TY - JOUR A1 - Froehlich, Matthias A1 - Zahner, Antonia A1 - Schmalzing, Marc A1 - Gernert, Michael A1 - Strunz, Patrick-Pascal A1 - Hueper, Sebastian A1 - Portegys, Jan A1 - Schwaneck, Eva Christina A1 - Gadeholt, Ottar A1 - Kübler, Andrea A1 - Hewig, Johannes A1 - Ziebell, Philipp T1 - Patient-reported outcomes provide evidence for increased depressive symptoms and increased mental impairment in giant cell arteritis JF - Frontiers in Medicine N2 - 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. KW - giant cell arteritis KW - PRO KW - depression KW - mental impairment KW - SF-36 KW - PHQ-9 KW - VAS KW - polymyalgia rheumatica Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-319761 VL - 10 ER - TY - JOUR A1 - Grapp, Miriam A1 - Ell, Johanna A1 - Kiermeier, Senta A1 - Haun, Markus W. A1 - Kübler, Andrea A1 - Friederich, Hans-Christoph A1 - Maatouk, Imad T1 - Feasibility study of a self-guided internet-based intervention for family caregivers of patients with cancer (OAse) JF - Scientific Reports N2 - 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. KW - cancer KW - oncology KW - psychology Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300537 VL - 12 ER - TY - JOUR A1 - Kleih-Dahms, Sonja Christina A1 - Botrel, Loic A1 - Kübler, Andrea T1 - The influence of motivation and emotion on sensorimotor rhythm-based brain-computer interface performance JF - Psychophysiology N2 - 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. KW - brain-computer interface KW - sensorimotor rhythm KW - psychological variables KW - motivation KW - emotional state KW - electroencephalogram Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259664 VL - 58 IS - 8 ER - TY - JOUR A1 - Eidel, Matthias A1 - Kübler, Andrea T1 - Wheelchair Control in a Virtual Environment by Healthy Participants Using a P300-BCI Based on Tactile Stimulation: Training Effects and Usability JF - Frontiers in Human Neuroscience N2 - 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. KW - brain-computer interface (BCI) KW - event-related-potential (ERP) KW - P300 KW - tactile KW - wheelchair control KW - tactually evoked potentials KW - replication Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-207775 SN - 1662-5161 VL - 14 ER - TY - JOUR A1 - Paelecke-Habermann, Yvonne A1 - Paelecke, Marko A1 - Mauth, Juliane A1 - Tschisgale, Juliane A1 - Lindenmeyer, Johannes A1 - Kübler, Andrea T1 - A comparison of implicit and explicit reward learning in low risk alcohol users versus people who binge drink and people with alcohol dependence JF - Addictive Behaviors Reports N2 - 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. KW - Alcohol dependence KW - Binge drinking KW - Low risk alcohol use KW - Implicit and explicit reward learning Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201406 VL - 9 ER - TY - JOUR A1 - Lulé, Dorothée A1 - Kübler, Andrea A1 - Ludolph, Albert C. T1 - Ethical principles in patient-centered medical care to support quality of life in amyotrophic lateral sclerosis JF - Frontiers in Neurology N2 - 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. KW - ethics KW - quality of life (QoL) KW - care KW - amyotrophic lateral sclerosis (ALS) KW - well-being KW - depression KW - coping KW - psychosocial adaptation Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-196239 SN - 1664-2295 VL - 10 ER - TY - JOUR A1 - Erlbeck, Helena A1 - Mochty, Ursula A1 - Kübler, Andrea A1 - Real, Ruben G. L. T1 - Circadian course of the P300 ERP in patients with amyotrophic lateral sclerosis - implications for brain-computer interfaces (BCI) JF - BMC Neurology N2 - Background: Accidents or neurodegenerative diseases like amyotrophic lateral sclerosis (ALS) can lead to progressing, extensive, and complete paralysis leaving patients aware but unable to communicate (locked-in state). Brain-computer interfaces (BCI) based on electroencephalography represent an important approach to establish communication with these patients. The most common BCI for communication rely on the P300, a positive deflection arising in response to rare events. To foster broader application of BCIs for restoring lost function, also for end-users with impaired vision, we explored whether there were specific time windows during the day in which a P300 driven BCI should be preferably applied. Methods: The present study investigated the influence of time of the day and modality (visual vs. auditory) on P300 amplitude and latency. A sample of 14 patients (end-users) with ALS and 14 healthy age matched volunteers participated in the study and P300 event-related potentials (ERP) were recorded at four different times (10, 12 am, 2, & 4 pm) during the day. Results: Results indicated no differences in P300 amplitudes or latencies between groups (ALS patients v. healthy participants) or time of measurement. In the auditory condition, latencies were shorter and amplitudes smaller as compared to the visual condition. Conclusion: Our findings suggest applicability of EEG/BCI sessions in patients with ALS throughout normal waking hours. Future studies using actual BCI systems are needed to generalize these findings with regard to BCI effectiveness/efficiency and other times of day. KW - brain computer interface KW - amyotrophic lateral sclerosis KW - ALS KW - P300 KW - auditory KW - visual KW - BCI Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157423 VL - 17 IS - 3 ER - TY - JOUR A1 - Käthner, Ivo A1 - Halder, Sebastian A1 - Hintermüller, Christoph A1 - Espinosa, Arnau A1 - Guger, Christoph A1 - Miralles, Felip A1 - Vargiu, Eloisa A1 - Dauwalder, Stefan A1 - Rafael-Palou, Xavier A1 - Solà, Marc A1 - Daly, Jean M. A1 - Armstrong, Elaine A1 - Martin, Suzanne A1 - Kübler, Andrea T1 - A Multifunctional Brain-Computer Interface Intended for Home Use: An Evaluation with Healthy Participants and Potential End Users with Dry and Gel-Based Electrodes JF - Frontiers in Neuroscience N2 - Current brain-computer interface (BCIs) software is often tailored to the needs of scientists and technicians and therefore complex to allow for versatile use. To facilitate home use of BCIs a multifunctional P300 BCI with a graphical user interface intended for non-expert set-up and control was designed and implemented. The system includes applications for spelling, web access, entertainment, artistic expression and environmental control. In addition to new software, it also includes new hardware for the recording of electroencephalogram (EEG) signals. The EEG system consists of a small and wireless amplifier attached to a cap that can be equipped with gel-based or dry contact electrodes. The system was systematically evaluated with a healthy sample, and targeted end users of BCI technology, i.e., people with a varying degree of motor impairment tested the BCI in a series of individual case studies. Usability was assessed in terms of effectiveness, efficiency and satisfaction. Feedback of users was gathered with structured questionnaires. Two groups of healthy participants completed an experimental protocol with the gel-based and the dry contact electrodes (N = 10 each). The results demonstrated that all healthy participants gained control over the system and achieved satisfactory to high accuracies with both gel-based and dry electrodes (average error rates of 6 and 13%). Average satisfaction ratings were high, but certain aspects of the system such as the wearing comfort of the dry electrodes and design of the cap, and speed (in both groups) were criticized by some participants. Six potential end users tested the system during supervised sessions. The achieved accuracies varied greatly from no control to high control with accuracies comparable to that of healthy volunteers. Satisfaction ratings of the two end-users that gained control of the system were lower as compared to healthy participants. The advantages and disadvantages of the BCI and its applications are discussed and suggestions are presented for improvements to pave the way for user friendly BCIs intended to be used as assistive technology by persons with severe paralysis. KW - end-user evaluation KW - brain-computer interface KW - EEG KW - practical electrodes KW - assistive technology Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157925 VL - 11 IS - 286 ER - TY - JOUR A1 - Lugo, Zulay R. A1 - Quitadamo, Lucia R. A1 - Bianchi, Luigi A1 - Pellas, Fréderic A1 - Veser, Sandra A1 - Lesenfants, Damien A1 - Real, Ruben G. L. A1 - Herbert, Cornelia A1 - Guger, Christoph A1 - Kotchoubey, Boris A1 - Mattia, Donatella A1 - Kübler, Andrea A1 - Laureys, Steven A1 - Noirhomme, Quentin T1 - Cognitive Processing in Non-Communicative Patients: What Can Event-Related Potentials Tell Us? JF - Frontiers in Human Neuroscience N2 - 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. KW - P300 KW - event-related potentials KW - locked-in syndrome KW - vegetative state KW - unresponsive wakefulness syndrome KW - minimally conscious state Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-165165 VL - 10 IS - 569 ER - TY - JOUR A1 - Zhou, Sijie A1 - Allison, Brendan Z. A1 - Kübler, Andrea A1 - Cichocki, Andrzej A1 - Wang, Xingyu A1 - Jin, Jing T1 - Effects of Background Music on Objective and Subjective Performance Measures in an Auditory BCI JF - Frontiers in Computational Neuroscience N2 - 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. KW - brain computer interface KW - event-related potentials KW - auditory KW - music background KW - audio stimulus Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-165101 VL - 10 IS - 105 ER -