BCIwiki (bciwiki.com) — People with chronic stroke who received real-time EEG-based brain-computer interface (BCI) neurofeedback during motor imagery improved beyond minimal clinically important difference (MCID) thresholds on at least one upper-limb outcome, most notably grip strength, in a 7-patient double-blind controlled case series reported in Applied Psychophysiology and Biofeedback on September 21, 2026 (PMID 42763839). The authors are affiliated with institutions including the Faculty of Medicine of the University of Porto and the Department of Neurology at São João University Hospital in Portugal.
Participants were allocated to an experimental group that performed motor imagery (MI) with real-time EEG-based BCI neurofeedback, or a control group that performed MI with sham feedback. All completed a standardized four-week physiotherapy program. Motor outcomes were measured with the Action Research Arm Test, Fugl-Meyer Assessment, Motor Assessment Scale and grip strength, while EEG-derived symmetry measures and task-related functional MRI were used to explore neuroplastic changes.
The real-feedback group also showed more symmetrical EEG activity and more consistent sensorimotor and cerebellar activation on fMRI. Responses in the sham group were more variable and appeared influenced by a single high responder.
The authors said the findings support the feasibility of combining EEG-based BCI neurofeedback with MI and physiotherapy in chronic stroke rehabilitation, while describing the intervention's role in upper-limb recovery as preliminary and exploratory given the small sample.