Objective: To investigate the efficacy of the supplementary motor area (SMA) facilitation using functional near infrared spectroscopy mediated neurofeedback system (fNIRS-NFB) on gait impairment in PD.

Background: Gait and balance impairment in PD has detrimental effect on their activities of daily living and quality of life. There is ample evidence suggesting contribution of the cortical and cortico-subcortical network including the SMA to axial symptom in PD, and it is hypothesized that the neuromodulative facilitation of the SMA would alleviate gait and balance impairment in PD

Method: Clinically established PD (N = 19, 8 males, age: 75.6 ± 5.6 y.o., duration: 6.7 ± 4.6 years) with written informed consent have participated in this pilot randomized controlled trial (RCT:UMIN000010723). Subjects are allocated to REAL and SHAM groups with double blinded manner. In addition to the usual inpatient rehabilitation, patients participated 6 sessions of neurofeedback training with gait and balance related motor imagery. As a feedback, their own SMA activity information was provided in REAL group but irrelevant signals were provided in SHAM group. Clinical measures including motor symptom, Hoehn-Yahr stage, and cognitive status are assessed as baseline characteristics. Gait and balance measures including Timed Up-and-go test (TUG), Berg Balance Scale (BBS), and Gait speed are also assessed before, immediately after, and 2 weeks after the end of intervention.

Results: Baseline clinical characteristics were comparable between two groups. After controlling the possible confound factors, there was significant interaction between group and TUG time (time×group interaction :F2,24=3.42, p<0.05), and group and gait speed (time×group interaction :F2,24=5.802, p<0.01). Although TUG time and gait speed improved significantly at the end of intervention in the REAL group (t9=-3.05, p<0.05, and t9=3.42, p<0.01, respectively), these effect did not sustain at the two weeks after the end of intervention (t9=0.63, p=0.55, and t9=1.8, p=0.10, respectively).There was no adverse effect associated with fNIRS-NFB in both groups.

Conclusion: Our pilot RCT revealed the safety and potentially beneficial effect of fNIRS-NFB on gait disturbance in PD, but its clinical efficacy did not last long.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-neurofeedback-facilitation-of-the-gait-and-balance-imagery-related-sma-activation-on-gait-function-in-pd/