Signal Characteristics, Motor Cortex Engagement, and Classification Performance of Combined Action Observation, Motor Imagery and SSMVEP (CAMS) BCI

Motor imagery (MI)-based Brain-Computer Interfaces (BCIs) have shown promise in engaging the motor cortex for recovery. However, individual responses to MI-based BCIs are highly variable and relatively weak. Conversely, combined action observation (AO) and motor imagery (MI) paradigms have demonstrated stronger responses compared to AO or MI alone, along with enhanced cortical excitability. In this study, a novel BCI called Combined AO, MI, and Steady-State Motion Visual Evoked Potential (SSMVEP) (CAMS) was proposed. CAMS was designed based on gait observation and imagination. Twenty-five healthy volunteers participated in the study with CAMS serving as the intervention and SSMVEP checkerboard as the control condition. We hypothesized the CAMS intervention can induce observable increases in the negativity of the movement-related cortical potential (MRCP) associated with ankle dorsiflexion. MRCP components, including Bereitschaftspotential, were measured pre- and post-intervention. Additionally, the signal characteristics of the visual and motor responses were quantified. Finally, a two-class visual BCI classification performance was assessed. A consistent increase in negativity was observed across all MRCP components in signals over the primary motor cortex, compared to the control condition. CAMS visual BCI achieved a median accuracy of 83.8%. These findings demonstrate the ability of CAMS BCI to enhance cortical excitability in relation to movement preparation and execution. The CAMS stimulus not only evokes SSMVEP-like activity and sensorimotor rhythm but also enhances the MRCP. These findings contribute to the understanding of CAMS paradigm in enhancing cortical excitability, consistent and reliable classification performance holding promise for motor rehabilitation outcomes and future BCI design considerations.