Neurofeedback Facilitation Improves Gait and Balance in Post-Stroke Patients
Post by Amanda McFarlan
What's the science?
Recovery from gait and balance impairments that arise following a stroke usually occurs in the first 12 weeks post-stroke, after which point there is little improvement. Recently, it has been shown that functional near-infrared spectroscopy (fNIRS) mediated neurofeedback, a technique where an individual can learn to use feedback about their brain activity to further regulate their neural activity, may be a promising tool to treat post-stroke patients with impairments. This week in Neurology, Mihara and colleagues used a two-center, double-blind, randomized, controlled study to investigate whether fNIRS-mediated neurofeedback is a feasible method of treatment for recovery of gait and balance in post-stroke patients.
How did they do it?
The authors recruited a total of 54 adult patients who had experienced a subcortical stroke that resulted in hemiplegic gait and balance disturbances that persisted more than 12 weeks after stroke onset. The patients were randomly assigned to be in the treatment group or the control group. To evaluate their motor function, all patients received a clinical assessment which included measures like the 3-meter-Timed Up-and-Go test and the Berg Balance Scale. These assessments occurred at three time points: (1) before the neurofeedback intervention, (2) immediately following the neurofeedback intervention, and (3) two weeks after the neurofeedback intervention. The neurofeedback intervention consisted of six sessions in which patients underwent the facilitation of the supplementary motor area using fNIRS while performing a motor imagery task. In the treatment group, patients received real-time neurofeedback signals that represented the activity of their supplementary motor area while performing the task, while the patients in the control group received pre-recorded signals that did not match their brain activity.
What did they find?
The authors found that following the neurofeedback intervention, the treatment group had a significant improvement on the 3-meter-Timed Up-and-Go assessment compared to the control group. The treatment group also had greater improvement on the Berg Balance Scale assessment compared to the control group. Additionally, when comparing the first and last sessions of the neurofeedback intervention, the treatment group had increased activity in the supplementary motor area and increased connectivity between the supplementary motor area and the ventrolateral premotor area. These enhancements in supplementary motor area activity and connectivity were positively correlated with balance recovery. Importantly, no adverse effects related to the neurofeedback intervention were reported during the study.
What’s the impact?
This study highlights the feasibility and efficacy of a neurofeedback-based intervention that can be used for the recovery of gait and balance disturbances in stroke patients. The authors showed that this intervention, which facilitates the activity of the supplementary motor area using fNIRS-mediated neurofeedback was correlated with balance recovery in post-stroke patients. Together, these findings provide evidence for a promising new treatment that may be useful for the recovery of stroke-related motor impairments.
Mihara et al. Effect of Neurofeedback Facilitation on Post-stroke Gait and Balance Recovery: A Randomized Controlled Trial. Neurology (2021). Access the original scientific publication here.