EEG-based sensorimotor neurofeedback for motor neurorehabilitation in children and adults: A scoping review

Abstract

Objective: Therapeutic interventions for children and young people with dystonia and dystonic/dyskinetic cerebral palsy are limited. EEG-based neurofeedback is emerging as a neurorehabilitation tool. This scoping review maps research investigating EEG-based sensorimotor neurofeedback in adults and children with neurological motor impairments, including augmentative strategies.

Methods: MEDLINE, CINAHL and Web of Science databases were searched up to 2023 for relevant studies. Study selection and data extraction were conducted independently by at least two reviewers.

Results: Of 4380 identified studies, 133 were included, only three enrolling children. The most common diagnosis was adult-onset stroke (77%). Paradigms mostly involved upper limb motor imagery or motor attempt. Common neurofeedback modes included visual, haptic and/or electrical stimulation. EEG parameters varied widely and were often incompletely described. Two studies applied augmentative strategies. Outcome measures varied widely and included classification accuracy of the Brain-Computer Interface, degree of enhancement of mu rhythm modulation or other neurophysiological parameters, and clinical/motor outcome scores. Few studies investigated whether functional outcomes related specifically to the EEG-based neurofeedback.

Conclusions: There is limited evidence exploring EEG-based sensorimotor neurofeedback in individuals with movement disorders, especially in children. Further clarity of neurophysiological parameters is required to develop optimal paradigms for evaluating sensorimotor neurofeedback.

Significance: The expanding field of sensorimotor neurofeedback offers exciting potential as a non-invasive therapy. However, this needs to be balanced by robust study design and detailed methodological reporting to ensure reproducibility and validation that clinical improvements relate to induced neurophysiological changes.

Keywords: Brain-Computer Interface; Children; EEG; Movement Disorders; Neurofeedback; Neurorehabilitation.

Fig. 1

PRISMA flow chart of screening process for scoping review. BCI=Brain-Computer Interface, CINAHL=Cumulative Index to Nursing and Allied Health Literature, DBS=Deep Brain Stimulation, EEG=Electroencephalography, fMRI=Functional Magnetic Resonance Imaging, SMC=Sensorimotor Cortex, SMR=Sensorimotor Rhythm.

Fig. 2

(A) Number of included articles published by year. (B) Neurological motor impairment diagnoses of study populations.

Fig. 3

(A) Sensorimotor task parameters. LL=Lower Limb, UL=Upper Limb. (B) Neurofeedback mode(s) employed in studies. As noted in the text, haptic feedback was delivered via multiple methods including robotic devices, vibrotactile and brush stimuli.

Fig. 4

Number of studies that employed each BCI participant performance measure. BCI=Brain-Computer Interface, CA=Classification Accuracy, SMR=Sensorimotor Rhythm, UL=Upper Limb.