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  Graded fMRI neurofeedback training of motor imagery in middle cerebral artery stroke patients: A preregistered proof-of-concept study

Mehler, D. M. A., Williams, A. N., Whittaker, J. R., Krause, F., Lührs, M., Kunas, S., et al. (2020). Graded fMRI neurofeedback training of motor imagery in middle cerebral artery stroke patients: A preregistered proof-of-concept study. Frontiers in Human Neuroscience, 14: 226. doi:10.3389/fnhum.2020.00226.

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Mehler, David M. A.1, 2, Author
Williams, Angharad N.1, 3, Author              
Whittaker, Joseph R.4, Author
Krause, Florian5, 6, Author
Lührs, Michael5, 7, Author
Kunas, Stefanie1, 8, Author
Wise, Richard G.1, 9, Author
Shetty, Hamsaraj G. M.10, Author
Turner, Duncan L.11, Author
Linden, David E. J.1, 12, Author
1Brain Research Imaging Centre, School of Psychology, Cardiff University, United Kingdom, ou_persistent22              
2Department of Psychiatry, Münster University, Germany, ou_persistent22              
3Max Planck Research Group Adaptive Memory, MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_2295691              
4School of Physics and Astronomy, Cardiff University, United Kingdom, ou_persistent22              
5Department of Cognitive Neuroscience, Maastricht University, the Netherlands, ou_persistent22              
6Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands, ou_persistent22              
7Research Department, Brain Innovation B.V., Maastricht, the Netherlands, ou_persistent22              
8Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany, ou_persistent22              
9Department of Neuroscience and Imaging, Gabriele D'Annunzio University, Chieti-Pescara, Italy, ou_persistent22              
10Department of Neurology, University Hospital of Wales, Cardiff, United Kingdom, ou_persistent22              
11School of Health, Sport and Bioscience, University of East London, United Kingdom, ou_persistent22              
12School for Mental Health and Neuroscience, Maastricht University, the Netherlands, ou_persistent22              


Free keywords: fMRI; Neurofeedback; Preregistration; Rehabilitation; Stroke
 Abstract: Ischemic stroke of the middle cerebral artery (MCA), a major brain vessel that supplies the primary motor and premotor cortex, is one of the most common causes for severe upper limb impairment. Currently available motor rehabilitation training largely lacks satisfying efficacy with over 70% of stroke survivors showing residual upper limb dysfunction. Motor imagery-based functional magnetic resonance imaging neurofeedback (fMRI-NF) has been suggested as a potential therapeutic technique to improve motor impairment in stroke survivors. In this preregistered proof-of-concept study (https://osf.io/y69jc/), we translated graded fMRI-NF training, a new paradigm that we have previously studied in healthy participants, to first-time MCA stroke survivors with residual mild to severe impairment of upper limb motor function. Neurofeedback was provided from the supplementary motor area (SMA) targeting two different neurofeedback target levels (low and high). We hypothesized that MCA stroke survivors will show (1) sustained SMA-region of interest (ROI) activation and (2) a difference in SMA-ROI activation between low and high neurofeedback conditions during graded fMRI-NF training. At the group level, we found only anecdotal evidence for these preregistered hypotheses. At the individual level, we found anecdotal to moderate evidence for the absence of the hypothesized graded effect for most subjects. These null findings are relevant for future attempts to employ fMRI-NF training in stroke survivors. The study introduces a Bayesian sequential sampling plan, which incorporates prior knowledge, yielding higher sensitivity. The sampling plan was preregistered together with a priori hypotheses and all planned analysis before data collection to address potential publication/researcher biases. Unforeseen difficulties in the translation of our paradigm to a clinical setting required some deviations from the preregistered protocol. We explicitly detail these changes, discuss the accompanied additional challenges that can arise in clinical neurofeedback studies, and formulate recommendations for how these can be addressed. Taken together, this work provides new insights about the feasibility of motor imagery-based graded fMRI-NF training in MCA stroke survivors and serves as a first example for comprehensive study preregistration of an (fMRI) neurofeedback experiment.


Language(s): eng - English
 Dates: 2020-02-022020-05-202020-07-14
 Publication Status: Published online
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: -
 Identifiers: DOI: 10.3389/fnhum.2020.00226
Other: eCollection 2020
PMID: 32760259
PMC: PMC7373077
 Degree: -



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Grant ID : HS/14/20
Funding program : -
Funding organization : Health and Care Research Wales

Source 1

Title: Frontiers in Human Neuroscience
  Abbreviation : Front Hum Neurosci
Source Genre: Journal
Publ. Info: Lausanne, Switzerland : Frontiers Research Foundation
Pages: - Volume / Issue: 14 Sequence Number: 226 Start / End Page: - Identifier: ISSN: 1662-5161
CoNE: https://pure.mpg.de/cone/journals/resource/1662-5161