Clinical evaluation of BrainTree, a motor imagery hybrid BCI speller

Objective. While brain-computer interfaces (BCIs) for communication have reached considerable technical maturity, there is still a great need for state-of-the-art evaluation by end-users outside laboratory environments. To achieve this primary objective, it is necessary to augment a BCI with a series of components that allow end-users to type text effectively. Approach. This work presents the clinical evaluation of a motor imagery (MI) BCI text-speller, called BrainTree, by 6 severely disabled end-users and 10 able-bodied users. Additionally, we dene a generic model of code-based BCI applications which serves as an analytical tool for evaluation and design. Main results. We show that all users achieved remarkable usability and efficiency outcomes in spelling. Furthermore, our model-based analysis highlights the added value of human-computer interaction (HCI) techniques and hybrid BCI error-handling mechanisms, and reveals the effects of BCI performances on usability and eciency in code-based applications. Significance. This study demonstrates the usability potential of code-based MI spellers, with BrainTree being the rst to be evaluated by a substantial number of end-users, establishing them as a viable, competitive alternative to other popular BCI spellers. Another major outcome of our model-based analysis is the derivation of a 80% minimum command accuracy requirement for successful code-based application control, revising upwards previous estimates attempted in the literature.