Effect of Neurofeedback Facilitation on Poststroke Gait and Balance Recovery: A Randomized Controlled Trial
Masahito Mihara1, Hiroaki Fujimoto2, Noriaki Hattori2
1From the Department of Neurology (M.M., Y.S.), Kawasaki Medical School, Kurashiki; Departments of Neurology (M.M., H.O., Y.K., K.K., H.M.) and Radiology (Y.W.), Osaka University Graduate School of Medicine, Suita; Neurorehabilitation Research Institute (H.F., Y.H., I.M.), Morinomiya Hospital, Osaka; Division of Clinical Neuroengineering (N.H.), Osaka University Global Center for Medical Engineering and Informatics, Suita; and Department of Rehabilitation (N.H.), Toyama University, Japan. mihara@med.kawasaki-m.ac.jp.
Objective:
To test the hypothesis that supplementary motor area (SMA) facilitation with functional near-infrared spectroscopy-mediated neurofeedback (fNIRS-NFB) augments poststroke gait and balance recovery, we conducted a 2-center, double-blind, randomized controlled trial involving 54 Japanese patients using the 3-meter Timed Up and Go (TUG) test.
Methods:
Patients with subcortical stroke-induced mild to moderate gait disturbance more than 12 weeks from onset underwent 6 sessions of SMA neurofeedback facilitation during gait- and balance-related motor imagery using fNIRS-NFB. Participants were randomly allocated to intervention (28 patients) or placebo (sham: 26 patients). In the intervention group, the fNIRS signal contained participants' cortical activation information. The primary outcome was TUG improvement 4 weeks postintervention.
Results:
The intervention group showed greater improvement in the TUG test (12.84 ± 15.07 seconds, 95% confidence interval 7.00-18.68) than the sham group (5.51 ± 7.64 seconds, 95% confidence interval 2.43-8.60; group difference 7.33 seconds, 95% CI 0.83-13.83; p = 0.028), even after adjusting for covariates (group × time interaction; F 1.23,61.69 = 4.50, p = 0.030, partial η2 = 0.083). Only the intervention group showed significantly increased imagery-related SMA activation and enhancement of resting-state connectivity between SMA and ventrolateral premotor area. Adverse effects associated with fNIRS-mediated neurofeedback intervention were absent.
Conclusion:
SMA facilitation during motor imagery using fNIRS neurofeedback may augment poststroke gait and balance recovery by modulating the SMA and its related network.
Classification Of Evidence:
This study provides Class III evidence that for patients with gait disturbance from subcortical stroke, SMA neurofeedback facilitation improves TUG time (UMIN000010723 at UMIN-CTR; umin.ac.jp/english/).
