Cardiff University | Prifysgol Caerdydd ORCA
Online Research @ Cardiff 
WelshClear Cookie - decide language by browser settings

Graded fMRI neurofeedback Training of motor imagery in middle cerebral artery stroke patients: a preregistered proof-of-concept study

Mehler, David M. A., Williams, Angharad N. ORCID:, Whittaker, Joseph R., Krause, Florian, Lührs, Michael, Kunas, Stefanie, Wise, Richard G. ORCID:, Shetty, Hamsaraj G. M., Turner, Duncan L. and Linden, David E. J. ORCID: 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 , 226. 10.3389/fnhum.2020.00226

[thumbnail of Wise. Graded fMRI] PDF - Published Version
Available under License Creative Commons Attribution.

Download (1MB)


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 (, 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.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Psychology
Physics and Astronomy
Cardiff University Brain Research Imaging Centre (CUBRIC)
Additional Information: This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).
Publisher: Frontiers Media
ISSN: 1662-5161
Date of First Compliant Deposit: 24 August 2021
Date of Acceptance: 20 May 2020
Last Modified: 06 Jan 2024 03:33

Citation Data

Cited 7 times in Scopus. View in Scopus. Powered By Scopus® Data

Actions (repository staff only)

Edit Item Edit Item


Downloads per month over past year

View more statistics