The Cybathlon BCI race: Successful longitudinal mutual learning with two tetraplegic users

This work aims at corroborating the importance and efficacy of mutual learning in motor imagery (MI) brain–computer interface (BCI) by leveraging the insights obtained through our participation in the BCI race of the Cybathlon event. We hypothesized that, contrary to the popular trend of focusing mostly on the machine learning aspects of MI BCI training, a comprehensive mutual learning methodology that reinstates the three learning pillars (at the machine, subject, and application level) as equally significant could lead to a BCI–user symbiotic system able to succeed in real-world scenarios such as the Cybathlon event. Two severely impaired participants with chronic spinal cord injury (SCI), were trained following our mutual learning approach to control their avatar in a virtual BCI race game. The competition outcomes substantiate the effectiveness of this type of training. Most importantly, the present study is one among very few to provide multifaceted evidence on the efficacy of subject learning during BCI training. Learning correlates could be derived at all levels of the interface—application, BCI output, and electroencephalography (EEG) neuroimaging—with two end-users, sufficiently longitudinal evaluation, and, importantly, under real-world and even adverse conditions.Author summary: Noninvasive brain–computer interface (BCI) based on imagined movements can restore functions lost to disability by enabling spontaneous, direct brain control of external devices without risks associated with surgical implantation of neural interfaces. We hypothesized that, contrary to the popular trend of focusing on the machine learning aspects of BCI training, a comprehensive mutual learning methodology could strongly promote users’ acquisition of BCI skills and lead to a system able to succeed in real-world scenarios such as the Cybathlon event, the first international competition for disabled pilots in control of assistive technology. Two severely impaired participants with chronic spinal cord injury (SCI) were trained following our mutual learning approach to control their avatar in a virtual BCI race game. The evolution of the training process, including competition outcomes (gold medal, tournament record), substantiates the effectiveness of this type of training. Most importantly, the present study provides multifaceted evidence on the efficacy of subject learning during BCI training. Learning correlates could be derived at all levels of the interface—application, BCI output, and electroencephalography—with two end-users, longitudinal evaluation, and, importantly, under real-world and even adverse conditions.