A Brain-Computer Interface-Based Action Observation Game that Enhances Mu Suppression.

Action observation training based on the theory of activation of the mirror-neuron system has been used for the rehabilitation of patients with stroke. In this paper, we sought to assess whether a brain-computer interface-based action observation rehabilitation game, using a flickering action video, could preferentially activate the mirror-neuron system. Feedback of stimulus observation, evoked by the flickering action video, was provided using steady state visually evoked potential and event related desynchronization. Fifteen healthy subjects experienced the game with brain-computer interface interaction (game and interaction), without brain-computer interface interaction (game without interaction), observed non-flickering stimuli, and flickering stimuli without the game background (stimuli only) in a counter-balanced order. The game and interface condition resulted in significantly stronger activation of the mirror-neuron system than did the other three conditions. In addition, the amount of mirror-neuron system activation gradually decreased in the game without interface, non-flickering stimuli, and stimuli only conditions in a time-dependent manner; however, in the game and interface condition, the amount of mirror-neuron system activation was maintained until the end of the training. Taken together, these data suggest that the proposed game paradigm, which integrates the action observation paradigm with brain-computer interface technology, could provide interactive responses for whether watching video clips can engage patients and enhance rehabilitation.