@article{FroehlichZahnerSchmalzingetal.2023, author = {Froehlich, Matthias and Zahner, Antonia and Schmalzing, Marc and Gernert, Michael and Strunz, Patrick-Pascal and Hueper, Sebastian and Portegys, Jan and Schwaneck, Eva Christina and Gadeholt, Ottar and K{\"u}bler, Andrea and Hewig, Johannes and Ziebell, Philipp}, title = {Patient-reported outcomes provide evidence for increased depressive symptoms and increased mental impairment in giant cell arteritis}, series = {Frontiers in Medicine}, volume = {10}, journal = {Frontiers in Medicine}, doi = {10.3389/fmed.2023.1146815}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-319761}, year = {2023}, abstract = {Objectives The spectrum of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) represents highly inflammatory rheumatic diseases. Patients mostly report severe physical impairment. Possible consequences for mental health have been scarcely studied. The aim of this study was to investigate psychological well-being in the context of GCA and PMR. Methods Cross-sectional study with N = 100 patients with GCA and/or PMR (GCA-PMR). Patient-reported outcomes (PROs) were measured using the Short Form 36 Version 2 (SF-36v2) and visual analog scale (VAS) assessment. Moreover, the Patient Health Questionnaire 9 (PHQ-9) was used in 35 of 100 patients to detect depression. To compare PROs with physician assessment, VAS was also rated from physician perspective. To assess a possible association with inflammation itself, serological parameters of inflammation (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]) were included. Results In all scales of the SF-36v2 except General Health (GH) and in the physical and mental sum score (PCS, MCS), a significant impairment compared to the German reference collective was evident (MCS: d = 0.533, p < 0.001). In the PHQ-9 categorization, 14 of the 35 (40\%) showed evidence of major depression disorder. VAS Patient correlated significantly with PHQ-9 and SF-36 in all categories, while VAS Physician showed only correlations to physical categories and not in the mental dimensions. Regarding inflammatory parameters, linear regression showed CRP to be a complementary significant positive predictor of mental health subscale score, independent of pain. Conclusion PRO show a relevant impairment of mental health up to symptoms of major depression disorder. The degree of depressive symptoms is also distinctly associated with the serological inflammatory marker CRP.}, language = {en} } @article{GrappEllKiermeieretal.2022, author = {Grapp, Miriam and Ell, Johanna and Kiermeier, Senta and Haun, Markus W. and K{\"u}bler, Andrea and Friederich, Hans-Christoph and Maatouk, Imad}, title = {Feasibility study of a self-guided internet-based intervention for family caregivers of patients with cancer (OAse)}, series = {Scientific Reports}, volume = {12}, journal = {Scientific Reports}, doi = {10.1038/s41598-022-21157-9}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300537}, year = {2022}, abstract = {Despite high levels of distress, family caregivers of patients with cancer rarely seek psychosocial support and Internet-based interventions (IBIs) are a promising approach to reduce some access barriers. Therefore, we developed a self-guided IBI for family caregivers of patients with cancer (OAse), which, in addition to patients' spouses, also addresses other family members (e.g., adult children, parents). This study aimed to determine the feasibility of OAse (recruitment, dropout, adherence, participant satisfaction). Secondary outcomes were caregivers' self-efficacy, emotional state, and supportive care needs. N = 41 family caregivers participated in the study (female: 65\%), mostly spouses (71\%), followed by children (20\%), parents (7\%), and friends (2\%). Recruitment (47\%), retention (68\%), and adherence rates (76\% completed at least 4 of 6 lessons) support the feasibility of OAse. Overall, the results showed a high degree of overall participant satisfaction (96\%). There were no significant pre-post differences in secondary outcome criteria, but a trend toward improvement in managing difficult interactions/emotions (p = .06) and depression/anxiety (p = .06). Although the efficacy of the intervention remains to be investigated, our results suggest that OAse can be well implemented in caregivers' daily lives and has the potential to improve family caregivers' coping strategies.}, language = {en} } @article{KleihDahmsBotrelKuebler2021, author = {Kleih-Dahms, Sonja Christina and Botrel, Loic and K{\"u}bler, Andrea}, title = {The influence of motivation and emotion on sensorimotor rhythm-based brain-computer interface performance}, series = {Psychophysiology}, volume = {58}, journal = {Psychophysiology}, number = {8}, doi = {10.1111/psyp.13832}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-259664}, year = {2021}, abstract = {While decades of research have investigated and technically improved brain-computer interface (BCI)-controlled applications, relatively little is known about the psychological aspects of brain-computer interfacing. In 35 healthy students, we investigated whether extrinsic motivation manipulated via monetary reward and emotional state manipulated via video and music would influence behavioral and psychophysiological measures of performance with a sensorimotor rhythm (SMR)-based BCI. We found increased task-related brain activity in extrinsically motivated (rewarded) as compared with nonmotivated participants but no clear effect of emotional state manipulation. Our experiment investigated the short-term effect of motivation and emotion manipulation in a group of young healthy subjects, and thus, the significance for patients in the locked-in state, who may be in need of a BCI, remains to be investigated.}, language = {en} } @article{EidelKuebler2020, author = {Eidel, Matthias and K{\"u}bler, Andrea}, title = {Wheelchair Control in a Virtual Environment by Healthy Participants Using a P300-BCI Based on Tactile Stimulation: Training Effects and Usability}, series = {Frontiers in Human Neuroscience}, volume = {14}, journal = {Frontiers in Human Neuroscience}, issn = {1662-5161}, doi = {10.3389/fnhum.2020.00265}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-207775}, year = {2020}, abstract = {Tactile stimulation is less frequently used than visual for brain-computer interface (BCI) control, partly because of limitations in speed and accuracy. Non-visual BCI paradigms, however, may be required for patients who struggle with vision dependent BCIs because of a loss of gaze control. With the present study, we attempted to replicate earlier results by Herweg et al. (2016), with several minor adjustments and a focus on training effects and usability. We invited 16 healthy participants and trained them with a 4-class tactile P300-based BCI in five sessions. Their main task was to navigate a virtual wheelchair through a 3D apartment using the BCI. We found significant training effects on information transfer rate (ITR), which increased from a mean of 3.10-9.50 bits/min. Further, both online and offline accuracies significantly increased with training from 65\% to 86\% and 70\% to 95\%, respectively. We found only a descriptive increase of P300 amplitudes at Fz and Cz with training. Furthermore, we report subjective data from questionnaires, which indicated a relatively high workload and moderate to high satisfaction. Although our participants have not achieved the same high performance as in the Herweg et al. (2016) study, we provide evidence for training effects on performance with a tactile BCI and confirm the feasibility of the paradigm.}, language = {en} } @article{LuleKueblerLudolph2019, author = {Lul{\´e}, Doroth{\´e}e and K{\"u}bler, Andrea and Ludolph, Albert C.}, title = {Ethical principles in patient-centered medical care to support quality of life in amyotrophic lateral sclerosis}, series = {Frontiers in Neurology}, volume = {10}, journal = {Frontiers in Neurology}, issn = {1664-2295}, doi = {10.3389/fneur.2019.00259}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-196239}, year = {2019}, abstract = {It is one of the primary goals of medical care to secure good quality of life (QoL) while prolonging survival. This is a major challenge in severe medical conditions with a prognosis such as amyotrophic lateral sclerosis (ALS). Further, the definition of QoL and the question whether survival in this severe condition is compatible with a good QoL is a matter of subjective and culture-specific debate. Some people without neurodegenerative conditions believe that physical decline is incompatible with satisfactory QoL. Current data provide extensive evidence that psychosocial adaptation in ALS is possible, indicated by a satisfactory QoL. Thus, there is no fatalistic link of loss of QoL when physical health declines. There are intrinsic and extrinsic factors that have been shown to successfully facilitate and secure QoL in ALS which will be reviewed in the following article following the four ethical principles (1) Beneficence, (2) Non-maleficence, (3) Autonomy and (4) Justice, which are regarded as key elements of patient centered medical care according to Beauchamp and Childress. This is a JPND-funded work to summarize findings of the project NEEDSinALS (www.NEEDSinALS.com) which highlights subjective perspectives and preferences in medical decision making in ALS.}, language = {en} } @article{PaeleckeHabermannPaeleckeMauthetal.2019, author = {Paelecke-Habermann, Yvonne and Paelecke, Marko and Mauth, Juliane and Tschisgale, Juliane and Lindenmeyer, Johannes and K{\"u}bler, Andrea}, title = {A comparison of implicit and explicit reward learning in low risk alcohol users versus people who binge drink and people with alcohol dependence}, series = {Addictive Behaviors Reports}, volume = {9}, journal = {Addictive Behaviors Reports}, doi = {10.1016/j.abrep.2019.100178}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-201406}, pages = {100178}, year = {2019}, abstract = {Chronic alcohol use leads to specific neurobiological alterations in the dopaminergic brain reward system, which probably are leading to a reward deficiency syndrome in alcohol dependence. The purpose of our study was to examine the effects of such hypothesized neurobiological alterations on the behavioral level, and more precisely on the implicit and explicit reward learning. Alcohol users were classified as dependent drinkers (using the DSM-IV criteria), binge drinkers (using criteria of the USA National Institute on Alcohol Abuse and Alcoholism) or low-risk drinkers (following recommendations of the Scientific board of trustees of the German Health Ministry). The final sample (n = 94) consisted of 36 low-risk alcohol users, 37 binge drinkers and 21 abstinent alcohol dependent patients. Participants were administered a probabilistic implicit reward learning task and an explicit reward- and punishment-based trial-and-error-learning task. Alcohol dependent patients showed a lower performance in implicit and explicit reward learning than low risk drinkers. Binge drinkers learned less than low-risk drinkers in the implicit learning task. The results support the assumption that binge drinking and alcohol dependence are related to a chronic reward deficit. Binge drinking accompanied by implicit reward learning deficits could increase the risk for the development of an alcohol dependence.}, language = {en} } @article{LugoQuitadamoBianchietal.2016, author = {Lugo, Zulay R. and Quitadamo, Lucia R. and Bianchi, Luigi and Pellas, Fr{\´e}deric and Veser, Sandra and Lesenfants, Damien and Real, Ruben G. L. and Herbert, Cornelia and Guger, Christoph and Kotchoubey, Boris and Mattia, Donatella and K{\"u}bler, Andrea and Laureys, Steven and Noirhomme, Quentin}, title = {Cognitive Processing in Non-Communicative Patients: What Can Event-Related Potentials Tell Us?}, series = {Frontiers in Human Neuroscience}, volume = {10}, journal = {Frontiers in Human Neuroscience}, number = {569}, doi = {10.3389/fnhum.2016.00569}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-165165}, year = {2016}, abstract = {Event-related potentials (ERP) have been proposed to improve the differential diagnosis of non-responsive patients. We investigated the potential of the P300 as a reliable marker of conscious processing in patients with locked-in syndrome (LIS). Eleven chronic LIS patients and 10 healthy subjects (HS) listened to a complex-tone auditory oddball paradigm, first in a passive condition (listen to the sounds) and then in an active condition (counting the deviant tones). Seven out of nine HS displayed a P300 waveform in the passive condition and all in the active condition. HS showed statistically significant changes in peak and area amplitude between conditions. Three out of seven LIS patients showed the P3 waveform in the passive condition and five of seven in the active condition. No changes in peak amplitude and only a significant difference at one electrode in area amplitude were observed in this group between conditions. We conclude that, in spite of keeping full consciousness and intact or nearly intact cortical functions, compared to HS, LIS patients present less reliable results when testing with ERP, specifically in the passive condition. We thus strongly recommend applying ERP paradigms in an active condition when evaluating consciousness in non-responsive patients.}, language = {en} } @article{ZhouAllisonKuebleretal.2016, author = {Zhou, Sijie and Allison, Brendan Z. and K{\"u}bler, Andrea and Cichocki, Andrzej and Wang, Xingyu and Jin, Jing}, title = {Effects of Background Music on Objective and Subjective Performance Measures in an Auditory BCI}, series = {Frontiers in Computational Neuroscience}, volume = {10}, journal = {Frontiers in Computational Neuroscience}, number = {105}, doi = {10.3389/fncom.2016.00105}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-165101}, year = {2016}, abstract = {Several studies have explored brain computer interface (BCI) systems based on auditory stimuli, which could help patients with visual impairments. Usability and user satisfaction are important considerations in any BCI. Although background music can influence emotion and performance in other task environments, and many users may wish to listen to music while using a BCI, auditory, and other BCIs are typically studied without background music. Some work has explored the possibility of using polyphonic music in auditory BCI systems. However, this approach requires users with good musical skills, and has not been explored in online experiments. Our hypothesis was that an auditory BCI with background music would be preferred by subjects over a similar BCI without background music, without any difference in BCI performance. We introduce a simple paradigm (which does not require musical skill) using percussion instrument sound stimuli and background music, and evaluated it in both offline and online experiments. The result showed that subjects preferred the auditory BCI with background music. Different performance measures did not reveal any significant performance effect when comparing background music vs. no background. Since the addition of background music does not impair BCI performance but is preferred by users, auditory (and perhaps other) BCIs should consider including it. Our study also indicates that auditory BCIs can be effective even if the auditory channel is simultaneously otherwise engaged.}, language = {en} } @article{MatuzBirbaumerHautzingeretal., author = {Matuz, Tamara and Birbaumer, Niels and Hautzinger, Martin and K{\"u}bler, Andrea}, title = {Psychosocial adjustment to ALS: a longitudinal study}, series = {Frontiers in Psychology}, volume = {6}, journal = {Frontiers in Psychology}, number = {1197}, issn = {1664-1078}, doi = {10.3389/fpsyg.2015.01197}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-190208}, abstract = {For the current study the Lazarian stress-coping theory and the appendant model of psychosocial adjustment to chronic illness and disabilities (Pakenham, 1999) has shaped the foundation for identifying determinants of adjustment to ALS. We aimed to investigate the evolution of psychosocial adjustment to ALS and to determine its long-term predictors. A longitudinal study design with four measurement time points was therefore, used to assess patients' quality of life, depression, and stress-coping model related aspects, such as illness characteristics, social support, cognitive appraisals, and coping strategies during a period of 2 years. Regression analyses revealed that 55\% of the variance of severity of depressive symptoms and 47\% of the variance in quality of life at T2 was accounted for by all the T1 predictor variables taken together. On the level of individual contributions, protective buffering, and appraisal of own coping potential accounted for a significant percentage in the variance in severity of depressive symptoms, whereas problem management coping strategies explained variance in quality of life scores. Illness characteristics at T2 did not explain any variance of both adjustment outcomes. Overall, the pattern of the longitudinal results indicated stable depressive symptoms and quality of life indices reflecting a successful adjustment to the disease across four measurement time points during a period of about two years. Empirical evidence is provided for the predictive value of social support, cognitive appraisals, and coping strategies, but not illness parameters such as severity and duration for adaptation to ALS. The current study contributes to a better conceptualization of adjustment, allowing us to provide evidence-based support beyond medical and physical intervention for people with ALS.}, language = {en} } @article{AcqualagnaBotrelVidaurreetal.2016, author = {Acqualagna, Laura and Botrel, Loic and Vidaurre, Carmen and K{\"u}bler, Andrea and Blankertz, Benjamin}, title = {Large-Scale Assessment of a Fully Automatic Co-Adaptive Motor Imagery-Based Brain Computer Interface}, series = {PLoS ONE}, volume = {11}, journal = {PLoS ONE}, number = {2}, doi = {10.1371/journal.pone.0148886}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-167230}, pages = {e0148886}, year = {2016}, abstract = {In the last years Brain Computer Interface (BCI) technology has benefited from the development of sophisticated machine leaning methods that let the user operate the BCI after a few trials of calibration. One remarkable example is the recent development of co-adaptive techniques that proved to extend the use of BCIs also to people not able to achieve successful control with the standard BCI procedure. Especially for BCIs based on the modulation of the Sensorimotor Rhythm (SMR) these improvements are essential, since a not negligible percentage of users is unable to operate SMR-BCIs efficiently. In this study we evaluated for the first time a fully automatic co-adaptive BCI system on a large scale. A pool of 168 participants naive to BCIs operated the co-adaptive SMR-BCI in one single session. Different psychological interventions were performed prior the BCI session in order to investigate how motor coordination training and relaxation could influence BCI performance. A neurophysiological indicator based on the Power Spectral Density (PSD) was extracted by the recording of few minutes of resting state brain activity and tested as predictor of BCI performances. Results show that high accuracies in operating the BCI could be reached by the majority of the participants before the end of the session. BCI performances could be significantly predicted by the neurophysiological indicator, consolidating the validity of the model previously developed. Anyway, we still found about 22\% of users with performance significantly lower than the threshold of efficient BCI control at the end of the session. Being the inter-subject variability still the major problem of BCI technology, we pointed out crucial issues for those who did not achieve sufficient control. Finally, we propose valid developments to move a step forward to the applicability of the promising co-adaptive methods.}, language = {en} }