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

Overview

Journal J Rehabil Med

Specialty Rehabilitation Medicine

Date 2024 Mar 7

PMID 38450442

Authors

Francisco Jose Sanchez Cuesta

Yeray Gonzalez-Zamorano

Marcos Moreno-Verdu

Athanasios Vourvopoulos

Ignacio J Serrano

Maria Dolores Del Castillo-Sobrino

Patricia Figueiredo

Juan Pablo Romero

Affiliations

Soon will be listed here.

Abstract

Objective: 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.

Design: Clinical trial following an AB/BA crossover design with counterbalanced assignment.

Subjects: Twenty individuals with subacute (n = 4) or chronic stroke (n = 16).

Methods: 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.

Results: 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.

Conclusion: 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.

Citing Articles

A scoping review on the body awareness rehabilitation after stroke: are we aware of what we are unaware?.

Cardile D, Lo Buono V, Corallo F, Quartarone A, Calabro R Front Neurol. 2025; 15():1497052.

PMID: 39839868 PMC: 11747327. DOI: 10.3389/fneur.2024.1497052.

Commentary on: "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".

Raghuwanshi A, Rafat S, Srivastav A J Rehabil Med. 2024; 56:jrm41133.

PMID: 39192733 PMC: 11367675. DOI: 10.2340/jrm.v56.41133.

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