Strength and power adaptations of the upper body following 20 training sessions on an eccentric arm-crank ergometer.

PURPOSE: Eccentric strength training is an innovative and promising approach to improve exercise performance. However, most eccentric training studies in the past were performed with a focus on the lower extremities. The present study aimed to test the feasibility and effects on strength and power adaptations of a structured upper-body eccentric training program. METHODS: Fourteen (median age (Q1-Q3) 29 years (27-32); 9 females, 5 males) healthy, regularly exercising individuals performed 20 progressive training sessions (2-3 sessions/week at 20-50% peak power for 8-14 min) on a symmetric eccentric arm-crank ergometer. Before and after the intervention, anaerobic peak power (PP) and maximal concentric aerobic power output (POmax) on an arm-crank ergometer as well as the one repetition maximum (1RM) for bench press were determined as main outcome parameters. A p-value ≤ 0.05 was considered statistically significant. RESULTS: Significant improvements in PP (+ 4% (1-8), p = 0.007), POmax (+ 6% (0-8); p = 0.01), and 1RM (+ 12% (10-17); p < 0.001) were found. Exercise intensity was relatively low at 64% (55-70) of maximum heart rate. CONCLUSIONS: Twenty progressive training sessions on a symmetric arm-crank ergometer are effective in inducing significant aerobic and anaerobic performance and strength improvements in the upper body. This intervention is safe and feasible, and can be performed at relatively low cardiovascular intensities. Therefore, this training method offers an interesting approach from elite sports to rehabilitation.

How Elite Athletes with a Spinal Cord Injury Sweat during Exercise-An Exploratory Study.

BACKGROUND: Sweat and thermal responses in individuals with spinal cord injury (SCI) are impaired depending on lesion characteristics. This is particularly problematic for athletes and may ultimately lead to reduced performance. This exploratory study investigated the feasibility of field-usable methods to objectively collect data relevant to sweat response in elite athletes with SCI. Differences in sweat response were also evaluated for different athlete characteristics. METHODS: Measurements were performed during exercise and included core temperature (Tc), heart rate, urine specific gravity, fluid intake, sweat rate, and sweat electrolyte concentration. Differences for sex, lesion level (tetraplegia versus paraplegia), motor impairment (complete versus incomplete), and sport type (endurance versus team/skill) were evaluated. RESULTS: Fifteen athletes (median (Q1-Q3) age, 30 (28-36) years; three females; 11 with complete lesions) were included. Endurance athletes were measured during indoor performance tests (n = 10), whereas team/skill athletes were measured during training sessions (n = 5). In the mixed exercise intensities, the average Tc was 37.7 (37.3-37.8) °C and the average heart rate was 126 (100-146) bpm. Dehydration, defined as a urine specific gravity > 1.020 ng/mL, was prevalent in six athletes before exercise and in five athletes after exercise. The sweat rate was lower in athletes with tetraplegia (p = 0.02) and in team/skill athletes (p = 0.008). CONCLUSIONS: Collecting sweat and thermal response data from athletes with SCI in the field is feasible. Given the suboptimal hydration status of many athletes, raising awareness of the importance of hydration seems valuable.

Characteristics of the gut microbiome of Swiss elite athletes with a spinal cord injury: An exploratory study.

OBJECTIVES: To illustrate and explore associations between the gut microbiome and spinal cord injury (SCI) characteristics, physical training, dietary intake, body composition, and blood biomarkers of elite Swiss athletes. DESIGN AND SETTING: Baseline data analysis of athletes with SCI who participated in a pilot trial (NCT04659408) in the Swiss Paraplegic Center, Nottwil, Switzerland. PARTICIPANTS: Elite athletes, five males, and six females, with SCI who competed internationally. OUTCOME MEASURES: We conducted a differential abundance analysis and measured the alpha and beta diversity of the gut microbiome. RESULTS: The athletes' median age was 34.5 years. Six had traumatic SCI and five had a spina bifida. The athletes competed in para-cycling (5), wheelchair athletics (3), and wheelchair tennis (3). A higher duration of training per week was positively associated with Akkermansia and Akkermansiaceae but negatively associated with Prevotellaceae. Muribaculaceae was negatively associated with the average number of trainings per week. Waist circumference is negatively associated with Butyricimonas. Significant differences in the alpha diversity were found with sex, gastrointestinal quality of life index (GIQLI) scores, total caloric intake, total fat intake, total carbohydrate intake, and high-sensitivity C-reactive protein (hs-CRP). Beta diversity differences were found with impairment of the sympathetic nervous system of the gut at the genus level and HbA1c at the family level. CONCLUSIONS: This study provides insight into the gut microbiome of athletes with SCI. Our results were similar to those found in athletes without SCI. Further replication is needed to confirm the relationships of organisms observed in the gut of athletes with SCI.

Eyelid Closure Behavior of Patients with Idiopathic and Nonorganic Hypersomnia, Narcolepsy-Cataplexy, and Healthy Controls in the Maintenance of Wakefulness Test.

Purpose: Differential diagnosis of central disorders of hypersomnolence remains challenging, particularly between idiopathic (IH) and nonorganic hypersomnia (NOH). We hypothesized that eyelid closure behavior in the maintenance of wakefulness test (MWT) could be a valuable biomarker. Patients and Methods: MWT recordings of patients with IH, NOH, narcolepsy-cataplexy (NC), and healthy sleep-deprived controls (H) were retrospectively analyzed (15 individuals per group). For each MWT trial, visual scoring of face videography for partial (50-80%) and full eyelid closure (≥80%) was performed from "lights off" to the first microsleep episode (≥3 s). Results: In all groups, the frequency and cumulative duration of periods with partial and full eyelid closure gradually increased toward the first microsleep episode. On the group level, significant differences occurred for the latency to the first microsleep episode (IH 21 min (18-33), NOH 23 min (17-35), NC 11 min (7-19), H 10 min (6-25); p = 0.009), the ratio between partial and full eyelid closure duration (IH 2.2 (0.9-3.1), NOH 0.5 (0-1.2), NC 2.8 (1.1-5), H 0.7 (0.4-3.3); p = 0.004), and the difference between full and partial eyelid closure duration in the five minutes prior to the first microsleep episode (∆full - partial eyelid closure duration: IH -16 s (-35 to 28); NOH 46 s (9-82); NC -6 s (-26 to 5); H 10 s (-4 to 18); p = 0.007). IH and NOH significantly differed comparing the ratio between partial and full eyelid closure (p = 0.005) and the difference between ∆full - partial eyelid closure duration in the five minutes prior to the first microsleep episode (p = 0.006). Conclusion: In the MWT, eyelid closure behavior (∆full - partial) in the period prior to the first microsleep episode could be of value for discriminating NOH from other etiologies of excessive daytime sleepiness, particularly IH.

Energy Availability and Nutritional Intake during Different Training Phases of Wheelchair Athletes.

Optimizing nutritional intake and timing helps athletes to improve performance and long-term health. Different training phases can require varying nutritional needs. In this study, we conducted a descriptive assessment of dietary intake, energy availability (EA), and blood biochemical parameters in elite wheelchair athletes during distinct training phases. Data analyzed in this study were collected as part of a randomized controlled crossover trial exploring the feasibility of probiotics and prebiotic supplementation. Data were obtained from consecutive three-day diaries and blood samples, both collected at four different time points across four consecutive months. We included 14 athletes (mean (standard deviation) age 34 (9) years, eight females, and six males) active in different wheelchair sports. The mean daily nutritional intake (g/kg body mass) for females and males was 2.7 (0.9) and 4.0 (0.7) for carbohydrates, 1.1 (0.3) and 1.5 (0.3) for protein, and 0.8 (0.3) and 1.4 (0.2) for fat. EA did not change across the four time points in either female (p = 0.30) or male (p = 0.05) athletes. The mean EA was lower in female athletes compared to male athletes (p = 0.03). Low EA (≤30 kcal/ kg fat-free mass/day) was observed in female (58 (29) % of days) and male (34 (23) % of days) athletes. Iron deficiency with anemia was observed in two female athletes. Mean vitamin D levels were insufficient (<75 nmol/L). Macronutrient intake, EA, and blood biochemical parameters were suboptimal in this cohort of elite wheelchair athletes, especially in female athletes.

The feasibility of a randomized controlled crossover trial to assess the effect of probiotic and prebiotic supplementation on the health of elite wheelchair athletes.

BACKGROUND: Gastrointestinal (GI) problems represent a health burden in Para athletes and can ultimately reduce athletic performance. This study aimed to evaluate the feasibility of a randomized controlled crossover trial (RCCT) assessing the effects of probiotic and prebiotic supplementation on the health of Swiss elite wheelchair athletes. METHODS: The RCCT was conducted between March 2021 and October 2021. Athletes were randomized to receive either a daily probiotic (3 g of probiotic preparation, including eight bacterial strains), or a daily prebiotic (5 g of oat bran) supplementation first. After the first supplementation phase (4 weeks), a washout period (4 weeks) and the second crossover supplementation phase (4 weeks) followed. Data were collected at four study visits (every 4 weeks) and included 3-day training and nutrition diaries, the Gastrointestinal Quality of Life Index (GIQLI) questionnaire, stool samples, and fasting blood samples. The study assessed the feasibility criteria such as recruitment rate, retention rate, success of data collection, adherence to the protocol, willingness to participate, and safety. RESULTS: This pilot study met the majority of the predefined minimum requirements for the feasibility criteria. Out of 43 invited elite wheelchair athletes, 14 (33%) consented (mean (standard deviation) age: 34 (9) years, eight females, 11 with a spinal cord injury). The desired sample size was not reached, but the achieved recruitment rate was modest, especially considering the population studied. All participating athletes completed the study. With the exception of one missing stool sample and two missing diaries, data were successfully collected for all athletes at all four visits. Most athletes adhered to the daily intake protocol for at least 80% of the days, both for probiotics (n = 12, 86%) and prebiotics (n = 11, 79%). Ten (71%) athletes would be willing to participate in a similar study again. No serious adverse events occurred. CONCLUSION: Despite the limited number of elite wheelchair athletes in Switzerland and the modest recruitment rate, the implementation of a RCCT in elite wheelchair athletes is feasible. The data collected in this study provide essential information for the design of the subsequent study which will include a larger cohort of physically active wheelchair users. TRIAL REGISTRATION: Swiss Ethics Committee for Northwest/Central Switzerland (EKNZ), 2020-02337). CLINICALTRIALS: gov, NCT04659408.

Prevalence of an insufficient vitamin D status at the onset of a spinal cord injury - a cross-sectional study.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: This study aimed to investigate the vitamin D status after acute spinal cord injury (SCI) onset. SETTING: Specialized SCI rehabilitation center in Switzerland. METHODS: Patients admitted to the center after an acute SCI onset were included. The prevalence of a deficient (25(OH)D ≤ 50 nmol/l), insufficient (50 < 25(OH)D ≤ 75 nmol/l) and sufficient (25(OH)D > 75 nmol/l) vitamin D status were determined after admission. Vitamin D status was compared between different patient groups based on demographic and SCI characteristics. The occurrence of bed rest, falls and pressure injuries were also assessed. RESULTS: In total, 87 patients (median (interquartile range); 53 (39-67) years, 25 females, 66 traumatic SCI, 54 paraplegia) were included. Assessed a median of 15 (9-22) days after SCI onset, median vitamin D status was 41 (26-57) (range 8-155) nmol/l. The majority of patients had a deficient (67%, 95% confidence interval (95% CI) 0.56-0.76) or insufficient (25%, 95% CI 0.17-0.36) vitamin D status. A moderate negative correlation was found between vitamin D status and body mass index (p = 0.003). A moderate positive correlation was found between vitamin D and calcium status (p = 0.01). CONCLUSION: A deficient or insufficient vitamin D status directly after SCI onset is highly prevalent. Vitamin D status should be carefully observed during acute SCI rehabilitation. We recommend that all patients with recent SCI onset should receive vitamin D supplementation with a dosage depending on their actual vitamin D status.

Sports nutrition knowledge in athletes with a spinal cord injury and coaches of para sports.

Sports nutrition for athletes with a spinal cord injury (SCI) is complex, making it challenging for athletes to stay informed. The aim of this study was to assess sports nutrition knowledge in athletes with an SCI and coaches of para sports. The secondary aim was to report sources of sports nutrition information. Eighty athletes and 26 coaches across various adapted sports were recruited. The Nutrition for Sport Knowledge Questionnaire was used to assess nutrition knowledge for both groups. Athletes achieved their highest score among the alcohol (65 ± 19%) category and the lowest in sports nutrition (43 ± 17%). Coaches demonstrated the most knowledge in the alcohol (73 ± 17%) category and lowest knowledge in the supplementation (45 ± 19%) category. Both groups relied on the internet, dietitians, and coaches for sports nutrition information. Future studies should explore the effects of nutrition education on nutrition knowledge and dietary intakes among these populations.

The feasibility of a crossover, randomized controlled trial design to assess the effect of probiotics and prebiotics on health of elite Swiss para-athletes: a study protocol.

BACKGROUND: Spinal cord injury (SCI) may cause an autonomic imbalance in the gastrointestinal tract, leading to deficits in colonic motility, mucosal secretions, vascular tone, and an increase of intestinal barrier permeability. Autonomic denervation and factors such as age, physical activity, antibiotic use and stress may cause intestinal bacterial translocation, decreased microbiota diversity, known as gut dysbiosis and thus increase susceptibility to experiencing gastrointestinal discomfort. Probiotic treatment in individuals with SCI may normalize the gut microbiota and improve overall health. We aim to assess the feasibility of probiotic and prebiotic intervention in athletes with SCI and collect information necessary for sample size calculation of a definite trial on improving health outcomes in para-athletes. METHODS AND ANALYSIS: Elite Swiss para-athletes (aged> 18 years), being shortlisted for the Paralympic Games 2021 in Tokyo or a member of a national team (n = 43), will be invited to participate in this single-center randomized crossover trial. Athletes suffering from chronic inflammatory bowel diseases, those currently taking antibiotics or other medication to alleviate gastro-intestinal complaints will not be eligible to be included in the study. Athletes will be randomized (1:1) to receive for 4 weeks a daily dose of either 3 g of probiotic preparation or 5 g of prebiotic (organic oat bran) supplementation in addition to usual diet, followed by a 4-week washout period or vice versa. The primary outcome is the feasibility of the study, measured by recruitment and dropout rates, feasibility of the measurements, acceptability and adherence to the intervention. Secondary outcomes include gastrointestinal health assessment, diet and training information, handgrip strength, blood diagnostic parameters, and intestinal microbiome characterization. The changes in clinically relevant secondary outcome values will be used to make a power calculation for definite trial. DISCUSSION: This pilot trial will address two common challenges in SCI research: the difficulty to recruit enough participants for a sufficiently powered study and the ability to collect data within the limits of a realistic budget and time frame. Upon demonstrated feasibility of the intervention and study procedures, the intervention will be evaluated in a definitive controlled trial comprising a larger sample of para-athletes (elite, engaged, or recreationally active) individuals with a SCI. TRIAL REGISTRATION: NCT04659408.

Vitamin D supplementation in chronic spinal cord injury (VitD-SCI): study protocol for a randomised controlled trial.

INTRODUCTION: Vitamin D insufficiency, a vitamin D status or serum 25(OH)D concentration of ≤75 nmol/L, is highly prevalent in individuals with a spinal cord injury (SCI). Vitamin D is important for the functioning of the musculoskeletal, immune and respiratory systems, which are relevant determinants of secondary health conditions in SCI. An insufficiency should be treated with vitamin D supplementation. However, there is a lack of evidence regarding the optimal dosage and duration of vitamin D supplementation for individualised and long-term management of the vitamin D status in the context of SCI. This paper presents the protocol for the vitamin D supplementation in chronic spinal cord injury (VitD-SCI) trial that aims to investigate the effect of a 12-month intake of vitamin D supplementation on vitamin D status as well as on several secondary parameters among individuals with a chronic SCI. METHODS AND ANALYSES: The VitD-SCI trial is a randomised, placebo-controlled, double-blinded, parallel-group, superiority trial, conducted at the Swiss Paraplegic Centre. A total of 45 participants living with an SCI for at least 3 years (chronic SCI) and a vitamin D insufficiency at the first study visit, will be randomly assigned to one of three intervention groups. Participants receive either a monthly dosage of 24 000 IU or 48 000 IU vitamin D or a placebo for 12 months. Measurements taking place every 3 months include the assessment of vitamin D status (primary outcome) as well as bone mineral density, handgrip strength, fatigue, mood, pain and pressure injuries (secondary outcomes). Safety and tolerance of vitamin D supplementation will also be evaluated. ETHICS AND DISSEMINATION: The Swiss Ethics Committee for Northwest/Central Switzerland (EKNZ, 2020-01493) and the Swiss Agency for Therapeutic Products (Swissmedic, 2020DR3150) approved this study. Findings will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBERS: NCT04652544 and SNCTP000004032.

Systematic Review of the Effects of Oat Intake on Gastrointestinal Health.

BACKGROUND: Oats are a food source with multiple health benefits that could support beneficial bacterial groups and provide important bioactive compounds for the gut. OBJECTIVES: This review explores the association between oat intake, gastrointestinal (GI) symptoms, and microbial community changes in individuals with celiac disease (CeD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD) and without GI disease. METHODS: Four databases and Google Scholar were systematically searched from inception until April 29, 2021. Clinical trials, observational studies, and in vitro studies with human gut-derived samples were included. RESULTS: There were 84 articles [23 randomized controlled trials (RCTs), 21 nonrandomized trials, 8 observational studies, and 32 in vitro studies] included. Oat intake increased total bacterial count, Lactobacilli spp., and Bifidobacterium spp. in healthy individuals and those with CeD. There was an increased concentration of short-chain fatty acids and improved gut permeability with oat intake but with no significant quality-of-life difference. In some individuals with CeD, consumption of certain oat types was associated with worsening of GI symptoms. We found no studies reporting on IBS and only 3 for IBD. The quality of RCTs showed some concerns mostly in domains of randomization (73.9%), whereas the quality of evidence of non-RCTs, observational studies, and in vitro studies was satisfactory. CONCLUSIONS: Oat intake was associated with the increase of beneficial bacterial groups in individuals without GI disease and those with CeD. Most studies showed no changes in GI symptoms with oat consumption. In vitro studies in CeD provide insight to oat-sensitive individuals and their GI mucosa, but the clinical studies remain limited, precluding our ability to draw firm conclusions. The prevalence of oat sensitivity in individuals with CeD should be further explored as this could improve clinical management and facilitate inclusion of oat in the diet for this population.

Automatic Detection of Microsleep Episodes With Deep Learning.

Brief fragments of sleep shorter than 15 s are defined as microsleep episodes (MSEs), often subjectively perceived as sleepiness. Their main characteristic is a slowing in frequency in the electroencephalogram (EEG), similar to stage N1 sleep according to standard criteria. The maintenance of wakefulness test (MWT) is often used in a clinical setting to assess vigilance. Scoring of the MWT in most sleep-wake centers is limited to classical definition of sleep (30 s epochs), and MSEs are mostly not considered in the absence of established scoring criteria defining MSEs but also because of the laborious work. We aimed for automatic detection of MSEs with machine learning, i.e., with deep learning based on raw EEG and EOG data as input. We analyzed MWT data of 76 patients. Experts visually scored wakefulness, and according to recently developed scoring criteria MSEs, microsleep episode candidates (MSEc), and episodes of drowsiness (ED). We implemented segmentation algorithms based on convolutional neural networks (CNNs) and a combination of a CNN with a long-short term memory (LSTM) network. A LSTM network is a type of a recurrent neural network which has a memory for past events and takes them into account. Data of 53 patients were used for training of the classifiers, 12 for validation and 11 for testing. Our algorithms showed a good performance close to human experts. The detection was very good for wakefulness and MSEs and poor for MSEc and ED, similar to the low inter-expert reliability for these borderline segments. We performed a visualization of the internal representation of the data by the artificial neuronal network performing best using t-distributed stochastic neighbor embedding (t-SNE). Visualization revealed that MSEs and wakefulness were mostly separable, though not entirely, and MSEc and ED largely intersected with the two main classes. We provide a proof of principle that it is feasible to reliably detect MSEs with deep neuronal networks based on raw EEG and EOG data with a performance close to that of human experts. The code of the algorithms (https://github.com/alexander-malafeev/microsleep-detection) and data (https://zenodo.org/record/3251716) are available.

Automatically Detected Microsleep Episodes in the Fitness-to-Drive Assessment.

Study Objectives: Microsleep episodes (MSEs) are short fragments of sleep (1-15 s) that can cause dangerous situations with potentially fatal outcomes. In the diagnostic sleep-wake and fitness-to-drive assessment, accurate and early identification of sleepiness is essential. However, in the absence of a standardised definition and a time-efficient scoring method of MSEs, these short fragments are not assessed in clinical routine. Based on data of moderately sleepy patients, we recently developed the Bern continuous and high-resolution wake-sleep (BERN) criteria for visual scoring of MSEs and corresponding machine learning algorithms for automatic MSE detection, both mainly based on the electroencephalogram (EEG). The present study aimed to investigate the relationship between automatically detected MSEs and driving performance in a driving simulator, recorded in parallel with EEG, and to assess algorithm performance for MSE detection in severely sleepy participants. Methods: Maintenance of wakefulness test (MWT) and driving simulator recordings of 18 healthy participants, before and after a full night of sleep deprivation, were retrospectively analysed. Performance of automatic detection was compared with visual MSE scoring, following the BERN criteria, in MWT recordings of 10 participants. Driving performance was measured by the standard deviation of lateral position and the occurrence of off-road events. Results: In comparison to visual scoring, automatic detection of MSEs in participants with severe sleepiness showed good performance (Cohen's kappa = 0.66). The MSE rate in the MWT correlated with the latency to the first MSE in the driving simulator (r s = -0.54, p < 0.05) and with the cumulative MSE duration in the driving simulator (r s = 0.62, p < 0.01). No correlations between MSE measures in the MWT and driving performance measures were found. In the driving simulator, multiple correlations between MSEs and driving performance variables were observed. Conclusion: Automatic MSE detection worked well, independent of the degree of sleepiness. The rate and the cumulative duration of MSEs could be promising sleepiness measures in both the MWT and the driving simulator. The correlations between MSEs in the driving simulator and driving performance might reflect a close and time-critical relationship between sleepiness and performance, potentially valuable for the fitness-to-drive assessment.

Microsleep episodes in the borderland between wakefulness and sleep.

STUDY OBJECTIVES: The wake-sleep transition zone represents a poorly defined borderland, containing, for example, microsleep episodes (MSEs), which are of potential relevance for diagnosis and may have consequences while driving. Yet, the scoring guidelines of the American Academy of Sleep Medicine (AASM) completely neglect it. We aimed to explore the borderland between wakefulness and sleep by developing the Bern continuous and high-resolution wake-sleep (BERN) criteria for visual scoring, focusing on MSEs visible in the electroencephalography (EEG), as opposed to purely behavior- or performance-defined MSEs. METHODS: Maintenance of Wakefulness Test (MWT) trials of 76 randomly selected patients were retrospectively scored according to both the AASM and the newly developed BERN scoring criteria. The visual scoring was compared with spectral analysis of the EEG. The quantitative EEG analysis enabled a reliable objectification of the visually scored MSEs. For less distinct episodes within the borderland, either ambiguous or no quantitative patterns were found. RESULTS: As expected, the latency to the first MSE was significantly shorter in comparison to the sleep latency, defined according to the AASM criteria. In certain cases, a large difference between the two latencies was observed and a substantial number of MSEs occurred between the first MSE and sleep. Series of MSEs were more frequent in patients with shorter sleep latencies, while isolated MSEs were more frequent in patients who did not reach sleep. CONCLUSION: The BERN criteria extend the AASM criteria and represent a valuable tool for in-depth analysis of the wake-sleep transition zone, particularly important in the MWT.

Automatic detection of microsleep episodes with feature-based machine learning.

STUDY OBJECTIVES: Microsleep episodes (MSEs) are brief episodes of sleep, mostly defined to be shorter than 15 s. In the electroencephalogram (EEG), MSEs are mainly characterized by a slowing in frequency. The identification of early signs of sleepiness and sleep (e.g. MSEs) is of considerable clinical and practical relevance. Under laboratory conditions, the maintenance of wakefulness test (MWT) is often used for assessing vigilance. METHODS: We analyzed MWT recordings of 76 patients referred to the Sleep-Wake-Epilepsy-Center. MSEs were scored by experts defined by the occurrence of theta dominance on ≥1 occipital derivation lasting 1-15 s, whereas the eyes were at least 80% closed. We calculated spectrograms using an autoregressive model of order 16 of 1 s epochs moved in 200 ms steps in order to visualize oscillatory activity and derived seven features per derivation: power in delta, theta, alpha and beta bands, ratio theta/(alpha + beta), quantified eye movements, and median frequency. Three algorithms were used for MSE classification: support vector machine (SVM), random forest (RF), and an artificial neural network (long short-term memory [LSTM] network). Data of 53 patients were used for the training of the classifiers, and 23 for testing. RESULTS: MSEs were identified with a high performance (sensitivity, specificity, precision, accuracy, and Cohen's kappa coefficient). Training revealed that delta power and the ratio theta/(alpha + beta) were most relevant features for the RF classifier and eye movements for the LSTM network. CONCLUSIONS: The automatic detection of MSEs was successful for our EEG-based definition of MSEs, with good performance of all algorithms applied.

Availability and need of home adaptations for personal mobility among individuals with spinal cord injury.

OBJECTIVE: To identify the availability and unmet need of home adaptations (HAs) among the Swiss population with spinal cord injury (SCI). DESIGN: Cross-sectional study. SETTING: Swiss Spinal Cord Injury Community Survey 2012. PARTICIPANTS: Individuals aged 16 or older with chronic SCI living in Switzerland. INTERVENTIONS: Not applicable. OUTCOME MEASURES: The availability of ten HAs (self-report) was analyzed by sex, age, living situation, indoor mobility, SCI severity, SCI etiology and time since SCI. The unmet need (self-report of not having a HA but needing it) of HAs was analyzed by financial hardship. RESULTS: Among the 482 study participants (mean age 55.2 years, standard deviation 15.0 years, 71.6% males), 85.1% had at least one HA. The most frequent HA was a wheelchair accessible shower (62.7%). Availability of HAs markedly varied with indoor mobility (e.g. 38.4% of participants using a wheelchair had a stair lift compared to 17.4% of those walking) and with SCI severity (e.g. 54.8% of those with complete paraplegia had a wheelchair accessible kitchen worktop compared to 26.0% of those with incomplete paraplegia). Unmet need was highest for adjustable kitchen worktops (78.7% of those with a need) and adjustable kitchen cabinets (75.7%) and lowest for wheelchair accessible showers (9.4%) and grab bars next to the toilet (8.5%). No significant differences in unmet need were found when stratifying for financial hardship. CONCLUSION: Availability of HAs is dependent on indoor mobility and SCI severity. There is a considerable degree of unmet need for selected HAs, which couldn't be explained by financial hardship.