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Background
- Brain-Computer Interfaces (BCI) enable their users to interact and communicate with the environment without requiring intact muscle control. To this end, brain activity is directly measured, digitized and interpreted by the computer. Thus, BCIs may be a valuable tool to assist severely or even completely paralysed patients. Many BCIs, however, rely on neurophysiological potentials evoked by visual stimulation, which can result in usability issues among patients with impaired vision or gaze control. Because of this, several non-visual BCI paradigms have been developed. Most notably, a recent study revealed promising results from a tactile BCI for wheelchair control. In this multi-session approach, healthy participants used the BCI to navigate a simulated wheelchair through a virtual apartment, which revealed not only that the BCI could be operated highly efficiently, but also that it could be trained over five sessions. The present thesis continues the research on this paradigm in order to - confirm its previously reported high performance levels and trainability - reveal the underlying factors responsible for observed performance increases - establish its feasibility among potential impaired end-users
Methods
- To approach these goals, three studies were conducted with both healthy participants and patients with amyotrophic lateral sclerosis (ALS). Brain activity during BCI operation was recorded via electroencephalography (EEG) and interpreted using a machine learning-based linear classifier. Wheelchair navigation was executed according to the classification results and visualized on a monitor. For offline statistical analysis, neurophysiological features were extracted from EEG data. Subjective data on usability were collected from all participants. Two specialized experiments were conducted to identify factors for training.
Results and Discussion
- Healthy participants: Results revealed positive effects of training on BCI performances and their underlying neurophysiological potentials. The paradigm was confirmed to be feasible and (for a non-visual BCI) highly efficient for most participants. However, some had to be excluded from analysis of the training effects because they could not achieve meaningful BCI control. Increased somatosensory sensitivity was identified as a possible mediator for training-related performance improvements. Participants with ALS: Out of seven patients with various stages of ALS, five could operate the BCI with accuracies significantly above chance level. Another ALS patient in a state of near-complete paralysis trained with the BCI for several months. Although no effects of training were observed, he was consistently able to operate the system above chance level. Subjective data regarding workload, satisfaction and other parameters were reported.
Significance
- The tactile BCI was evaluated on the example of wheelchair control. In the future, it could help impaired patients to regain some lost mobility and self-sufficiency. Further, it has the potential to be adapted to other purposes, including communication. Once visual BCIs and other assistive technologies fail for patients with (progressive) motor impairments, vision-independent paradigms such as the tactile BCI may be among the last remaining alternatives to interact with the environment. The present thesis has strongly confirmed the general feasibility of the tactile paradigm for healthy participants and provides first clues about the underlying factors of training. More importantly, the BCI was established among potential end-users with ALS, providing essential external validity.
In situations of real threat, showing a fear reaction makes sense, thus, increasing the chance to survive. The question is, how could anybody differentiate between a real and an apparent threat? Here, the slogan counts “better safe than sorry”, meaning that it is better to shy away once too often from nothing than once too little from a real threat. Furthermore, in a complex environment it is adaptive to generalize from one threatening situation or stimulus to another similar situation/stimulus. But, the danger hereby is to generalize in a maladaptive manner involving as it is to strong and/or fear too often “harmless” (safety) situations/stimuli, as it is known to be a criterion of anxiety disorders (AD). Fear conditioning and fear generalization paradigms are well suited to investigate fear learning processes. It is remarkable that despite increasing interest in this topic there is only little research on fear generalization. Especially, most research on human fear conditioning and its generalization has focused on adults, whereas only little is known about these processes in children, even though AD is typically developing during childhood. To address this knowledge gap, four experiments were conducted, in which a discriminative fear conditioning and generalization paradigm was used.
In the first two experiments, developmental aspects of fear learning and generalization were of special interest. Therefore, in the first experiment 267 children and 285 adults were compared in the differential fear conditioning paradigm and generalization test. Skin conductance responses (SCRs) and ratings of valence and arousal were obtained to indicate fear learning. Both groups displayed robust and similar differential conditioning on subjective and physiological levels. However, children showed heightened fear generalization compared to adults as indexed by higher arousal ratings and SCRs to the generalization stimuli. Results indicate overgeneralization of conditioned fear as a developmental correlate of fear learning. The developmental change from a shallow to a steeper generalization gradient is likely related to the maturation of brain structures that modulate efficient discrimination between threatening and (ambiguous) safety cues. The question hereby is, at which developmental stage fear generalization gradients of children adapt to the gradients of adults. Following up on this question, in a second experiment, developmental changes in fear conditioning and fear generalization between children and adolescents were investigated. According to experiment 1 and previous studies in children, which showed changes in fear learning with increasing age, it was assumed that older children were better at discriminating threat and safety stimuli. Therefore, 396 healthy participants (aged 8 to 12 years) were examined with the fear conditioning and generalization paradigm. Again, ratings of valence, arousal, and SCRs were obtained. SCRs indicated differences in fear generalization with best fear discrimination in 12-year-old children suggesting that the age of 12 years seems to play an important role, since generalization gradients were similar to that of adults. These age differences were seen in boys and girls, but best discrimination was found in 12-year-old boys, indicating different development of generalization gradients according to sex. This result fits nicely with the fact that the prevalence of AD is higher in women than in men.
In a third study, it was supposed that the developmental trajectory from increased trait anxiety in childhood to manifest AD could be mediated by abnormal fear conditioning and generalization processes. To this end, 394 children aged 8 to 12 years with different scores in trait anxiety were compared with each other. Results provided evidence that children with high trait anxiety showed stronger responses to threat cues and impaired safety signal learning contingent on awareness as indicated by arousal at acquisition. Furthermore, analyses revealed that children with high trait anxiety showed overall higher arousal ratings at generalization. Contrary to what was expected, high trait anxious children did not show significantly more fear generalization than children with low trait anxiety. However, high-trait-anxious (HA) participants showed a trend for a more linear gradient, whereas moderate-trait-anxious (MA) and low-trait-anxious (LA) participants showed more quadratic gradients according to arousal. Additionally, after controlling for age, sex and negative life experience, SCR to the safety stimulus predicted the trait anxiety level of children suggesting that impaired safety signal learning may be a risk factor for the development of AD.
Results provide hints that frontal maturation could develop differently according to trait anxiety resulting in different stimuli discrimination. Thus, in a fourth experiment, 40 typically developing volunteers aged 10 to 18 years were screened for trait anxiety and investigated with the differential fear conditioning and generalization paradigm in the scanner. Functional magnetic resonance imaging (fMRI) were used to identify the neural mechanisms of fear learning and fear generalization investigating differences in this neural mechanism according to trait anxiety, developmental aspects and sex. At acquisition, HA participants showed reduced activation in frontal brain regions, but at generalization, HA participants showed an increase in these frontal regions with stronger linear increase in activation with similarity to CS+ in HA when compared to LA participants. This indicates that there is a hyper-regulation in adolescents to compensate the higher difficulties at generalization in form of a compensatory mechanism, which decompensates with adulthood and/or may be collapsed in manifest AD. Additionally, significant developmental effects were found: the older the subjects the stronger the hippocampus and frontal activation with resemblance to CS+, which could explain the overgeneralization of younger children. Furthermore, there were differences according to sex: males showed stronger activation with resemblance to CS+ in the hippocampus and frontal regions when compared to females fitting again nicely with the observation that prevalence rates for AD are higher for females than males.
In sum, the studies suggest that investigating developmental aspects of (maladaptive) overgeneralization may lead to better understanding of the mechanisms of manifest anxiety disorders, which could result in development and provision of prevention strategies. Although, there is need for further investigations, the present work gives some first hints for such approaches.
Brain-computer interfaces (BCIs) are devices that translate signals from the brain into control commands for applications. Within the last twenty years, BCI applications have been developed for communication, environmental control, entertainment, and substitution of motor functions. Since BCIs provide muscle independent communication and control of the environment by circumventing motor pathways, they are considered as assistive technologies for persons with neurological and neurodegenerative diseases leading to motor paralysis, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal muscular atrophy and stroke (Kübler, Kotchoubey, Kaiser, Wolpaw, & Birbaumer, 2001). Although most researcher mention persons with severe motor impairment as target group for their BCI systems, most studies include healthy participants and studies including potential BCI end-users are sparse. Thus, there is a substantial lack of studies that investigate whether results obtained in healthy participants can be transferred to patients with neurodegenerative diseases. This clearly shows that BCI research faces a translational gap between intense BCI research and bringing BCI applications to end-users outside the lab (Kübler, Mattia, Rupp, & Tangermann, 2013). Translational studies are needed that investigate whether BCIs can be successfully used by severely disabled end-users and whether those end-users would accept BCIs as assistive devices. Another obvious discrepancy exists between a plethora of short-term studies and a sparse number of long-term studies. BCI research thus also faces a reliability gap (Kübler, Mattia, et al., 2013). Most studies present only one BCI session, however the few studies that include several testing sessions indicate high inter- and intra-individual variance in the end-users’ performance due to non-stationarity of signals. Long-term studies, however, are needed to demonstrate whether a BCI can be reliably used as assistive device over a longer period of time in the daily-life of a person. Therefore there is also a great need for reliability studies.
The purpose of the present thesis was to address these research gaps and to bring BCIs closer to end-users in need, especially into their daily-lives, following a user-centred design (UCD). The UCD was suggested as theoretical framework for bringing BCIs to end-users by Kübler and colleagues (Kübler et al., 2014; Zickler et al., 2011). This approach aims at the close and iterative interaction between BCI developers and end-users with the final goal to develop BCI systems that are accepted as assistive devices by end-users. The UCD focuses on usability, that is, how well a BCI technology matches the purpose and meets the needs and requirements of the targeted end-users and was standardized with the ISO 9241-210.
Within the UCD framework, usability of a device can be defined with regard to its effectiveness, efficiency and satisfaction. These aspects were operationalized by Kübler and colleagues to evaluate BCI-controlled applications. As suggested by Vaughan and colleagues, the number of BCI sessions, the total usage duration and the impact of the BCI on the life of the person can be considered as indicators of usefulness of the BCI in long-term daily-life use (Vaughan, Sellers, & Wolpaw, 2012). These definitions and metrics for usability and usefulness were applied for evaluating BCI applications as assistive devices in controlled settings and independent use. Three different BCI applications were tested and evaluated by in total N=10 end-users: In study 1 a motor-imagery (MI) based BCI for gaming was tested by four end-users with severe motor impairment. In study 2, a hybrid P300 event-related (ERP) based BCI for communication was tested by four severely motor restricted end-users with severe motor impairment. Study 1 and 2 are short-term studies conducted in a controlled-setting. In study 3 a P300-ERP BCI for creative expression was installed for long-term independent use at the homes of two end-users in the locked-in state. Both end-users are artists who had gradually lost the ability to paint after being diagnosed with ALS.
Results reveal that BCI controlled devices are accepted as assistive devices. Main obstacles for daily-life use were the not very aesthetic design of the EEG-cap and electrodes (cap is eye-catching and looks medical), low comfort (cables disturb, immobility, electrodes press against head if lying on a head cushion), complicated and time-consuming adjustment, low efficiency and low effectiveness, and not very high reliability (many influencing factors). While effectiveness and efficiency in the MI based BCI were lower compared to applications using the P300-ERP as input channel, the MI controlled gaming application was nevertheless better accepted by the end-users and end-users would rather like to use it compared to the communication applications. Thus, malfunctioning and errors, low speed, and the EEG cap are rather tolerated in gaming applications, compared to communication devices. Since communication is essential for daily-life, it has to be fast and reliable. BCIs for communication, at the current state of the art, are not considered competitive with other assistive devices, if other devices, such as eye-gaze, are still an option. However BCIs might be an option when controlling an application for entertainment in daily-life, if communication is still available. Results demonstrate that BCI is adopted in daily-life if it matches the end-users needs and requirements. Brain Painting serves as best representative, as it matches the artists’ need for creative expression. Caveats such as uncomfortable cap, dependence on others for set-up, and experienced low control are tolerated and do not prevent BCI use on a daily basis. Also end-users in real need of means for communication, such as persons in the locked-in state with unreliable eye-movement or no means for independent communication, do accept obstacles of the BCI, as it is the last or only solution to communicate or control devices. Thus, these aspects are “no real obstacles” but rather “challenges” that do not prevent end-users to use the BCI in their daily-lives. For instance, one end-user, who uses a BCI in her daily-life, stated: “I don’t care about aesthetic design of EEG cap and electrodes nor amplifier”. Thus, the question is not which system is superior to the other, but which system is best for an individual user with specific symptoms, needs, requirements, existing assistive solutions, support by caregivers/family etc.; it is thereby a question of indication. These factors seem to be better “predictors” for adoption of a BCI in daily-life, than common usability criterions such as effectiveness or efficiency. The face valid measures of daily-life demonstrate that BCI-controlled applications can be used in daily-life for more than 3 years, with high satisfaction for the end-users, without experts being present and despite a decrease in the amplitude of the P300 signal. Brain Painting re-enabled both artists to be creatively active in their home environment and thus improved their feelings of happiness, usefulness, self-esteem, well-being, and consequently quality of life and supports social inclusion. This thesis suggests that BCIs are valuable tools for people in the locked-in state.
The present work comprises four studies dealing with the investigation of the auditory event-related potentials (ERP) Mismatch Negativity (MMN), P300, and N400 under different attentional instructions, and with their application in patients with disorders of consciousness (DOC) to assess residual cognitive functioning. In guided interviews (study 1), practitioners working with DOC patients stated their general interest in and an objective need for the complementation of current diagnostic procedures by reliable and valid ERP-based methods. Subsequently, in study 2, simple oddball and semantic paradigms were applied to 19 behaviorally non-responsive DOC patients revealing the presence of at least one ERP in eight patients investigated. In the third and fourth study, specific attentional effects on ERPs were investigated in healthy participants to define optimal instructions and stimulus parameters. In study 3, MMN and N400 amplitudes were assessed in 18 participants, and in study 4, MMN and P300 amplitudes were assessed in 32 participants. Both studies included an ignore task (attention on simultaneous visual stimuli), a passive task, and a focused task and revealed distinct attentional effects on P300 and N400 with largest amplitudes in the focused task, smaller ones in the passive task and no ERP in the ignore task. An MMN was elicited in all tasks, but still, amplitudes differed as a function of task. In addition, study 4 included oddball paradigms comprising several deviants in different dimensions. Higher amplitudes were found in this multifeature paradigm compared to traditional oddball paradigms and larger amplitudes were elicited by deviants highly different from standards. It is concluded that ERPs represent a promising tool to complement clinical assessment of DOC patients. Application of ERP paradigms should include focused instructions, especially when using semantic material. Furthermore, multifeature paradigms have been proven especially useful eliciting large amplitudes and allowing for the investigation of several dimensions of deviants at the same time.
Brain-computer interfaces (BCIs) could provide a muscle-independent communication channel to persons with severe paralysis by translating brain activity into device commands. As a means of communication, in particular BCIs based on event-related potentials (ERPs) as control signal have been researched. Most of these BCIs rely on visual stimulation and have been investigated with healthy participants in controlled laboratory environments. In proof-of-principle studies targeted end users gained control over BCI systems; however, these systems are not yet established as an assistive technology for persons who would most benefit from them. The main aim of this thesis is to advance the usability of ERP-BCIs for target users. To this end, five studies with BCIs have been conducted that enabled users to communicate by focusing their attention on external stimuli.
Two studies were conducted in order to demonstrate the advantages and to further improve the practical application of visual BCIs. In the first study, mental workload was experimentally manipulated during prolonged BCI operation. The study showed the robustness of the visual ERP-BCI since users maintained a satisfactory level of control despite constant distraction in the form of background noise. Moreover, neurophysiological markers that could potentially serve as indicators of high mental workload or fatigue were revealed. This is a first step towards future applications in which the BCI could adapt to the mental state of the user (e.g. pauses if high mental workload is detected to prevent false selections). In the second study, a head-mounted display (HMD), which assures that stimuli are presented in the field of view of the user, was evaluated. High accuracies and information transfer rates, similar to a conventional display, were achieved by healthy participants during a spelling task. Furthermore, a person in the locked-in state (LIS) gained control over the BCI using the HMD. The HMD might be particularly suited for initial communication attempts with persons in the LIS in situations, where mounting a conventional monitor is difficult or not feasible.
Visual ERP-BCIs could prove valuable for persons with residual control over eye muscles and sufficient vision. However, since a substantial number of target users have limited control over eye movements and/or visual impairments, BCIs based on non-visual modalities are required. Therefore, a main aspect of this thesis was to improve an auditory paradigm that should enable motor impaired users to spell by focusing attention on different tones. The two conducted studies revealed that healthy participants were able to achieve high spelling performance with the BCI already in the first session and stress the importance of the choice of the stimulus material. The employed natural tones resulted in an increase in performance compared to a previous study that used artificial tones as stimuli. Furthermore, three out of five users with a varying degree of motor impairments could gain control over the system within the five conducted sessions. Their performance increased significantly from the first to the fifth session - an effect not previously observed for visual ERP-BCIs. Hence, training is particularly important when testing auditory multiclass BCIs with potential users.
A prerequisite for user satisfaction is that the BCI technology matches user requirements. In this context, it is important to compare BCIs with already established assistive technology. Thus, the fifth study of this dissertation evaluated gaze dependent methods (EOG, eye tracking) as possible control signals for assistive technology and a binary auditory BCI with a person in the locked-in state. The study participant gained control over all tested systems and rated the ease of use of the BCI as the highest among the tested alternatives, but also rated it as the most tiring due to the high amount of attention that was needed for a simple selection. Further efforts are necessary to simplify operation of the BCI.
The involvement of end users in all steps of the design and development process of BCIs will increase the likelihood that they can eventually be used as assistive technology in daily life. The work presented in this thesis is a substantial contribution towards the goal of re-enabling communication to users who cannot rely on motor activity to convey their thoughts.
The impact of acquired severe motor impairments is pervasive and may lead to a complete loss of communication and voluntary motor control, rendering the patient behaviourally unresponsive. In routine clinical care it may thus be unclear, whether some of these patients are even conscious. Given that finding a cure is unlikely, care focuses on providing the best possible quality of life (QoL), and knowing its predictors might contribute to that aim. Patients who still can communicate often report a high QoL, and several predictors have been identified. However, many instruments used to assess QoL require at least residual verbal and motor abilities. Thus, a method to assess QoL independent of these requirements is desirable. In addition, many instruments assume QoL to be temporarily stable, and little information is available on predictors of instantaneous QoL, i.e. QoL as it fluctuates from moment to moment throughout the day.
Für eine gesunde kindliche Entwicklung ist besonders in der frühen Kindheit
guter Schlaf sehr wichtig. Gerade im Baby- und Kleinkindalter sind
Schlafschwierigkeiten jedoch ein häufiges Phänomen. Vor allem Ein- und
Durchschlafstörungen kommen vielfach vor, die nicht automatisch mit zunehmendem
Alter eines Kindes remittieren. Sie können persistieren und zum
Teil auch schwerwiegende Folgen für die kindliche Entwicklung haben. Nicht
nur Hyperaktivität, Reizbarkeit und Aggressivität treten bei Kindern mit
Schlafstörungen gehäuft auf, sondern auch Tagesmüdigkeit, Konzentrationsund
Gedächtnisstörungen sowie kognitive Beeinträchtigungen können die
Folge sein. Darüber hinaus können Depressionen, Angststörungen und
Übergewicht langfristige Folgen von Schlafstörungen sein. Auch wirken sich
die Schlafstörungen bei jungen Kindern negativ auf die Eltern aus. Daher
ist es wichtig, Schlafprobleme im frühen Kindesalter zu erkennen, ernst zu
nehmen und frühzeitig zu behandeln.
Die vorliegende Arbeit besteht aus drei Teilen. Es wurden das elterliche
Wissen über Schlaf im Kleinkindalter sowie eine Auswahl von Elternratgeberliteratur
für kindliche Schlafprobleme untersucht. Ferner wurde das
multimodale Elterntrainingsprogramm „Mini-KiSS“, ein Elterntraining für
Kinder bis vier Jahren mit Schlafstörungen (Schlarb_2014), hinsichtlich
seiner externen Validität betrachtet.
Da Eltern diejenigen sind, die als erste mit den Schlafproblemen ihres
Kindes konfrontiert sind, sollten sie kindliche Schlafstörungen als diese
erkennen und auch einschätzen können, um ggf. weiterführende Maßnahme
einzuleiten. Deshalb ist es wichtig, dass Eltern über den kindlichen Schlaf
informiert sind. Um dieses elterliche Wissen über Schlaf von jungen Kindern
zu erfassen, wurde ein Fragebogen entwickelt, in dem Anwendungs- und Faktenwissen über Schlaf im Baby- und Kleinkindalter erfragt wurden. Dieser
wurde einer Online-Stichprobe (N = 1291) vorgelegt. Insgesamt verfügten die
Eltern über ein gutes Wissen, sie beantworteten 65% der Fragen korrekt. Es
zeigte sich jedoch ein Unterschied zwischen dem Anwendungswissen, wo die
Eltern 72% korrekt beantworteten und dem Faktenwissen, wo die Eltern 61%
der gestellten Fragen korrekt beantworteten. Allerdings wurden auch Unsicherheiten
sowie Wissensdefizite deutlich, die noch genauer erfasst werden
und denen künftig mit unverbindlichen Informations- und Beratungsangeboten
begegnet werden sollte. Insbesondere bei den Interventionsmöglichkeiten
zum Umgang mit einer Schlafproblematik im Kleinkindalter wurde ein
Dissens deutlich, der sich auch in der nachfolgenden Analyse von Elternratgeberliteratur
für Schlafschwierigkeiten widerspiegelte. Es wurden
Literaturanalysen über Ratgeber für das Kindesalter einerseits und für das
Baby- und Kleinkindalter andererseits durchgeführt. Dabei konnte gezeigt
werden, dass die Autoren entweder eine Position zum lerntheoretischen
Ansatz der graduierten Extinktion bezogen und diese Methode empfohlen
oder das Co-Sleeping, also das gemeinsame Schlafen von Eltern und Kind
in einem Bett, favorisierten. Zudem wurde in der vorliegenden Arbeit das
multimodale Elterntraining Mini-KiSS bezüglich der externen Validität im
Langzeitverlauf erfolgreich überprüft. Das Elterntraining richtet sich an
Eltern von Kindern im Alter von sechs Monaten bis vier Jahren mit Schlafstörungen
und findet in Form von sechs aufeinanderfolgenden Elternabenden
statt. Durch das Training kam es zu signifikanten Verbesserungen des kindlichen
und mütterlichen Schlafes, diese bis zur Ein-Jahres-Katamnese stabil.
Auch weitere mit problematischem kindlichem Schlafverhalten assoziierte
Parameter, wie das allgemeine kindliche Problemverhalten sowie die elterliche
Gesamtbelastung, konnten nachhaltig reduziert werden. Im Rahmen
der vorliegenden Arbeit konnte gezeigt werden, dass sich die Intervention
sowohl auf das Kind als auch auf die Eltern positiv auswirkte, was auch
anhand von objektiven Verfahren bestätigt werden konnte. Zusammengefasst leistet diese Arbeit somit mit der Befragung einer großen Online-Stichprobe zu frühkindlichem Schlaf, der literaturanalytischen Betrachtung
ausgewählter Ratgeberliteratur sowie der erfolgreichen Prüfung
der externen Validität des Mini-KiSS-Trainings einen wichtigen und richtungsweisenden
Beitrag zur aktuellen Forschung im Bereich der nichtorganischen
Schlafstörungen im Kleinkindalter.
Beyond the state of the art, towards intuitive and reliable non-visual Brain-Computer-Interfacing
(2016)
For the present work three main goals were formulated:
goal 1 To design a tactile BCI used for mobility which is
intuitive (G1.1), reliable and fast while being usable
by participants aged 50 years and above.
goal 2 To design an auditory BCI used for communication
which is intuitive and reliable.
goal 3 To examine the effects of training on tactile and
auditory BCI performance.
Three studies were performed to achieve these goals.
In the first study nine participants aged above 50 years
performed a five-session training after which eight participants
were able to navigate a virtual wheelchair with
mean accuracy above 95% and an ITR above 20 bits / min.
In the second study 15 participants, four of them endusers
with motor-impairment, were able to communicate
meaningful with high accuracies using an auditory BCI.
In the third study nine healthy and nine visually impaired
participants (regarded as sensory experts for non-visual
perception) performed tactile, auditory and visual (for
healthy participants only) copy tasks. Participants with
trained perception significantly outperformed control
participants for tactile but not for auditory performance.
Tactile performance of sensory experts was on equal levels
as the visual performance of control participants.
We were able to demonstrate viability of intuitive gazeindependent
tactile and auditory BCI. Our tactile BCI performed
on levels similar to those of visual BCI, outperforming
current tactile BCI protocols. Furthermore, we were
able to demonstrate significant beneficial effect of training
on tactile BCI performance. Our results demonstrate previously
untapped potential for tactile BCI and avenues for
future research in the field of gaze-independent BCI.
Feedback efficiency and training effects during alpha band modulation over the sensorimotor cortex
(2015)
Neural oscillations can be measured by electroencephalography (EEG) and these oscillations can be characterized by their frequency, amplitude and phase. The mechanistic properties of neural oscillations and their synchronization are able to explain various aspects of many cognitive functions such as motor control, memory, attention, information transfer across brain regions, segmentation of the sensory input and perception (Arnal and Giraud, 2012). The alpha band frequency is the dominant oscillation in the human brain. This oscillatory activity is found in the scalp EEG at frequencies around 8-13 Hz in all healthy adults (Makeig et al., 2002) and considerable interest has been generated in exploring EEG alpha oscillations with regard to their role in cognitive (Klimesch et al., 1993; Hanselmayr et al., 2005), sensorimotor (Birbaumer, 2006; Sauseng et al., 2009) and physiological (Lehmann, 1971; Niedermeyer, 1997; Kiyatkin, 2010) aspects of human life. The ability to voluntarily regulate the alpha amplitude can be learned with neurofeedback training and offers the possibility to control a brain-computer interface (BCI), a muscle independent interaction channel. BCI research is predominantly focused on the signal processing, the classification and the algorithms necessary to translate brain signals into control commands than on the person interacting with the technical system. The end-user must be properly trained to be able to successfully use the BCI and factors such as task instructions, training, and especially feedback can therefore play an important role in learning to control a BCI (Neumann and Kübler, 2003; Pfurtscheller et al., 2006, 2007; Allison and Neuper, 2010; Friedrich et al., 2012; Kaufmann et al., 2013; Lotte et al., 2013).
The main purpose of this thesis was to investigate how end-users can efficiently be trained to perform alpha band modulation recorded over their sensorimotor cortex. The herein presented work comprises three studies with healthy participants and participants with schizophrenia focusing on the effects of feedback and training time on cortical activation patterns and performance. In the first study, the application of a realistic visual feedback to support end-users in developing a concrete feeling of kinesthetic motor imagery was tested in 2D and 3D visualization modality during a single training session. Participants were able to elicit the typical event-related desynchronisation responses over sensorimotor cortex in both conditions but the most significant decrease in the alpha band power was obtained following the three-dimensional realistic visualization. The second study strengthen the hypothesis that an enriched visual feedback with information about the quality of the input signal supports an easier approach for motor imagery based BCI control and can help to enhance performance. Significantly better performance levels were measurable during five online training sessions in the groups with enriched feedback as compared to a conventional simple visual feedback group, without significant differences in performance between the unimodal (visual) and multimodal (auditory–visual) feedback modality. Furthermore, the last study, in which people with schizophrenia participated in multiple sessions with simple feedback, demonstrated that these patients can learn to voluntarily regulate their alpha band. Compared to the healthy group they required longer training times and could not achieve performance levels as high as the control group. Nonetheless, alpha neurofeedback training lead to a constant increase of the alpha resting power across all 20 training session.
To date only little is known about the effects of feedback and training time on BCI performance and cortical activation patterns. The presented work contributes to the evidence that healthy individuals can benefit from enriched feedback: A realistic presentation can support participants in getting a concrete feeling of motor imagery and enriched feedback, which instructs participants about the quality of their input signal can give support while learning to control the BCI. This thesis demonstrates that people with schizophrenia can learn to gain control of their alpha oscillations recorded over the sensorimotor cortex when participating in sufficient training sessions. In conclusion, this thesis improved current motor imagery BCI feedback protocols and enhanced our understanding of the interplay between feedback and BCI performance.
Häufige Schlafstörungen im Jugendalter umfassen Ein- und Durchschlafprobleme (Insomnie), verstärkte Tagesmüdigkeit oder einen verschobenen Schlaf-Wachrhythmus (zirkadiane Rhythmusstörung). Über unzureichenden Schlaf klagen 40-60% aller Jugendlichen, wobei ca. 10% eine klinisch bedeutsame insomnische Störung aufweisen. In der vorliegenden Arbeit wurde ein altersspezifisches, multimodales Gruppenpsychotherapieprogramm für Jugendliche (11-17 Jahre) mit nicht-organischen Schlafbeschwerden extern evaluiert. Das eingesetzte Training „JuSt“ bestand aus 6 Sitzungen, wobei sich 5 Sitzungen an die Jugendlichen richteten und eine Sitzung als Elternabend stattfand. Zur Überprüfung der Wirksamkeit des JuSt-Programms am Institut für Psychologie der Universität Würzburg wurden schlafbezogene Parameter sowie Maße aus assoziierten Bereichen herangezogen. Zudem wurden Trainingseffekte auf den Schlaf und die psychische Belastung der Eltern untersucht. Die Erfassung dieser Ergebnisgrößen erfolgte sowohl vor und nach der Trainingsteilnahme als auch über einen Katamnesezeitraum von bis zu 12 Monaten. Daneben umfasste das Studiendesign eine Gruppe mit einer Wartephase vor Trainingsbeginn und die Überprüfung möglicher den Trainingserfolg moderierender Faktoren, wie Alter, Geschlecht und Chronotyp, d.h. zirkadiane Präferenz, der Teilnehmer.
Bereits nach dem diagnostischen Erstkontakt zeigte sich eine Abnahme selbstberichteter externalisierender und internalisierender Probleme bei den jugendlichen Teilnehmern in der Gruppe mit Wartephase (n = 9). Alle anderen Parameter blieben dagegen von der Wartezeit unberührt. Unmittelbar nach dem Training zeigten die Schlaftagebücher der Teilnehmer (n = 22) ein verbessertes Durchschlafen und eine erhöhte Schlafeffizienz an. Fragebogendaten belegten zudem weniger selbst- und fremdberichtete Ein- und Durchschlafprobleme, seltenere dysfunktionale schlafbezogene Kognitionen, eine bessere Schlafhygiene und weniger Tagesmüdigkeit in der Wahrnehmung der Eltern. Bis zur 3-Monatskatamnese hatten sich außerdem die Gesamtschlafdauer, die Einschlaflatenz und die selbstberichtete Tagesmüdigkeit positiv verändert. In den assoziierten Maßen zeigte sich ein unmittelbarer Trainingseffekt auf selbst- und fremdberichtete externalisierende Probleme sowie auf das Fremdurteil bezüglich internalisierender Probleme. Im Selbsturteil hatte sich dieses Maß erst zum 3-Monats Follow-Up verbessert. Auf Elternseite verringerten sich während der Trainingsdurchführung die nächtliche Aufwachhäufigkeit der Mütter und die Schwere psychischer und somatischer Symptome beider Elternteile. Auf die Schlafeffizienz, die Dauer nächtlichen Wachseins von Vätern und Müttern sowie auf die nächtliche Aufwachhäufigkeit der Väter hatte das Training eine verzögerte positive Wirkung, da diese Effekte erst zum 3-Monats Follow-Up sichtbar wurden. Im Verlauf der Langzeitkatamnese (3-Monats- bis 1-Jahres Follow-Up, n = 16) blieben alle schlafbezogenen und assoziierten Ergebnisgrößen sowohl auf Kinder- als auch auf Elternseite auf konstantem Niveau. Darüber hinaus wurden explorativ die Merkmale Alter, Geschlecht und Chronotyp der Teilnehmer als mögliche Moderatoren des Trainingserfolgs untersucht. Die Ergebnisse zeigten, dass der Trainingserfolg nicht an ein bestimmtes Geschlecht, ein bestimmtes Alter zwischen 11 und 17 Jahren oder einen bestimmten Chronotyp gebunden war.
Insgesamt kann ein positives Fazit bezüglich der Wirksamkeit des JuSt-Programms zur Behandlung nicht-organischer Insomnien bei Jugendlichen und zur Entlastung ihrer Eltern am Standort Würzburg gezogen werden. Für die klinische Versorgung jugendlicher Insomniker wird angeregt, das JuSt-Training im deutschsprachigen Raum zukünftig verstärkt in der therapeutischen Praxis zu implementieren.