Implementing Performance Accommodation Mechanisms in Online BCI for Stroke Rehabilitation: A Study on Perceived Control and Frustration

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.