Brain-computer interfaces (BCIs) can serve as a means for stroke rehabilitation, but low BCI performance can decrease agency (users' perceived control), frustrate users and thereby hamper rehabilitation. In such rehabilitative tasks BCIs can implement fabricated input (preprogrammed positive feedback) that improve agency and frustration. Two substudies with healthy subjects and stroke patients investigated this potential through completion of a game and a simple task with: 1) 16 healthy subjects using motor imagery-based online BCI and 2) 13 stroke patients using a surrogate BCI system based on eyeblink detection through an eye-tracker to have a highly reliable input signal. Substudy 1 measured perceived control and frustration in four conditions: 1) unaltered BCI control, 2) 30% guaranteed positive feedback from fabricated input 3) 50% guaranteed negative feedback, and 4) 50% guaranteed negative feedback and 30% guaranteed positive feedback. In substudy 2, stroke patients had 50% control over outcomes and four conditions added from 0% to 50% positive feedback. In both substudies, positive feedback improved participants' perceived control and reduced frustration with increasing improvements when the amount of positive fabricated input increased. The stroke patients did not react as much to the fabricated input as the healthy participants. Fabricated input can be concealed in both online and surrogate BCIs which can be used to improve perceived control and frustration in a game-based interaction and simple task. This suggests that BCI designers can exercise artistic freedom to create engaging motor imagery-based interactions of narrative-based games or simpler gamified interactions to facilitate improved training efforts.
Brain–computer interfaces (BCIs) are successfully used for stroke rehabilitation, but the training is repetitive and patients can lose the motivation to train. Moreover, controlling the BCI may be difficult, which causes frustration and leads to even worse control. Patients might not adhere to the regimen due to frustration and lack of motivation/engagement. The aim of this study was to implement three performance accommodation mechanisms (PAMs) in an online motor imagery-based BCI to aid people and evaluate their perceived control and frustration. Nineteen healthy participants controlled a fishing game with a BCI in four conditions: (1) no help, (2) augmented success (augmented successful BCI-attempt), (3) mitigated failure (turn unsuccessful BCI-attempt into neutral output), and (4) override input (turn unsuccessful BCI-attempt into successful output). Each condition was followed-up and assessed with Likert-scale questionnaires and a post-experiment interview. Perceived control and frustration were best predicted by the amount of positive feedback the participant received. PAM-help increased perceived control for poor BCI-users but decreased it for good BCI-users. The input override PAM frustrated the users the most, and they differed in how they wanted to be helped. By using PAMs, developers have more freedom to create engaging stroke rehabilitation games.
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