Frontiers in human neuroscience · 2026
Graded multisensory neurofeedback via the iNems system for comprehensive upper limb recovery after stroke: a multiple baseline study.
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Kodama Takayuki, Kitai Ken, Mizomoto Yasuhisa, Nishigaya Kaichi, Hashimoto Shoutarou, Hiraga Riona, Shimizu Satomi, Kawabata Miki, Hirabayashi Yuumi, Ikesue Keita, Kako Hazime, Yasui Syouta, Ito Hiroki, Nishimoto Kazuhei, Katayama Osamu, Yamaguchi Hideaki, Nagano Hikaru, Inoue Mari, Murata Shin, Morita Kiichiro
Аннотация
INTRODUCTION: Post-stroke upper-limb recovery remains challenging, especially in the presence of sensory impairments. Conventional brain-computer interfaces (BCIs) are constrained by binary feedback, single-modality stimulation, and exclusion of patients with sensory deficits. We developed the Imagery Neurofeedback-based Multi-sensory System (iNems), a neurofeedback system that provides graded multisensory (visual and electrical) feedback based on ERD magnitude. This study validated iNems' efficacy in motor function, self-reported numbness, and cognitive functions using a multiple-baseline design (MBD).
METHODS: Four participants with post-stroke upper-limb motor and sensory impairments underwent a multiple baseline design. The baseline phase (phase A) used random feedback; the intervention (phase B) used adaptive iNems. iNems quantified motor intention via sensorimotor EEG event-related desynchronization (ERD) and delivered graded visual and electrical feedback. Primary outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Box and Block Test (BBT). Secondary outcomes included body cognition, numbness, and neurophysiological (ERD/ERS) changes.
RESULTS: All participants demonstrated significant improvement during the intervention. FMA-UE increased by 6-16 points. The BBT showed large effects (integrated Tau-U = 0.75). Body cognition improved significantly in both sense of agency (Tau-U = 0.80) and ownership (Tau-U = 0.89). Numbness was reduced in affected cases (Tau-U = -0.85). Neurophysiological changes correlated with functional gains, with some patterns suggesting increased neural efficiency.
CONCLUSION: This first MBD-validated demonstration shows that graded, multisensory graded neurofeedback based on ERD magnitude can improve motor, self-reported numbness, and cognitive domains after stroke. These findings support adaptive closed-loop therapy as a promising, multifaceted rehabilitation strategy.
METHODS: Four participants with post-stroke upper-limb motor and sensory impairments underwent a multiple baseline design. The baseline phase (phase A) used random feedback; the intervention (phase B) used adaptive iNems. iNems quantified motor intention via sensorimotor EEG event-related desynchronization (ERD) and delivered graded visual and electrical feedback. Primary outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Box and Block Test (BBT). Secondary outcomes included body cognition, numbness, and neurophysiological (ERD/ERS) changes.
RESULTS: All participants demonstrated significant improvement during the intervention. FMA-UE increased by 6-16 points. The BBT showed large effects (integrated Tau-U = 0.75). Body cognition improved significantly in both sense of agency (Tau-U = 0.80) and ownership (Tau-U = 0.89). Numbness was reduced in affected cases (Tau-U = -0.85). Neurophysiological changes correlated with functional gains, with some patterns suggesting increased neural efficiency.
CONCLUSION: This first MBD-validated demonstration shows that graded, multisensory graded neurofeedback based on ERD magnitude can improve motor, self-reported numbness, and cognitive domains after stroke. These findings support adaptive closed-loop therapy as a promising, multifaceted rehabilitation strategy.