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Obstructive sleep apnoea (OSA) is a common disorder that can present with various clinical Background -Although oral appliances are effective in some patients with ob-consequences.1 Nasal continuous positive airway pressure therapy (nCPAP) is a highly structive sleep apnoea (OSA), they are not universally effective. A novel anterior effective treatment for OSA, 2 but there can be substantial problems with patient acceptance mandibular positioner (AMP) has been developed with an adjustable hinge that and long term compliance.3 The most common surgical treatment for OSA is uvulopalatoallows progressive advancement of the mandible. The objective of this prospective pharyngoplasty (UPPP) but this approach is limited by its variable success. 4 Consequently, crossover study was to compare efficacy, side effects, patient compliance, and pref-there is a need for alternative treatments for OSA that are safe, effective, and acceptable. erence between AMP and nasal continuous positive airway pressure (nCPAP) in Oral appliances represent a relatively new approach in the management of OSA. 5 Schmidtpatients with symptomatic mild to moderate OSA.Nowara and co-workers have reported their experience with a mandibular repositioning apMethods -Twenty four patients of mean (SD) age 44.0 (10.6) years were recruited pliance in 68 patients with either snoring or OSA. 6 In the 20 patients with follow up polywith a mean (SD) body mass index of 32.0 (8.2) kg/m 2 , Epworth sleepiness score 10.7 somnography the appliance reduced the apnoea and hypopnoea index (AHI) by more than 50% (3.4), and apnoea/hypopnoea index 26.8 (11.9)/hour. There was a two week wash-and improved both arterial oxygen saturation and sleep quality. O'Sullivan and co-workers in and a two week wash-out period and two treatment periods (AMP and nCPAP) have recently shown that a mandibular advancement splint decreased AHI to <20/hour each of four months. Efficacy, side effects, compliance, and preference were evalu-in 12 of 17 patients in whom untreated AHI was 20-60 per hour, and in two of nine patients ated by a questionnaire and home sleep monitoring.in whom untreated AHI was >60/hour. 7 Eveloff and colleagues reported their results with an Results -One patient dropped out early in the study and three refused to cross over anterior mandibular positioning appliance in 19 patients with OSA. 8 Their success rate was so treatment results are presented on the remaining 20 patients. The apnoea/hypo-53% when they defined treatment response as a reduction in AHI to <10/hour with the pnoea index (AHI) was lower with nasal CPAP 4.2 (2.2)/hour than with the AMP appliance. Division of (14.5)/hour (p<0.01). Eleven of the 20There are major design differences in the

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Recent studies have shown that scalp electroencephalogram (EEG) based brain-computer interface (BCI) has a great potential for motor rehabilitation in stroke patients with severe hemiplegia. However, key elements in BCI architecture for functional recovery has yet to be clear. We in this study focused on the type of feedback to the patients, which is given contingently to their motor-related EEG in a BCI context. The efficacy of visual and somatosensory feedbacks was compared by a two-group study with the chronic stroke patients who are suffering with severe motor hemiplegia. Twelve patients were asked an attempt of finger opening in the affected side repeatedly, and the event-related desynchronization (ERD) in EEG of alpha and beta rhythms was monitored over bilateral parietal regions. Six patients were received a simple visual feedback in which the hand open/grasp picture on screen was animated at eye level, following significant ERD. Six patients were received a somatosensory feedback in which the motor-driven orthosis was triggered to extend the paralyzed fingers from 90 to 50°. All the participants received 1-h BCI treatment with 12–20 training days. After the training period, while no changes in clinical scores and electromyographic (EMG) activity were observed in visual feedback group after training, voluntary EMG activity was newly observed in the affected finger extensors in four cases and the clinical score of upper limb function in the affected side was also improved in three participants in somatosensory feedback group. Although the present study was conducted with a limited number of patients, these results imply that BCI training with somatosensory feedback could be more effective for rehabilitation than with visual feedback. This pilot trial positively encouraged further clinical BCI research using a controlled design.

These results indicate that self-directed training with a brain computer interface may induce activity- dependent cortical plasticity and promote functional recovery. This preliminary clinical investigation encourages further research using a controlled design.

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Anodal tDCS can be a conditioning tool for brain-computer interface training in patients with severe hemiparetic stroke.