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Purpose This paper aims to design and evaluate an innovative community-based service for adults with autism in a rural region of Northern Ireland. The goal was to reduce their social isolation through gaining social skills and building social networks. Design/methodology/approach Over three years, 54 persons with a median age of 21 years received 12 months of one-to-one, personalised support and opportunities to participate in peer groups and social activities which are detailed in the paper. Quantitative and qualitative information about the impact of the service was obtained from its users, their relatives, as well as service personnel. Findings Service users rated themselves to have changed in more ways than did their relatives and staff although there was a consensus that the changes were most marked in terms of spending more time out of the house, engaging in more community activities, being more independent and increased confidence. The main benefits they perceived from participation in the project were socialising, new experiences and learning new things. Research limitations/implications As with many service projects, a longer term follow-up of service users was not possible due to resource constraints. Practical implications The service could be replicated with suitable staff although current constraints on social care budgets have limited its expansion to more users and extension to other areas in Northern Ireland. Social implications Reducing the social isolation of adult persons with autism spectrum disorders needs to be personalised to the person, their living circumstances and the community in which they live. Family carers also stand to gain from community support services. Originality/value This low level, low cost service was implemented in a predominantly rural area with a majority of users from socially deprived areas.

Cognitive rehabilitation is established as a core intervention within rehabilitation programs following a traumatic brain injury (TBI). Digitally enabled assistive technologies offer opportunities for clinicians to increase remote access to rehabilitation supporting transition into home. Brain Computer Interface (BCI) systems can harness the residual abilities of individuals with limited function to gain control over computers through their brain waves. This paper presents an online cognitive rehabilitation application developed with therapists, to work remotely with people who have TBI, who will use BCI at home to engage in the therapy. A qualitative research study was completed with people who are community dwellers post brain injury (end users), and a cohort of therapists involved in cognitive rehabilitation. A user-centered approach over three phases in the development, design and feasibility testing of this cognitive rehabilitation application included two tasks (Find-a-Category and a Memory Card task). The therapist could remotely prescribe activity with different levels of difficulty. The service user had a home interface which would present the therapy activities. This novel work was achieved by an international consortium of academics, business partners and service users.

Gathering end users requirements at the development phase of innovative systems is a critical but often over looked feature of design. This paper presents the outcome of five focus groups undertaken to determine the key user needs for a novel state of the art modular multimodal system that can be customized and adapted to the needs of people with complex disabilities. Users discussed their desires for the system, their preferences for control, the use of a wearable upper limb exoskeleton, and finally usability factors were outlined. Future research will focus on target end users validating the iterative prototypes that emerge from this user centered design approach.

The BackHome system is a multifunctional BCI system, the final outcome of a User-Centered Design approach, whose ambition is to move BCI systems from laboratories into the home of people in need for their independent home use. The paper presents the results of testing and evaluation of the BackHome system with end-users at their own homes. Results show moderate to good acceptance from end-users, caregivers, and therapists, which reported promising usability levels, good user satisfaction, and levels of control in the use of services and home support based on remote monitoring tools.

The novel BackHome system offers individuals with disabilities a range of useful services available via brain-computer interfaces (BCIs), to help restore their independence. This is the time such technology is ready to be deployed in the real world, that is, at the target end users’ home. This has been achieved by the development of practical electrodes, easy to use software, and delivering telemonitoring and home support capabilities which have been conceived, implemented, and tested within a user-centred design approach. The final BackHome system is the result of a 3-year long process involving extensive user engagement to maximize effectiveness, reliability, robustness, and ease of use of a home based BCI system. The system is comprised of ergonomic and hassle-free BCI equipment; one-click software services for Smart Home control, cognitive stimulation, and web browsing; and remote telemonitoring and home support tools to enable independent home use for nonexpert caregivers and users. BackHome aims to successfully bring BCIs to the home of people with limited mobility to restore their independence and ultimately improve their quality of life.

This paper presents the findings from an evaluation of a Brain Computer Interface (BCI) with a group of people without brain injury and end users with acquired brain injury. The system held a number of applications to enable communication, web browsing, smart home control and cognitive rehabilitation. Participants engaged in a three-session cycle of testing and completed usability questionnaires within the user centred design approach adopted. The average accuracy score for the people without brain injury was 82.6% (±4.7) with the cognitive rehabilitation reporting the highest response rate. End users recorded an average accuracy score of 74% (±11.5), with the speller logging the highest accuracy score. The findings outline the importance of engaging with end users to identify the current functionality and usability of such systems in order to move them closer towards a marketable product used in a domestic environment.

The effects of the somatostatin analogue, octreotide on postural hypotension have been compared with placebo, before and after food ingestion in two groups with primary autonomic failure; patients with pure autonomic failure, and patients with additional neurological involvement as part of multiple system atrophy. After placebo, supine blood pressure was unchanged, but after octreotide, it rose in both groups. Octreotide reduced pre-prandial postural and supine post-prandial hypotension in both pure autonomic failure and multiple system atrophy patients. Postural hypotension post-prandially was considerably worse after placebo; this was reduced after octreotide. Plasma noradrenaline and adrenaline levels remained unchanged. Plasma glucose levels rose higher and faster after placebo. Insulin levels were similar in both groups at rest, but rose higher in patients with pure autonomic failure after placebo. After octreotide, the insulin response in both groups was suppressed. We conclude that octreotide prevents post-prandial hypotension in both groups with primary autonomic failure and additionally reduces postural hypotension both before and after food ingestion. The greater rise in insulin levels in patients with pure autonomic failure suggests that insulin may be a contributing factor to the more severe post-prandial hypotension observed in this group of patients.

Corneal and conjunctival sensitivity are important components of the eye’s defence mechanism. However, it is also suggested that they play a role in detecting thinning or breaks in the preocular tear film as part of the normal blink process.1,2 The mechanism for detecting these changes in the tear film structure is unclear, but the following model can be proposed. The open eye experiences a slight reduction in surface temperature, as a result of evaporation, over both the cornea and conjunctiva.3 This temperature reduction is not even and where the tear film thins, a greater temperature change occurs. Sensory nerves in the cornea and conjunctiva detect these temperature changes, and a blink is initiated. This reforms the tear film and re-stabilises the preocular tear film temperature.

A patient with recurrent episodes of dizziness and blackouts is described. Detailed cardiac and neurological investigations were normal. Autonomic assessment excluded postural hypotension and confirmed normal sympathetic vasoconstrictor function. Cardiac parasympathetic function in response to deep breathing, hyperventilation and ocular pressure was normal. Left carotid sinus massage only reproducibly lowered blood pressure with minimal change in heart rate. This occurred mainly during head-up tilt. The fall in blood pressure was not affected by the muscarinic blocker atropine, or the peptide release inhibitor, octreotide. A diagnosis of left carotid sinus hypersensitivity of the vasodepressor variety was made. Left carotid sinus denervation was performed. This successfully prevented further episodes of dizziness and blackouts. The ability to measure beat-to-beat blood pressure non-invasively was of particular importance in diagnosis, and in the assessment of management options in this patient.

Corneal and conjunctival sensitivity are important components of the eye’s defence mechanism. However, it is also suggested that they play a role in detecting thinning or breaks in the preocular tear film as part of the normal blink process.1,2 The mechanism for detecting these changes in the tear film structure is unclear, but the following model can be proposed. The open eye experiences a slight reduction in surface temperature, as a result of evaporation, over both the cornea and conjunctiva.3 This temperature reduction is not even and where the tear film thins, a greater temperature change occurs. Sensory nerves in the cornea and conjunctiva detect these temperature changes, and a blink is initiated. This reforms the tear film and re-stabilises the preocular tear film temperature.

Brain-Computer Interfaces (BCI) are systems that can be controlled by the user through harnessing their brain signals. Extensive research has been undertaken within a laboratory setting with healthy users to illustrate the usability of such systems. To bring these systems to users with severe disabilities it is necessary to develop simple, easy to use systems that can be operated by non-experts outside of the lab and are evaluated by real end users preferably through a user centered design approach. This paper presents a user centered evaluation of a P300 BCI operated by non-expert users in a rehabilitation center with a control group of five healthy participants without acquired brain injury (ABI) and five end users with ABI. Each participant aimed to complete the 30-step protocol three separate times and rate his or her satisfaction from 0 to 10 on the Visual Analogue Scale after each session. Participants then rated their satisfaction with the BCI on the extended QUEST 2.0 and a customized usability questionnaire. The results indicated that end-users were able to achieve an average accuracy of 55% compared to the control group that reported an average of 78%. The findings indicated that participants were satisfied with the BCI but felt frustrated when it did not respond to their commands. This work was phase one of three to move the BCI system into end users homes. Key recommendations for advancing the P300 BCI towards an easy to use, home-based system were identified, including reducing the complexity of the setup, ensuring the system becomes more responsive and increasing the overall functionality.