Neurofeedback-Guided Motor Imagery in Chronic Stroke: A Case Series on Upper-Limb Recovery, Cortical Activation, and Brain Symmetry.

IF 3 3区心理学 Q2 PSYCHOLOGY, CLINICAL

Applied Psychophysiology and Biofeedback Pub Date : 2026-09-20 DOI:10.1007/s10484-026-09808-3

Raquel Carvalho, Elsa Azevedo, Paulo Marques, Nuno Dias, João José Cerqueira

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引用次数: 0

Abstract

Background: Brain-computer interface (BCI) systems combined with motor imagery (MI) have emerged as promising tools in neurorehabilitation. Real-time neurofeedback may further enhance motor recovery by promoting use-dependent neuroplasticity; however, evidence in chronic stroke remains limited, particularly from controlled pilot studies.

Objective: This case series explored the feasibility and preliminary effects of EEG-based BCI neurofeedback combined with MI and physiotherapy on upper-limb motor function and brain activation patterns in individuals with chronic stroke.

Methods: In a double-blind, controlled protocol, seven individuals with chronic stroke were allocated to either an experimental group receiving MI with real-time EEG-based BCI neurofeedback or a control group receiving MI with sham feedback. All participants completed a standardized four-week physiotherapy program. Motor outcomes were assessed with the Action Research Arm Test, Fugl-Meyer Assessment, Motor Assessment Scale, and grip strength, with functional changes interpreted against minimal clinically important difference (MCID) thresholds. Neuroplastic changes were explored using EEG-derived symmetry measures and task-related functional MRI.

Results: Participants receiving real neurofeedback exhibited consistent improvements exceeding MCID thresholds in at least one functional outcome, most notably grip strength. This group also demonstrated more symmetrical EEG activity and more consistent sensorimotor and cerebellar activation patterns on fMRI. In contrast, responses in the sham group were more variable and appeared influenced by a single high responder.

Conclusions: These findings support the feasibility of integrating EEG-based BCI neurofeedback with MI and physiotherapy in chronic stroke rehabilitation. The observed functional gains and associated neurophysiological changes suggest a preliminary, exploratory role for this intervention in promoting upper-limb recovery in this small sample.

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慢性中风的神经反馈引导运动意象：上肢恢复、皮质激活和大脑对称的病例系列。

背景：脑机接口（BCI）系统结合运动意象（MI）已成为神经康复中很有前途的工具。实时神经反馈可能通过促进使用依赖性神经可塑性进一步增强运动恢复；然而，慢性中风的证据仍然有限，特别是来自对照试验研究。目的：本系列病例探讨脑电图为基础的脑机接口神经反馈联合心肌梗死和物理治疗对慢性脑卒中患者上肢运动功能和脑激活模式的可行性和初步影响。方法：在双盲对照方案中，7名慢性脑卒中患者被分配到实验组和对照组，实验组接受基于脑电图的实时脑机接口神经反馈的心肌梗死，对照组接受假反馈的心肌梗死。所有的参与者都完成了一个标准化的为期四周的物理治疗项目。运动结果通过动作研究臂测试、Fugl-Meyer评估、运动评估量表和握力进行评估，功能变化根据最小临床重要差异（MCID）阈值进行解释。使用脑电图衍生的对称性测量和任务相关功能MRI来探索神经可塑性变化。结果：接受真正神经反馈的参与者在至少一项功能结果上表现出持续的改善，超过了MCID阈值，最显著的是握力。这一组在fMRI上也表现出更对称的脑电图活动和更一致的感觉运动和小脑激活模式。相比之下，假手术组的反应变化更大，似乎受到单一高反应者的影响。结论：这些研究结果支持将脑电脑接口神经反馈与心肌梗死和物理治疗相结合用于慢性脑卒中康复的可行性。观察到的功能增益和相关的神经生理变化表明，在这个小样本中，这种干预在促进上肢恢复方面具有初步的探索性作用。

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来源期刊

Applied Psychophysiology and Biofeedback PSYCHOLOGY, CLINICAL-

CiteScore

5.30

自引率

13.30%

发文量

期刊介绍： Applied Psychophysiology and Biofeedback is an international, interdisciplinary journal devoted to study of the interrelationship of physiological systems, cognition, social and environmental parameters, and health. Priority is given to original research, basic and applied, which contributes to the theory, practice, and evaluation of applied psychophysiology and biofeedback. Submissions are also welcomed for consideration in several additional sections that appear in the journal. They consist of conceptual and theoretical articles; evaluative reviews; the Clinical Forum, which includes separate categories for innovative case studies, clinical replication series, extended treatment protocols, and clinical notes and observations; the Discussion Forum, which includes a series of papers centered around a topic of importance to the field; Innovations in Instrumentation; Letters to the Editor, commenting on issues raised in articles previously published in the journal; and select book reviews. Applied Psychophysiology and Biofeedback is the official publication of the Association for Applied Psychophysiology and Biofeedback.