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

This is totally useless unless you make this available in a protocol format that all stroke survivors can find and bring to their doctors and therapists attention. The only way survivors will ever get better is if they can control what rehab they receive. Your stroke medical professionals have had decades to accomplish that and proven to be complete failures. As noted by the 10% full recovery rate.
http://journals.sagepub.com/doi/full/10.1177/1550059417717398?

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Catharina Zich, Stefan Debener, Clara Schweinitz, ...

First Published July 5, 2017 Research Article

https://doi.org/10.1177/1550059417717398

Article information

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.

Keywords motor imagery, neurofeedback, stroke, neurorehabilitation, mobile EEG, home-based training

Introduction

Many of the roughly 33 million stroke survivors worldwide per year¹ do not recover completely, so that stroke is one of the leading causes of disability.² Upper-limb hemiparesis is the most prevalent consequence in stroke survivors³ with enduring and disabling effects, causing negative impact on quality of life and independence. One approach aiming to facilitate motor recovery after stroke is mental practice with motor imagery (MI). The theoretical foundation of this approach is the neural simulation of action theory,⁴ which states that executing and imagining the same movement involves similar, overlapping networks. Hence, mental practice with MI may help prevent nonuse driven cortical reorganization, and facilitate compensatory reorganization such that in the long run, motor functions improve. Indeed, a number of studies using mental practice with MI as an add-on to physical therapy suggest that MI supports recovery of upper-limb functioning,^5-9 resulting in long-lasting behavioral improvements.⁹
A more recent development is the combination of MI training with online neurofeedback (NF). This development is closely linked to the notion that feedback in combination with high-intensity task-specific practice is essential for the facilitation of adaptive cortical reorganization.⁶ Accordingly, NF should help to induce adaptive neural plasticity and thereby contribute to restoring lost motor function.¹⁰ Several studies indicate that MI training in combination with NF can indeed induce positive changes at behavioral, functional, and structural levels.^11-15 At least 1 study provides clear evidence that functional changes are more pronounced when MI is combined with NF as compared with MI without NF.¹⁶ Moreover, concurrent acquisition of electroencephalogram (EEG) NF and functional magnetic resonance imaging (fMRI) in healthy individuals validated systematic NF effects on cortical activation patterns.¹⁷
The effectiveness of neurorehabilitation training regimes such as MI NF is difficult to evaluate, in particular because most approaches are technically demanding, and all of them require frequent, regular practice. The latter issue is of particular importance for stroke victims, because frequent laboratory or hospital visits place a large burden on motor impaired individuals. Without experiencing immediate training effects this effort may negatively impact on a patient’s training motivation. Recently developed small and wireless EEG systems may help overcome this problem. They are portable and low in cost,^18,19 perform on par with nonportable EEG systems,²⁰ and soon, NF protocols will be available on smartphones.²¹
We investigated whether home-based, frequent MI EEG-based NF training is feasible. Specifically, we examined whether chronic stroke patients can stay motivated over a 4-week training period. In addition, we wanted to know whether they experience NF as helpful for MI training. We designed the MI NF protocol to facilitate stronger cortical activity in the ipsilesional than in the contralesional hemisphere in response to MI of the paretic hand. Frequent, high-intensity MI NF should result in systematic behavioral, functional, and structural improvements. To assess training effects, the home-based training was framed by detailed laboratory-based assessments of motor functions, high-density EEG, structural as well as fMRI, and by diffusion tensor imaging of the corticospinal tract (CST).
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