Influence of a placebo tDCS treatment on cybersickness and EEG-neurofeedback success.

Virtual Reality (VR) serves as a modern and powerful tool within the domain of neurofeedback (NF). Users can learn how to alter their own brain activation with the help of NF, for example visual feedback. VR can help to make the training more engaging and motivating with its immersive nature. However, cybersickness (CS) poses a serious problem, as it negatively affects up to 80% of all VR users. Especially women seem to be affected. Some studies suggest positive effects of placebo interventions, so that less CS in the users can be detected. Hence, we investigated whether a transcranial direct current stimulation (tDCS) placebo intervention can influence CS symptoms in a VR-based NF training and whether CS affects NF performance. Additionally, we focused on possible sex differences in the development of CS and the NF success. For this purpose, we tested 41 healthy participants in an EEG-NF-training with sensorimotor rhythm (SMR, 12-15 Hz) upregulation and VR feedback. Half of the participants got a placebo tDCS stimulation in advance to the training and were told that the stimulation would prevent them from getting cybersick. The other half received no such treatment. Both groups underwent six NF runs to three minutes each where they were asked to follow a ball along a predefined path in the virtual environment by increasing their SMR. Results showed that women experienced significantly more CS than men regardless of whether they received a placebo intervention or not. Women were also not able to increase their SMR successfully over the six NF runs. Male participants were able to increase their SMR. Also, only participants in the non-placebo group were able to increase their SMR, not those from the placebo group. The tDCS placebo intervention had little to no effect on sickness symptoms in VR, however it hampered the ability to increase SMR power. Also, CS seems to be associated with a worse NF training outcome, especially in women. Strategies to reduce CS inducing factors in VR environments could help participants to benefit more from a VR-based NF training. This should be especially considered in vulnerable groups that are more prone to CS.

Triathletes are experts in self-regulating physical activity - But what about self-regulating neural activity?

Regular exercise improves cognitive control abilities and successful self-regulation of physical activity. However, it is not clear whether exercising also improves the ability to self-regulate one's own brain activity. We investigated this in 26 triathletes and 25 control participants who did not exercise regularly. Within each group half of the participants performed one session of sensorimotor rhythm (SMR, 12-15 Hz) upregulation neurofeedback training, the other half received a sham neurofeedback training. The neurofeedback training session took about 45 min. In a separate session, participants underwent structural magnetic resonance imaging (MRI) to investigate possible differences in brain structure between triathletes and controls. Triathletes and controls were able to voluntarily upregulate their SMR activity during neurofeedback when receiving real feedback. Triathletes showed a stronger increase in SMR activity in the second half of the training compared to controls, suggesting that triathletes are able to self-regulate their own brain activity over a longer period of time. Further, triathletes and controls showed differences in brain structure as reflected by larger gray and white matter volumes in the inferior frontal gyrus and insula compared to controls. These brain areas are generally involved in cognitive control mechanisms. Our results provide new evidence regarding self-regulation abilities of people who exercise regularly and might impact the practical application of neurofeedback.

MRI correlates of cognitive improvement after home-based EEG neurofeedback training in patients with multiple sclerosis: a pilot study.

OBJECTIVE: Neurofeedback training may improve cognitive function in patients with neurological disorders. However, the underlying cerebral mechanisms of such improvements are poorly understood. Therefore, we aimed to investigate MRI correlates of cognitive improvement after EEG-based neurofeedback training in patients with MS (pwMS). METHODS: Fourteen pwMS underwent ten neurofeedback training sessions within 3-4 weeks at home using a tele-rehabilitation system. Half of the pwMS (N = 7, responders) learned to self-regulate sensorimotor rhythm (SMR, 12-15 Hz) by visual feedback and improved cognitively after training, whereas the remainder (non-responders, n = 7) did not. Diffusion-tensor imaging and resting-state fMRI of the brain was performed before and after training. We analyzed fractional anisotropy (FA) and functional connectivity (FC) of the default-mode, sensorimotor (SMN) and salience network (SAL). RESULTS: At baseline, responders and non-responders were comparable regarding sex, age, education, disease duration, physical and cognitive impairment, and MRI parameters. After training, compared to non-responders, responders showed increased FA and FC within the SAL and SMN. Cognitive improvement correlated with increased FC in SAL and a correlation trend with increased FA was observed. CONCLUSIONS: This exploratory study suggests that successful neurofeedback training may not only lead to cognitive improvement, but also to increases in brain microstructure and functional connectivity.

Self-regulation of brain activity and its effect on cognitive function in patients with multiple sclerosis - First insights from an interventional study using neurofeedback.

OBJECTIVE: To investigate the effects of EEG-based neurofeedback training, in which one can learn to self-regulate one's own brain activity, on cognitive function in patients with multiple sclerosis (pwMS). METHODS: Fourteen pwMS performed ten neurofeedback training sessions within 3-4 weeks at home using a tele-rehabilitation system. The aim of the neurofeedback training was to increase voluntarily the sensorimotor rhythm (SMR, 12-15 Hz) in the EEG over central brain areas by receiving visual real-time feedback thereof. Cognitive function was assessed before and after all neurofeedback training sessions using a comprehensive standardized neuropsychological test battery. RESULTS: Half of the pwMS (N = 7) showed cognitive improvements in long-term memory and executive functions after neurofeedback training. These patients successfully learned to self-regulate their own brain activity by means of neurofeedback training. The other half of pwMS (N = 7) did neither show any cognitive changes when comparing the pre- and post-assessment nor were they able to modulate their own brain activity in the desired direction during neurofeedback training. CONCLUSIONS: Data from this interventional study provide first preliminary evidence that successful self-regulation of one's own brain activity may be associated with cognitive improvements in pwMS. SIGNIFICANCE: These promising results should stimulate further studies. Neurofeedback might be a promising and alternative tool for future cognitive rehabilitation.

Age-related differences in the within-session trainability of hemodynamic parameters: a near-infrared spectroscopy-based neurofeedback study.

Neurofeedback studies revealed that the hemodynamic response as assessed with near-infrared spectroscopy (NIRS) can be voluntarily modulated. However, the hemodynamic response generally changes with age, and it remains unclear whether age-related differences in the hemodynamic response affect the trainability of brain signals. In the present study, N = 24 healthy young adults (mean age: 23 years; age range: 21-28 years) and N = 19 healthy older individuals (mean age: 69 years; age range: 60-84 years) performed one NIRS-based neurofeedback session. Half of all participants either tried to increase deoxygenated hemoglobin (deoxy-Hb) or decrease oxygenated hemoglobin over the inferior frontal gyrus (IFG) during imagery of swallowing movements. In addition, the hemodynamic response during motor imagery and execution of swallowing without real-time feedback was compared between groups. Young and older adults showed an opposite NIRS signal change during motor imagery, probably indicating a reduced movement inhibition ability in older individuals. Age-related differences in the trainability of the hemodynamic response during neurofeedback training were observed, too. Young participants were able to decrease oxygenated hemoglobin and increase deoxy-Hb over the bilateral IFG, whereas older participants were mainly able to increase deoxy-Hb over the left IFG. Our results provide evidence of age-related differences in the within-session trainability of the hemodynamic response as assessed with NIRS and have an impact on the application of NIRS-based real-time feedback.

Effects of Motor Imagery and Visual Neurofeedback on Activation in the Swallowing Network: A Real-Time fMRI Study.

Motor imagery of movements is used as mental strategy in neurofeedback applications to gain voluntary control over activity in motor areas of the brain. In the present functional magnetic resonance imaging (fMRI) study, we first addressed the question whether motor imagery and execution of swallowing activate comparable brain areas, which has been already proven for hand and foot movements. Prior near-infrared spectroscopy (NIRS) studies provide evidence that this is the case in the outer layer of the cortex. With the present fMRI study, we want to expand these prior NIRS findings to the whole brain. Second, we used motor imagery of swallowing as mental strategy during visual neurofeedback to investigate whether one can learn to modulate voluntarily activity in brain regions, which are associated with active swallowing, using real-time fMRI. Eleven healthy adults performed one offline session, in which they executed swallowing movements and imagined swallowing on command during fMRI scanning. Based on this functional localizer task, we identified brain areas active during both tasks and defined individually regions for feedback. During the second session, participants performed two real-time fMRI neurofeedback runs (each run comprised 10 motor imagery trials), in which they should increase voluntarily the activity in the left precentral gyrus by means of motor imagery of swallowing while receiving visual feedback (the visual feedback depicted one's own fMRI signal changes in real-time). Motor execution and imagery of swallowing activated a comparable network of brain areas including the bilateral pre- and postcentral gyrus, inferior frontal gyrus, basal ganglia, insula, SMA, and the cerebellum compared to a resting condition. During neurofeedback training, participants were able to increase the activity in the feedback region (left lateral precentral gyrus) but also in other brain regions, which are generally active during swallowing, compared to the motor imagery offline task. Our results indicate that motor imagery of swallowing is an adequate mental strategy to activate the swallowing network of the whole brain, which might be useful for future treatments of swallowing disorders.

EEG Neurofeedback Is Under Strong Control of Psychosocial Factors.

Recently, a deep impact of psychosocial effects on the outcomes of neurofeedback training was suggested. Previous findings point out an association between locus of control in dealing with technology and the individual ability to up-regulate the sensorimotor rhythm (12-15 Hz) in the EEG. Since the antecedents of locus of control in dealing with technology differ between males and females, we have investigated the effect of sex of participant and experimenter on the outcomes of neurofeedback training. Mindfulness and SMR baseline power also were assessed as possible confounding variables. Undergraduate psychology students (n = 142) took part in a single session of neurofeedback training conducted by either male or female experimenters. Male participants as well as those female participants instructed by male experimenters were able to upregulate SMR, while female participants trained by female experimenters were not. A strong positive correlation between training outcomes and locus of control in dealing with technology was observed only in the female participants trained by female experimenters. These results are suggestive about the impact of psychosocial factors-particularly gender-related effects-on neurofeedback training outcomes and the urgent need to document it in neurofeedback studies.

Placebo hampers ability to self-regulate brain activity: A double-blind sham-controlled neurofeedback study.

It is still poorly understood how unspecific effects peripheral to the supposed action mechanism of neurofeedback (NF) influence the ability to self-regulate one's own brain signals. Recently, skeptical researchers have even attributed the lion's part of therapeutic outcomes of NF to placebo and other psychosocial factors. Here, we investigated whether and by which mechanisms unspecific factors influence neural self-regulation during NF. To manipulate the impact of unspecific influences on NF performance, we used a sham transcranial direct current stimulation (tDCS) as active placebo intervention suggesting positive effects on NF performance. Our results show that the expectation of receiving brain stimulation, which should boost neural self-regulation, interferes with the ability to self-regulate the sensorimotor rhythm in the EEG. Hence, these results provide evidence that placebo reduces NF performance, and thereby challenge current theories on unspecific effects related to NF.

Trainability of hemodynamic parameters: A near-infrared spectroscopy based neurofeedback study.

We investigated the trainability of the hemodynamic response as assessed with near-infrared spectroscopy (NIRS) during one neurofeedback (NF) session. Forty-eight participants were randomly assigned to four different groups that tried to either increase or decrease oxygenated (oxy-Hb) or deoxygenated hemoglobin (deoxy-Hb) over the inferior frontal gyrus during imagery of swallowing movements. Deoxy-Hb could be successfully up-regulated while oxy-Hb could be successfully down-regulated during NF. Participants were not able to down-regulate deoxy-Hb or to up-regulate oxy-Hb. These results show that the natural course of oxy- and deoxy-Hb during movement imagery can be reinforced by providing real-time feedback of the corresponding NIRS parameter since deoxy-Hb generally increases and oxy-Hb decreases during imagery of swallowing. Furthermore, signal-to-noise ratio of deoxy-Hb but not of oxy-Hb improved during training. Our results provide new insights into the trainability of the hemodynamic response as assessed with NIRS and have an impact on the application of NIRS-based real-time feedback.

Specific or nonspecific? Evaluation of band, baseline, and cognitive specificity of sensorimotor rhythm- and gamma-based neurofeedback.

Neurofeedback (NF) is often criticized because of the lack of empirical evidence of its specificity. Our present study thus focused on the specificity of NF on three levels: band specificity, cognitive specificity, and baseline specificity. Ten healthy middle-aged individuals performed ten sessions of SMR (sensorimotor rhythm, 12-15Hz) NF training. A second group (N=10) received feedback of a narrow gamma band (40-43Hz). Effects of NF on EEG resting measurements (tonic EEG) and cognitive functions (memory, intelligence) were evaluated using a pre-post design. Both training groups were able to linearly increase the target training frequencies (either SMR or gamma), indicating the trainability of these EEG frequencies. Both NF training protocols led to nonspecific changes in other frequency bands during NF training. While SMR NF only led to concomitant changes in slower frequencies, gamma training affected nearly the whole power spectrum. SMR NF specifically improved memory functions. Gamma training showed only marginal effects on cognitive functions. SMR power assessed during resting measurements significantly increased after SMR NF training compared to a pre-assessment, indicating specific effects of SMR NF on baseline/tonic EEG. The gamma group did not show any pre-post changes in their EEG resting activity. In conclusion, SMR NF specifically affects cognitive functions (cognitive specificity) and tonic EEG (baseline specificity), while increasing SMR during NF training nonspecifically affects slower EEG frequencies as well (band non-specificity). Gamma NF was associated with nonspecific effects on the EEG power spectrum during training, which did not lead to considerable changes in cognitive functions or baseline EEG activity.

Upper Alpha Based Neurofeedback Training in Chronic Stroke: Brain Plasticity Processes and Cognitive Effects.

In the present study, we investigated the effects of upper alpha based neurofeedback (NF) training on electrical brain activity and cognitive functions in stroke survivors. Therefore, two single chronic stroke patients with memory deficits (subject A with a bilateral subarachnoid hemorrhage; subject B with an ischemic stroke in the left arteria cerebri media) and a healthy elderly control group (N = 24) received up to ten NF training sessions. To evaluate NF training effects, all participants performed multichannel electroencephalogram (EEG) resting measurements and a neuropsychological test battery assessing different cognitive functions before and after NF training. Stroke patients showed improvements in memory functions after successful NF training compared to the pre-assessment. Subject B had a pathological delta (0.5-4 Hz) and upper alpha (10-12 Hz) power maximum over the unaffected hemisphere before NF training. After NF training, he showed a more bilateral and "normalized" topographical distribution of these EEG frequencies. Healthy participants as well as subject A did not show any abnormalities in EEG topography before the start of NF training. Consequently, no changes in the topographical distribution of EEG activity were observed in these participants when comparing the pre- and post-assessment. Hence, our results show that upper alpha based NF training had on the one hand positive effects on memory functions, and on the other hand led to cortical "normalization" in a stroke patient with pathological brain activation patterns, which underlines the potential usefulness of NF as neurological rehabilitation tool.

Specific effects of EEG based neurofeedback training on memory functions in post-stroke victims.

BACKGROUND: Using EEG based neurofeedback (NF), the activity of the brain is modulated directly and, therefore, the cortical substrates of cognitive functions themselves. In the present study, we investigated the ability of stroke patients to control their own brain activity via NF and evaluated specific effects of different NF protocols on cognition, in particular recovery of memory. METHODS: N = 17 stroke patients received up to ten sessions of either SMR (N = 11, 12-15 Hz) or Upper Alpha (N = 6, e.g. 10-12 Hz) NF training. N = 7 stroke patients received treatment as usual as control condition. Furthermore, N = 40 healthy controls performed NF training as well. To evaluate the NF training outcome, a test battery assessing different cognitive functions was performed before and after NF training. RESULTS: About 70 % of both patients and controls achieved distinct gains in NF performance leading to improvements in verbal short- and long-term memory, independent of the used NF protocol. The SMR patient group showed specific improvements in visuo-spatial short-term memory performance, whereas the Upper Alpha patient group specifically improved their working memory performance. NF training effects were even stronger than effects of traditional cognitive training methods in stroke patients. NF training showed no effects on other cognitive functions than memory. CONCLUSIONS: Post-stroke victims with memory deficits could benefit from NF training as much as healthy controls. The used NF training protocols (SMR, Upper Alpha) had specific as well as unspecific effects on memory. Hence, NF might offer an effective cognitive rehabilitation tool improving memory deficits of stroke survivors.

Voluntary Modulation of Hemodynamic Responses in Swallowing Related Motor Areas: A Near-Infrared Spectroscopy-Based Neurofeedback Study.

In the present study, we show for the first time that motor imagery of swallowing, which is defined as the mental imagination of a specific motor act without overt movements by muscular activity, can be successfully used as mental strategy in a neurofeedback training paradigm. Furthermore, we demonstrate its effects on cortical correlates of swallowing function. Therefore, N = 20 healthy young adults were trained to voluntarily increase their hemodynamic response in swallowing related brain areas as assessed with near-infrared spectroscopy (NIRS). During seven training sessions, participants received either feedback of concentration changes in oxygenated hemoglobin (oxy-Hb group, N = 10) or deoxygenated hemoglobin (deoxy-Hb group, N = 10) over the inferior frontal gyrus (IFG) during motor imagery of swallowing. Before and after the training, we assessed cortical activation patterns during motor execution and imagery of swallowing. The deoxy-Hb group was able to voluntarily increase deoxy-Hb over the IFG during imagery of swallowing. Furthermore, swallowing related cortical activation patterns were more pronounced during motor execution and imagery after the training compared to the pre-test, indicating cortical reorganization due to neurofeedback training. The oxy-Hb group could neither control oxy-Hb during neurofeedback training nor showed any cortical changes. Hence, successful modulation of deoxy-Hb over swallowing related brain areas led to cortical reorganization and might be useful for future treatments of swallowing dysfunction.

Resting-state sensorimotor rhythm (SMR) power predicts the ability to up-regulate SMR in an EEG-instrumental conditioning paradigm.

OBJECTIVE: Instrumental conditioning of EEG activity (EEG-IC) is a promising method for improvement and rehabilitation of cognitive functions. However, it has been found that even healthy adults are not always able to learn how to regulate their brain activity during EEG-IC. In the present study, the role of a neurophysiological predictor of EEG-IC learning performance, the resting-state power of sensorimotor rhythm (rs-SMR, 12-15Hz), was investigated. METHODS: Eyes-open and eyes-closed rs-SMR power was assessed before N=28 healthy adults underwent 10 training sessions of instrumental SMR conditioning (ISC), in which participants should learn to voluntarily increase their SMR power by means of audio-visual feedback. A control group of N=19 participants received gamma (40-43Hz) or sham EEG-IC. RESULTS: N=19 of the ISC participants could be classified as "responders" as they were able to increase SMR power during training sessions, while N=9 participants ("non-responders") were not able to increase SMR power. Rs-SMR power in responders before start of ISC was higher in widespread parieto-occipital areas than in non-responders. A discriminant analysis indicated that eyes-open rs-SMR power in a central brain region specifically predicted later ISC performance, but not an increase of SMR in the control group. CONCLUSIONS: Together, these findings indicate that rs-SMR power is a specific and easy-to-measure predictor of later ISC learning performance. SIGNIFICANCE: The assessment of factors that influence the ability to regulate brain activity is of high relevance, as it could be used to avoid potentially frustrating and expensive EEG-IC training sessions for participants who have a low chance of success.

Shutting down sensorimotor interference unblocks the networks for stimulus processing: an SMR neurofeedback training study.

OBJECTIVE: In the present study, we investigated how the electrical activity in the sensorimotor cortex contributes to improved cognitive processing capabilities and how SMR (sensorimotor rhythm, 12-15Hz) neurofeedback training modulates it. Previous evidence indicates that higher levels of SMR activity reduce sensorimotor interference and thereby promote cognitive processing. METHODS: Participants were randomly assigned to two groups, one experimental (N=10) group receiving SMR neurofeedback training, in which they learned to voluntarily increase SMR, and one control group (N=10) receiving sham feedback. Multiple cognitive functions and electrophysiological correlates of cognitive processing were assessed before and after 10 neurofeedback training sessions. RESULTS: The experimental group but not the control group showed linear increases in SMR power over training runs, which was associated with behavioural improvements in memory and attentional performance. Additionally, increasing SMR led to a more salient stimulus processing as indicated by increased N1 and P3 event-related potential amplitudes after the training as compared to the pre-test. Finally, functional brain connectivity between motor areas and visual processing areas was reduced after SMR training indicating reduced sensorimotor interference. CONCLUSIONS: These results indicate that SMR neurofeedback improves stimulus processing capabilities and consequently leads to improvements in cognitive performance. SIGNIFICANCE: The present findings contribute to a better understanding of the mechanisms underlying SMR neurofeedback training and cognitive processing and implicate that SMR neurofeedback might be an effective cognitive training tool.

Electrophysiological correlates of mental navigation in blind and sighted people.

The aim of the present study was to investigate functional reorganization of the occipital cortex for a mental navigation task in blind people. Eight completely blind adults and eight sighted matched controls performed a mental navigation task, in which they mentally imagined to walk along familiar routes of their hometown during a multi-channel EEG measurement. A motor imagery task was used as control condition. Furthermore, electrophysiological activation patterns during a resting measurement with open and closed eyes were compared between blind and sighted participants. During the resting measurement with open eyes, no differences in EEG power were observed between groups, whereas sighted participants showed higher alpha (8-12Hz) activity at occipital sites compared to blind participants during an eyes-closed resting condition. During the mental navigation task, blind participants showed a stronger event-related desynchronization in the alpha band over the visual cortex compared to sighted controls indicating a stronger activation in this brain region in the blind. Furthermore, groups showed differences in functional brain connectivity between fronto-central and parietal-occipital brain networks during mental navigation indicating stronger visuo-spatial processing in sighted than in blind people during mental navigation. Differences in electrophysiological parameters between groups were specific for mental navigation since no group differences were observed during motor imagery. These results indicate that in the absence of vision the visual cortex takes over other functions such as spatial navigation.