Laterality of brain activity during motor imagery is modulated by the provision of source level neurofeedback

An investigation of the effectiveness of neurofeedback training on motor performance in healthy adults: A systematic review and meta-analysis

Neurofeedback training (NFT) refers to a training where the participants voluntarily aim to manipulate their own brain activity using the sensory feedback abstracted from their brain activity. NFT has attracted attention in the field of motor learning due to its potential as an alternative or additional training method for general physical training. In this study, a systematic review of NFT studies for motor performance improvements in healthy adults and a meta-analysis on the effectiveness of NFT were conducted. A computerized search was performed using the databases Web of Science, Scopus, PubMed, JDreamIII, and Ichushi-Web to identify relevant studies published between January 1st, 1990, and August 3rd, 2021. Thirty-three studies were identified for the qualitative synthesis and 16 randomized controlled trials (374 subjects) for the meta-analysis. The meta-analysis, including all trials found in the search, revealed significant effects of NFT for motor performance improvement examined at the timing after the last NFT session (standardized mean difference = 0.85, 95% CI [0.18-1.51]), but with the existence of publication biases and substantial heterogeneity among the trials. Subsequent meta-regression analysis demonstrated the dose-response gradient between NFTs and motor performance improvements; more than 125 min of cumulative training time may benefit for the subsequent motor performance. For each motor performance measure (e.g., speed, accuracy, and hand dexterity), the effectiveness of NFT remains inconclusive, mainly due to its small sample sizes. More empirical NFT studies for motor performance improvement may be needed to show beneficial effects on motor performance and to safely incorporate NFT into real-world scenarios.

Activation of the brain during motor imagination task with auditory stimulation

Introduction

Auditory stimulation is one of the most important influence factors in the cognitive process. It is an important guiding role in cognitive motor process. However, previous studies on auditory stimuli mainly focused on the cognitive effects of auditory stimuli on the cortex, while the role of auditory stimuli in motor imagery tasks is still unclear.

Methods

In order to explore the role of auditory stimuli in motor imagery tasks, we studied the EEG power spectrum distribution characteristics, frontal parietal mismatch negative (MMN) wave characteristics, and the Inter trial phase locking consistency (ITPC) characteristics of the prefrontal cognitive cortex and parietal motor cortex. In this study, 18 subjects were hired to complete the motor imagery tasks, induced by auditory stimuli of task related verbs and task independent nouns.

Results

EEG power spectrum analysis showed that the activity of the contralateral motor cortex was significantly increased under the stimulation of verbs, and the amplitude of mismatch negative wave was also significantly increased. ITPC is mainly concentrated in μ, α, and γ bands in the process of motor imagery task guided by the auditory stimulus of verbs, while it is mainly concentrated in the β band under the nouns stimulation. This difference may be due to the impact of auditory cognitive process on motor imagery.

Discussion

We speculate that there may be a more complex mechanism for the effect of auditory stimulation on the inter test phase lock consistency. When the stimulus sound has the corresponding meaning to the motor action, the parietal motor cortex may be more affected by the cognitive prefrontal cortex, thus changing its normal response mode. This mode change is due to the joint action of motor imagination, cognitive and auditory stimuli. This study provides new insight into the neural mechanism of motor imagery task guided by auditory stimuli, and provides more information on the activity characteristics of the brain network in motor imagery task by cognitive auditory stimulation.

Hand and Foot Selection in Mental Body Rotations Involves Motor-Cognitive Interactions

Action imagery involves the mental representation of an action without overt execution, and can contribute to perspective taking, such as that required for left-right judgments in mental body rotation tasks. It has been shown that perspective (back view, front view), rotational angle (head-up, head-down), and abstractness (abstract, realistic) of the stimulus material influences speed and correctness of the judgement. The present studies investigated whether left-right judgements are more difficult on legs than on arms and whether the type of limb interacts with the other factors. Furthermore, a combined score for speed and accuracy was explored to eliminate possible tradeoffs and to obtain the best possible measure of subjects' individual ability. Study 1 revealed that the front view is more difficult than the back view because it involves a vertical rotation in perspective taking. Head-down rotations are more difficult than head-up rotations because they involve a horizontal rotation in perspective taking. Furthermore, leg stimuli are more difficult than hand stimuli, particularly in head-down rotations. In Study 2, these findings were replicated in abstract stimuli as well as in realistic stimuli. In addition, perspective taking for realistic stimuli in the back view is easier than realistic stimuli in the front view or abstract stimuli (in both perspectives). We conclude that realistic stimulus material facilitates task comprehension and amplifies the effects of perspective. By replicating previous findings, the linear speed-accuracy score was shown to be a valid measure to capture performance in mental body rotations.

fNIRS-based adaptive visuomotor task improves sensorimotor cortical activation

OBJECTIVE

Investigating how to promote the functional activation of the central sensorimotor system is an important goal in the neurorehabilitation research domain. We aim to validate the effectiveness of facilitating cortical excitability using a closed-loop visuomotor task, in which the task difficulty is adaptively adjusted based on an individual's sensorimotor cortical activation.

APPROACH

We developed a novel visuomotor task, in which subjects moved a handle of a haptic device along a specific path while exerting a constant force against a virtual surface under visual feedback. The difficulty levels of the task were adapted with the aim of increasing the activation of sensorimotor areas, measured non-invasively by functional near-infrared spectroscopy. The changes in brain activation of the bilateral prefrontal cortex, sensorimotor cortex, and the occipital cortex obtained during the adaptive visuomotor task (adaptive group), were compared to the brain activation pattern elicited by the same duration of task with random difficulties in a control group.

MAIN RESULTS

During one intervention session, the adaptive group showed significantly increased activation in the bilateral sensorimotor cortex, also enhanced effective connectivity between the prefrontal and sensorimotor areas compared to the control group.

SIGNIFICANCE

Our findings demonstrated that the fNIRS-based adaptive visuomotor task with high ecological validity can facilitate the neural activity in sensorimotor areas and thus has the potential to improve hand motor functions.

Brain-Computer Interface Training Based on Brain Activity Can Induce Motor Recovery in Patients With Stroke: A Meta-Analysis

BACKGROUND

Brain-computer interface (BCI) is a procedure involving brain activity in which neural status is provided to the participants for self-regulation. The current review aims to evaluate the effect sizes of clinical studies investigating the use of BCI-based rehabilitation interventions in restoring upper extremity function and effective methods to detect brain activity for motor recovery.

METHODS

A computerized search of MEDLINE, CENTRAL, Web of Science, and PEDro was performed to identify relevant articles. We selected clinical trials that used BCI-based training for post-stroke patients and provided motor assessment scores before and after the intervention. The pooled standardized mean differences of BCI-based training were calculated using the random-effects model.

RESULTS

We initially identified 655 potentially relevant articles; finally, 16 articles fulfilled the inclusion criteria, involving 382 participants. A significant effect of neurofeedback intervention for the paretic upper limb was observed (standardized mean difference = .48, [.16-.80], P = .006). However, the effect estimates were moderately heterogeneous among the studies (I² = 45%, P = .03). Subgroup analysis of the method of measurement of brain activity indicated the effectiveness of the algorithm focusing on sensorimotor rhythm.

CONCLUSION

This meta-analysis suggested that BCI-based training was superior to conventional interventions for motor recovery of the upper limbs in patients with stroke. However, the results are not conclusive because of a high risk of bias and a large degree of heterogeneity due to the differences in the BCI interventions and the participants; therefore, further studies involving larger cohorts are required to confirm these results.

Improving Motor Imagery-Based Brain-Computer Interface Performance Based on Sensory Stimulation Training: An Approach Focused on Poorly Performing Users

The motor imagery (MI)-based brain-computer interface (BCI) is an intuitive interface that provides control over computer applications directly from brain activity. However, it has shown poor performance compared to other BCI systems such as P300 and SSVEP BCI. Thus, this study aimed to improve MI-BCI performance by training participants in MI with the help of sensory inputs from tangible objects (i.e., hard and rough balls), with a focus on poorly performing users. The proposed method is a hybrid of training and imagery, combining motor execution and somatosensory sensation from a ball-type stimulus. Fourteen healthy participants participated in the somatosensory-motor imagery (SMI) experiments (within-subject design) involving EEG data classification with a three-class system (signaling with left hand, right hand, or right foot). In the scenario of controlling a remote robot to move it to the target point, the participants performed MI when faced with a three-way intersection. The SMI condition had a better classification performance than did the MI condition, achieving a 68.88% classification performance averaged over all participants, which was 6.59% larger than that in the MI condition (p < 0.05). In poor performers, the classification performance in SMI was 10.73% larger than in the MI condition (62.18% vs. 51.45%). However, good performers showed a slight performance decrement (0.86%) in the SMI condition compared to the MI condition (80.93% vs. 81.79%). Combining the brain signals from the motor and somatosensory cortex, the proposed hybrid MI-BCI system demonstrated improved classification performance, this phenomenon was predominant in poor performers (eight out of nine subjects). Hybrid MI-BCI systems may significantly contribute to reducing the proportion of BCI-inefficiency users and closing the performance gap with other BCI systems.

A BCI-Based Vibrotactile Neurofeedback Training Improves Motor Cortical Excitability During Motor Imagery

In this study, we address the issue of whether vibrotactile feedback can enhance the motor cortex excitability translated into the plastic changes in local cortical areas during motor imagery (MI) BCI-based training. For this purpose, we focused on two of the most notable neurophysiological effects of MI - the event-related desynchronization (ERD) level and the increase in cortical excitability assessed with navigated transcranial magnetic stimulation (nTMS). For TMS navigation, we used individual high-resolution 3D brain MRIs. Ten BCI-naive and healthy adults participated in this study. The MI (rest or left/right hand imagery using Graz-BCI paradigm) tasks were performed separately in the presence and absence of feedback. To investigate how much the presence/absence of vibrotactile feedback in MI BCI-based training could contribute to the sensorimotor cortical activations, we compared the MEPs amplitude during MI after training with and without feedback. In addition, the ERD levels during MI BCI-based training were investigated. Our findings provide evidence that applying vibrotactile feedback during MI training leads to (i) an enhancement of the desynchronization level of mu-rhythm EEG patterns over the contralateral motor cortex area corresponding to the MI of the non-dominant hand; (ii) an increase in motor cortical excitability in hand muscle representation corresponding to a muscle engaged by the MI.

RT-NET: real-time reconstruction of neural activity using high-density electroencephalography

High-density electroencephalography (hdEEG) has been successfully used for large-scale investigations of neural activity in the healthy and diseased human brain. Because of their high computational demand, analyses of source-projected hdEEG data are typically performed offline. Here, we present a real-time noninvasive electrophysiology toolbox, RT-NET, which has been specifically developed for online reconstruction of neural activity using hdEEG. RT-NET relies on the Lab Streaming Layer for acquiring raw data from a large number of EEG amplifiers and for streaming the processed data to external applications. RT-NET estimates a spatial filter for artifact removal and source activity reconstruction using a calibration dataset. This spatial filter is then applied to the hdEEG data as they are acquired, thereby ensuring low latencies and computation times. Overall, our analyses show that RT-NET can estimate real-time neural activity with performance comparable to offline analysis methods. It may therefore enable the development of novel brain–computer interface applications such as source-based neurofeedback.

Laterality judgements in patients with frequent episodic migraine

INTRODUCTION

Migraine is a cyclic disorder but also a chronic pain condition. Left-right recognition tasks have been shown to be impaired in patients with chronic pain.

OBJECTIVES

To investigate whether laterality judgements of migraine patients depend on the status within the migraine cycle.

METHODS

34 episodic migraine patients completed a laterality recognition task on 30 consecutive days using the Recognise™ software. Reaction time and number of mistakes of recognising the left or right side of a face or neck movements to the right or left were recorded and analysed longitudinally. Ictal days (48 h and 24 h prior to the attack; during the headache phase; 24 h after the attack) were contrasted against interictal days using repeated measures ANOVAs. 4 headache-free controls served to investigate the natural fluctuation over time and to compare migraine versus non-migraine data in a secondary exploratory analysis.

RESULTS

1691 data sets from migraine patients and 183 from control participants were included in the analyses. Results indicated that performance varied throughout the migraine cycle but only showed a clear pattern of prolonged response times for images of movements to the right (F(4,1690) = 2.412; p = 0.047), while data for frequency of correct answers and for the left side remained inconclusive. Migraine patients had a reduced frequency of correct answers (right: F(1,1873) = 11.426; p = 0.001; left: F(1,1873) = 5.873; p = 0.015). Response times where unaffected. Laterality judgements were not correlated with the dominant headache side.

CONCLUSIONS

The current data shows that laterality judgements can depend on the status within the migraine cycle. Laterality judgements of migraine patients where comparable to other chronic pain conditions.

Improving Real-Time Brain State Classification of Motor Imagery Tasks During Neurofeedback Training

In this study, we investigated the effect of the dynamic changes in brain activation during neurofeedback training in the classification of the different brain states associated with the target tasks. We hypothesized that ongoing activation patterns could change during neurofeedback session due to learning effects and, in the process, could affect the performance of brain state classifiers trained using data obtained prior to the session. Using a motor imagery paradigm, we then examined the application of an incremental training approach where classifiers were continuously updated in order to account for these activation changes. Our results confirmed our hypothesis that neurofeedback training could be associated with dynamic changes in brain activation characterized by an initially more widespread brain activation followed by a more focused and localized activation pattern. By continuously updating the trained classifiers after each feedback run, significant improvement in accurately classifying the different brain states associated with the target motor imagery tasks was achieved. These findings suggest the importance of taking into account brain activation changes during neurofeedback in order to provide more reliable and accurate feedback information to the participants, which is critical for an effective neurofeedback application.

Neurofeedback-Linked Suppression of Cortical β Bursts Speeds Up Movement Initiation in Healthy Motor Control: A Double-Blind Sham-Controlled Study

Abnormally increased β bursts in cortical-basal ganglia-thalamic circuits are associated with rigidity and bradykinesia in patients with Parkinson's disease. Increased β bursts detected in the motor cortex have also been associated with longer reaction times (RTs) in healthy participants. Here we further hypothesize that suppressing β bursts through neurofeedback training can improve motor performance in healthy subjects.

Abnormally increased β bursts in cortical-basal ganglia-thalamic circuits are associated with rigidity and bradykinesia in patients with Parkinson's disease. Increased β bursts detected in the motor cortex have also been associated with longer reaction times (RTs) in healthy participants. Here we further hypothesize that suppressing β bursts through neurofeedback training can improve motor performance in healthy subjects. We conducted a double-blind sham-controlled study on 20 human volunteers (10 females) using a sequential neurofeedback-behavior task with the neurofeedback reflecting the occurrence of β bursts over sensorimotor cortex quantified in real time. The results show that neurofeedback training helps healthy participants learn to volitionally suppress β bursts in the sensorimotor cortex, with training being accompanied by reduced RT in subsequent cued movements. These changes were only significant in the real feedback group but not in the sham group, confirming the effect of neurofeedback training over simple motor imagery. In addition, RTs correlated with the rate and accumulated duration of β bursts in the contralateral motor cortex before the go-cue, but not with averaged β power. The reduced RTs induced by neurofeedback training positively correlated with reduced β bursts across all tested hemispheres. These results strengthen the link between the occurrence of β bursts in the sensorimotor cortex before the go-cue and slowed movement initiation in healthy motor control. The results also highlight the potential benefit of neurofeedback training in facilitating voluntary suppression of β bursts to speed up movement initiation.

SIGNIFICANCE STATEMENT This double-blind sham-controlled study suggested that neurofeedback training can facilitate volitional suppression of β bursts in sensorimotor cortex in healthy motor control better than sham feedback. The training was accompanied by reduced reaction time (RT) in subsequent cued movements, and the reduced RT positively correlated with the level of reduction in cortical β bursts before the go-cue, but not with average β power. These results provide further evidence of a causal link between sensorimotor β bursts and movement initiation and suggest that neurofeedback training could potentially be used to train participants to speed up movement initiation.

Effects of MEG-based neurofeedback for hand rehabilitation after tetraplegia: preliminary findings in cortical modulations and grip strength

OBJECTIVE

Neurofeedback (NF) trains people to volitionally modulate their cortical activity to affect a behavioral outcome. We evaluated the feasibility of using NF to improve hand function after chronic cervical-level spinal cord injury (SCI) using biologically-relevant visual feedback of motor-related brain activity and an intuitive control scheme.

APPROACH

The NF system acquired magnetoencephalography (MEG) data in real-time to provide feedback of event-related desynchronization (ERD) measured over the sensorimotor cortex during attempted hand grasping. During brain control, stronger ERD resulting from attempted grasping drove the virtual hand towards a more closed grasp, while less ERD drove the hand more open.

MAIN RESULTS

Eight individuals with partial or complete hand impairment due to chronic SCI controlled the NF to perform a grasping task that increased in difficulty as the participants achieved success. During their first NF session, participants achieved an average success rate of 63.7 ± 6.4% (chance level of 13.9%). After as few as one intervention session, four of the seven individuals evaluated for ERD changes had significantly strengthened ERD and three of the four participants with measurable grip strength prior to NF had increased grip strength. Interestingly, both individuals who participated in a longer-term study (i.e. >8 NF sessions) had improved grip strength and significantly strengthened ERD.

SIGNIFICANCE

This study demonstrates that MEG-based NF training can change brain activity in individuals with hand impairment due to SCI and has the potential to induce acute changes in grip strength. Future studies will evaluate whether neuroplasticity induced with long term NF can improve hand function for those with moderate impairment.

G-Causality Brain Connectivity Differences of Finger Movements between Motor Execution and Motor Imagery

Motor imagery is one of the classical paradigms which have been used in brain-computer interface and motor function recovery. Finger movement-based motor execution is a complex biomechanical architecture and a crucial task for establishing most complicated and natural activities in daily life. Some patients may suffer from alternating hemiplegia after brain stroke and lose their ability of motor execution. Fortunately, the ability of motor imagery might be preserved independently and worked as a backdoor for motor function recovery. The efficacy of motor imagery for achieving significant recovery for the motor cortex after brain stroke is still an open question. In this study, we designed a new paradigm to investigate the neural mechanism of thirty finger movements in two scenarios: motor execution and motor imagery. Eleven healthy participants performed or imagined thirty hand gestures twice based on left and right finger movements. The electroencephalogram (EEG) signal for each subject during sixty trials left and right finger motor execution and imagery were recorded during our proposed experimental paradigm. The Granger causality (G-causality) analysis method was employed to analyze the brain connectivity and its strength between contralateral premotor, motor, and sensorimotor areas. Highest numbers for G-causality trials of 37 ± 7.3, 35.5 ± 8.8, 36.3 ± 10.3, and 39.2 ± 9.0 and lowest Granger causality coefficients of 9.1 ± 3.2, 10.9 ± 3.7, 13.2 ± 0.6, and 13.4 ± 0.6 were achieved from the premotor to motor area during execution/imagination tasks of right and left finger movements, respectively. These results provided a new insight into motor execution and motor imagery based on hand gestures, which might be useful to build a new biomarker of finger motor recovery for partially or even completely plegic patients. Furthermore, a significant difference of the G-causality trial number was observed during left finger execution/imagery and right finger imagery, but it was not observed during the right finger execution phase. Significant difference of the G-causality coefficient was observed during left finger execution and imagery, but it was not observed during right finger execution and imagery phases. These results suggested that different MI-based brain motor function recovery strategies should be taken for right-hand and left-hand patients after brain stroke.

BCI Monitor Enhances Electroencephalographic and Cerebral Hemodynamic Activations During Motor Training

Motor imagery-based brain-computer interface (MI-BCI) controlling functional electrical stimulation (FES) is promising for disabled patients to restore their motor functions. However, it remains unclear how much the BCI part can contribute to the functional coupling between the brain and muscle. Specifically, whether it can enhance the cerebral activation for motor training? Here, we investigate the electroencephalographic and cerebral hemodynamic responses for MI-BCI-FES training and MI-FES training, respectively. Twelve healthy subjects were recruited in the motor training study when concurrent electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) were recorded. Compared with the MI-FES training conditions, the MI-BCI-FES could induce significantly stronger event-related desynchronization (ERD) and blood oxygen response, which demonstrates that BCI indeed plays a functional role in the closed-loop motor training. Therefore, this paper verifies the feasibility of using BCI to train motor functions in a closed-loop manner.

Evidence for age-related changes in sensorimotor neuromagnetic responses during cued button pressing in a large open-access dataset

Mu, beta, and gamma rhythms increase and decrease in amplitude during movement. This event-related synchronization (ERS) and desynchronization (ERD) can be readily recorded non-invasively using magneto- and electro-encephalography (M/EEG). In addition, event-related potentials and fields (i.e., evoked responses) can be elucidated during movement. There is some evidence that the frequency, amplitude and latency of the movement-related ERS/ERD changes with ageing, however the evidence surrounding this topic comes mainly from studies in sample sizes on the order of tens of participants. The objective of this study was to examine a large open-access MEG dataset for age-related changes in movement-related ERS/ERD and evoked responses. MEG data acquired at the Cambridge Centre for Ageing and Neuroscience during cued button pressing was used from 567 participants between the ages of 18 and 88 years. The characteristics movement-related ERD/ERS and evoked responses were calculated for each individual participant. Based on linear regression analysis, significant relationships were found between participant age and some response characteristics, although the predictive value of these relationships was low. Specifically, we conclude that peak beta rebound frequency and amplitude decreased with age, peak beta suppression amplitude increased with age, movement-related gamma burst amplitude decreased with age, and peak motor-evoked response amplitude increased with age. Given our current understanding of the underlying mechanisms of these responses, our findings suggest the existence of age-related changes in the neurophysiology of thalamocortical loops and local circuitry in the primary somatosensory and motor cortices.

Endogenously generated gamma-band oscillations in early visual cortex: A neurofeedback study

Human subjects were trained with neurofeedback (NFB) to enhance the power of narrow-band gamma oscillations in circumscribed regions of early visual cortex. To select the region and the oscillation frequency for NFB training, gamma oscillations were induced with locally presented drifting gratings. The source and frequency of these induced oscillations were determined using beamforming methods. During NFB training the power of narrow band gamma oscillations was continuously extracted from this source with online beamforming and converted into the pitch of a tone signal. We found that seven out of ten subjects were able to selectively increase the amplitude of gamma oscillations in the absence of visual stimulation. One subject however failed completely and two subjects succeeded to manipulate the feedback signal by contraction of muscles. In all subjects the attempts to enhance visual gamma oscillations were associated with an increase of beta oscillations over precentral/frontal regions. Only successful subjects exhibited an additional marked increase of theta oscillations over precentral/prefrontal and temporal regions whereas unsuccessful subjects showed an increase of alpha band oscillations over occipital regions. We argue that spatially confined networks in early visual cortex can be entrained to engage in narrow band gamma oscillations not only by visual stimuli but also by top down signals. We interpret the concomitant increase in beta oscillations as indication for an engagement of the fronto-parietal attention network and the increase of theta oscillations as a correlate of imagery. Our finding support the application of NFB in disease conditions associated with impaired gamma synchronization.

Resting-state functional connectivity and motor imagery brain activation

Motor imagery (MI) relies on the mental simulation of an action without any overt motor execution (ME), and can facilitate motor learning and enhance the effect of rehabilitation in patients with neurological conditions. While functional magnetic resonance imaging (fMRI) during MI and ME reveals shared cortical representations, the role and functional relevance of the resting-state functional connectivity (RSFC) of brain regions involved in MI is yet unknown. Here, we performed resting-state fMRI followed by fMRI during ME and MI with the dominant hand. We used a behavioral chronometry test to measure ME and MI movement duration and compute an index of performance (IP). Then, we analyzed the voxel-matched correlation between the individual MI parameter estimates and seed-based RSFC maps in the MI network to measure the correspondence between RSFC and MI fMRI activation. We found that inter-individual differences in intrinsic connectivity in the MI network predicted several clusters of activation. Taken together, present findings provide first evidence that RSFC within the MI network is predictive of the activation of MI brain regions, including those associated with behavioral performance, thus suggesting a role for RSFC in obtaining a deeper understanding of neural substrates of MI and of MI ability. Hum Brain Mapp 37:3847-3857, 2016. © 2016 Wiley Periodicals, Inc.

Enhanced Motor Imagery-Based BCI Performance via Tactile Stimulation on Unilateral Hand

Brain-computer interface (BCI) has attracted great interests for its effectiveness in assisting disabled people. However, due to the poor BCI performance, this technique is still far from daily-life applications. One of critical issues confronting BCI research is how to enhance BCI performance. This study aimed at improving the motor imagery (MI) based BCI accuracy by integrating MI tasks with unilateral tactile stimulation (Uni-TS). The effects were tested on both healthy subjects and stroke patients in a controlled study. Twenty-two healthy subjects and four stroke patients were recruited and randomly divided into a control-group and an enhanced-group. In the control-group, subjects performed two blocks of conventional MI tasks (left hand vs. right hand), with 80 trials in each block. In the enhanced-group, subjects also performed two blocks of MI tasks, but constant tactile stimulation was applied on the non-dominant/paretic hand during MI tasks in the second block. We found the Uni-TS significantly enhanced the contralateral cortical activations during MI of the stimulated hand, whereas it had no influence on activation patterns during MI of the non-stimulated hand. The two-class BCI decoding accuracy was significantly increased from 72.5% (MI without Uni-TS) to 84.7% (MI with Uni-TS) in the enhanced-group (p < 0.001, paired t-test). Moreover, stroke patients in the enhanced-group achieved an accuracy >80% during MI with Uni-TS. This novel approach complements the conventional methods for BCI enhancement without increasing source information or complexity of signal processing. This enhancement via Uni-TS may facilitate clinical applications of MI-BCI.

The potential of real-time fMRI neurofeedback for stroke rehabilitation: A systematic review

Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback aids the modulation of neural functions by training self-regulation of brain activity through operant conditioning. This technique has been applied to treat several neurodevelopmental and neuropsychiatric disorders, but its effectiveness for stroke rehabilitation has not been examined yet. Here, we systematically review the effectiveness of rt-fMRI neurofeedback training in modulating motor and cognitive processes that are often impaired after stroke. Based on predefined search criteria, we selected and examined 33 rt-fMRI neurofeedback studies, including 651 healthy individuals and 15 stroke patients in total. The results of our systematic review suggest that rt-fMRI neurofeedback training can lead to a learned modulation of brain signals, with associated changes at both the neural and the behavioural level. However, more research is needed to establish how its use can be optimized in the context of stroke rehabilitation.

The impact of goal-oriented task design on neurofeedback learning for brain-computer interface control

Neurofeedback training teaches individuals to modulate brain activity by providing real-time feedback and can be used for brain-computer interface control. The present study aimed to optimize training by maximizing engagement through goal-oriented task design. Participants were shown either a visual display or a robot, where each was manipulated using motor imagery (MI)-related electroencephalography signals. Those with the robot were instructed to quickly navigate grid spaces, as the potential for goal-oriented design to strengthen learning was central to our investigation. Both groups were hypothesized to show increased magnitude of these signals across 10 sessions, with the greatest gains being seen in those navigating the robot due to increased engagement. Participants demonstrated the predicted increase in magnitude, with no differentiation between hemispheres. Participants navigating the robot showed stronger left-hand MI increases than those with the computer display. This is likely due to success being reliant on maintaining strong MI-related signals. While older participants showed stronger signals in early sessions, this trend later reversed, suggesting greater natural proficiency but reduced flexibility. These results demonstrate capacity for modulating neurofeedback using MI over a series of training sessions, using tasks of varied design. Importantly, the more goal-oriented robot control task resulted in greater improvements.

[Neurofeedback-based motor imagery training for rehabilitation after stroke]

Mental training, including motor observation and motor imagery, has awakened much academic interest. The presumed functional equivalence of motor imagery and motor execution has given hope that mental training could be used for motor rehabilitation after a stroke. Results obtained from randomized controlled trials have shown mixed results. Approximately half of the studies demonstrate positive effects of motor imagery training but the rest do not show an additional benefit. Possible reasons why motor imagery training has so far not become established as a robust therapeutic approach are discussed in detail. Moreover, more recent approaches, such as neurofeedback-based motor imagery or closed-loop systems are presented and the potential importance for motor learning and rehabilitation after a stroke is discussed.

Proprioceptive Feedback Facilitates Motor Imagery-Related Operant Learning of Sensorimotor β-Band Modulation

Motor imagery (MI) activates the sensorimotor system independent of actual movements and might be facilitated by neurofeedback. Knowledge on the interaction between feedback modality and the involved frequency bands during MI-related brain self-regulation is still scarce. Previous studies compared the cortical activity during the MI task with concurrent feedback (MI with feedback condition) to cortical activity during the relaxation task where no feedback was provided (relaxation without feedback condition). The observed differences might, therefore, be related to either the task or the feedback. A proper comparison would necessitate studying a relaxation condition with feedback and a MI task condition without feedback as well. Right-handed healthy subjects performed two tasks, i.e., MI and relaxation, in alternating order. Each of the tasks (MI vs. relaxation) was studied with and without feedback. The respective event-driven oscillatory activity, i.e., sensorimotor desynchronization (during MI) or synchronization (during relaxation), was rewarded with contingent feedback. Importantly, feedback onset was delayed to study the task-related cortical activity in the absence of feedback provision during the delay period. The reward modality was alternated every 15 trials between proprioceptive and visual feedback. Proprioceptive input was superior to visual input to increase the range of task-related spectral perturbations in the α- and β-band, and was necessary to consistently achieve MI-related sensorimotor desynchronization (ERD) significantly below baseline. These effects occurred in task periods without feedback as well. The increased accuracy and duration of learned brain self-regulation achieved in the proprioceptive condition was specific to the β-band. MI-related operant learning of brain self-regulation is facilitated by proprioceptive feedback and mediated in the sensorimotor β-band.

Combined Action Observation and Motor Imagery Neurofeedback for Modulation of Brain Activity

Motor imagery (MI) and action observation have proven to be efficacious adjuncts to traditional physiotherapy for enhancing motor recovery following stroke. Recently, researchers have used a combined approach called imagined imitation (II), where an individual watches a motor task being performed, while simultaneously imagining they are performing the movement. While neurofeedback (NFB) has been used extensively with MI to improve patients' ability to modulate sensorimotor activity and enhance motor recovery, the effectiveness of using NFB with II to modulate brain activity is unknown. This project tested the ability of participants to modulate sensorimotor activity during electroencephalography-based II-NFB of a complex, multi-part unilateral handshake, and whether this ability transferred to a subsequent bout of MI. Moreover, given the goal of translating findings from NFB research into practical applications, such as rehabilitation, the II-NFB system was designed with several user interface and user experience features, in an attempt to both drive user engagement and match the level of challenge to the abilities of the subjects. In particular, at easy difficulty levels the II-NFB system incentivized contralateral sensorimotor up-regulation (via event related desynchronization of the mu rhythm), while at higher difficulty levels the II-NFB system incentivized sensorimotor lateralization (i.e., both contralateral up-regulation and ipsilateral down-regulation). Thirty-two subjects, receiving real or sham NFB attended four sessions where they engaged in II-NFB training and subsequent MI. Results showed the NFB group demonstrated more bilateral sensorimotor activity during sessions 2–4 during II-NFB and subsequent MI, indicating mixed success for the implementation of this particular II-NFB system. Here we discuss our findings in the context of the design features included in the II-NFB system, highlighting limitations that should be considered in future designs.

Comparing Features for Classification of MEG Responses to Motor Imagery

BACKGROUND

Motor imagery (MI) with real-time neurofeedback could be a viable approach, e.g., in rehabilitation of cerebral stroke. Magnetoencephalography (MEG) noninvasively measures electric brain activity at high temporal resolution and is well-suited for recording oscillatory brain signals. MI is known to modulate 10- and 20-Hz oscillations in the somatomotor system. In order to provide accurate feedback to the subject, the most relevant MI-related features should be extracted from MEG data. In this study, we evaluated several MEG signal features for discriminating between left- and right-hand MI and between MI and rest.

METHODS

MEG was measured from nine healthy participants imagining either left- or right-hand finger tapping according to visual cues. Data preprocessing, feature extraction and classification were performed offline. The evaluated MI-related features were power spectral density (PSD), Morlet wavelets, short-time Fourier transform (STFT), common spatial patterns (CSP), filter-bank common spatial patterns (FBCSP), spatio-spectral decomposition (SSD), and combined SSD+CSP, CSP+PSD, CSP+Morlet, and CSP+STFT. We also compared four classifiers applied to single trials using 5-fold cross-validation for evaluating the classification accuracy and its possible dependence on the classification algorithm. In addition, we estimated the inter-session left-vs-right accuracy for each subject.

RESULTS

The SSD+CSP combination yielded the best accuracy in both left-vs-right (mean 73.7%) and MI-vs-rest (mean 81.3%) classification. CSP+Morlet yielded the best mean accuracy in inter-session left-vs-right classification (mean 69.1%). There were large inter-subject differences in classification accuracy, and the level of the 20-Hz suppression correlated significantly with the subjective MI-vs-rest accuracy. Selection of the classification algorithm had only a minor effect on the results.

CONCLUSIONS

We obtained good accuracy in sensor-level decoding of MI from single-trial MEG data. Feature extraction methods utilizing both the spatial and spectral profile of MI-related signals provided the best classification results, suggesting good performance of these methods in an online MEG neurofeedback system.

What Turns Assistive into Restorative Brain-Machine Interfaces?

Brain-machine interfaces (BMI) may support motor impaired patients during activities of daily living by controlling external devices such as prostheses (assistive BMI). Moreover, BMIs are applied in conjunction with robotic orthoses for rehabilitation of lost motor function via neurofeedback training (restorative BMI). Using assistive BMI in a rehabilitation context does not automatically turn them into restorative devices. This perspective article suggests key features of restorative BMI and provides the supporting evidence: In summary, BMI may be referred to as restorative tools when demonstrating subsequently (i) operant learning and progressive evolution of specific brain states/dynamics, (ii) correlated modulations of functional networks related to the therapeutic goal, (iii) subsequent improvement in a specific task, and (iv) an explicit correlation between the modulated brain dynamics and the achieved behavioral gains. Such findings would provide the rationale for translating BMI-based interventions into clinical settings for reinforcement learning and motor rehabilitation following stroke.

A Comparison of Independent Event-Related Desynchronization Responses in Motor-Related Brain Areas to Movement Execution, Movement Imagery, and Movement Observation

Electroencephalographic (EEG) event-related desynchronization (ERD) induced by movement imagery or by observing biological movements performed by someone else has recently been used extensively for brain-computer interface-based applications, such as applications used in stroke rehabilitation training and motor skill learning. However, the ERD responses induced by the movement imagery and observation might not be as reliable as the ERD responses induced by movement execution. Given that studies on the reliability of the EEG ERD responses induced by these activities are still lacking, here we conducted an EEG experiment with movement imagery, movement observation, and movement execution, performed multiple times each in a pseudorandomized order in the same experimental runs. Then, independent component analysis (ICA) was applied to the EEG data to find the common motor-related EEG source activity shared by the three motor tasks. Finally, conditional EEG ERD responses associated with the three movement conditions were computed and compared. Among the three motor conditions, the EEG ERD responses induced by motor execution revealed the alpha power suppression with highest strengths and longest durations. The ERD responses of the movement imagery and movement observation only partially resembled the ERD pattern of the movement execution condition, with slightly better detectability for the ERD responses associated with the movement imagery and faster ERD responses for movement observation. This may indicate different levels of involvement in the same motor-related brain circuits during different movement conditions. In addition, because the resulting conditional EEG ERD responses from the ICA preprocessing came with minimal contamination from the non-related and/or artifactual noisy components, this result can play a role of the reference for devising a brain-computer interface using the EEG ERD features of movement imagery or observation.

Reinforcement learning of self-regulated sensorimotor β-oscillations improves motor performance

Self-regulation of sensorimotor oscillations is currently researched in neurorehabilitation, e.g. for priming subsequent physiotherapy in stroke patients, and may be modulated by neurofeedback or transcranial brain stimulation. It has still to be demonstrated, however, whether and under which training conditions such brain self-regulation could also result in motor gains. Thirty-two right-handed, healthy subjects participated in a three-day intervention during which they performed 462 trials of kinesthetic motor-imagery while a brain-robot interface (BRI) turned event-related β-band desynchronization of the left sensorimotor cortex into the opening of the right hand by a robotic orthosis. Different training conditions were compared in a parallel-group design: (i) adaptive classifier thresholding and contingent feedback, (ii) adaptive classifier thresholding and non-contingent feedback, (iii) non-adaptive classifier thresholding and contingent feedback, and (iv) non-adaptive classifier thresholding and non-contingent feedback. We studied the task-related cortical physiology with electroencephalography and the behavioral performance in a subsequent isometric motor task. Contingent neurofeedback and adaptive classifier thresholding were critical for learning brain self-regulation which, in turn, led to behavioral gains after the intervention. The acquired skill for sustained sensorimotor β-desynchronization correlated significantly with subsequent motor improvement. Operant learning of brain self-regulation with a BRI may offer a therapeutic perspective for severely affected stroke patients lacking residual hand function.

Brain state-dependent robotic reaching movement with a multi-joint arm exoskeleton: combining brain-machine interfacing and robotic rehabilitation

While robot-assisted arm and hand training after stroke allows for intensive task-oriented practice, it has provided only limited additional benefit over dose-matched physiotherapy up to now. These rehabilitation devices are possibly too supportive during the exercises. Neurophysiological signals might be one way of avoiding slacking and providing robotic support only when the brain is particularly responsive to peripheral input. We tested the feasibility of three-dimensional robotic assistance for reaching movements with a multi-joint exoskeleton during motor imagery (MI)-related desynchronization of sensorimotor oscillations in the β-band. We also registered task-related network changes of cortical functional connectivity by electroencephalography via the imaginary part of the coherence function. Healthy subjects and stroke survivors showed similar patterns—but different aptitudes—of controlling the robotic movement. All participants in this pilot study with nine healthy subjects and two stroke patients achieved their maximum performance during the early stages of the task. Robotic control was significantly higher and less variable when proprioceptive feedback was provided in addition to visual feedback, i.e., when the orthosis was actually attached to the subject’s arm during the task. A distributed cortical network of task-related coherent activity in the θ-band showed significant differences between healthy subjects and stroke patients as well as between early and late periods of the task. Brain-robot interfaces (BRIs) may successfully link three-dimensional robotic training to the participants’ efforts and allow for task-oriented practice of activities of daily living with a physiologically controlled multi-joint exoskeleton. Changes of cortical physiology during the task might also help to make subject-specific adjustments of task difficulty and guide adjunct interventions to facilitate motor learning for functional restoration, a proposal that warrants further investigation in a larger cohort of stroke patients.

MEG-based neurofeedback for hand rehabilitation

BACKGROUND

Providing neurofeedback (NF) of motor-related brain activity in a biologically-relevant and intuitive way could maximize the utility of a brain-computer interface (BCI) for promoting therapeutic plasticity. We present a BCI capable of providing intuitive and direct control of a video-based grasp.

METHODS

Utilizing magnetoencephalography's (MEG) high temporal and spatial resolution, we recorded sensorimotor rhythms (SMR) that were modulated by grasp or rest intentions. SMR modulation controlled the grasp aperture of a stop motion video of a human hand. The displayed hand grasp position was driven incrementally towards a closed or opened state and subjects were required to hold the targeted position for a time that was adjusted to change the task difficulty.

RESULTS

We demonstrated that three individuals with complete hand paralysis due to spinal cord injury (SCI) were able to maintain brain-control of closing and opening a virtual hand with an average of 63 % success which was significantly above the average chance rate of 19 %. This level of performance was achieved without pre-training and less than 4 min of calibration. In addition, successful grasp targets were reached in 1.96 ± 0.15 s. Subjects performed 200 brain-controlled trials in approximately 30 min excluding breaks. Two of the three participants showed a significant improvement in SMR indicating that they had learned to change their brain activity within a single session of NF.

CONCLUSIONS

This study demonstrated the utility of a MEG-based BCI system to provide realistic, efficient, and focused NF to individuals with paralysis with the goal of using NF to induce neuroplasticity.

Reinforcement learning of self-regulated β-oscillations for motor restoration in chronic stroke

Neurofeedback training of Motor imagery (MI)-related brain-states with brain-computer/brain-machine interfaces (BCI/BMI) is currently being explored as an experimental intervention prior to standard physiotherapy to improve the motor outcome of stroke rehabilitation. The use of BCI/BMI technology increases the adherence to MI training more efficiently than interventions with sham or no feedback. Moreover, pilot studies suggest that such a priming intervention before physiotherapy might—like some brain stimulation techniques—increase the responsiveness of the brain to the subsequent physiotherapy, thereby improving the general clinical outcome. However, there is little evidence up to now that these BCI/BMI-based interventions have achieved operate conditioning of specific brain states that facilitate task-specific functional gains beyond the practice of primed physiotherapy. In this context, we argue that BCI/BMI technology provides a valuable neurofeedback tool for rehabilitation but needs to aim at physiological features relevant for the targeted behavioral gain. Moreover, this therapeutic intervention has to be informed by concepts of reinforcement learning to develop its full potential. Such a refined neurofeedback approach would need to address the following issues: (1) Defining a physiological feedback target specific to the intended behavioral gain, e.g., β-band oscillations for cortico-muscular communication. This targeted brain state could well be different from the brain state optimal for the neurofeedback task, e.g., α-band oscillations for differentiating MI from rest; (2) Selecting a BCI/BMI classification and thresholding approach on the basis of learning principles, i.e., balancing challenge and reward of the neurofeedback task instead of maximizing the classification accuracy of the difficulty level device; and (3) Adjusting the difficulty level in the course of the training period to account for the cognitive load and the learning experience of the participant. Here, we propose a comprehensive neurofeedback strategy for motor restoration after stroke that addresses these aspects, and provide evidence for the feasibility of the suggested approach by demonstrating that dynamic threshold adaptation based on reinforcement learning may lead to frequency-specific operant conditioning of β-band oscillations paralleled by task-specific motor improvement; a proposal that requires investigation in a larger cohort of stroke patients.

Brain computer interface learning for systems based on electrocorticography and intracortical microelectrode arrays

A brain-computer interface (BCI) system transforms neural activity into control signals for external devices in real time. A BCI user needs to learn to generate specific cortical activity patterns to control external devices effectively. We call this process BCI learning, and it often requires significant effort and time. Therefore, it is important to study this process and develop novel and efficient approaches to accelerate BCI learning. This article reviews major approaches that have been used for BCI learning, including computer-assisted learning, co-adaptive learning, operant conditioning, and sensory feedback. We focus on BCIs based on electrocorticography and intracortical microelectrode arrays for restoring motor function. This article also explores the possibility of brain modulation techniques in promoting BCI learning, such as electrical cortical stimulation, transcranial magnetic stimulation, and optogenetics. Furthermore, as proposed by recent BCI studies, we suggest that BCI learning is in many ways analogous to motor and cognitive skill learning, and therefore skill learning should be a useful metaphor to model BCI learning.

Noninvasive Brain-Computer Interfaces Based on Sensorimotor Rhythms

Brain-computer interfaces (BCIs) have been explored in the field of neuroengineering to investigate how the brain can use these systems to control external devices. We review the principles and approaches we have taken to develop a sensorimotor rhythm EEG based brain-computer interface (BCI). The methods include developing BCI systems incorporating the control of physical devices to increase user engagement, improving BCI systems by inversely mapping scalp-recorded EEG signals to the cortical source domain, integrating BCI with noninvasive neuromodulation strategies to improve learning, and incorporating mind-body awareness training to enhance BCI learning and performance. The challenges and merits of these strategies are discussed, together with recent findings. Our work indicates that the sensorimotor-rhythm-based noninvasive BCI has the potential to provide communication and control capabilities as an alternative to physiological motor pathways.

Brain-computer interface boosts motor imagery practice during stroke recovery

OBJECTIVE

Motor imagery (MI) is assumed to enhance poststroke motor recovery, yet its benefits are debatable. Brain-computer interfaces (BCIs) can provide instantaneous and quantitative measure of cerebral functions modulated by MI. The efficacy of BCI-monitored MI practice as add-on intervention to usual rehabilitation care was evaluated in a randomized controlled pilot study in subacute stroke patients.

METHODS

Twenty-eight hospitalized subacute stroke patients with severe motor deficits were randomized into 2 intervention groups: 1-month BCI-supported MI training (BCI group, n = 14) and 1-month MI training without BCI support (control group; n = 14). Functional and neurophysiological assessments were performed before and after the interventions, including evaluation of the upper limbs by Fugl-Meyer Assessment (FMA; primary outcome measure) and analysis of oscillatory activity and connectivity at rest, based on high-density electroencephalographic (EEG) recordings.

RESULTS

Better functional outcome was observed in the BCI group, including a significantly higher probability of achieving a clinically relevant increase in the FMA score (p < 0.03). Post-BCI training changes in EEG sensorimotor power spectra (ie, stronger desynchronization in the alpha and beta bands) occurred with greater involvement of the ipsilesional hemisphere in response to MI of the paralyzed trained hand. Also, FMA improvements (effectiveness of FMA) correlated with the changes (ie, post-training increase) at rest in ipsilesional intrahemispheric connectivity in the same bands (p < 0.05).

INTERPRETATION

The introduction of BCI technology in assisting MI practice demonstrates the rehabilitative potential of MI, contributing to significantly better motor functional outcomes in subacute stroke patients with severe motor impairments.

Oscillatory entrainment of the motor cortical network during motor imagery is modulated by the feedback modality

Neurofeedback of self-regulated brain activity in circumscribed cortical regions is used as a novel strategy to facilitate functional restoration following stroke. Basic knowledge about its impact on motor system oscillations and functional connectivity is however scarce. Specifically, a direct comparison between different feedback modalities and their neural signatures is missing. We assessed a neurofeedback training intervention of modulating β-activity in circumscribed sensorimotor regions by kinesthetic motor imagery (MI). Right-handed healthy participants received two different feedback modalities contingent to their MI-associated brain activity in a cross-over design: (I) visual feedback with a brain-computer interface (BCI) and (II) proprioceptive feedback with a brain-robot interface (BRI) orthosis attached to the right hand. High-density electroencephalography was used to examine the reactivity of the cortical motor system during the training session of each task by studying both local oscillatory power entrainment and distributed functional connectivity. Both feedback modalities activated a distributed functional connectivity network of coherent oscillations. A significantly higher skill and lower variability of self-controlled sensorimotor β-band modulation could, however, be achieved in the BRI condition. This gain in controlling regional motor oscillations was accompanied by functional coupling of remote β-band and θ-band activity in bilateral fronto-central regions and left parieto-occipital regions, respectively. The functional coupling of coherent θ-band oscillations correlated moreover with the skill of regional β-modulation thus revealing a motor learning related network. Our findings indicate that proprioceptive feedback is more suitable than visual feedback to entrain the motor network architecture during the interplay between motor imagery and feedback processing thus resulting in better volitional control of regional brain activity.

Motor imagery-based brain activity parallels that of motor execution: evidence from magnetic source imaging of cortical oscillations

Motor imagery (MI) is a form of practice in which an individual mentally performs a motor task. Previous research suggests that skill acquisition via MI is facilitated by repetitive activation of brain regions in the sensorimotor network similar to that of motor execution, however this evidence is conflicting. Further, many studies do not control for overt muscle activity and thus the activation patterns reported for MI may be driven in part by actual movement. The purpose of the current research is to further establish MI as a secondary modality of skill acquisition by providing electrophysiological evidence of an overlap between brain areas recruited for motor execution and imagery. Non-disabled participants (N=18; 24.7±3.8 years) performed both execution and imagery of a unilateral sequence button-press task. Magnetoencephalography (MEG) was utilized to capture neural activity, while electromyography used to rigorously monitor muscle activity. Event-related synchronization/desynchronization (ERS/ERD) analysis was conducted in the beta frequency band (15-30 Hz). Whole head dual-state beamformer analysis was applied to MEG data and 3D t-tests were conducted after Talairach normalization. Source-level analysis showed that MI has similar patterns of spatial activity as ME, including activation of contralateral primary motor and somatosensory cortices. However, this activation is significantly less intense during MI (p<0.05). As well, activation during ME was more lateralized (i.e., within the contralateral hemisphere). These results confirm that ME and MI have similar spatial activation patterns. Thus, the current research provides direct electrophysiological evidence to further establish MI as a secondary form of skill acquisition.