Patient feedback on self-managed brain computer interface treatment of central neuropathic pain in spinal cord injury: Steps towards service design

Petric-Gray, N., Al-Taleb, M., Purcell, M., Fraser, M. and Vuckovic, A. (2018) Patient feedback on self-managed brain computer interface treatment of central neuropathic pain in spinal cord injury: Steps towards service design. 7th International BCI Meeting, Pacific Grove, CA, 21-25 May 2018.

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Abstract

Introduction: As part of a wider study into the user centred design of Brain Computer Interface (BCI) for treatment of neuropathic pain [1], patient feedback was evaluated to identify themes and prioritise future developments. Material, Methods and Results: Twenty participants with chronic Spinal Cord Injury (SCI) (17 males and 3 females, aged 50.6 ± 14.1 years, para- and tetraplegic) with Central Neuropathic Pain larger than 4 on a Visual Analogue Scale participated in this study. Fifteen participants had a response to neurofeedback and were given a portable BCI headset (Emotiv, Epoch, USA) to use, practicing neurofeedback therapy on their own or with assistance from their caregivers (2 tetra and 4 paraplegic patients). They used BCI for a period ranging from several weeks to several months. Eight out of fifteen experienced clinically significant reduction of pain, greater than 30%. The neurofeedback protocol consisted of upregulating alpha (9 to 12Hz) and suppressing theta (4 to 8Hz) and higher beta (20 to 30 Hz) band relative powers above/below the pre-determined threshold from electrode location C4 [2]. Patients and caregivers received two to four training sessions before taking BCI (headset and a tablet computer) home. Interviews were carried out on patient check-up visits to the hospital after they had been using the device on their own for few weeks and after the quality of recorded EEG signal was checked to ensure that it did not contain excessive noise, i.e. that patients were doing feedback correctly. In addition, some of the information was taken from emails or SMS messages by patients to researchers. All material type was printed verbatim and analysed independently by two researchers, one of whom was not involved in the interviews. Thematic analysis was used to extract patterns within the qualitative data in order to identify patient feedback themes. Four main themes were identified: effects of treatment, usage, hardware and software. Within these topics further subtopics were identified. Fig 1 shows two classification tiers. Theme "Effects of treatment" had two categories: -Location (at and under the level of injury), pain reduction (more than 30% and less than 30%), descriptors (burning, stinging etc.) -Side effects: positive (better sleep, less spasm), negative (hypersensitivity, headache) Theme "Usage" had four categories: -Preferred time of use (morning, evening) -Location of use (place with no distractions) -Usage pattern (1-7 times a week, 20-30 minutes daily) -Reasons for abandonment (changes of daily routine such as infections and negative opinion of a trusted person) and reasons to reuse (recurring pain) Theme "Software" comprised of two categories: -Usage pattern and related problems: easy to use, forgetting instructions, small font of warning signs -Suggested improvements (step-by-step instruction on screen, better measure of daily performance) Theme "Hardware" comprised on three categories: -Usage patterns and related problems: no problems, awkward to put on, unsure about the quality of EEG, robustness, electrodes braking, caregiver training/time -Setup time: ranging from 5 to 20 minutes -Suggested improvements: dedicated headset for pain treatment, increased robustness, unambiguous location on the head Discussion: An important area of patient oriented BCI is home/community use. This requires design of the whole service, including understanding patient predisposition to using assistive technology [3], patient and caregiver education and training, effective user support, dedicated hardware and software design, understanding preferred usage patterns and most common reasons for abandonment and re-use. This study provides important feedback on usage pattern and technical problems which cannot be collected based on patients BCI experience in clinical trials. Reasons for abandoning the use and reasons for re-use are particularly relevant for creating a successful service support for future applications. Significance: Informing future service design studies of BCI as a home-based therapy.

Item Type:Conference or Workshop Item
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Petric-Gray, Miss Nina and Purcell, Mariel and Al-Taleb, Mr Manaf and Vuckovic, Dr Aleksandra
Authors: Petric-Gray, N., Al-Taleb, M., Purcell, M., Fraser, M., and Vuckovic, A.
College/School:College of Science and Engineering > School of Engineering
College of Science and Engineering > School of Engineering > Biomedical Engineering
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