Performance of the Action Observation-Based Brain–Computer Interface in Stroke Patients and Gaze Metrics Analysis

Brain-computer interfaces (BCIs) are anticipated to improve the efficacy of rehabilitation for people with motor disabilities. However, applying BCI in clinical practice is still a challenge due to the great diversity of patients. In the current study, a novel action observation (AO) based BCI was proposed and tested on stroke patients. Ten non-hemineglect patients and ten hemineglect patients were recruited. Four AO stimuli were designed, each presenting a decomposed action to complete the reach-and-grasp task. EEG data and eye movement data were collected. Eye movement data was utilized to analyze the reasons for individual differences in BCI performance. Task discriminative component analysis was utilized to perform online target detection. The results showed that the designed AO-based BCI could simultaneously induce steady state motion visual evoked potential (SSMVEP) from the occipital region and sensory motor rhythm from the sensorimotor region in stroke patients. The average online detection accuracy among the four AO stimuli reached 67% within 3 s in the non-hemineglect group, while the accuracy only reached 35% in the hemineglect group. Gaze metrics showed that the average total duration of fixations during the stimulus phase in the hemineglect group was only 1.31 s ± 0.532 s which was significantly lower than that in the non-hemineglect group. The results indicated that hemineglect patients have difficulty gazing at the AO stimulus, resulting in poor detection performance and weak desynchronization in the sensorimotor region. Furthermore, the degree of neglect is inversely proportional to the target detection accuracy in hemineglect stroke patients. In addition, the gaze metrics associated with cognitive load were significantly correlated with the accuracy in non-hemineglect patients. It indicated the cognitive load may affect the AO-based BCI. The current study will expedite the clinical application of AO-based BCI.