eprintid: 10158940 rev_number: 9 eprint_status: archive userid: 699 dir: disk0/10/15/89/40 datestamp: 2022-11-11 11:25:03 lastmod: 2022-11-11 11:25:03 status_changed: 2022-11-11 11:25:03 type: article metadata_visibility: show sword_depositor: 699 creators_name: Sanders, ZB creators_name: Fleming, MK creators_name: Smejka, T creators_name: Marzolla, MC creators_name: Zich, C creators_name: Rieger, SW creators_name: Lührs, M creators_name: Goebel, R creators_name: Sampaio-Baptista, C creators_name: Johansen-Berg, H title: Self-modulation of motor cortex activity after stroke: a randomized controlled trial ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D07 divisions: F84 keywords: stroke, real-time fMRI, neurofeedback, motor cortex, white matter note: © The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). abstract: Real-time functional MRI neurofeedback allows individuals to self-modulate their ongoing brain activity. This may be a useful tool in clinical disorders that are associated with altered brain activity patterns. Motor impairment after stroke has previously been associated with decreased laterality of motor cortex activity. Here we examined whether chronic stroke survivors were able to use real-time fMRI neurofeedback to increase laterality of motor cortex activity and assessed effects on motor performance and on brain structure and function. We carried out a randomized, double-blind, sham-controlled trial (ClinicalTrials.gov: NCT03775915) in which 24 chronic stroke survivors with mild to moderate upper limb impairment experienced three training days of either Real (n = 12) or Sham (n = 12) neurofeedback. Assessments of brain structure, brain function and measures of upper-limb function were carried out before and 1 week after neurofeedback training. Additionally, measures of upper-limb function were repeated 1 month after neurofeedback training. Primary outcome measures were (i) changes in lateralization of motor cortex activity during movements of the stroke-affected hand throughout neurofeedback training days; and (ii) changes in motor performance of the affected limb on the Jebsen Taylor Test (JTT). Stroke survivors were able to use Real neurofeedback to increase laterality of motor cortex activity within (P = 0.019), but not across, training days. There was no group effect on the primary behavioural outcome measure, which was average JTT performance across all subtasks (P = 0.116). Secondary analysis found improvements in the performance of the gross motor subtasks of the JTT in the Real neurofeedback group compared to Sham (P = 0.010). However, there were no improvements on the Action Research Arm Test or the Upper Extremity Fugl-Meyer score (both P > 0.5). Additionally, decreased white-matter asymmetry of the corticospinal tracts was detected 1 week after neurofeedback training (P = 0.008), indicating that the tracts become more similar with Real neurofeedback. Changes in the affected corticospinal tract were positively correlated with participants neurofeedback performance (P = 0.002). Therefore, here we demonstrate that chronic stroke survivors are able to use functional MRI neurofeedback to self-modulate motor cortex activity in comparison to a Sham control, and that training is associated with improvements in gross hand motor performance and with white matter structural changes. date: 2022-10 date_type: published publisher: Oxford University Press (OUP) official_url: https://doi.org/10.1093/brain/awac239 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1987193 doi: 10.1093/brain/awac239 medium: Print pii: 6663819 lyricists_name: Zich, Catharina lyricists_id: CZICH47 actors_name: Zich, Catharina actors_id: CZICH47 actors_role: owner funding_acknowledgements: [Wellcome Trust] full_text_status: public publication: Brain volume: 145 number: 10 pagerange: 3391-3404 event_location: England citation: Sanders, ZB; Fleming, MK; Smejka, T; Marzolla, MC; Zich, C; Rieger, SW; Lührs, M; ... Johansen-Berg, H; + view all <#> Sanders, ZB; Fleming, MK; Smejka, T; Marzolla, MC; Zich, C; Rieger, SW; Lührs, M; Goebel, R; Sampaio-Baptista, C; Johansen-Berg, H; - view fewer <#> (2022) Self-modulation of motor cortex activity after stroke: a randomized controlled trial. Brain , 145 (10) pp. 3391-3404. 10.1093/brain/awac239 <https://doi.org/10.1093/brain%2Fawac239>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10158940/2/Zich_Self-modulation%20of%20motor%20cortex%20activity%20after%20stroke-%20a%20randomized%20controlled%20trial_VoR.pdf