Lorenzo Desideri

A Brain-Computer Interface as Input Channel for a Standard Assistive Technology Software

Recently brain-computer interface (BCI) control was integrated into the commercial assistive technology product QualiWORLD (QualiLife Inc., Paradiso-Lugano, CH). Usability of the first prototype was evaluated in terms of effectiveness (accuracy), efficiency (information transfer rate and subjective workload/NASA Task Load Index) and user satisfaction (Quebec User Evaluation of Satisfaction with assistive Technology, QUEST 2.0) by four end-users with severe disabilities. Three assistive technology experts evaluated the device from a third person perspective. The results revealed high performance levels in communication and internet tasks. Users and assistive technology experts were quite satisfied with the device. However, none could imagine using the device in daily life without improvements. Main obstacles were the EEG-cap and low speed.

The user-centered design as novel perspective for evaluating the usability of BCI-controlled applications.

Albeit research on brain-computer interfaces (BCI) for controlling applications has expanded tremendously, we still face a translational gap when bringing BCI to end-users. To bridge this gap, we adapted the user-centered design (UCD) to BCI research and development which implies a shift from focusing on single aspects, such as accuracy and information transfer rate (ITR), to a more holistic user experience. The UCD implements an iterative process between end-users and developers based on a valid evaluation procedure. Within the UCD framework usability of a device can be defined with regard to its effectiveness, efficiency, and satisfaction. We operationalized these aspects to evaluate BCI-controlled applications. Effectiveness was regarded equivalent to accuracy of selections and efficiency to the amount of information transferred per time unit and the effort invested (workload). Satisfaction was assessed with questionnaires and visual-analogue scales. These metrics have been successfully applied to several BCI-controlled applications for communication and entertainment, which were evaluated by end-users with severe motor impairment. Results of four studies, involving a total of N = 19 end-users revealed: effectiveness was moderate to high; efficiency in terms of ITR was low to high and workload low to medium; depending on the match between user and technology, and type of application satisfaction was moderate to high. The here suggested evaluation metrics within the framework of the UCD proved to be an applicable and informative approach to evaluate BCI controlled applications, and end-users with severe impairment and in the locked-in state were able to participate in this process.

Towards Independence: A BCI Telepresence Robot for People With Severe Motor Disabilities

This paper presents an important step forward towards increasing the independence of people with severe motor disabilities, by using brain-computer interfaces to harness the power of the Internet of Things. We analyze the stability of brain signals as end-users with motor disabilities progress from performing simple standard on-screen training tasks to interacting with real devices in the real world. Furthermore, we demonstrate how the concept of shared control-which interprets the users commands in context-empowers users to perform rather complex tasks without a high workload. We present the results of nine end-users with motor disabilities who were able to complete navigation tasks with a telepresence robot successfully in a remote environment (in some cases in a different country) that they had never previously visited. Moreover, these end-users achieved similar levels of performance to a control group of 10 healthy users who were already familiar with the environment.

Clinical evaluation of BrainTree, a motor imagery hybrid BCI speller

OBJECTIVE While brain-computer interfaces (BCIs) for communication have reached considerable technical maturity, there is still a great need for state-of-the-art evaluation by the end-users outside laboratory environments. To achieve this primary objective, it is necessary to augment a BCI with a series of components that allow end-users to type text effectively. APPROACH This work presents the clinical evaluation of a motor imagery (MI) BCI text-speller, called BrainTree, by six severely disabled end-users and ten able-bodied users. Additionally, we define a generic model of code-based BCI applications, which serves as an analytical tool for evaluation and design. MAIN RESULTS We show that all users achieved remarkable usability and efficiency outcomes in spelling. Furthermore, our model-based analysis highlights the added value of human-computer interaction techniques and hybrid BCI error-handling mechanisms, and reveals the effects of BCI performances on usability and efficiency in code-based applications. SIGNIFICANCE This study demonstrates the usability potential of code-based MI spellers, with BrainTree being the first to be evaluated by a substantial number of end-users, establishing them as a viable, competitive alternative to other popular BCI spellers. Another major outcome of our model-based analysis is the derivation of a 80% minimum command accuracy requirement for successful code-based application control, revising upwards previous estimates attempted in the literature.

User Centred Design in BCI Development

Development of assistive solutions for people with disabilities clearly benefits from the full involvement of potential users in all stages of the development cycle. In this chapter we will discuss different aspects of user involvement and the role that users could or should have in the design and development of BCI driven assistive applications. We will focus on BCI applications in the field of communication, access to ICT and environmental control, typical areas where AT solutions can make the difference between participation or exclusion.

Recommending assistive technology (AT) for children with multiple disabilities: A systematic review and qualitative synthesis of models and instruments for AT professionals

PURPOSE: To review the AT specific assessment models and instruments that have been developed for children with multiple disabilities in order to provide an overview of the strategies to be employed in interdisciplinary rehabilitation. METHOD: A systematic review was conducted utilizing the MEDLINE, CINAHL, PsycINFO, ERIC and ISI databases covering the period January 1990–September 2011. In addition, 4 conference proceedings, 35 journals and various web resources were hand searched. Papers were reviewed in three steps by three independent investigators according to specific inclusion and exclusion criteria. RESULTS: The search resulted in the finding of 25 papers. Only one model for structuring the AT assessment process and four instruments developed to support decisions about AT solutions for children with multiple disabilities were found. The validity and reliability of the models and instruments found are not documented in the literature reviewed. CONCLUSIONS: We argue that there is a need to develop validated models and instruments to guide AT professionals in the process of AT assessment for children with multiple disabilities.

Satisfaction of users with assistive technology service delivery: An exploratory analysis of experiences of parents of children with physical and multiple disabilities

Abstract Objective: To describe experience of assistive technology service delivery (ATSD) by parents of children with physical or multiple disabilities (aged 3–18 years). Method: Forty-seven of 115 parents participated in a postal survey assessing satisfaction with the ATSD process, employing the QUEST 2.0 and the KWAZO scales. Six of these participated in two focus groups. Descriptive statistics were used for satisfaction scores. The focus group transcripts were coded and combined with survey results by two independent researchers. Results: Low satisfaction scores were reported for follow-up, AT delivery, maintenance services, access to services, coordination, and efficiency of ATSD. Several barriers to and facilitators of ATSD were mentioned and solutions to improve ATSD quality were identified. Conclusion: Evaluation of parents’ service experience is central for identifying shortcomings in ATSD. Health professionals are advised to utilize validated instruments and strategies to assess effectiveness of technological interventions and to assure ATSD quality.

Is cognitive behavioural therapy an effective complement to antidepressants in adolescents? A meta-analysis

Calati R, Pedrini L, Alighieri S, Alvarez MI, Desideri L, Durante D, Favero F, Iero L, Magnani G, Pericoli V, Polmonari A, Raggini R, Raimondi E, Riboni V, Scaduto MC, Serretti A, De Girolamo G. Is cognitive behavioural therapy an effective complement to antidepressants in adolescents? A meta-analysis. Objective: Evidence on effectiveness of combined treatments versus antidepressants alone in adolescents consists on a few studies in both major depressive and anxiety disorders. A meta-analysis of randomised 12-week follow-up studies in which antidepressant treatment was compared to combined treatment consisting of the same antidepressant with cognitive behavioural therapy has been performed. Methods: Data were entered into the Cochrane Collaboration Review Manager software and were analysed within a random effect framework. A quality assessment has been performed through Jadad Scale. Results: Higher global functioning at the Childrens Global Assessment Scale was found in the combined treatment group (p < 0.0001) as well as higher improvement at the Clinical Global Impressions Improvement Scale (p = 0.04). No benefit of combined treatment was found on depressive symptomatology at the Childrens Depression Rating Scale – Revised. Conclusion: Combined treatment seems to be more effective than antidepressant alone on global functioning and general improvement in adolescents with major depressive and anxiety disorders.

Implementing a routine outcome assessment procedure to evaluate the quality of assistive technology service delivery for children with physical or multiple disabilities: Perceived effectiveness, social cost, and user satisfaction

ABSTRACT There is a lack of evidence on the effects and quality of assistive technology service delivery (ATSD). This study presents a quasi-experimental 3-months follow-up using a pre-test/post-test design aimed at evaluating outcomes of assistive technology (AT) interventions targeting children with physical and multiple disabilities. A secondary aim was to evaluate the feasibility of the follow-up assessment adopted in this study with a view to implement the procedure in routine clinical practice. Forty-five children aged 3–17 years were included. Parents were asked to complete the Individual Prioritised Problem Assessment (IPPA) for AT effectiveness; KWAZO (Kwaliteit van Zorg [Quality of Care]) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0 for satisfaction with ATSD; Siva Cost Analysis Instrument (SCAI) for estimating the social cost of AT interventions. At follow-up, 25 children used the AT recommended. IPPA effect sizes ranged from 1.4 to 0.7, showing a large effect of AT interventions. Overall, parents were satisfied with ATSD, but Maintenance, Professional Services, and AT Delivery were rated not satisfactory. SCAI showed more resources spent for AT intervention compared to human assistance without technological supports. AT may be an effective intervention for children with disabilities. Issues concerning responsiveness and feasibility of the IPPA and the SCAI instruments are discussed with a view to inform routine clinical practice.

Development of a Team-Based Method for Assuring the Quality of Assistive Technology Documentation

Good practice in assistive technology (AT) service delivery targeting children with disabilities has come increasingly to include providing AT stakeholders with a final text record that documents the rationale and procedures behind the recommendations made during the AT assessment process (AT documentation). In the present case study of one AT service provider, we developed a team-based approach for conducting an evaluation of the quality of the AT documentation. A service-specific scale for the evaluation of AT documentation was developed following a five-step approach. The scale was employed to review AT documentation utilizing specific review criteria in order to evaluate the quality of AT documentation practices with regard to the service investigated. Two independent reviewers examined the AT documentation for 130 cases of AT service provision. Weighted kappa and Intraclass correlation coefficients (ICC) were employed as a measure of inter-rater agreement. The results of the documentation evaluation allowed AT professionals to objectively assess the quality of the AT documentation produced by the service under investigation, identify shortcomings in the documentation process, and make related corrections. AT services may benefit from the employment of strategic approaches for the evaluation of service provision. Possible applications to other AT service providers are discussed.