Self-Management Analysis in Chronic Conditions (SMACC) checklist: an international consensus-based tool to develop, compare and evaluate self-management support programmes.

OBJECTIVES: The Self-Management Analysis in Chronic Conditions (SMACC) checklist was developed as a guidance tool to support the development, comparison and evaluation of self-management support programmes for persons with a chronic condition. The checklist was based on a previously performed concept analysis of self-management. The aim of this study was to validate its content using an international Delphi study and to deliver a final version. DESIGN: A two-round Delphi study was conducted between October 2022 and January 2023. Using the researchers' networks, professionals with research or clinical expertise in self-management support and chronic conditions were recruited via online purposive snowball sampling. Participants were asked to score each item of the checklist (16 items total) on 3 content validity indicators: (1) clarity and comprehensibility, (2) relevance and importance and (3) degree of alignment with the overall goal of the checklist to promote adequate and comprehensive self-management support programmes. A consensus threshold of 75% agreement was used. The participants were also asked general questions about the checklist as a whole and were asked to provide feedback considering its refinement. RESULTS: Fifty-four professionals with an average 14.5 years of experience participated in round 1, 48 with an average 12.5 years of experience participated in round 2. The majority of professionals were from Western Europe. For the majority of items consensus was reached after round 1. In round 2, 3 of the 4 remaining items reached consensus, 1 last item was retained based on highly recurring feedback. CONCLUSIONS: The SMACC checklist was considered a valid and comprehensive tool to aid the development, evaluation and comparison of self-management support programmes. It was acknowledged as a useful instrument to supplement existing frameworks and was seen as feasible to implement in both research and clinical settings. Further validation in the field, with input from patients and peer experts, will be valuable.

Clinical and Surgical Approach for Cerebral Cortical Dysplasia.

The present article describes pathophysiological and clinical aspects of congenital malformations of the cerebral tissue (cortex and white matter) that cause epilepsy and very frequently require surgical treatment. A particular emphasis is given to focal cortical dysplasias, the most common pathology among these epilepsy-related malformations. Specific radiological and surgical features are also highlighted, so a thorough overview of cortical dysplasias is provided.

Long-term seizure outcome and mobility after surgical treatment for Rasmussen encephalitis in children: A single-center experience.

OBJECTIVE: Rasmussen Encephalitis (RE) is a rare inflammatory neurodegenerative disease associated with refractory seizures, hemiparesis, and cognitive deterioration, due to lateralized cortical atrophy. Hemispheric surgery (hemispherotomy) is the mainstay of treatment, but its unavoidable motor deficits and lack of long-term data regarding seizure outcomes can make patients and families apprehensive to undergo this procedure. The present study aimed at analyzing the results of surgical treatment for RE from a motor and epilepsy standpoint, and mitigate such concerns. METHODS: Clinical and operative data were retrospectively collected from medical records of pharmacoresistant patients treated with functional hemispherectomy at a tertiary reference center for epilepsy surgery, during a 24-year period (1996-2020). Variables such as age of epilepsy onset, seizure semiology, seizure frequency, immunomodulatory therapy, age at surgery, duration of epilepsy, surgical procedures and complications, number of medications used preoperatively and postoperatively were described and statistically analyzed. RESULTS: Forty-three (43) patients were included in this study. Mean age of epilepsy onset was 6.14 years, the average interval between epilepsy onset and hemispherotomy was 2.21 years. and the mean age at surgery was 8.28 years. Thirty patients (69.7%) were Engel I at their last follow-up, of whom 23 (56.4%) were Engel Ia, within a mean follow-up of 11.3 years. Duration of epilepsy, seizure frequency, and age at surgery, among others, did not correlate with seizure outcome, except the use of immunotherapy which led to worse outcomes (p < .05). Also, after surgery, motor functionality was significantly recovered (i.e., most patients returned to their previous status) with time. SIGNIFICANCE: This study tackled some issues regarding the surgical treatment of this disease, particularly showing that hemispherotomy is safe and leads to potentially recoverable disability of motor functions while providing high rates of effective and long-lasting seizure control; therefore, early surgical indication should be warranted once medical refractoriness has been established.

[S1 guidelines for the management of postviral conditions using the example of post-COVID-19]. / Leitlinie S1 für das Management postviraler Zustände am Beispiel Post-COVID-19.

These S1 guidelines are an updated and expanded version of the S1 guidelines on long COVID differential diagnostic and management strategies. They summarize the state of knowledge on postviral conditions like long/post COVID at the time of writing. Due to the dynamic nature of knowledge development, they are intended to be "living guidelines". The focus is on practical applicability at the level of primary care, which is understood to be the appropriate place for initial access and for primary care and treatment. The guidelines provide recommendations on the course of treatment, differential diagnostics of the most common symptoms that can result from infections like with SARS-CoV-2, treatment options, patient management and care, reintegration and rehabilitation. The guidelines have been developed through an interdisciplinary and interprofessional process and provide recommendations on interfaces and possibilities for collaboration.

[Occupational Therapy Guideline for the management of sequelae of viral diseases with SARS-CoV-2 : Supplement to the S1 guidelines for the management of post-viral conditions exemplified by post-COVID-19]. / Leitfaden für das Management von Folgen viraler Erkrankung mit SARS-CoV-2 aus Sicht der Ergotherapie : Ergänzung zur Leitlinie S1 für das Management postviraler Zustände am Beispiel Post-COVID-19.

Sequelae of viral disease with SARS-CoV-2 impact clients' biopsychosocial health, thus their daily life, with limitations resp. barriers in their occupational capacities and opportunities. Occupational therapists have numerous and, with constantly growing evidence, personalised therapeutic means, measures, and methods in any intervention phase relevant to these according health problems, supporting i. e. coping, occupational adaptation, quality of life and participatory re-shaping of (daily) life. Based on ongoing research findings and practice evidence, this document contains recommendations for occupational therapy intervention for clients with biopsychosocial health conditions post COVID-19.

Desordens orais potencialmente malignas: uma análise bibliométrica dos trabalhos apresentados na sociedade brasileira de pesquisa odontológica (sbpqo) / Oral potentially malignant disorders: a bibliometric analysisof the works presented at brazilian society of dental research (sbpqo)

Objetivo: as Desordens Orais Potencialmente Malignas (DOPMs) consistem em lesões e condições epiteliais que apresentam risco aumentado de malignidade. Nessa pesquisa, buscou-se identificar o perfil da produção cien-tífica brasileira sobre as DOPMs, a partir de uma análise bibliométrica dos trabalhos apresentados nas Reuniões da Sociedade Brasileira de Pesquisa Odontológica (SBPqO). Materiais e Métodos: foi realizado um estudo bibliométrico, em que foram analisados os anais das reuniões anuais da SBPqO realizadas entre 2015 a 2019. Incluiu-se resumos sobre DOPMs apresentados em qualquer categoria e as seguintes informações foram extraídas: ano, desenho do estudo, tipo de DOPM, unidade federativa, localização e instituição de ensino superior de origem. Os dados foram analisados por meio de estatística descritiva. Resultados:foram identificados 91 resumos. A maior parte foi publicada em 2015 (24,2%) e por autores do estado de São Paulo (22%). A leucoplasia foi a desordem mais frequente (36,2%), seguida pela queilite actínica (35,2%). A maioria dos estudos foi de autoria de pesquisadores das regiões Sudeste (29%) e Sul (28%). Em relação à instituição de ensino, grande parte (68,1%) foi proveniente de universidades públicas. O tipo de estudo mais frequente foi pesquisa labo-ratorial básica (57,1%). Discussão: os achados do estudo indicam que o número de pesquisas sobre as DOPMs apresentadas nas Reuniões da SBPqO ainda é reduzido, concentrados na região sudeste e nas universidades públicas. Conclusão: realizar novas pesquisas a respeito desse tema é muito importante, pois permite a descoberta de informações relevantes para a saúde dos indivíduos frente a essa neoplasia.

Objective: Oral Potentially Malignant Disorders (OPMDs) are lesions and epithelial conditions that present an increased risk of malignancy. In this research, the aim was to identify the profile of Brazilian scientific produc-tion on DOPMs, based on a bibliometric analysis of the works presented at the Meetings of the Brazilian Dental Research Society (SBPqO). Materials and Methods: a bibliometric study was carried out, in which the annals of the annual SBPqO meetings held between 2015 and 2019 were analyzed. Abstracts about DOPMs presented in any category were included and the following information was extracted: year, study design, type of DOPM, federative unit, location and educational institution of origin. The data were analyzed using descriptive sta-tistics. Results: 91 abstracts were identified. Most were published in 2015 (24.2%) and by authors from the state of São Paulo (22%). Leukoplakia was the most frequent disorder (36.2%), followed by actinic cheilitis (35.2%). Most of the studies were authored by researchers from the Southeast (29%) and South (28%) regions. Regarding the educational institution, a large part (68.1%) came from public universities. The most frequent type of study was basic laboratory research (57.1%). Discussion: the study findings indicate that the number of researches on DOPMs presented at the SBPqO Meetings is still small, concentrated in the Southeast region and in public universities. Conclusion: conducting new research on this topic is very important, as it allows the discovery of information relevant to the health of individuals in the face of this neoplasm.

A 46-Year Retrospective Study of Oral Vascular Anomalies in a Brazilian Population

ABSTRACT: A retrospective study was performed to describe the demographic and clinicopathological characteristics of cases of vascular anomalies in a Brazilian population. The data of cases diagnosed as vascular anomalies over a period of 46 years, were retrieved from the archives of the Pathological Anatomy Service of the Department of Dentistry of Federal University of Rio Grande do Norte. Information about sex, age, race, diagnosis, location, and clinical characteristics was extracted. A database was created for analysis in the SPSS system and description of the results. The sample consisted of 597 cases categorized as follows: pyogenic granuloma (n = 454), infantile hemangioma (n = 57), vascular malformation (n = 37), lymphangioma (n = 20), hemangiolymph angioma (n = 10), vascular thrombus (n = 7), hemangio endothelioma (n = 5), angiofibroma (n = 1), hemangioendothelio sarcoma (n = 1), and Kaposi sarcoma (n = 5). Overall, there was a predominance of females (64.2 %), white race (54.2 %), and patients in the 3rd and 4th decades of life. Most cases affected the gingiva/ ridge (44.75 %), had a red/reddish color (60.07 %), sessile implantation (52.4 %), soft consistency (52.7 %) and nodular appearance (53, 9 %), and were non-hemorrhagic (51.3 %) and asymptomatic (76.6 %). The demographic and clinicopathological findings obtained for most of the vascular lesions analyzed are similar to those reported in published studies involving other populations. Knowledge of the particularities of these disorders is important for appropriate diagnosis and treatment decision.

RESUMEN: Se realizó un estudio retrospectivo para describir las características demográficas y clínico-patológicas de casos de anomalías vasculares en una población brasileña. Los datos de los casos diagnosticados como anomalías vasculares durante un período de 46 años, fueron obtenidos de los archivos del Servicio de Anatomía Patológica del Departamento de Odontología de la Universidade Federal de Rio Grande do Norte. Se analizó la información de sexo, edad, raza, diagnóstico, ubicación y características clínicas, y se creó una base de datos para análisis en el sistema SPSS y descripción de los resultados. La muestra consistió de 597 casos categorizados de la siguiente manera: granuloma piógeno (n = 454), hemangioma infantil (n = 57), malformación vascular (n = 37), linfangioma (n = 20), hemangiolinfangioma (n = 10), trombo vascular (n = 7), hemangioendotelioma (n = 5), angiofibroma (n = 1), hemangioendoteliosarcoma (n = 1) y sarcoma de Kaposi (n = 5). En general predominaron las mujeres de raza blanca (64,2 %), (54,2 %), y pacientes en la 3ª y 4ª década de la vida. La mayoría de los casos afectaban la encía / cresta (44,75 %), tenían un color rojo / rojizo (60,07 %), implantación sésil (52,4 %), consistencia blanda (52,7 %) y apariencia nodular (53,9 %), no hemorrágicos (51,3 %) y asintomáticos (76,6 %). Los hallazgos demográficos y clínico-patológicos de la mayoría de las lesiones vasculares analizadas son similares a los reportados en la literatura de otras poblaciones. El conocimiento de las particularidades de estos trastornos es importante para el diagnóstico y la decisión de tratamientos adecuados.

Fissuras orofaciais: uma análise bibliométrica dos trabalhos apresentados em um congresso brasileiro / Orofacial fissures: a bibliometric analysis of the works presented at a Brazilian congress

Objetivo: Investigar a produção científica sobre fendas orofaciais em um congresso brasileiro, entre os anos de 2009 a 2019. Métodos:Realizou-se um estudo bibliométrico, observacional, pela análise de resumos publicados em anais das Reuniões Anuais da Sociedade Brasileira de Pesquisa Odontológica (SBPqO), que envolviam o tema de fissuras orofaciais.Os dados referentes aos resumos (ano de publicação, local do estudo ­ unidade federativa, tipo de fissura, grande área de conhecimento, desenho, tipo de instituição,recebimento de fomento) foram coletados e analisados através de uma estatística descritiva e analítica. Foi aplicado o teste não paramétrico de Mann-Whitney (p < 0,05). Resultados: Dentre 28.578 resumos, 194 (0,67%) eram sobre fissuras orofaciais. A maioria deles envolvia mais de um tipo de fissura (n = 180; 93,3%) e foram realizados,principalmente, em instituições públicas (n = 128; 66%) das regiões Sudeste (n = 121;62,3%), e Sul (n = 23; 11,8%), sem recebimento de fomento (60,8%). A área de conhecimento mais comum foi Epidemiologia/Saúde Coletiva (n = 60; 30,9%), com predominância dos desenhos de estudos transversais (n = 85; 43,8%). Houve associação estatisticamente significativa entre recebimento de financiamento e maior tamanho amostral. Conclusão: Poucos estudos investigaram as fissuras orofaciais na SBPqO.Uma investigação mais aprofundada nesse campo de pesquisa permite identificar problemáticas que possibilitam a organização, planejamento e monitoramento da atenção especializada para os portadores dessas anomalias, assim como criar condições para uma descentralização do cuidado pela ampliação da rede de serviços para outras localidades no Brasil.

Aim: To investigate the scientific production concerning orofacial clefts presented at a Brazilian congress, between 2009 and 2019. Methods: A bibliometric and observational study was conducted, though the analysis of abstracts published in the annals of the Annual Meetings of the Brazilian Society of Dental Research (SBPqO), concerning orofacial clefts. Data referring to the abstracts (year of publication, place of study - federative unit, type of fissure, broad area of knowledge, design, type of institution, receipt of funding) were collected and organized through descriptive and analytical statistics. The Mann-Whitney non-parametric test was applied (p < 0.05). Results: Among 28,578 abstracts, 194 (0.67%) concerned orofacial clefts. Most of them dealt with more than one type of cleft (n = 180; 93.3%) and were mainly conducted in public institutions (n = 128; 66%), in the Southeast (n = 121; 62.3%) and South (n = 23; 11.8%) regions, and without funding (60.8%). The most common field of knowledge was Epidemiology/Public Health (n = 60; 30.9%), with a predominance of cross-sectional studies (n = 185; 43.8%). There was a statistically significant association between funding and higher sample size. Conclusion:Few studies have investigated orofacial clefts in SBPqO. An in-depth investigation in this field of research allows for the identification of problems that make it possible to organize, plan, and monitor specialized care for people with these anomalies, as well as create conditions for the decentralization of care by expanding the service network to other locations in Brazil.

Delineating the concept of self-management in chronic conditions: a concept analysis.

OBJECTIVES: Self-management is a concept frequently used within healthcare but lacks consensus. It is the aim of this study to clarify the concept. DESIGN: Concept analysis according to Walker and Avant, comprises eight steps: select concept, determine purpose, identify uses, determine defining attributes, identify model case, identify additional cases, identify antecedents and consequences and define empirical referents. SOURCES USED: PubMed, Scopus and Web of Science. RESULTS: Ten attributes delineating the concept have been identified and organised into three groups. Group (a): person-oriented attributes: the person must (1) actively take part in the care process, (2) take responsibility for the care process and (3) have a positive way of coping with adversity. Group (b): person-environment-oriented attributes: (4) the person must be informed about the condition, disease and treatment and self-management, (5) should be individualised, which entails expressing needs, values and priorities, (6) requires openness to ensure a reciprocal partnership with healthcare providers and (7) demands openness to social support. Finally, Group (c): summarising attributes: self-management (8) is a lifetime task, (9) assumes personal skills and (10) encompasses the medical, role and emotional management. CONCLUSIONS: The findings of this study recognise the complexity of the concept, but also show the need for further investigation to make the concept more measurable. Clarity about the concept will enhance understanding and facilitate implementation in self-management programmes for chronic conditions.

Altered sleep patterns in patients with non-functional GHRH receptor.

OBJECTIVES: GH-releasing hormone (GHRH) exerts hypnotic actions increasing the non-rapid eye movement (NREM) sleep. Conversely, GH stimulates the REM sleep. GH deficiency (GHD) often leads to sleep problems, daytime fatigue and reduced quality of life (QoL). GHD may be due to lack of hypothalamic GHRH or destruction of somatotroph cells. We have described a cohort with isolated GHD (IGHD) due to GHRH resistance caused by a homozygous null mutation (c.57 + 1G > A) in the GHRH receptor gene. They have normal QoL and no obvious complaints of chronic tiredness. The aim of this study was to determine the sleep quality in these subjects. METHODS: A cross-sectional study was carried out in 21 adult IGHD subjects, and 21 age- and gender-matched controls. Objective sleep assessment included polygraphic records of the awake, stages NREM [N1 (drowsiness), N2 and N3 (already sleeping)] and REM (R). Subjective evaluation included the Pittsburgh Sleep Quality Index, the Insomnia Severity Index and the Epworth Sleepiness Scale. RESULTS: IGHD subjects showed a reduction in sleep efficiency (P = 0.007), total sleep time (P = 0.028), duration of N2 and R in minutes (P = 0.026 and P = 0.046 respectively), but had increased duration and percentage of N1 stage (P = 0.029 and P = 0.022 respectively), wake (P = 0.007) and wake-time after sleep onset (P = 0.017). There was no difference in N3 or in sleep quality questionnaire scores. CONCLUSION: Patients with IGHD due to GHRH resistance exhibit objective reduction in the sleep quality, with changes in NREM and REM sleep, with no detectable subjective consequences. GHRH resistance seems to have a preponderant role over GHD in the sleep quality of these subjects.

Collaborative goal setting with and for children as part of therapeutic intervention.

PURPOSE: This study explored collaborative goal setting with children, parents, and teachers, and children's reasons for their goals based on their perceived self-efficacy, using the Austrian-German Perceived Efficacy and Goal Setting System (AG-PEGS). METHOD: Thirty-eight children from age 5 to 10 years (referred to occupational therapists because of difficulties in performing everyday activities), their parents and teachers participated in this mixed methods study. Participants' goals were analyzed using descriptive statistics and content analysis. Data were grouped into thematic categories, and attributed to health factors according to the International Classification of Functioning, Disability, and Health-Children & Youth Version (ICF-CY). RESULTS: Children's responses underlined the significance of self-efficacy and participation for a child's health and well-being. They gave priority to their independence, competence, and joy in meaningful everyday activities and indicated social motives such as belonging to and being accepted by others for their mainly participation-oriented goals. Parents' main concerns were related to school task performance, whereas teachers mainly chose body functions and school activities to be the focus of occupational therapy intervention. CONCLUSIONS: Exploring clients' priorities, the meanings they attributed to activities in daily life, and their underlying motives for goals should be part of therapeutic intervention. Children and their caregivers are valid and important sources for therapeutic goal setting. Basic human needs, e.g., for relatedness, competence (self-efficacy), autonomy, and meaningful personal orientation, should be considered when prioritizing goals for intervention. Implications for Rehabilitation Children are a valid and important source for therapeutic goal setting. Children's goals focused on activities and participation in all life areas, and half of the parents' goals on activities as relevant for productivity (followed by self-care and leisure), while teachers tended to prioritize goals at the body functions and structures level. The experience of their task performance affecting participation, and the basic needs for independence, relatedness (belonging to and being accepted by others), competence (self-efficacy), and joy through engagement in personally meaningful activities are main motives for children with developmental disabilities to choose their goals for intervention. A client-centred approach in working with children with developmental disabilities requires time and attention for exploring meaning-attributed activities for children and their proxies when collaboratively setting goals.

Abnormal vascular and neural retinal morphology in congenital lifetime isolated growth hormone deficiency.

OBJECTIVE: Experimental models demonstrate an important role of GH in retinal development. However, the interactions between GH and the neuro-vascularization of the human retina are still not clear. A model of untreated congenital isolated GH deficiency (IGHD) may clarify the actions of GH on the retina. The purpose of this work was to assess the retinal neuro-vascularization in untreated congenital IGHD (cIGHD). DESIGN: In a cross sectional study, we performed an endocrine and ophthalmological assessment of 25 adult cIGHD subjects, homozygous for a null mutation (c.57+1G>A) in the GHRH receptor gene and 28 matched controls. Intraocular pressure measurement, retinography (to assess the number of retinal vascular branching points and the optic disc and cup size), and optical coherence tomography (to assess the thickness of macula) were performed. RESULTS: cIGHD subjects presented a more significant reduction of vascular branching points in comparison to controls (91% vs. 53% [p=0.049]). The percentage of moderate reduction was higher in cIGHD than in controls (p=0.01). The percentage of individuals with increased optic disc was higher in cIGHD subjects in comparison to controls (92.9% vs. 57.1%). The same occurred for cup size (92.9% vs. 66.7%), p<0.0001 in both cases. There was no difference in macula thickness. CONCLUSIONS: Most cIGHD individuals present moderate reduction of vascular branching points, increase of optic disc and cup size, but have similar thickness of the macula.

Brazilian adult individuals with untreated isolated GH deficiency do not have accelerated subclinical atherosclerosis.

GH and its principal mediator IGF1 have important effects on metabolic and cardiovascular (CV) status. While acquired GH deficiency (GHD) is often associated with increased CV risk, the consequences of congenital GHD are not known. We have described a large group of patients with isolated GHD (IGHD) due to a homozygous mutation (c.57+1G>A) in the GH releasing hormone receptor gene, and shown that adult GH-naïve individuals have no evidence of clinically evident premature atherosclerosis. To test whether subclinical atherosclerosis is anticipated in untreated IGHD, we performed a cross-sectional study of 25 IGHD and 27 adult controls matched for age and gender. A comprehensive clinical and biochemical panel and coronary artery calcium scores were evaluated by multi-detector tomography. Height, weight, IGF1, homeostasis model assessment of insulin resistance, creatinine and creatininekinase were lower in the IGHD group. Median and interquartile range of calcium scores distribution was similar in the two groups: IGHD 0(0) and control 0(4.9). The vast majority of the calcium scores (20 of 25 IGHD (80%) and 18 of 27 controls (66.6%)) were equal to zero (difference not significant). There was no difference in the calcium scores classification. None of IGHD subjects had minimal calcification, which were present in four controls. Three IGHD and four controls had mild calcification. There were two IGHD individuals with moderate calcification and one control with severe calcification. Our study provides evidence that subjects with congenital isolated lifetime and untreated severe IGHD do not have accelerated subclinical coronary atherosclerosis.

Individually adapted imagery improves brain-computer interface performance in end-users with disability.

Brain-computer interfaces (BCIs) translate oscillatory electroencephalogram (EEG) patterns into action. Different mental activities modulate spontaneous EEG rhythms in various ways. Non-stationarity and inherent variability of EEG signals, however, make reliable recognition of modulated EEG patterns challenging. Able-bodied individuals who use a BCI for the first time achieve - on average - binary classification performance of about 75%. Performance in users with central nervous system (CNS) tissue damage is typically lower. User training generally enhances reliability of EEG pattern generation and thus also robustness of pattern recognition. In this study, we investigated the impact of mental tasks on binary classification performance in BCI users with central nervous system (CNS) tissue damage such as persons with stroke or spinal cord injury (SCI). Motor imagery (MI), that is the kinesthetic imagination of movement (e.g. squeezing a rubber ball with the right hand), is the "gold standard" and mainly used to modulate EEG patterns. Based on our recent results in able-bodied users, we hypothesized that pair-wise combination of "brain-teaser" (e.g. mental subtraction and mental word association) and "dynamic imagery" (e.g. hand and feet MI) tasks significantly increases classification performance of induced EEG patterns in the selected end-user group. Within-day (How stable is the classification within a day?) and between-day (How well does a model trained on day one perform on unseen data of day two?) analysis of variability of mental task pair classification in nine individuals confirmed the hypothesis. We found that the use of the classical MI task pair hand vs. feed leads to significantly lower classification accuracy - in average up to 15% less - in most users with stroke or SCI. User-specific selection of task pairs was again essential to enhance performance. We expect that the gained evidence will significantly contribute to make imagery-based BCI technology become accessible to a larger population of users including individuals with special needs due to CNS damage.

Bring mental activity into action! An enhanced online co-adaptive brain-computer interface training protocol.

Non-stationarity and inherent variability of the noninvasive electroencephalogram (EEG) makes robust recognition of spontaneous EEG patterns challenging. Reliable modulation of EEG patterns that a BCI can robustly detect is a skill that users must learn. In this paper, we present a novel online co-adaptive BCI training paradigm. The system autonomously screens users for their ability to modulate EEG patterns in a predictive way and adapts its model parameters online. Results of a supporting study in seven first-time BCI users with disability are very encouraging. Three of 7 users achieved online accuracy > 70% for 2-class BCI control after 24 minutes of training. Online performance in 6 of 7 users was significantly higher than chance level. Online control was based on one single bipolar EEG channel. Beta band activity carried most discriminant information. Our fully automatic co-adaptive online approach allows to evaluate whether user benefit from current BCI technology within a reasonable timescale.

Non-motor tasks improve adaptive brain-computer interface performance in users with severe motor impairment.

Individuals with severe motor impairment can use event-related desynchronization (ERD) based BCIs as assistive technology. Auto-calibrating and adaptive ERD-based BCIs that users control with motor imagery tasks ("SMR-AdBCI") have proven effective for healthy users. We aim to find an improved configuration of such an adaptive ERD-based BCI for individuals with severe motor impairment as a result of spinal cord injury (SCI) or stroke. We hypothesized that an adaptive ERD-based BCI, that automatically selects a user specific class-combination from motor-related and non motor-related mental tasks during initial auto-calibration ("Auto-AdBCI") could allow for higher control performance than a conventional SMR-AdBCI. To answer this question we performed offline analyses on two sessions (21 data sets total) of cue-guided, five-class electroencephalography (EEG) data recorded from individuals with SCI or stroke. On data from the twelve individuals in Session 1, we first identified three bipolar derivations for the SMR-AdBCI. In a similar way, we determined three bipolar derivations and four mental tasks for the Auto-AdBCI. We then simulated both, the SMR-AdBCI and the Auto-AdBCI configuration on the unseen data from the nine participants in Session 2 and compared the results. On the unseen data of Session 2 from individuals with SCI or stroke, we found that automatically selecting a user specific class-combination from motor-related and non motor-related mental tasks during initial auto-calibration (Auto-AdBCI) significantly (p < 0.01) improved classification performance compared to an adaptive ERD-based BCI that only used motor imagery tasks (SMR-AdBCI; average accuracy of 75.7 vs. 66.3%).

A co-adaptive brain-computer interface for end users with severe motor impairment.

Co-adaptive training paradigms for event-related desynchronization (ERD) based brain-computer interfaces (BCI) have proven effective for healthy users. As of yet, it is not clear whether co-adaptive training paradigms can also benefit users with severe motor impairment. The primary goal of our paper was to evaluate a novel cue-guided, co-adaptive BCI training paradigm with severely impaired volunteers. The co-adaptive BCI supports a non-control state, which is an important step toward intuitive, self-paced control. A secondary aim was to have the same participants operate a specifically designed self-paced BCI training paradigm based on the auto-calibrated classifier. The co-adaptive BCI analyzed the electroencephalogram from three bipolar derivations (C3, Cz, and C4) online, while the 22 end users alternately performed right hand movement imagery (MI), left hand MI and relax with eyes open (non-control state). After less than five minutes, the BCI auto-calibrated and proceeded to provide visual feedback for the MI task that could be classified better against the non-control state. The BCI continued to regularly recalibrate. In every calibration step, the system performed trial-based outlier rejection and trained a linear discriminant analysis classifier based on one auto-selected logarithmic band-power feature. In 24 minutes of training, the co-adaptive BCI worked significantly (p = 0.01) better than chance for 18 of 22 end users. The self-paced BCI training paradigm worked significantly (p = 0.01) better than chance in 11 of 20 end users. The presented co-adaptive BCI complements existing approaches in that it supports a non-control state, requires very little setup time, requires no BCI expert and works online based on only two electrodes. The preliminary results from the self-paced BCI paradigm compare favorably to previous studies and the collected data will allow to further improve self-paced BCI systems for disabled users.

Translation and cross-cultural adaptation of the Perceived Efficacy and Goal Setting System (PEGS): results from the first Austrian-German PEGS version exploring meaningful activities for children.

Occupation-based participatory assessment and treatment planning requires appropriate tools to explore clients' perceptions and priorities for their day-to-day lives. Currently, no such instrument is available in German for use with children and their proxies. This study aimed to translate and adapt the Perceived Efficacy and Goal Setting System (PEGS) for use in German-speaking regions. Translation, adaptation, and field testing of the Austrian-German PEGS version followed guidelines for cross-cultural adaptation of self-report assessments. Forty-two children, ages 5 to 10, with various health conditions, their parents, and teachers participated in this study. The Austrian-German PEGS was successfully translated and culturally adapted. Children, their parents, and teachers reported the child's competences related to the addressed items and identified goals for intervention. Participants added specific culturally relevant activities. Data can now be used to further develop the PEGS for German-speaking regions and to continue research on culturally meaningful activities for children and families.

Effects of high-frequency repetitive transcranial magnetic stimulation on motor and gait improvement in incomplete spinal cord injury patients.

OBJECTIVE: Incomplete spinal cord injury (SCI) patients have the potential to regain some ambulatory function, and optimal reorganization of remaining circuits can contribute to this recovery. We hypothesized that repetitive transcranial magnetic stimulation (rTMS) may promote active recovery of motor function during gait rehabilitation. METHODS: A total of 17 incomplete SCI patients were randomized to receive active rTMS or sham stimulation coupled with rehabilitation therapy; 3 patients who began in the sham group crossed over to the active rTMS group after a washout period of more than 3 weeks. Active rTMS consisted of 15 daily sessions over the leg motor area (at 20 Hz). We compared lower-extremity motor score (LEMS), 10-m walking test for walking speed, timed up and go, Walking Index for SCI Scale, Modified Ashworth Scale, and Spinal Cord Injury Spasticity Evaluation Tool at baseline, after the last session, and 2 weeks later in the active rTMS and sham stimulation groups. RESULTS: A significant improvement was observed after the last rTMS session in the active group for LEMS, walking speed, and spasticity. Improvement in walking speed was maintained during the follow-up period. Sham stimulation did not induce any improvement in LEMS, gait assessment, and spasticity after the last session and neither during follow-up. CONCLUSION: In incomplete SCI, 15 daily sessions of high-frequency rTMS can improve motor score, walking speed, and spasticity in the lower limbs. The study provides evidence for the therapeutic potential of rTMS in the lower extremities in SCI rehabilitation.

An observational report of intensive robotic and manual gait training in sub-acute stroke.

BACKGROUND: The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training. METHODS: We followed 103 sub-acute stroke patients who met the clinical inclusion criteria for Body Weight Supported Robotic Gait Training (BWSRGT). Patients completed an intensive 8-week gait-training program comprising robotic gait training (weeks 0-4) followed by manual gait training (weeks 4-8). A change in clinical function was determined by the following assessments taken at 0, 4 and 8 weeks (baseline, mid-point and end-point respectively): Functional Ambulatory Categories (FAC), 10 m Walking Test (10 MWT), and Tinetti Gait and Balance Scales. RESULTS: Over half of the patients made a clinically meaningful improvement on the Tinetti Gait Scale (> 3 points) and Tinetti Balance Scale (> 5 points), while over 80% of the patients increased at least 1 point on the FAC scale (0-5) and improved walking speed by more than 0.2 m/s. Patients responded positively in gait function regardless of variables gender, age, aetiology (hemorrhagic/ischemic), and affected hemisphere. The most robust and significant change was observed for patients in the FAC categories two and three. The therapy was well tolerated and no patients withdrew for factors related to the type or intensity of training. CONCLUSIONS: Eight-weeks of intensive rehabilitation including robotic and manual gait training was well tolerated by early stroke patients, and was associated with significant gains in function. Patients with mid-level gait dysfunction showed the most robust improvement following robotic training.