Adaptive Neurofeedback Training Using a Virtual Reality Game Enhances Motor Imagery Performance in Brain-Computer...

Neurofeedback training (NFT) has been widely used in motor rehabilitation. However, NFT combined with motor imagery-based brain-computer interface (MI-BCI) faces challenges such as mental fatigue and non-personalized training strategies. Therefore, we proposed an adaptive NFT based on a VR game that simulates real-life motor tasks to improve training efficiency. We conducted a detailed comparative analysis of the efficiency of the VR-based NFT and traditional Graz-based NFT. Forty-eight healthy subjects were randomly assigned to five groups and underwent various NFT protocols. Among them, the subjects in the four experimental groups were required to perform the NFT three times over five days, including virtual or real scenarios, as well as unilateral or bilateral hands training. We evaluated training effects by analyzing EEG features and classification performance, while online recognition duration served as the primary measure for assessing the adaptive NFT strategy. EEG analysis showed that VR-based NFT significantly enhanced the Event-related desynchronization (ERD) activations in the sensorimotor cortices over five days. The VR-based NFT group achieved a classification accuracy of 81.85%, representing a 10.14% improvement from baseline, which exceeded the 6.43% increase observed in the Graz-based NFT group. Furthermore, implementing the adaptive NFT strategy reduced the mean task duration by over 30% compared to the fixed-time training protocol. The results demonstrated that the adaptive MI-BCI-based NFT in a VR game achieves superior training outcomes while reducing training duration. These findings suggest the promising potential for applying MI-BCI NFT with VR games in motor rehabilitation following a stroke.