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Scherer R.,University of Graz | Faller J.,University of Graz | Friedrich E.V.C.,University of Graz | Friedrich E.V.C.,University of California at San Diego | And 4 more authors.
PLoS ONE | Year: 2015

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. © 2015 Scherer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Opisso E.,Institute Universitari Of Neurorehabilitacio Adscrit Uab | Opisso E.,Autonomous University of Barcelona | Borau A.,Institute Universitari Of Neurorehabilitacio Adscrit Uab | Borau A.,Autonomous University of Barcelona | Rijkhoff N.J.M.,University of Aalborg
Neurourology and Urodynamics | Year: 2013

Aims To investigate the effects of subject controlled dorsal genital nerve (DGN) electrical stimulation on neurogenic detrusor overactivity (NDO) in subjects at home. Methods Subjects underwent a 5-day study at home with DGN stimulation. Stimulation was provided with surface electrodes placed either on the dorsal penile shaft in males and on or close to the clitoris in females. The days 1 and 5 were with no stimulation whereas days 2-4 were with stimulation. Two urodynamic studies were performed at the beginning and at the end of the study. A bladder diary was obtained. Results Eleven subjects with NDO and with urge incontinence were included. One subject stopped the protocol before the end of the 5-day trial and two did not undergo the second urodynamic study. The subjects showed a statistically significant increase in bladder capacities compared to baseline (P = 0.047). Mean volume per day voided significantly increased over the study within the subjects. Differences between day 1 and day 5 were statistically significant (P = 0.028). Conclusions The feasibility and the globally positive outcomes of the study indicate that the stimulation of the dorsal genital nerve can be an option for the treatment of the NDO. Neurourol. Urodynam. 32: 1004-1009, 2013. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc.

Subirats L.,Eurecat | Subirats L.,Autonomous University of Barcelona | Lopez-Blazquez R.,Institute Universitari Of Neurorehabilitacio Adscrit Uab | Ceccaroni L.,1000001 Labs | And 4 more authors.
International Journal of Environmental Research and Public Health | Year: 2015

The objective of this research is to provide a standardized platform to monitor and predict indicators of people with traumatic brain injury using the International Classification of Functioning, Disability and Health, and analyze its potential benefits for people with disabilities, health centers and administrations. We developed a platform that allows automatic standardization and automatic graphical representations of indicators of the status of individuals and populations. We used data from 730 people with acquired brain injury performing periodic comprehensive evaluations in the years 2006–2013. Health professionals noted that the use of color-coded graphical representation is useful for quickly diagnose failures, limitations or restrictions in rehabilitation. The prognosis system achieves 41% of accuracy and sensitivity in the prediction of emotional functions, and 48% of accuracy and sensitivity in the prediction of executive functions. This monitoring and prognosis system has the potential to: (1) save costs and time, (2) provide more information to make decisions, (3) promote interoperability, (4) facilitate joint decision-making, and (5) improve policies of socioeconomic evaluation of the burden of disease. Professionals found the monitoring system useful because it generates a more comprehensive understanding of health oriented to the profile of the patients, instead of their diseases and injuries. © 2015 by the authors; licensee MDPI, Basel, Switzerland.

Vidal J.,Institute Universitari Of Neurorehabilitacio Adscrit Uab | Slof J.,Autonomous University of Barcelona | Serrano D.,Autonomous Consultant | Marques T.,Institute Universitari Of Neurorehabilitacio Adscrit Uab | And 2 more authors.
Expert Review of Pharmacoeconomics and Outcomes Research | Year: 2016

Background: Current knowledge about long-term economic consequences of Intrathecal Baclofen Therapy (ITB Therapy®) is incomplete. Methods: A markov model was developed to estimate long-term clinical and economic outcomes with ITB Therapy® and conventional medical management of severe refractory non-focal disabling spasticity. Clinical and cost inputs were obtained through a non-interventional, prospective, observational study in a Spanish neurorehabilitation hospital. Results: ITB Therapy® increased remaining lifetime costs by €35,605 and resulted in a gain of 1.06 quality-adjusted life-years (QALYs), thus showing an incremental cost-effectiveness ratio (ICER) of €33,619/QALY gained. In alternative scenarios, reflecting other clinical settings and management options, considerably lower ICER values were obtained. In particular, opportunities were identified to improve efficiency by setting clinically and economically sound targets for post-operation length of stay. Conclusion: In the Spanish setting, ITB Therapy® resulted in an ICER close to €30,000/QALY gained; potential ways to reduce costs and further enhance efficiency can be identified. © 2016 Informa UK Limited, trading as Taylor & Francis Group

Kumru H.,Institute Universitari Of Neurorehabilitacio Adscrit Uab | Kumru H.,University of Barcelona | Kumru H.,Fundacio Institute Dinvestigacio En Ciencies Of La Salut Germans Trias I Pujol | Portell E.,Institute Universitari Of Neurorehabilitacio Adscrit Uab | And 6 more authors.
Parkinsonism and Related Disorders | Year: 2014

Background: No studies have examined the association between RLS and the sequelae of poliomyelitis (PM). We studied the frequency and severity of RLS in a group of consecutive patients with the sequelae of poliomyelitis (PM) and the effect of treatment with dopaminergic drugs. Methods: A diagnosis of RLS was made according to the criteria of the International RLS Study Group, and severity was assessed by the RLS rating scale. Information on sex, age, age at onset, site affected by PM, disease duration of PM, and history of post-polio syndrome (pPS) was obtained in a cohort of 52 PM patients. Result: The mean age was 55.9±6.5 years; 39 patients had post-polio syndrome (75%). RLS was diagnosed in 21 (40.4%) patients. Sixteen of the 21 patients (76.2%) with RLS had pPS, which was similar to the non-RLS group (74.2% patients with pPS). RLS symptoms were very severe in 5 patients, severe in 13, moderate in 2 and mild in 1. Nineteen of the 21 patients with RLS had symptoms predominantly in the more affected lower limb (90% of patients). Sixteen patients received dopaminergic agonist treatment with a significant reduction in their scores on the RLS severity scale from 28.3±4.7 to 6.9±7.3 (. p<0.001). Discussion: RLS occurs frequently in patients with PM, both in those with and without pPS, and responds well to treatment with dopaminergic drugs. © 2014 Elsevier Ltd.

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