Several reported previously on motor imagery-based rehabilitation in stroke patients. However, these reports have been irreconcilable. We studied along with motor imagery, whether Neurofeedback using Near-Infrared spectroscopy(NIRS) can enhance the efficacy of rehabilitation in stroke patients.

Sixty patients with hemiplegia due to ischemic and hemorrhagic strokes visiting the AIIMS Neurology department from May 2017 to January 2019 were included in the study. The patients were randomly allocated into two groups. The intervention group received mental practice with motor imagery along with Neurofeedback using near-infrared spectroscopy. Both groups received standard stroke management.

The patients in the intervention group showed significant improvement in the cortical activation when compared to the control group as measured by the change in oxyhemoglobin. At the end of 3 months HbO decreased in the control group(-0.6 + 6.6) whereas it increased in the intervention group(4.7 + 8.8) with a difference of -5.4, 95% Confidence Interval (CI) -9.4 to -1.4, p=0.008]. However, it failed to show a statistically significant difference in the clinical outcomes measured using Fugl Meyer Assessment Scale (90.8 + 30.9 and 101.8 + 26.0 in intervention and control group respectively with a difference of 10.9, 95% CI -3.7 to 25.6, p=0.14 ) and modified Rankin Scale (2.8 + 0.5 and 2.8 + 0.6 in intervention and control group respectively with 95% CI -0.3 to 0.2, p=0.79 ) in both the groups at the end of 3 months.

The Neurofeedback using NIRS has the potential to enhance the outcome of motor imagery-based rehabilitation in stroke patients. Further studies with large sample size and long follow up periods are required to establish the role of Neurofeedback with motor imagery in improving the motor recovery.