-based BCI. This system was controlled by the subjects' voluntary modulations of EEG sensorimotor rhythms recorded on the scalp; this skill was learnt even though the subjects have not had control over their limbs for a long time. We conclude that such a prototype system, which integrates several different assistive technologies including a BCI system, can potentially facilitate the translation from pre-clinical demonstrations to a clinical useful BCI.

Mobile applications in otolaryngology for patients: An update.

OBJECTIVE: Recently smartphones and tablets have spread in developed countries, and healthcare-related apps are growing incredibly in different specialties. The aim of this study is to provide an up-to-date review of the current OtoHNS (otolaryngology-head and neck surgery) apps developed for patients. METHODS: This mobile applications review was conducted in September 2017. Relevant apps about OtoHNS were searched in the Apple Store and in the Google Play using various keywords. We included helpful apps for OtoHNS patients. Apps for medical students, physician (95 apps) and non-English apps (6 apps) were excluded. RESULTS: At the end of our selection process, 216 apps have been included for mobile applications review. The number of apps published per year in OtoHNS has increased each year. The most common apps were about hearing, in particular 63 of 216 (29%) were hearing test; 75 of 216 (35%) for tinnitus treatment; 10 of 216 (5%) for sounds measurement around the patients; and 7 of 216 (3%) to treat vertigo. One hundred thirty-seven of 216 (63%) apps were free of charge. Physicians were clearly involved in the app's development in only 73 of 216 (34%) apps. One hundred sixty-three of 216 (75%) had no user ratings. CONCLUSIONS: Apps are increasingly and easily accessible, although their use in clinical practice is not yet totally accepted. Our review showed that most apps have been created with no guidance from otolaryngologist. Further steps are needed to regulate apps' development. Hoping an "App Board," such as editorial board for scientific journal, to assess app quality, validity, and effectiveness before they can be fully incorporated into clinical practice and medical education. LEVEL OF EVIDENCE: N/A.

Monitoring mood states in everyday life: a new device for patients with cerebellar ataxia.

Thirty patients with cerebellar ataxia and 40 healthy volunteers underwent 7 days of mood monitoring using a new device requiring a low motor load. Its convergent validity and compliance were tested. The measurements resulted consistent with validated scale scores. Patients׳ motor impairment did not affect the compliance.

Asynchronous gaze-independent event-related potential-based brain-computer interface.

OBJECTIVE: In this study a gaze independent event related potential (ERP)-based brain computer interface (BCI) for communication purpose was combined with an asynchronous classifier endowed with dynamical stopping feature. The aim was to evaluate if and how the performance of such asynchronous system could be negatively affected in terms of communication efficiency and robustness to false positives during the intentional no-control state. MATERIAL AND METHODS: The proposed system was validated with the participation of 9 healthy subjects. A comparison was performed between asynchronous and synchronous classification technique outputs while users were controlling the same gaze independent BCI interface. The performance of both classification techniques were assessed both off-line and on-line by means of the efficiency metric introduced by Bianchi et al. (2007). This latter metric allows to set a different misclassification cost for wrong classifications and abstentions. Robustness was evaluated as the rate of false positives occurring during voluntary no-control states. RESULTS: The asynchronous classifier did not exhibited significantly higher accuracy or lower error rate with respect to the synchronous classifier (accuracy: 74.66% versus 87.96%, error rate: 7.11% versus 12.04% respectively). However, the on-line and off-line analysis revealed that the communication efficiency was significantly improved (p<.05) with the asynchronous classification modality as compared with the synchronous. Furthermore, the asynchronous classifier proved to be robust to false positives during intentional no-control state which occur during the ongoing visual stimulation (less than 1 false positive every 6min). CONCLUSION: As such, the proposed ERP-BCI system which combines an asynchronous classifier with a gaze independent interface is a promising solution to be further explored in order to increase the general usability of ERP-based BCI systems designed for severely disabled people with an impairment of the voluntary control of eye movements. In fact, the asynchronous classifier can improve communication efficiency automatically adapting the number of stimulus repetitions to the current user's state and suspending the control if he/she does not intend to select an item.

On the control of brain-computer interfaces by users with cerebral palsy.

OBJECTIVE: Brain-computer interfaces (BCIs) have been proposed as a potential assistive device for individuals with cerebral palsy (CP) to assist with their communication needs. However, it is unclear how well-suited BCIs are to individuals with CP. Therefore, this study aims to investigate to what extent these users are able to gain control of BCIs. METHODS: This study is conducted with 14 individuals with CP attempting to control two standard online BCIs (1) based upon sensorimotor rhythm modulations, and (2) based upon steady state visual evoked potentials. RESULTS: Of the 14 users, 8 are able to use one or other of the BCIs, online, with a statistically significant level of accuracy, without prior training. Classification results are driven by neurophysiological activity and not seen to correlate with occurrences of artifacts. However, many of these users' accuracies, while statistically significant, would require either more training or more advanced methods before practical BCI control would be possible. CONCLUSIONS: The results indicate that BCIs may be controlled by individuals with CP but that many issues need to be overcome before practical application use may be achieved. SIGNIFICANCE: This is the first study to assess the ability of a large group of different individuals with CP to gain control of an online BCI system. The results indicate that six users could control a sensorimotor rhythm BCI and three a steady state visual evoked potential BCI at statistically significant levels of accuracy (SMR accuracies; mean ± STD, 0.821 ± 0.116, SSVEP accuracies; 0.422 ± 0.069).

Control or no-control? Reducing the gap between brain-computer interface and classical input devices.

In order to improve Brain Computer Interface usability for real life context, they should be able to adapt their speed to the user's current psychophysical state and to understand from the ongoing EEG when he/she intends to suspend the control. In this work we evaluated an asynchronous classifier which provides these feature with 20 healthy subjects, who were engaged in an environmental control task or in a spelling task. We also demonstrated how the proposed classifier can improve communication efficiency with respect to classical synchronous classifiers.

Accuracy of a P300 speller for people with motor impairments: a comparison.

A Brain-Computer Interface (BCI) provides a completely new output pathway that can provide an additional option for a person to express himself/herself if he/she suffers a disorder like amyotrophic lateral sclerosis (ALS), brainstem stroke, brain or spinal cord injury or other diseases which impair the function of the common output pathways which are responsible for the control of muscles. For a P300 based BCI a matrix of randomly flashing characters is presented to the participant. To spell a character the person has to attend to it and to count how many times the character flashes. Although most BCIs are designed to help people with disabilities, they are mainly tested on healthy, young subjects who may achieve better results than people with impairments. In this study we compare measurements, performed on people suffering motor impairments, such as stroke or ALS, to measurements performed on healthy people. The overall accuracy of the persons with motor impairments reached 70.1% in comparison to 91% obtained for the group of healthy subjects. When looking at single subjects, one interesting example shows that under certain circumstances, when it is difficult for a patient to concentrate on one character for a longer period of time, the accuracy is higher when fewer flashes (i.e., stimuli) are presented. Furthermore, the influence of several tuning parameters is discussed as it shows that for some participants adaptations for achieving valuable spelling results are required. Finally, exclusion criteria for people who are not able to use the device are defined.

Asynchronous P300-based brain-computer interface to control a virtual environment: initial tests on end users.

Motor disability and/or ageing can prevent individuals from fully enjoying home facilities, thus worsening their quality of life. Advances in the field of accessible user interfaces for domotic appliances can represent a valuable way to improve the independence of these persons. An asynchronous P300-based Brain-Computer Interface (BCI) system was recently validated with the participation of healthy young volunteers for environmental control. In this study, the asynchronous P300-based BCI for the interaction with a virtual home environment was tested with the participation of potential end-users (clients of a Frisian home care organization) with limited autonomy due to ageing and/or motor disabilities. System testing revealed that the minimum number of stimulation sequences needed to achieve correct classification had a higher intra-subject variability in potential end-users with respect to what was previously observed in young controls. Here we show that the asynchronous modality performed significantly better as compared to the synchronous mode in continuously adapting its speed to the users' state. Furthermore, the asynchronous system modality confirmed its reliability in avoiding misclassifications and false positives, as previously shown in young healthy subjects. The asynchronous modality may contribute to filling the usability gap between BCI systems and traditional input devices, representing an important step towards their use in the activities of daily living.

Out of the frying pan into the fire--the P300-based BCI faces real-world challenges.

Brain-computer interfaces (BCIs) have been investigated for more than 20 years. Many BCIs use noninvasive electroencephalography as a measurement technique and the P300 event-related potential as an input signal (P300 BCI). Since the first experiment with a P300 BCI system in 1988 by Farwell and Donchin, not only data processing has improved but also stimuli presentation has been varied and a plethora of applications was developed and refined. Nowadays, these applications are facing the challenge of being transferred from the research laboratory into real-life situations to serve motor-impaired people in their homes as assistive technology.

On the use of EEG or MEG brain imaging tools in neuromarketing research.

Here we present an overview of some published papers of interest for the marketing research employing electroencephalogram (EEG) and magnetoencephalogram (MEG) methods. The interest for these methodologies relies in their high-temporal resolution as opposed to the investigation of such problem with the functional Magnetic Resonance Imaging (fMRI) methodology, also largely used in the marketing research. In addition, EEG and MEG technologies have greatly improved their spatial resolution in the last decades with the introduction of advanced signal processing methodologies. By presenting data gathered through MEG and high resolution EEG we will show which kind of information it is possible to gather with these methodologies while the persons are watching marketing relevant stimuli. Such information will be related to the memorization and pleasantness related to such stimuli. We noted that temporal and frequency patterns of brain signals are able to provide possible descriptors conveying information about the cognitive and emotional processes in subjects observing commercial advertisements. These information could be unobtainable through common tools used in standard marketing research. We also show an example of how an EEG methodology could be used to analyze cultural differences between fruition of video commercials of carbonated beverages in Western and Eastern countries.

Smart homes to improve the quality of life for all.

A home is smart when, being aware of its own state and that of its users, is capable of controlling itself in order to support the user wishes and thus improving their quality of life. This holds both for users with special needs and for those with ordinary domestic needs. In this paper, we overview the Smart Homes for All project which represents the current state of the art with respect to software control and user interfaces in the smart homes arena.

Patterns of cortical activity during the observation of Public Service Announcements and commercial advertisings.

BACKGROUND: In the present research we were interested to study the cerebral activity of a group of healthy subjects during the observation a documentary intermingled by a series of TV advertisements. In particular, we desired to examine whether Public Service Announcements (PSAs) are able to elicit a different pattern of activity, when compared with a different class of commercials, and correlate it with the memorization of the showed stimuli, as resulted from a following subject's verbal interview. METHODS: We recorded the EEG signals from a group of 15 healthy subjects and applied the High Resolution EEG techniques in order to estimate and map their Power Spectral Density (PSD) on a realistic cortical model. The single subjects' activities have been z-score transformed and then grouped to define four different datasets, related to subjects who remembered and forgotten the PSAs and to subjects who remembered and forgotten cars commercials (CAR) respectively, which we contrasted to investigate cortical areas involved in this encoding process. RESULTS: The results we here present show that the cortical activity elicited during the observation of the TV commercials that were remembered (RMB) is higher and localized in the left frontal brain areas when compared to the activity elicited during the vision of the TV commercials that were forgotten (FRG) in theta and gamma bands for both categories of advertisements (PSAs and CAR). Moreover, the cortical maps associated with the PSAs also show an increase of activity in the alpha and beta band. CONCLUSIONS: In conclusion, the TV advertisements that will be remembered by the experimental population have increased their cerebral activity, mainly in the left hemisphere. These results seem to be congruent with and well inserted in the already existing literature, on this topic, related to the HERA model. The different pattern of activity in different frequency bands elicited by the observation of PSAs may be justified by the existence of additional cortical networks processing these kind of audiovisual stimuli. Further research with an extended set of subjects will be necessary to further validate the observations reported in this paper.

EEG analysis of the brain activity during the observation of commercial, political, or public service announcements.

The use of modern brain imaging techniques could be useful to understand what brain areas are involved in the observation of video clips related to commercial advertising, as well as for the support of political campaigns, and also the areas of Public Service Announcements (PSAs). In this paper we describe the capability of tracking brain activity during the observation of commercials, political spots, and PSAs with advanced high-resolution EEG statistical techniques in time and frequency domains in a group of normal subjects. We analyzed the statistically significant cortical spectral power activity in different frequency bands during the observation of a commercial video clip related to the use of a beer in a group of 13 normal subjects. In addition, a TV speech of the Prime Minister of Italy was analyzed in two groups of swing and "supporter" voters. Results suggested that the cortical activity during the observation of commercial spots could vary consistently across the spot. This fact suggest the possibility to remove the parts of the spot that are not particularly attractive by using those cerebral indexes. The cortical activity during the observation of the political speech indicated a major cortical activity in the supporters group when compared to the swing voters. In this case, it is possible to conclude that the communication proposed has failed to raise attention or interest on swing voters. In conclusions, high-resolution EEG statistical techniques have been proved to able to generate useful insights about the particular fruition of TV messages, related to both commercial as well as political fields.

The study of brain activity during the observation of commercial advertising by using high resolution EEG techniques.

In this paper we illustrate the capability of tracking brain activity during the observation of commercial TV spots by using advanced high resolution EEG statistical techniques in time and frequency domains. In particular, we analyzed the statistically significant cortical spectral power activity in different frequency bands during the observation of a commercial video clip related to the use of a beer in a group of 13 normal subjects. In addition, a TV speech of the prime minister of Italy was analyzed in two groups of swing and "supporter" voters. Results suggested that the cortical activity during the observation of commercial spots could vary consistently across the spot. This fact suggest the possibility to remove the part of the spot that are not particularly attractive by using those cerebral indexes. The cortical activity during the observation of the political speech indicated a major cortical activity in the supporters group when compared to the swing voters. In this case, it is possible to conclude that the communication proposed has failed to raise attention or interest on swing voters. In conclusions, high resolution EEG have been proved able to generate useful insights about the particular fruition of TV messages, related to both commercial as well as political fields.