Neurofeedback in patients with frontal brain lesions: A randomized, controlled double-blind trial

Christine Annaheim, Kerstin Hug, Caroline Stumm, Maya Messerli, Yves Simon, Margret Hund-Georgiadis, Christine Annaheim, Kerstin Hug, Caroline Stumm, Maya Messerli, Yves Simon, Margret Hund-Georgiadis

Abstract

Background: Frontal brain dysfunction is a major challenge in neurorehabilitation. Neurofeedback (NF), as an EEG-based brain training method, is currently applied in a wide spectrum of mental health conditions, including traumatic brain injury.

Objective: This study aimed to explore the capacity of Infra-Low Frequency Neurofeedback (ILF-NF) to promote the recovery of brain function in patients with frontal brain injury.

Materials and methods: Twenty patients hospitalized at a neurorehabilitation clinic in Switzerland with recently acquired, frontal and optionally other brain lesions were randomized to either receive NF or sham-NF. Cognitive improvement was assessed using the Frontal Assessment Battery (FAB) and the Test of Attentional Performance (TAP) tasks regarding intrinsic alertness, phasic alertness and impulse control.

Results: With respect to cognitive improvements, there was no significant difference between the two groups after 20 sessions of either NF or sham-NF. However, in a subgroup of patients with predominantly frontal brain lesions, the improvements measured by the FAB and intrinsic alertness were significantly higher in the NF-group.

Conclusion: This is the first double-blind controlled study using NF in recovery from brain injury, and thus also the first such study of ILF NF. Although the result of the subgroup has limited significance because of the small number of participants, it accentuates the trend seen in the whole group regarding the FAB and intrinsic alertness (p = 0.068, p = 0.079, respectively). We therefore conclude that NF could be a promising candidate promoting the recoveryfrom frontal brain lesions. Further studies with larger numbers of patients and less lesion heterogeneity are needed to verify the usefulness of NF in the neurorehabilitation of patients with frontal brain injury (NCT02957695 ClinicalTrials.gov).

Keywords: brain computer interface; brain recovery; cognitive dysfunction; frontal brain injury; infra-low frequency neurofeedback; neurofeedback (NFB); neurorehabilitation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Annaheim, Hug, Stumm, Messerli, Simon and Hund-Georgiadis.

Figures

FIGURE 1
FIGURE 1
EEG Electrode Positioning for NF-Training (adapted from: Othmer, 2013).
FIGURE 2
FIGURE 2
Flowchart showing the number of participants and drop-outs during the course of the trial.
FIGURE 3
FIGURE 3
Cognitive improvement in both intervention groups. (A) Frontal Assessment Battery (FAB), (B) TAP intrinsic alertness, (C) TAP phasic alertness, (D) TAP Go/NoGo, n = 20. TAP, Task of Attentional Performance.
FIGURE 4
FIGURE 4
(A–D) Cognitive improvement in the subgroup of patients with mainly frontal brain lesions (FAB), TAP intrinsic alertness, TAP phasic alertness, TAP Go/Nogo, n = 9.

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