Jacinta McElligott

Sensorimotor Modulation Assessment and Brain-Computer Interface Training in Disorders of Consciousness

OBJECTIVES To assess awareness in subjects who are in a minimally conscious state by using an electroencephalogram-based brain-computer interface (BCI), and to determine whether these patients may learn to modulate sensorimotor rhythms with visual feedback, stereo auditory feedback, or both. DESIGN Initial assessment included imagined hand movement or toe wiggling to activate sensorimotor areas and modulate brain rhythms in 90 trials (4 subjects). Within-subject and within-group analyses were performed to evaluate significant activations. A within-subject analysis was performed involving multiple BCI technology training sessions to improve the capacity of the user to modulate sensorimotor rhythms through visual and auditory feedback. SETTING Hospital, homes of subjects, and a primary care facility. PARTICIPANTS Subjects (N=4; 3 men, 1 woman) who were in a minimally conscious state (age range, 27-53 y; 1-12 y after brain injury). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Awareness detection was determined from sensorimotor patterns that differed for each motor imagery task. BCI performance was determined from the mean classification accuracy of brain patterns by using a BCI signal processing framework and assessment of performance in multiple sessions. RESULTS All subjects demonstrated significant and appropriate brain activation during the initial assessment, and real-time feedback was provided to improve arousal. Consistent activation was observed in multiple sessions. CONCLUSIONS The electroencephalogram-based assessment showed that patients in a minimally conscious state may have the capacity to operate a simple BCI-based communication system, even without any detectable volitional control of movement.

A qualitative exploration of how individuals reconstruct their sense of self following acquired brain injury in comparison with spinal cord injury

Abstract Primary objective: The present study aimed to investigate the specific ways in which individuals reconstruct their sense of self following injury to the nervous system, by comparing individuals with acquired brain injury (ABI) and individuals with spinal cord injury (SCI), two groups that have experienced a sudden-onset injury with life-changing repercussions. Research design: Phenomenological qualitative research. Methods and procedures: Nine individuals with ABI and 10 individuals with SCI took part in an interview exploring the ways in which individuals reconstruct their sense of self following injury. Data were analysed using interpretative thematic analysis. Main outcomes and results: Findings showed similar themes identified within the interview data of the ABI and SCI groups. Both groups developed positive and negative self-narratives. Individuals employed strategies that facilitated the reconstruction of positive self-narratives. In addition, individuals described their sense of self as simultaneously continuous and changing. Discussion: Findings are discussed in relation to proposed models of self-reconstruction post-injury to the nervous system.

European models of multidisciplinary rehabilitation services for traumatic brain injury.

McElligott J, Carroll A, Morgan J, Macdonnell C, Neumann V, Gutenbrunner C, Fialka-Moser V, Christodoulou N, Varela E, Giustini A, Delarque A, Assucena A, Lukmann A, Tuulik-Leisi V, Zoltan D: European models of multidisciplinary rehabilitation services for traumatic brain injury. Am J Phys Med Rehabil 2011;90:74Y78.

Measuring rehabilitation research capacity: report from the AAPM&R Research Advisory Committee.

Wagner AK, McElligott J, Wagner II EP, Gerber LH: Measuring rehabilitation research capacity: Report from the AAPM&R research advisory committee. Am J Phys Med Rehabil 2005;84:955–968. There is considerable concern regarding the paucity of individuals pursuing biomedical research in general and rehabilitation research in particular. The Research Advisory Committee (RAC) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) accepted the task to explore the barriers to biomedical research careers for physicians and rehabilitation scientists and, in particular, those factors pertaining to successfully conducting rehabilitation research. Concurrently, the Foundation for PM&R was also exploring the related issue of building capacity for rehabilitation research and planning a Rehabilitation Research Summit to address this issue for the spring of 2005. The goals of the Research Summit included the identification of barriers to rehabilitation research and development of an active agenda to enhance research capacity. As such, AAPM&R and the Foundation for PM&R worked through the RAC survey to provide some key information that would help the summit leaders achieve their goals. This report presents portions of the survey related to research capacity and outlines the methodology of the data collection and analysis within the context of the capacity taxonomy framework as presented at the Research Summit, “Building Research Capacity,” held in the spring of 2005. This survey report provides quantitative information about researchers and academicians, their research environment, as well as their barriers and incentives for conducting rehabilitation research. Observations here provide a platform for future work in understanding the adequacy of the rehabilitation research enterprise, its appropriateness, and ability to meet societal needs for those with disabilities

Motor Imagery BCI with Auditory Feedback as a Mechanism for Assessment and Communication in Disorders of Consciousness

Patients with disorders of consciousness (DoC) are difficult to assess both because of their unpredictable fluctuation of awareness and the current adopted scales, which have a poor prognostic reliability [1]. Individuals who are in a minimally conscious state (MCS) or vegetative state (VS), or with unresponsive wakefulness syndrome (UWS), may be incapable of providing volitional overt motor responses. This has resulted in a rate of 43% of patients who were diagnosed as having VS being reclassified as MCS after further assessment.