Modeling the acceptability of BCIs for motor rehabilitation after stroke: A large scale study on the general public

Introduction

Strokes leave around 40% of survivors dependent in their activities of daily living, notably due to severe motor disabilities. Brain-computer interfaces (BCIs) have been shown to be efficiency for improving motor recovery after stroke, but this efficiency is still far from the level required to achieve the clinical breakthrough expected by both clinicians and patients. While technical levers of improvement have been identified (e.g., sensors and signal processing), fully optimized BCIs are pointless if patients and clinicians cannot or do not want to use them. We hypothesize that improving BCI acceptability will reduce patients' anxiety levels, while increasing their motivation and engagement in the procedure, thereby favoring learning, ultimately, and motor recovery. In other terms, acceptability could be used as a lever to improve BCI efficiency. Yet, studies on BCI based on acceptability/acceptance literature are missing. Thus, our goal was to model BCI acceptability in the context of motor rehabilitation after stroke, and to identify its determinants.

Methods

The main outcomes of this paper are the following: i) we designed the first model of acceptability of BCIs for motor rehabilitation after stroke, ii) we created a questionnaire to assess acceptability based on that model and distributed it on a sample representative of the general public in France (N = 753, this high response rate strengthens the reliability of our results), iii) we validated the structure of this model and iv) quantified the impact of the different factors on this population.

Results

Results show that BCIs are associated with high levels of acceptability in the context of motor rehabilitation after stroke and that the intention to use them in that context is mainly driven by the perceived usefulness of the system. In addition, providing people with clear information regarding BCI functioning and scientific relevance had a positive influence on acceptability factors and behavioral intention.

Discussion

With this paper we propose a basis (model) and a methodology that could be adapted in the future in order to study and compare the results obtained with: i) different stakeholders, i.e., patients and caregivers; ii) different populations of different cultures around the world; and iii) different targets, i.e., other clinical and non-clinical BCI applications.

Juvenile dermatomyositis: treatment with intravenous gammaglobulin

High-dose intravenous gammaglobulin (IVGG) has proved to be effective in the treatment of a number of immune disorders. We report two patients with juvenile dermatomyositis (DM) who improved with IVGG therapy. These patients had become refractory to corticosteroids and had developed unacceptable steroid toxicity. We suggest that IVGG can be useful in the treatment of juvenile DM, by reducing steroid requirements, and replacing immunosuppressive drugs.

[Neonatal hepatitis with alpha-1-antitrypsin deficit. Apropos of a personal case]

The authors report a case of neonatal hepatitis with alpha-1-antitrypsin occuring in a child of ZZ phenotype. The anatomopathological study carried out on two liver biopsies showed changes of common cholestatic hepatitis developing into cirrhosis, as well as intrahepatocytary globulins. Moreover, these globulins, P.A.S. positive after treatment by alphaamylase, fix an antialpha-1-antitrypsine antiserum. Ultrastructural analysis shows them to be masses of amorphous material, feebly osmiophilic, outlined by a unitary membrane the moniliform aspect of which recalls the ergastoplasmic membrane. These findings are identical to those already made in cases of cirrhogenous neonatal hepatitis by alpha-1-antitrypsine deficit reported in the literature. They point out the irreversibility of the affection which, after a stage of cholestatic hepatitis with or without inflammatory portal fibrosis, develops into cirrhosis. At this stage cholestasis has regressed or disappeared whereas portal sclerosis, often infiltrated with free elements, surrounds hepatic lobules and biliary neocanaliculi. But the globulins are still present and appear to be the specific feature of this deficit. By their ultrastructural and immuno-histochemical features, these globulins would represent a form of accumulation of alpha-1-antitrypsin in the hepatocytes which normally carry out the synthesis of this antienzyme. Accumulation in the hepatocytes proves excretory disturbance of hypothetical mechanism: structural anomaly, changes in the permeability of the membrane. Its role in the occurrence of hepatitis or cirrhosis lesions is still to be demonstrated but one may think that it consists in absence of inhibition of the enzymatic factors discharged during agressions.