Improving Motor Corticothalamic Communication After Stroke Using Real-Time fMRI Connectivity-Based Neurofeedback

Abstract

BACKGROUND: Two thirds of stroke survivors experience motor impairment resulting in long-term disability. The anatomical substrate is often the disruption ofcortico-subcortical pathways. It has been proposed that reestablishment ofcortico-subcortical communication relates to functional recovery.OBJECTIVE: In this study, we applied a novel training protocol to augmentipsilesional cortico-subcortical connectivity after stroke. Chronic strokepatients with severe motor impairment were provided online feedback ofblood-oxygenation level dependent signal connectivity between cortical andsubcortical regions critical for motor function using real-time functionalmagnetic resonance imaging neurofeedback.RESULTS: In this proof of principle study, 3 out of 4 patients learned tovoluntarily modulate cortico-subcortical connectivity as intended.CONCLUSIONS: Our results document for the first time the feasibility and safetyfor patients with chronic stroke and severe motor impairment to self-regulate andaugment ipsilesional cortico-subcortical connectivity through neurofeedback usingreal-time functional magnetic resonance imaging.