Optimizing motor imagery neurofeedback through the use of multimodal immersive virtual reality and motor priming

Stroke is among the leading causes of long-term disability, leaving an increasing number of people with cognitive and motor impairments, loss of independence in their daily life and with a high societal cost. So far, the development of Brain-Computer Interfaces (BCIs) that translate brain activity into control signals in computers or external devices provide new strategies to overcome stroke-related motor limitations. Recent studies demonstrated the brain´s capacity for functional and structural plasticity and recovery even in severe chronic stroke. However, it is not fully clear how we can exploit the neurobiological mechanisms underlying recovery. This is the case for restorative BCI research. There is currently no standardized and accepted treatment for the use of BCIs with patients suffering from acute or chronic motor impairments. In this study we investigated with 9 healthy participants the role of multimodal virtual reality (VR) simulations and motor priming (MP) in a motor imagery BCI training. Our findings show improved BCI performance for VR and MP conditions, as well as the capacity to modulate and enhance brain activity patterns. Our data suggest that both VR and MP can be useful to promote neural activation and neuroplastic changes in the rehabilitation of stroke patients in a motor imagery neurofeedback paradigm.