Graded fMRI Neurofeedback Training of Motor Imagery in Middle Cerebral Artery Stroke Patients: A Preregistered Proof-of-Concept Study

Article


Mehler, D. M. A., Williams, A. N., Whittaker, J. R., Krause, F., Lührs, M., Kunas, S., Wise, R. G., Shetty H. G. M., Turner, D. and Linden, D. E. J. 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 (Art. 226). https://doi.org/10.3389/fnhum.2020.00226
AuthorsMehler, D. M. A., Williams, A. N., Whittaker, J. R., Krause, F., Lührs, M., Kunas, S., Wise, R. G., Shetty H. G. M., Turner, D. and Linden, D. E. J.
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.

JournalFrontiers in Human Neuroscience
Journal citation14 (Art. 226)
ISSN1662-5161
Year2020
PublisherFrontiers Media
Publisher's version
License
File Access Level
Anyone
Supplemental file
File Access Level
Anyone
Digital Object Identifier (DOI)https://doi.org/10.3389/fnhum.2020.00226
Web address (URL)https://doi.org/10.3389/fnhum.2020.00226
Publication dates
Online14 Jul 2020
Publication process dates
Accepted20 May 2020
Deposited15 Jul 2020
FunderMedical Research Council (MRC)
Health and Care Research Wales
Copyright holder© 2020 The Authors
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