Synergistic effects of action observation and object affordance on cortical excitability during BCI-triggered motor imagery in stroke: a randomized, within-subject, 2 × 2 factorial study protocol

Background

Brain-computer interfaces (BCI) using motor imagery (MI) offer promising rehabilitation potential for upper limb function in stroke survivors. Conventional paradigms rely on abstract visual feedback, which may lack ecological validity and could limit neural recruitment. Action observation (AO) and object affordance (OA) independently modulate motor cortical excitability via the mirror neuron system and canonical neural pathways. However, their potential synergistic effects in enhancing BCI performance have not been systematically investigated. We propose a novel "Phygital" intervention integrating dynamic visual cues (AO) with static environmental cues (OA) to potentially enhance cortical excitability and support motor rehabilitation.

Methods