Effects of motor imagery-based neurofeedback training after bilateral repetitive transcranial magnetic stimulation on post-stroke upper limb motor function: an exploratory crossover clinical trial

• Published in: Journal of rehabilitation medicine 2024-03, Vol.56, p.jrm18253-jrm18253
• Main Authors: Sánchez Cuesta, Francisco José, González-Zamorano, Yeray, Moreno-Verdú, Marcos, Vourvopoulos, Athanasios, Serrano, Ignacio J, Del Castillo-Sobrino, Maria Dolores, Figueiredo, Patrícia, Romero, Juan Pablo
• Format: Article
• Language: English
• Subjects: Biofeedback; Chronic illnesses; Clinical outcomes; Clinical research; Clinical trials; Cross-Over Studies; Electroencephalography; Evaluation; Functional performance; Grip strength; Hand Strength; Humans; Imagery; Limbs; Motor ability; motor cortex; motor imagery; Neurofeedback; Original Report; repetitive transcranial magnetic stimulation; rTMS; Sensory functioning; Stroke; Stroke - complications; Transcranial Magnetic Stimulation; Upper Extremity
• ISSN: 1651-2081; 1650-1977; 1651-2081
• DOI: 10.2340/jrm.v56.18253

To examine the clinical effects of combining motor imagery-based neurofeedback training with bilateral repetitive transcranial magnetic stimulation for upper limb motor function in subacute and chronic stroke. Clinical trial following an AB/BA crossover design with counterbalanced assignment. Twenty individuals with subacute (n = 4) or chronic stroke (n = 16). Ten consecutive sessions of bilateral repetitive transcranial magnetic stimulation alone (therapy A) were compared vs a combination of10 consecutive sessions of bilateral repetitive transcranial magnetic stimulation with 12 non-consecutive sessions of motor imagery-based neurofeedback training (therapy B). Patients received both therapies (1-month washout period), in sequence AB or BA. Participants were assessed before and after each therapy and at 15-days follow-up, using the Fugl-Meyer Assessment-upper limb, hand-grip strength, and the Nottingham Sensory Assessment as primary outcome measures. Both therapies resulted in improved functionality and sensory function. Therapy B consistently exhibited superior effects compared with therapy A, according to Fugl-Meyer Assessment and tactile and kinaesthetic sensory function across multiple time-points, irrespective of treatment sequence. No statistically significant differences between therapies were found for hand-grip strength. Following subacute and chronic stroke, integrating bilateral repetitive transcranial magnetic stimulation and motor imagery-based neurofeedback training has the potential to enhance functional performance compared with using bilateral repetitive transcranial magnetic stimulation alone in upper limb recovery.