Applying Action Observation During a Brain-Computer Interface on Upper Limb Recovery in Chronic Stroke Patients

The study aimed to compare the effects of combined action observation and motor imagery (AOMI) and motor imagery (MI)-based brain-computer interface (BCI) training on upper limb recovery, cortical excitation, and cognitive task performance in chronic stroke patients. 17 chronic stroke patients were recruited and randomly assigned to AOMI-based BCI (n = 9) and MI-based BCI groups (n = 8). The AOMI-based BCI group received AOMI-based BCI training via functional electrical stimulation (FES) feedback, whereas the MI-based BCI group obtained MI-based BCI training via FES feedback. Both groups participated in training for 12 sessions (3 days/week, consecutive four weeks). To evaluate upper limb function recovery, the Fugl–Meyer Assessment for upper extremity (FMA-UE) was employed. Event-related desynchronization (ERD) and online classification accuracy were utilized to measure cortical excitation of the affected sensorimotor hand region and cognitive task performance, respectively. Both AOMI and MI-based BCI training improved upper limb function in chronic stroke patients. However, the AOMI-based BCI group showed significantly greater motor gain than the MI-based BCI group. In addition, the AOMI-based BCI group demonstrated significantly greater cortical excitation of the affected sensorimotor hand region and cognitive task performance. The correlation analysis revealed that higher cognitive task performance during AOMI-based BCI training may promote greater cortical excitation of the affected sensorimotor hand region, which contributes to greater upper limb function improvement compared to MI-based BCI training.