High-Intensity Chronic Stroke Motor Imagery Neurofeedback Training at Home: Three Case Reports

Abstract

Motor imagery (MI) with neurofeedback has been suggested as promising for motor recovery after stroke. Evidence suggests that regular training facilitates compensatory plasticity, but frequent training is difficult to integrate into everyday life. Using a wireless electroencephalogram (EEG) system, we implemented a frequent and efficient neurofeedback training at the patients' home. Aiming to overcome maladaptive changes in cortical lateralization patterns we presented a visual feedback, representing the degree of contralateral sensorimotor cortical activity and the degree of sensorimotor cortex lateralization. Three stroke patients practiced every other day, over a period of 4 weeks. Training-related changes were evaluated on behavioral, functional, and structural levels. All 3 patients indicated that they enjoyed the training and were highly motivated throughout the entire training regime. EEG activity induced by MI of the affected hand became more lateralized over the course of training in all three patients. The patient with a significant functional change also showed increased white matter integrity as revealed by diffusion tensor imaging, and a substantial clinical improvement of upper limb motor functions. Our study provides evidence that regular, home-based practice of MI neurofeedback has the potential to facilitate cortical reorganization and may also increase associated improvements of upper limb motor function in chronic stroke patients.

Brain‐computer interfaces for post‐stroke motor rehabilitation: a meta‐analysis

“…Since it was shown that repeated use of neuroelectric or neuromagnetic BCI systems after stroke can lead to long‐lasting effects on functional brain oscillatory activity (e.g., magnitude of event‐related desynchronization70 or hemispheric blood‐oxygen‐level‐dependent signals, BOLD39), follow‐up studies indicated that such BCI paradigm may also lead to structural reorganization of the brain (as measured by diffusion tensor imaging71, 72, 73, 74). Another study that used real‐time functional magnetic resonance imaging showed that just two training sessions were sufficient to increase ipsilesional cortico‐subcortical resting state connectivity in 3 out of 4 stroke survivors 75…”

A Multi-Target Motor Imagery Training Using Bimodal EEG-fMRI Neurofeedback: A Pilot Study in Chronic Stroke Patients

“…The pilot study involved four chronic patients with various degrees of motor impairment and stroke characteristics. In recent years, few studies have explored the potential of real-time NF for improving motor performances in stroke using different imaging modality such as fMRI (Liew et al, 2016), EEG (Pichiorri et al, 2015;Zich et al, 2017) or functional Near-Infrared Spectroscopy -NIRS (Mihara et al, 2013). A recent systematic review on fMRI NF for motor training in healthy subjects and stroke patients (Wang et al, 2017) indicated that real-time fMRI is effective in promoting self-regulation of targeted areas and has potential to improve motor outcomes.…”

Online detection of auditory attention with mobile EEG: closing the loop with neurofeedback

“…The latter furnished a proof-of-concept for a mobile, low-density EEG system for effective NFB training at the home of the participant. Furthermore, recent case study reports by [39] strengthened the notion that MI training at home can lead to noticeable changes in brain patterns. Considering the AAD paradigm there is no reference study or standardized training protocol to date.…”