The review describes the status of brain–computer or brain–machine interface research. We focus on non-invasive brain–computer interfaces (BCIs) and their clinical utility for direct brain communication in paralysis and motor restoration in stroke. A large gap between the promises of invasive animal and human BCI preparations and the clinical reality characterizes the literature: while intact monkeys learn to execute more or less complex upper limb movements with spike patterns from motor brain regions alone without concomitant peripheral motor activity usually after extensive training, clinical applications in human diseases such as amyotrophic lateral sclerosis and paralysis from stroke or spinal cord lesions show only limited success, with the exception of verbal communication in paralysed and locked-in patients. BCIs based on electroencephalographic potentials or oscillations are ready to undergo large clinical studies and commercial production as an adjunct or a major assisted communication device for paralysed and locked-in patients. However, attempts to train completely locked-in patients with BCI communication after entering the complete locked-in state with no remaining eye movement failed. We propose that a lack of contingencies between goal directed thoughts and intentions may be at the heart of this problem. Experiments with chronically curarized rats support our hypothesis; operant conditioning and voluntary control of autonomic physiological functions turned out to be impossible in this preparation. In addition to assisted communication, BCIs consisting of operant learning of EEG slow cortical potentials and sensorimotor rhythm were demonstrated to be successful in drug resistant focal epilepsy and attention deficit disorder. First studies of non-invasive BCIs using sensorimotor rhythm of the EEG and MEG in restoration of paralysed hand movements in chronic stroke and single cases of high spinal cord lesions show some promise, but need extensive evaluation in well-controlled experiments. Invasive BMIs based on neuronal spike patterns, local field potentials or electrocorticogram may constitute the strategy of choice in severe cases of stroke and spinal cord paralysis. Future directions of BCI research should include the regulation of brain metabolism and blood flow and electrical and magnetic stimulation of the human brain (invasive and non-invasive). A series of studies using BOLD response regulation with functional magnetic resonance imaging (fMRI) and near infrared spectroscopy demonstrated a tight correlation between voluntary changes in brain metabolism and behaviour.

/pdf/brain-computer-interfaces-communication-and-restoration-of-2iwsmmfmqs.pdf

Brain-computer interfaces: communication and restoration of movement in paralysis.

Brain–computer interfaces (BCI) allow control of computers or external devices with regulation of brain activity alone. Invasive BCIs, almost exclusively investigated in animal models using implanted electrodes in brain tissue, and noninvasive BCIs using electrophysiological recordings in humans are described. Clinical applications were reserved with few exceptions for the noninvasive approach: communication with the completely paralyzed and locked-in syndrome with slow cortical potentials, sensorimotor rhythm and P300, and restoration of movement and cortical reorganization in high spinal cord lesions and chronic stroke. It was demonstrated that noninvasive EEG-based BCIs allow brain-derived communication in paralyzed and locked-in patients but not in completely locked-in patients. At present no firm conclusion about the clinical utility of BCI for the control of voluntary movement can be made. Invasive multielectrode BCIs in otherwise healthy animals allowed execution of reaching, grasping, and force variations based on spike patterns and extracellular field potentials. The newly developed fMRI-BCIs and NIRS-BCIs, like EEG BCIs, offer promise for the learned regulation of emotional disorders and also disorders of young children.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-8986.2006.00456.x

Breaking the silence: Brain–computer interfaces (BCI) for communication and motor control

With the increasing efficiency of life-support systems and better intensive care, more patients survive severe injuries of the brain and spinal cord. Many of these patients experience locked-in syndrome: The active mind is locked in a paralyzed body. Consequently, communication is extremely restricted or impossible. A muscle-independent communication channel overcomes this problem and is realized through a brain-computer interface, a direct connection between brain and computer. The number of technically elaborated brain-computer interfaces is in contrast with the number of systems used in the daily life of locked-in patients. It is hypothesized that a profound knowledge and consideration of psychological principles are necessary to make brain-computer interfaces feasible for locked-in patients.

Brain-computer communication: unlocking the locked in.

The thought translation device trains locked-in patients to self regulate slow cortical potentials (SCP's) of their electroencephalogram (EEG). After operant learning of SCP self control, patients select letters, words or pictograms in a computerized language support program. Results of five respirated, locked-in-patients are described, demonstrating the usefulness of the thought translation device as an alternative communication channel in motivated totally paralyzed patients with amyotrophic lateral sclerosis.

The thought translation device (TTD) for completely paralyzed patients

Major depressive disorder (MDD) is a common mood disorder that can result in significant discomfort as well as interpersonal and functional disability. A growing body of research indicates that autonomic function is altered in depression, as evidenced by impaired baroreflex sensitivity, changes in heart rate, and reduced heart rate variability (HRV). Decreased vagal activity and increased sympathetic arousal have been proposed as major contributors to the increased risk of cardiovascular mortality in participants with MDD, and baroreflex gain is decreased. Study objectives: To assess the feasibility of using HRV biofeedback to treat major depression. Design: This was an open-label study in which all eleven participants received the treatment condition. Participants attended 10 weekly sessions. Questionnaires and physiological data were collected in an orientation (baseline) session and Treatment Sessions 1, 4, 7 and 10. Measurements and results: Significant improvements were noted in the Hamilton Depression Scale (HAM-D) and the Beck Depression Inventory (BDI-II) by Session 4, with concurrent increases in SDNN, standard deviation of normal cardiac interbeat intervals) an electrocardiographic estimate of overall measure of adaptability. SDNN decreased to baseline levels at the end of treatment and at follow-up, but clinically and statistically significant improvement in depression persisted. Main effects for task and session occurred for low frequency range (LF) and SDNN. Increases in these variables also occurred during breathing at one’s resonant frequency, which targets baroreflex function and vagus nerve activity, showing that subjects performed the task correctly Conclusions: HRV biofeedback appears to be a useful adjunctive treatment for the treatment of MDD, associated with large acute increases in HRV and some chronic increases, suggesting increased cardiovagal activity. It is possible that regular exercise of homeostatic reflexes helps depression even when changes in baseline HRV are smaller. A randomized controlled trial is warranted.

Preliminary Results of an Open Label Study of Heart Rate Variability Biofeedback for the Treatment of Major Depression

https://kops.uni-konstanz.de/bitstream/handle/123456789/11272/Elbert_1993_Cortical_self_regulation.pdf;sequence=1

Cortical self-regulation in patients with epilepsies

Recent epidemiological data show an increased trend of official estimates for syphilis infection in the general population. Many of the infected cases remain undetected leaving an underestimation of the true prevalence of syphilis in the general population, but also among subpopulations such as illicit drug users. There is limited epidemiological data published on the proportion and risk factors of syphilis infections associated with illicit drug abuse. Illicit drug addicts (n = 1223) in inpatients units in Germany were screened (2000–01) for syphilis and interviewed regarding patterns of drug use and sexual behaviour. TPHA-test for initial screening and FTA-ABS-IgM test in TPHA-positive patients were used. In total, TPHA-tests were positive in 39 (3.3%) and 7 patients (0.6%) were IgM positive. The prevalence rate for syphilis in males was 1.9% and for women it was 8.5%. Female patients were 4.56 (CI 95% 2.37–8.78) times more likely to have a positive TPHA test than males. Sexual behaviours such as high number of sexual partners, sex for drugs/money, sex on the first day were associated with syphilis infection only in women. Females with frequent sex for drugs or money had 4.31 (CI 95% 2.32–8.52) times more likely a reactive TPHA test than remaining patients. Neither the sociodemographic factors nor sexual behaviour were statistically significant associated with syphilis infection among men at all. Our data suggest the need for screening for syphilis among these illicit drug users in inpatient settings, in particular among sexual active women. This conclusion is corroborated by the finding of increasing numbers of syphilis infections in the general population. The identification of syphilis cases among drug addicts would give treatment options to these individuals and would help to reduce the spread of infection in this population, but also a spread into heterosexual populations related to prostitution.

/pdf/prevalence-and-risk-factors-of-syphilis-infection-among-drug-14id3ideq4.pdf

Prevalence and risk factors of syphilis infection among drug addicts

It remains a pertinent problem that dependent on the type of epilepsy, 20–50% of patients are not sufficiently controlled with antiepileptic medication. Alternative approaches such as behavioral treatment have therefore been explored. The behavioral research was stimulated by a famous single case study published by Efron (1975) documenting the classical conditioning of seizure depression. Reduction in seizure frequency has been reported following the application of desensitization and extinction procedures (Forster, 1969, 1972, 1977; Rockstroh & Elbert, 1990), self-control procedures implying self-perception, self-control, and relaxation (Dahl, Brorson, 1985; Dahl, Melin, & Leissner, 1988; Buhring & Weltek, 1990), biofeedback of respiratory parameters (Fried, Rubin, Carlton, & Fox, 1984), and instrumental modification of EEG spectra (Lubar, 1984; Sterman, 1984; Rockstroh, Elbert, Birbaumer, Wolf, Duchting-Roth, Reker, Daum, Lutzenberger, & Dichgans, 1993). For recent overviews, see Birbaumer, Elbert, Canavan, and Rockstroh (1990) and Elbert, Rockstroh, Canavan, Birbaumer, Lutzenberger, von Bulow, and Linden (1991).

/pdf/biofeedback-of-slow-cortical-potentials-in-epilepsy-3vg66d5bi9.pdf

Biofeedback of Slow Cortical Potentials in Epilepsy

Syphilis infection among drug addicts in western Germany.


 Zur Abstinenz motivieren  
 
Alkoholsucht ist ein stets präsentes, oft frustrierendes Thema für alle, die in psychosozialen Berufsfeldern arbeiten. Das Buch bietet eine kompakte Einführung in das Thema mit Fallbeispielen und praktischen Tipps, wie sich die Motivation zur Abstinenz oder Reduktion anschieben und stützen lassen. Auch Angehörige finden im Buch hilfreiche Impulse. 
 
Praxisnah und kompetent erleichtert der Autor den Zugang zur subjektiven Seite des süchtigen Alkoholkonsums, zur biografischen Dimension der Sucht und zu somatischen und sozialen Folgen ihrer Verfestigung. Das Buch weckt Verständnis für die Art der Störung und erläutert professionelle Handlungsoptionen. Dabei zielen die Behandlungsstrategien und -möglichkeiten auf die Unterstützung der Betroffenen bei der persönlichen Zielfindung, der Ressourcenorientierung und durch positive Verstärker. Möglichkeiten der Online-Beratung werden ausführlich dargestellt; Aktualisierungen betreffen die Eingliederungshilfe, die epidemiologischen Zahlen sowie das Thema »Sucht und Arbeit«.

Martin Reker

Papers

Cortical self-regulation in patients with epilepsies

Prevalence and risk factors of syphilis infection among drug addicts

Biofeedback of Slow Cortical Potentials in Epilepsy

Syphilis infection among drug addicts in western Germany.

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