Neurofeedback-Guided Motor Imagery in Chronic Stroke: A Case Series on Upper-Limb Recovery, Cortical Activation, and Brain Symmetry.

Seven people with chronic stroke completed motor-imagery training and physiotherapy with either real or sham EEG feedback. Functional and brain-activation findings favored real feedback in this tiny exploratory study, but the result is not yet reliable efficacy evidence.

Carvalho R, Azevedo E, Marques P, Dias N, Cerqueira JJ.
Applied psychophysiology and biofeedback · Publication date: 2026-09-20
Added to site: 2026-09-21
DOI: 10.1007/s10484-026-09808-3

Electronic publication date verified in Europe PMC.

Modalities

EEG neurofeedback, BCI, Motor imagery, fMRI

Clinical focus

Chronic stroke, Upper-limb rehabilitation, Neuroplasticity

Population

People with chronic stroke completing a four-week standardized physiotherapy program

Sample

7 people with chronic stroke; exact active and sham group sizes were not reported in the accessible abstract

Intervention / method

Motor imagery with real-time EEG-based BCI neurofeedback plus physiotherapy, with functional testing, EEG symmetry measures and task-related fMRI

Comparator

Motor imagery with sham feedback plus the same standardized physiotherapy program

Clinician summary

Participants receiving real feedback exceeded a minimal clinically important difference on at least one functional outcome, most notably grip strength, and showed more symmetrical EEG activity and more consistent sensorimotor and cerebellar fMRI activation. Sham responses were variable and influenced by one high responder.

How to interpret the findings

The total sample was seven, arm sizes were not provided in the abstract and all participants received physiotherapy. Multiple functional and imaging outcomes, uncertain allocation details, absence of durability data and one influential sham responder make the findings highly preliminary.

Equipment and disclosures

The study used real-time EEG-based BCI neurofeedback, EEG symmetry measures and task-related fMRI. Device manufacturers, channel count and complete feedback parameters were not available in the checked abstract.

The authors declared no commercial or financial relationships that could be construed as a conflict. Funding details were not available in the checked indexed record.

Related evidence

Compare findings from the same clinical area, including mixed results.

• Operant Conditioning of the Motor Evoked Potential in Forearm Extensors of Individuals with Chronic Incomplete Cervical Spinal Cord Injury: Case Studies. · Positive with limitations
• Kilohertz Transcranial Magnetic Perturbation (kTMP) for Upper Extremity Motor Recovery After Stroke: A Nonrandomized Pilot Trial · Positive with limitations