Attitude of the subject towards feedback and its implications for BCI use in neurorehabilitation

Brain-Computer Interface (BCI) systems allow user to operate devices without muscular activation and experimental results indicate that they can induce activity-dependent plasticity. A BCI system has two key features: exploitation of brain signal changes induced by the cognitive task assigned to the user and mutual learning. With respect to the first feature, BCI users can learn to control and hence change their cortical activity, for example by performing a motor imagery task. Mutual learning, on the other hand, is set up between users, which have to learn how to control their brain activity, and the classifier used for learning and categorize brain signal changes. This mutual learning can be mediated by the use of feedback, which in turn can be discrete or continuous, abstract or realistic and so on. Motor imagery represents a promising approach for stroke rehabilitation, thus a BCI based on a motor imagery paradigm could be a useful tool. Nevertheless, in stroke rehabilitation settings two issues are emerging which are also crucial for motor imagery BCIs. The first one relates to the importance of recognize the imagery ability of the subject, the second one to the importance of feedback in re-learning of motor skills. The present study relates to this second issue and it is aimed at investigating attitudes of BCI users towards feedback. We considered a sample of six healthy males, using an EEG-based BCI and executing a Motor Imagery task without feedback (training phase) and with feedback (performance phase). A horizontal bar of varying length depicted on a computer screen was used as feedback medium and overall accuracy data were matched with neurophysiological data acquired from P_z and O_z. Results could be of importance for BCI use as neurorehabilitation tool in stroke rehabilitation protocols since they suggest that some subjects could need an increased cortical activation in order to deal with a stimulus like visual feedback. Moreover, they reveal a possible association between worsening in performance and increased cortical activation needed in order to cope with feedback.