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Shared emotional experiences during musical activities among musicians can be coupled with brainwave synchronization. For non-speaking individuals with CP, verbal communication may be limited in expressing mutual empathy. Therefore, this case study explored interbrain synchronization among a non-speaking CP (female, 18 yrs), her parent, and a music therapist by measuring their brainwaves simultaneously during four music and four storytelling sessions. In only the youth-parent dyad, we observed a significantly higher level of interbrain synchronization during music rather than story-telling condition. However, in both the youth-parent and youth-therapist dyad, regardless of condition type, significant interbrain synchronization emerged in frontal and temporal lobes in the low-frequency bands, which are associated with socio-emotional responses. Although interbrain synchronization may have been induced by multiple factors (e.g., external stimuli, shared empathetic experiences, and internal physiological rhythms), the music activity setting deserves further study as a potential facilitator of neurophysiological synchrony between youth with CP and caregivers/healthcare providers.

A concussion is known as a functional injury affecting brain communication, integration, and processing. There is a need to objectively measure how concussions disrupt brain activation while completing ecologically relevant tasks.The objective of this study was to compare brain activation patterns between concussion and comparison groups (non-concussed youth) during a cognitive-motor single and dual-task paradigm utilizing functional near-infrared spectroscopy (fNIRS) in regions of the frontal-parietal attention network and compared to task performance.Youth with concussion generally exhibited hyperactivation and recruitment of additional brain regions in the dorsal lateral prefrontal (DLPFC), superior (SPC) and inferior parietal cortices (IPC), which are associated with processing, information integration, and response selection. Additionally, hyper- or hypo-activation patterns were associated with slower processing speed on the cognitive task. Our findings corroborate the growing literature suggesting that neural recovery may be delayed compared to the restoration of behavioral performance post-concussion.Concussion, near-infrared spectroscopy, dual-task paradigm, cognitive, motor, brain activation.

There is increasing interest in developing intuitive brain-computer interfaces (BCIs) to differentiate intuitive mental tasks such as imagined speech. Both electroencephalography (EEG) and function...

One method for improving the accuracy and hence the rate of communication of a brain–computer interface (BCI) is to automatically correct erroneous classifications by exploiting error-related poten...

Purpose: Existing speech generating devices (SGD) often require caregiver intervention for setup and positioning, and thus limit opportunities for spontaneous social interaction. The advent of cond...

For non-verbal individuals, brain-computer interfaces (BCIs) are a potential means of communication. Near-infrared spectroscopy (NIRS) is a brain-monitoring modality that has been considered for BCIs. To date, limited NIRS-BCI testing has involved online classification, particularly with individuals with severe motor impairments.We tested an online NIRS-BCI developed for a non-verbal individual with severe congenital motor impairments. The binary BCI differentiated categorical verbal fluency task (VFT) performance and rest using prefrontal measurements. The participant attended five sessions, the last two of which were online with classification feedback.An online classification accuracy of 63.33% was achieved using a linear discriminant classifier trained on a four-dimensional feature set. An offline, cross-validation analysis of all data yielded an optimal adjusted classification accuracy of 66.6 ± 9.11%. Inconsistent functional responses, contradictory effects of feedback, participant fatigue and motion artefacts were identified as challenges to online classification specific to this participant.Results suggest potential in using an NIRS-BCI controlled by the VFT in instances of severe congenital impairments. Further testing with users with severe disabilities is necessary. Implications for Rehabilitation Brain-computer interfaces (BCIs) can provide a non-motor based means of communication for individuals with severe motor impairments. Near-infrared spectroscopy (NIRS) is a haemodynamic-based brain-imaging modality used in BCIs. To date, NIRS-BCIs have not been thoroughly tested with potential target users. This case study shows that NIRS-BCIs may offer a means of practical communication for individuals with severe congenital impairments and continued exploration is advisable.

The error-related potential (ErrP) can inform the correction of brain-computer interface (BCI) mistakes, but it has thus far been incorporated only into visual BCIs, with mixed success. Given that ErrPs are thought to have higher impact when BCI accuracy is relatively low, we sought to identify the aurally evoked ErrP and investigate its auto-corrective value in auditory BCIs, which typically yield lower accuracies than visual BCIs. We implemented an auditory P300 BCI with four selectable items. Each of nine typically developed participants attempted to spell letter sequences on two separate days. Erroneous feedback was detected by (i) making use of the ErrP, (ii) assessing BCI selection confidence, and (iii) combining these two pieces of information into a hybrid detector. ErrPs were detected with an average cross-validation area under the curve of 0.946. Simulated automatic correction by reverting to the second-ranked letter improved participant-wise information transfer rate by 2.3 bits/minute when err...

This study further delineates the merits and limitations of the Access Technology Delivery Protocol (ATDP) through its application to two children with severe disabilities.We conducted mixed methods case studies to demonstrate the ATDP with two children with no reliable means of access to an external device. Evaluations of response efficiency, satisfaction, goal attainment, technology use and participation were made after 8 and 16 weeks of training with custom access technologies.After 16 weeks, one child's switch offered improved response efficiency, high teacher satisfaction and increased participation. The other child's switch resulted in improved satisfaction and switch effectiveness but lower overall efficiency. The latter child was no longer using his switch by the end of the study.These contrasting findings indicate that changes to any contextual factors that may impact the user's switch performance should mandate a reassessment of the access pathway. Secondly, it is important to ensure that individuals who will be responsible for switch training be identified at the outset and engaged throughout the ATDP. Finally, the ATDP should continue to be tested with individuals with severe disabilities to build an evidence base for the delivery of response efficient access solutions. Implications for Rehabilitation A data-driven, comprehensive access technology delivery protocol for children with complex communication needs could help to mitigate technology abandonment. Successful adoption of an access technology requires personalized design, training of the technology user, the teaching staff, the caregivers and other communication partners, and integration with functional activities.

Background Physiological responses have been used in individuals with acquired disability to enable communicative interaction without motor movement. This study explored four autonomic nervous system (ANS) signals — electrodermal activity, skin temperature, cardiac patterns and respiratory patterns — to enable interaction with individuals born with profound intellectual and multiple disabilities (PIMD). Method A series of case studies were conducted to teach a 15-year-old individual with PIMD to voluntarily control his ANS signals for the purposes of communicative interaction. Training was carried out according to an alternating treatment single-subject research design. Results Training was unsuccessful; however, ANS signal patterns revealed issues unique to people with PIMD: profound intrasubject variability, discrepancy between physiological responses and caregiver perspectives, and the participant ’ s lack of contingency awareness. Conclusions These three priority areas unique to people with congenital PIMD must be addressed before ANS signals can be used to enable communicative interaction with this population.

Children with hyperkinetic movement (HKM) often have limited access to traditional augmentative and alternative communication technologies (e.g., mechanical switches). To seek a communication solution for these children, this study explored the possibility that discernable biomechanical patterns, related to preference, exist amid HKM. We deployed a unified approach to analyse a child's movements, fusing caregiver and clinician observations with quantitative data (accelerations of the upper extremities). Two case studies were examined. In both, the accelerometer data identified preference at adjusted accuracies statistically above chance using a linear discriminant classifier. Visually, communicative movement patterns were identified in the first child (κ=0.25-0.27) but not in the second child (κ=0.03-0.11). Implications of this study include possible enhancement in communication and independence for these children.

Infrared thermography has been recently proposed as an access technology for individuals with disabilities, but body functions and structures pertinent to its use have not been documented. Seven clients (2 adults, 5 youth) with severe disabilities and their primary caregivers participated in this study. All clients had a Gross Motor Functional Classification System (GMFCS) level of 5, but each possessed a unique set of extant physical movements. We tested the clients' ability to activate the infrared thermal access technology via a cued mouth open-close exercise. In addition, the clients or their primary caregivers were interviewed for descriptive information about the clients' physical, cognitive, and sensory function; communication skills; medical background; and history of switch use. Several impairments were identified as contraindications to infrared thermal access, spanning physiological (e.g., frequent fluctuations in body temperature, seizures, pain), motor (e.g., poor trunk control, involuntary m...

A novel dual-output vocal cord vibration switch is described and evaluated for two individuals with severe motor disabilities and complex communication needs. An evaluative case series was performed to compare the new device to its previously proposed single-output counterpart in terms of accuracy, speed and user fatigue.In an ABAB design, participants were followed for up to 16 days as they performed several image matching tasks. Custom-written software recorded the average time taken to match each item, as well as the total number of selection errors. Participants reported their fatigue levels using a modified five-point Borg scale.For one participant, the dual-output version significantly decreased task completion time and selection error (p0.05, Kolmogorov-Smirnov test), thus improving her communication ability. For the second participant, no significant differences were observed between the single- and dual-output systems. Fatigue associated with illness and self-reported stress with school exams were identified as limiting factors.The dual-output vocal cord vibration switch provides a promising new alternative for individuals with severe and multiple disabilities who are able to hum or produce vocalizations. Both participants expressed desire to continue using the device for educational and entertainment purposes.

Purpose. This study reports a client-centred development of a non-contact access switch based on an infrared thermal imaging of mouth opening–closing activity of an individual with severe spastic quadriplegic cerebral palsy.Method. Over a 6-month period, the client participated in five test sessions to inform the development of an infrared thermal switch. The client completed eight stimulus-response trials (switch test) and eight word-matching trials (scan test) using the infrared thermal switch and provided subjective feedback throughout.Results. For the switch test, the client achieved an average correct activation rate of 90% and average response time of 2.4 s. His mean correct activation rate on the scan test improved from 65 to 80% over the course of system development, with an average response time of 11.7 s.Conclusions. An infrared thermography switch tuned to a client's extant orofacial gestures is a practical non-invasive access solution and warrants further research in clients with severe physic...

This case study documents the process of designing a custom-tailored bedside computer access solution for a 20-year old individual with quadriplegia and reports the effects of computer access on her participation in life activities.We adopted a person-focused approach to match the individual to an access solution. Two months after the access solution's introduction, we measured its impact using a 2-dimensional Fitt's Law test and questionnaire from the ISO 9241-9 standards document, typing tests, a usage log and a semi-structured interview. The Canadian Occupational Performance Measure was also administered pre- and post- access, focusing on the client's perceived ability to use the computer.After 2 months, the individual was spending an average of 8.4 h per day on the computer, engaging in electronic communication, recreational, and educational activities. She learned single-switch typing with a throughput of 1.03 bits/s and targeting accuracy of 87.5%. The questionnaire revealed that the client was thoroughly satisfied with the interface. These results were interpreted as positive gains in the International Classification of Functioning, Disability and Health domains of communication and social interaction.By addressing individual goals, abilities and relevant environmental factors, a bedside computer access solution can be developed for individuals in long-term care. The introduction of a computer access solution augmented the participant's communication, leisure and educational activities, as well as perceived independence.

The present study proposed a video-based access technology that facilitated a non-contact tongue protrusion access modality for a 7-year-old boy with severe spastic quadriplegic cerebral palsy (GMFCS level 5). The proposed system featured a centre camera and two peripheral cameras to extend coverage of the frontal face view of this user for longer durations.The child participated in a descriptive case study. The participant underwent 3 months of tongue protrusion training while the multiple camera tongue switch prototype was being prepared. Later, the participant was brought back for five experiment sessions where he worked on a single-switch picture matching activity, using the multiple camera tongue switch prototype in a controlled environment.The multiple camera tongue switch achieved an average sensitivity of 82% and specificity of 80%. In three of the experiment sessions, the peripheral cameras were associated with most of the true positive switch activations. These activations would have been missed by a centre-camera-only setup.The study demonstrated proof-of-concept of a non-contact tongue access modality implemented by a video-based system involving three cameras and colour video processing.

Research and development in the field of access technologies for individuals with severe motor impairments has accelerated over the past 10 years. Many emergent alternatives to conventional mechanical switches, such as infrared sensing, electromyography, oculography, and computer vision, have been investigated for those retaining some limited volitional motor ability. At the same time, electroencephalography, electrocorticography, intracortical recordings, and electrodermal activity have been explored for those presenting as locked in. The relevant literature is scattered across many disciplines, obfuscating the strength of the clinical evidence in support of the different access technologies currently in development. This article systematically organizes the literature on the aforementioned access technologies, summarizing their underlying operational mechanisms while reviewing the clinical evidence reported between 1996 and 2006. Research evidence within this period is generally found to be at the case study or uncontrolled study level, with very modest sample sizes. Novel mechanical switches and electroencephalography-based access systems dominate the literature, whereas many other movement-based access modalities have emerged with promising early findings. Access methods for those without extant physical movement constitute a critical direction for future and ongoing research efforts.

To measure consumer satisfaction with upper limb prosthetics and provide an enumerated list of design priorities for future developments.A self-administered, anonymous survey collected information on participant demographics, history of and goals for prosthesis use, satisfaction, and design priorities. The questionnaire was available online and in paper format and was distributed through healthcare providers, community support groups, and one prosthesis manufacturer; 242 participants of all ages and levels of upper limb absence completed the survey.Rates of rejection for myoelectric hands, passive hands, and body-powered hooks were 39%, 53%, and 50%, respectively. Prosthesis wearers were generally satisfied with their devices while prosthesis rejecters were dissatisfied. Reduced prosthesis weight emerged as the highest priority design concern of consumers. Lower cost ranked within the top five design priorities for adult wearers of all device types. Life-like appearance is a priority for passive/cosmetic prostheses, while improved harness comfort, wrist movement, grip control and strength are required for body-powered devices. Glove durability, lack of sensory feedback, and poor dexterity were also identified as design priorities for electric devices.Design priorities reflect consumer goals for prosthesis use and vary depending on the type of prosthesis used and age. Future design efforts should focus on the development of more light-weight, comfortable prostheses.

Prosthesis use and abandonment is a complex function of variables defining the contextualized individual. This review presents a comprehensive panoramic of these factors as related to the management of upper limb deficiency. Menderson's model for health service utilization was used to frame prosthesis use and abandonment as a function of (1) predisposing characteristics of the individual (e.g. gender or level of limb loss); (2) established need, as characterized by lifestyle- and age-related demands; and (3) enabling resources (e.g. clinical and social). English-language articles pertaining to these components were identified in a search of Ovid, PubMed, ISI Web of Science and www.scholar.google.com (1980-November 2006) for key words upper limb and prosthesis. Approximately 90 articles were included as evidence in this review. Reersonal and contextual factors are critical determinants of prosthesis acceptance. While the influence of some factors (i.e. lifestyle, level of limb loss), is strongly supported in the literature, the impact of others, (i.e. age of fitting, efficacy of training protocols), remain controversial. Conhanced understanding of these factors is required to optimize clinical practices, guide design efforts, and satiate demand for evidence-based measures of intervention. Future research should comprise of controlled, multifactor studies adopting standardized outcome measures and providing comprehensive descriptions of population characteristics.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited., Art plays a vital role in developing a child’s communication, problem solving, social and emotional skills as well as motor control, creativity and self-expression. For children with severe impairments that limit their access to traditional art processes, it is important to find alternative methods to enable these children to express themselves creatively. Advantages of a virtual art program include its ability to compensate for specific physical impairments, flexibility of incorporating sensory feedback, such as audio, to improve engagement, the avoidance of the untidiness often associated with children’s arts activities, and the absence of physical parts conducive to accidental ingestion. The Kinect Virtual Art Program (KVAP) uses the Microsoft Kinect gesture recognition technology that facilitates a new method of engaging children in therapeutic recreation. The program was designed to allow the creation of art through non-contact ‘virtual’ button activation. A pilot study was performed with five children with severe impairments to determine the level of physical engagement that these children could attain while using the KVAP over five sessions. The results indicated that the participants enjoyed using the KVAP and increasingly engaged with it over the sessions. The KVAP encouraged physical activity and enabled children to create their own works of art, an activity that was previously inaccessible to them using traditional approaches. The KVAP may offer a potential new avenue for therapy, play and exploration.