Intensive Home-Based Motor Imagery Neurofeedback Training Using Mobile EEG to Assess Changes in Brain Activity and Motor Function in Stroke Survivors: A Multiple Baseline Design (MINTS Study Protocol)

Abstract

Background: Motor imagery neurofeedback (MI-NF) engages sensorimotor brain networks and has shown potential for motor recovery after stroke. While laboratory-based studies have demonstrated neural and behavioral effects, evidence on real-world MI-NF training and its impact on brain activity and connectivity in stroke survivors remains limited. The Motor Imagery Neurofeedback Training in Stroke (MINTS) study investigates the effects of intensive, home-based MI-NF training using mobile EEG in chronic stroke survivors. Specifically, the study examines whether MI-NF training induces changes in neural activity and functional connectivity and whether these changes are accompanied by improvements in upper-limb motor function. Additionally, the study explores the temporal evolution of neural and behavioral changes across repeated baseline and training measurements. Methods: MINTS is a prospective, single-group, multimodal intervention study using an across-subjects multiple-baseline design. Twenty-one individuals with chronic stroke (at least 6 months post-stroke) and persistent upper-limb motor impairments undergo a pre-assessment phase, a variable-length baseline period, an intervention phase with 14 MI-NF training sessions, a post-assessment phase, and an exploratory three-month follow-up. MI-NF training is performed every second day at participants' homes using mobile EEG. Repeated baseline and training measurements include grip strength, resting-state EEG, motor imagery tasks with and without neurofeedback, and daily-life movement monitoring. Pre- and post-assessments comprise comprehensive motor and cognitive testing, stationary EEG, and functional MRI. Primary outcomes are resting-state EEG coherence as an index of functional connectivity and MI-related EEG activity derived from mobile EEG within the multiple-baseline design. Secondary outcomes include MI-related EEG activity derived from stationary EEG, fMRI-based measures of brain activity and connectivity, clinical motor outcomes, and quantitative movement characteristics derived from movement sensors and video recordings. Tertiary outcomes and exploratory directions address broader motor and cognitive performance, associations between neural and behavioral changes, lesion-related effects, and persistence of training-related changes. Discussion: By combining intensive home-based MI-NF training with repeated multimodal assessments, MINTS is designed to characterize neural and behavioral dynamics of motor recovery after stroke and to evaluate the potential clinical relevance of MI-NF training in everyday life settings. Trial Registration: The study protocol was registered in the German Clinical Trials Register (DRKS00036147) on 25 March 2025.