Competing at the Cybathlon championship for people with disabilities: long-term motor imagery brain-computer interface training of a cybathlete who has tetraplegia

Background

The brain–computer interface (BCI) race at the Cybathlon championship, for people with disabilities, challenges teams (BCI researchers, developers and pilots with spinal cord injury) to control an avatar on a virtual racetrack without movement. Here we describe the training regime and results of the Ulster University BCI Team pilot who has tetraplegia and was trained to use an electroencephalography (EEG)-based BCI intermittently over 10 years, to compete in three Cybathlon events.

Methods

A multi-class, multiple binary classifier framework was used to decode three kinesthetically imagined movements (motor imagery of left arm, right arm, and feet), and relaxed state. Three game paradigms were used for training i.e., NeuroSensi, Triad, and Cybathlon Race: BrainDriver. An evaluation of the pilot’s performance is presented for two Cybathlon competition training periods—spanning 20 sessions over 5 weeks prior to the 2019 competition, and 25 sessions over 5 weeks in the run up to the 2020 competition.

Results

Having participated in BCI training in 2009 and competed in Cybathlon 2016, the experienced pilot achieved high two-class accuracy on all class pairs when training began in 2019 (decoding accuracy > 90%, resulting in efficient NeuroSensi and Triad game control). The BrainDriver performance (i.e., Cybathlon race completion time) improved significantly during the training period, leading up to the competition day, ranging from 274–156 s (255 ± 24 s to 191 ± 14 s mean ± std), over 17 days (10 sessions) in 2019, and from 230–168 s (214 ± 14 s to 181 ± 4 s), over 18 days (13 sessions) in 2020. However, on both competition occasions, towards the race date, the performance deteriorated significantly.

Conclusions

The training regime and framework applied were highly effective in achieving competitive race completion times. The BCI framework did not cope with significant deviation in electroencephalography (EEG) observed in the sessions occurring shortly before and during the race day. Changes in cognitive state as a result of stress, arousal level, and fatigue, associated with the competition challenge and performance pressure, were likely contributing factors to the non-stationary effects that resulted in the BCI and pilot achieving suboptimal performance on race day.

Trial registration not registered

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-022-01073-9.

Mobile Health in Solid Organ Transplant: The Time Is Now

Despite being in existence for >40 years, the application of telemedicine has lagged significantly in comparison to its generated interest. Detractors include the immobile design of most historic telemedicine interventions and the relative lack of smartphones among the general populace. Recently, the exponential increase in smartphone ownership and familiarity have provided the potential for the development of mobile health (mHealth) interventions that can be mirrored realistically in clinical applications. Existing studies have demonstrated some potential clinical benefits of mHealth in the various phases of solid organ transplantation (SOT). Furthermore, studies in nontransplant chronic diseases may be used to guide future studies in SOT. Nevertheless, substantially more must be accomplished before mHealth becomes mainstream. Further evidence of clinical benefits and a critical need for cost-effectiveness analysis must prove its utility to patients, clinicians, hospitals, insurers, and the federal government. The SOT population is an ideal one in which to demonstrate the benefits of mHealth. In this review, the current evidence and status of mHealth in SOT is discussed, and a general path forward is presented that will allow buy-in from the health care community, insurers, and the federal government to move mHealth from research to standard care.

How Gender Impacts Career Development and Leadership in Rehabilitation Medicine: A Report From the AAPM&R Research Committee

OBJECTIVE

To examine the role that gender plays in meeting the medical academic mission by assessing career development, leadership, and research productivity among rehabilitation researchers.

DESIGN

Prospective, cross-sectional cohort study.

SETTING

National survey.

PARTICIPANTS

Three hundred sixty rehabilitation professionals linked to the American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, and/or the American Congress of Rehabilitation Medicine.

INTERVENTION

Online or paper survey.

MAIN OUTCOME MEASURES

Research skills, resources and productivity, salary, leadership, and academic advancement.

RESULTS

Results suggested that women rated themselves as being less skilled and having fewer resources for research compared with their male counterparts. Additionally, significantly fewer women applied for grant funding and had a lower publication rate compared with men. A proportionally larger number of women remained at lower academic ranks than men, and fewer women achieved senior academic ranks or positions of leadership. Even after adjusting for potential confounding factors, female sex remained a significant variable associated with lower salaries and lower manuscript production. Unlike men, female respondents tended to believe that being a woman was a negative factor with respect to academic advancement, leadership opportunities, salary, and resources.

CONCLUSIONS

Female rehabilitation researchers were less developed professionally than their male counterparts and saw themselves as disadvantaged. These findings have potential implications for attracting women into rehabilitation research and the rehabilitation research community's efforts to sustain its academic mission, to improve research capacity, and to meet the needs of the 52 million people in the United States with disabilities.

Measuring rehabilitation research capacity: report from the AAPM&R Research Advisory Committee

There is considerable concern regarding the paucity of individuals pursuing biomedical research in general and rehabilitation research in particular. The Research Advisory Committee (RAC) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) accepted the task to explore the barriers to biomedical research careers for physicians and rehabilitation scientists and, in particular, those factors pertaining to successfully conducting rehabilitation research. Concurrently, the Foundation for PM&R was also exploring the related issue of building capacity for rehabilitation research and planning a Rehabilitation Research Summit to address this issue for the spring of 2005. The goals of the Research Summit included the identification of barriers to rehabilitation research and development of an active agenda to enhance research capacity. As such, AAPM&R and the Foundation for PM&R worked through the RAC survey to provide some key information that would help the summit leaders achieve their goals. This report presents portions of the survey related to research capacity and outlines the methodology of the data collection and analysis within the context of the capacity taxonomy framework as presented at the Research Summit, "Building Research Capacity," held in the spring of 2005. This survey report provides quantitative information about researchers and academicians, their research environment, as well as their barriers and incentives for conducting rehabilitation research. Observations here provide a platform for future work in understanding the adequacy of the rehabilitation research enterprise, its appropriateness, and ability to meet societal needs for those with disabilities.

Asymptomatic patients at high risk for deep venous thrombosis who receive inadequate prophylaxis should be screened

BACKGROUND

Patients after stroke and major orthopedic surgery have increased factors for developing deep vein thrombosis. We sought to determine the implications of screening high-risk patients to detect proximal deep vein thrombosis.

METHODS

We used decision analysis to determine the implications of screening vs not screening asymptomatic high risk patients with duplex ultrasonography to detect proximal deep venous thrombosis. The outcomes were bleeding, pulmonary embolism, death, and number of patients with true-positive, false-positive, and false-negative tests.

RESULTS

Screening with ultrasonography, all asymptomatic patients who receive appropriate prophylaxis, prevalence 5%, would result in the treatment of 3.1% patients with proximal deep vein thrombosis (true positives); 2.9% without proximal deep vein thrombosis (false positives) and in the lack of diagnosis in 1.9% patients (false negatives). At a prevalence of 20%, no prophylaxis, screening would result in the treatment of 12.4% patients with proximal deep vein thrombosis (true positives), 2.4% without proximal deep vein thrombosis (false positives), and in the lack of diagnosis in 7.6% of patients (false negatives).

CONCLUSIONS

Screening high-risk patients who receive prophylaxis is not warranted. Patients who receive no prophylaxis should be screened with ultrasonography.

Identification of preventable trauma deaths: confounded inquiries?

The published evaluation of methods for identifying preventable trauma deaths contains many unstudied confounding factors. To investigate the reliability of methods for identifying such preventable deaths, we compared three consensus systems using separate five-member general review panels assessing 20 non-central nervous system fatalities: panel A, independent judgments; panel B, discussion of all cases preceding individual judgments; and panel C, independent judgments followed by discussion and equivocal case reassignment. The Kappa concordance index was low for all methods (method A, 0.20; methods B and C, 0.40). Of the 11 deaths judged preventable by at least one panel, only one death was judged preventable by all three panels. Consensus agreement (four of five assessors) was 20% for panel A, 45% for panel B, and 10% for panel C (difference between panels B and C, p less than 0.03). In panel C, discussion affected the rate of equivocal case designation from 30% to 5%. Thus different consensus methods yielded different results. We conclude that individual case review can be severely flawed and therefore should not be used to measure institutional quality of patient care. We recommend that assessment of institutional performance should be based on objective evaluation methods, which require the study of patient population outcomes, rather than on subjective methods in which individual cases are reviewed.

Behavioral disturbances in children after trauma

The psychological effects of nonneurologic trauma on children are poorly recognized. We hypothesized that physical trauma in children, with or without head injury, would result in substantial and persistent psychological and behavioral abnormalities. Using a short telephone survey followed by a detailed behavioral checklist, we studied psychobehavioral dysfunction in children who had experienced trauma either with or without minor head injury (n = 40 each) as well as in a comparative group of children after emergency appendectomy (n = 80). Substantial behavioral disability was identified by the detailed checklist in 35% and 28% of children without and with head injury, respectively, but in none after appendectomy. Dysfunctions included phobias, major scholastic difficulties, rage attacks, and episodic depression that continued for a long period. Even in the 67% of children who eventually fully recovered, the duration of symptoms after the time of injury was an average of 19 months. Demographics, socioeconomic status, severity of injury, and length of hospitalization did not correlate with dysfunction, and these traumatized children's siblings had no reported history of trauma or psychological difficulties. Thus, parental opinion about behavioral dysfunction appears sensitive and specific and is therefore a useful screening index. These results suggest that injured children, even after minor trauma, may suffer substantial and long-lasting behavioral changes to a degree hitherto unrecognized.

Low back injury in industry: the value of a recovery program

Low back pain is the most frequent chronic disabling condition in the United States in patients younger than 45 years, and it is the second largest cause of employee absenteeism. In this retrospective study involving extreme working conditions at an industrial plant, we found that 20% of all employees incurred a back injury (occupational and nonoccupational) during the 12-month study period, costing more than 5,000 days of work lost, and approximately $920,000. Based on these findings a three-phased program of education/prevention, physical therapy, and an on-site rehabilitation workshop was implemented. After the first operational year, the net saving to the corporation was $255,000, and all employees who participated in the program returned to work within 60 days. We conclude that good job design, employee education on back injury prevention, and immediate on-site rehabilitation for injuries incurred can reduce employee disability and lost work time thus benefiting the employer and employee alike.

Splenic rupture at colonoscopy

We report splenic rupture a few hours after a colonoscopy. Even though the patient had no previous history of splenic injury or symptoms attributable to splenocolonic adhesions, exploration revealed adhesions between the spleen and the colon at the level of the splenic flexure. Pathological examination revealed capsular thickening and fibrosis. Splenocolonic adhesions may lead to potentially lethal rupture of the spleen. A careful history prior to endoscopy should rule out pathological conditions that may lead to formation of adhesions between the spleen and the colon. In addition, the endoscopist should consider splenic rupture after colonoscopy in the patient who develops abdominal pain and acute anemia without evidence of intestinal perforation or external bleeding.