| Summary: | Neurofeedback training of motor imagery-related brain-states with brain-machine interfaces (BMI) is currently being explored prior to standard physiotherapy to improve the motor outcome of stroke rehabilitation. Pilot studies suggest that such a priming intervention before physiotherapy might increase the responsiveness of the brain to the subsequent physiotherapy, thereby improving the clinical outcome. However, there is little evidence up to now that these BMI-based interventions have achieved operate conditioning of specific brain states that facilitate task-specific functional gains beyond the practice of primed physiotherapy. In this context, we argue that BMI technology needs to aim at physiological features relevant for the targeted behavioral gain. Moreover, this therapeutic intervention has to be informed by concepts of reinforcement learning to develop its full potential. Such a refined neurofeedback approach would need to address the following issues (1) Defining a physiological feedback target specific to the intended behavioral gain, e.g. β-band oscillations for cortico-muscular communication. This targeted brain state could well be different from the brain state optimal for the neurofeedback task (2) Selecting a BMI classification and thresholding approach on the basis of learning principles, i.e. balancing challenge and reward of the neurofeedback task instead of maximizing the classification accuracy of the feedback device (3) Adjusting the feedback in the course of the training period to account for the cognitive load and the learning experience of the participant. The proposed neurofeedback strategy provides evidence for the feasibility of the suggested approach by demonstrating that dynamic threshold adaptation based on reinforcement learning may lead to frequency-specific operant conditioning of β-band oscillations paralleled by task-specific motor improvement; a proposal that requires investigation in a larger cohort of stroke patients.
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