Using a hybrid brain computer interface and virtual reality system to monitor and promote cortical reorganization through motor activity and motor imagery training.

Stroke is one of the leading causes of adult disability with high economical and societal costs. In recent years, novel rehabilitation paradigms have been proposed to address the life-long plasticity of the brain to regain motor function. We propose a hybrid brain-computer interface (BCI)-virtual reality (VR) system that combines a personalized motor training in a VR environment, exploiting brain mechanisms for action execution and observation, and a neuro-feedback paradigm using mental imagery as a way to engage secondary or indirect pathways to access undamaged cortico-spinal tracts. Furthermore, we present the development and validation experiments of the proposed system. More specifically, EEG data on nine naïve healthy subjects show that a simultaneous motor activity and motor imagery paradigm is more effective at engaging cortical motor areas and related networks to a larger extent. Additionally, we propose a motor imagery driven BCI-VR version of our system that was evaluated with nine different healthy subjects. Data show that users are capable of controlling a virtual avatar in a motor imagery training task that dynamically adjusts its difficulty to the capabilities of the user. User self-report questionnaires indicate enjoyment and acceptance of the proposed system.