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Peer-reviewedCC BYFrontiers in human neuroscience

Graded multisensory neurofeedback via the iNems system for comprehensive upper limb recovery after stroke: a multiple baseline study.

  • Takayuki Kodama1
  • Ken Kitai1
  • Yasuhisa Mizomoto2,3
  • Kaichi Nishigaya2,4
  • Shoutarou Hashimoto5
  • Riona Hiraga4
  • Satomi Shimizu4
  • Miki Kawabata4
  • Yuumi Hirabayashi4
  • Keita Ikesue4
  • Hazime Kako4
  • Syouta Yasui4
8 more authors
  • Hiroki Ito1
  • Kazuhei Nishimoto1
  • Osamu Katayama2,6
  • Hideaki Yamaguchi2,7
  • Hikaru Nagano8
  • Mari Inoue9
  • Shin Murata1
  • Kiichiro Morita10
10 affiliations
  1. 1Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan.
  2. 2Visiting Researcher, Kyoto Tachibana University, Kyoto, Japan.
  3. 3Watanabe Hospital, Zuisinkai Medical Corporation, Mihama, Aichi, Japan.
  4. 4Zenjokai Rehabilitation Hospital, Zenjokai Medical Foundation, Nagoya, Aichi, Japan.
  5. 5Sun Baden, Geriatric Health Services Facility, Mihama, Aichi, Japan.
  6. 6National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
  7. 7CARETECH Plus Inc., Aichi, Nagoya, Japan.
  8. 8Faculty of Fiber Science and Engineering, Kyoto Institute of Technology, Kyoto, Japan.
  9. 9Graduate School of Human Development and Environment, Kobe University, Kobe, Hyogo, Japan.
  10. 10Research Institute for Brain Diseases, Kurume University, Fukuoka, Japan.
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Abstract

Introduction

Post-stroke upper-limb recovery remains challenging, especially in the presence of sensory impairments. Conventional brain-computer interfaces (BCIs) are constrained by binary feedback, single-modality stimulation, and exclusion of patients with sensory deficits. We developed the Imagery Neurofeedback-based Multi-sensory System (iNems), a neurofeedback system that provides graded multisensory (visual and electrical) feedback based on ERD magnitude. This study validated iNems' efficacy in motor function, self-reported numbness, and cognitive functions using a multiple-baseline design (MBD).Methods

Four participants with post-stroke upper-limb motor and sensory impairments underwent a multiple baseline design. The baseline phase (phase A) used random feedback; the intervention (phase B) used adaptive iNems. iNems quantified motor intention via sensorimotor EEG event-related desynchronization (ERD) and delivered graded visual and electrical feedback. Primary outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Box and Block Test (BBT). Secondary outcomes included body cognition, numbness, and neurophysiological (ERD/ERS) changes.Results

All participants demonstrated significant improvement during the intervention. FMA-UE increased by 6-16 points. The BBT showed large effects (integrated Tau-U = 0.75). Body cognition improved significantly in both sense of agency (Tau-U = 0.80) and ownership (Tau-U = 0.89). Numbness was reduced in affected cases (Tau-U = -0.85). Neurophysiological changes correlated with functional gains, with some patterns suggesting increased neural efficiency.Conclusion

This first MBD-validated demonstration shows that graded, multisensory graded neurofeedback based on ERD magnitude can improve motor, self-reported numbness, and cognitive domains after stroke. These findings support adaptive closed-loop therapy as a promising, multifaceted rehabilitation strategy.

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Cite

BibTeXRIS
BibTeX
@article{kodama2026graded,
  title = {{Graded multisensory neurofeedback via the iNems system for comprehensive upper limb recovery after stroke: a multiple baseline study.}},
  author = {Takayuki Kodama and Ken Kitai and Yasuhisa Mizomoto and Kaichi Nishigaya and Shoutarou Hashimoto and Riona Hiraga and Satomi Shimizu and Miki Kawabata and Yuumi Hirabayashi and Keita Ikesue and Hazime Kako and Syouta Yasui and Hiroki Ito and Kazuhei Nishimoto and Osamu Katayama and Hideaki Yamaguchi and Hikaru Nagano and Mari Inoue and Shin Murata and Kiichiro Morita},
  journal = {Frontiers in human neuroscience},
  year = {2026},
  month = oct,
  doi = {10.3389/fnhum.2026.1938622},
  url = {https://europepmc.org/article/MED/42908918},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Graded multisensory neurofeedback via the iNems system for comprehensive upper limb recovery after stroke: a multiple baseline study.
AU  - Takayuki Kodama
AU  - Ken Kitai
AU  - Yasuhisa Mizomoto
AU  - Kaichi Nishigaya
AU  - Shoutarou Hashimoto
AU  - Riona Hiraga
AU  - Satomi Shimizu
AU  - Miki Kawabata
AU  - Yuumi Hirabayashi
AU  - Keita Ikesue
AU  - Hazime Kako
AU  - Syouta Yasui
AU  - Hiroki Ito
AU  - Kazuhei Nishimoto
AU  - Osamu Katayama
AU  - Hideaki Yamaguchi
AU  - Hikaru Nagano
AU  - Mari Inoue
AU  - Shin Murata
AU  - Kiichiro Morita
PY  - 2026
DA  - 2026/10/07
JO  - Frontiers in human neuroscience
DO  - 10.3389/fnhum.2026.1938622
UR  - https://europepmc.org/article/MED/42908918
AB  - Introduction  Post-stroke upper-limb recovery remains challenging, especially in the presence of sensory impairments. Conventional brain-computer interfaces (BCIs) are constrained by binary feedback, single-modality stimulation, and exclusion of patients with sensory deficits. We developed the Imagery Neurofeedback-based Multi-sensory System (iNems), a neurofeedback system that provides graded multisensory (visual and electrical) feedback based on ERD magnitude. This study validated iNems' efficacy in motor function, self-reported numbness, and cognitive functions using a multiple-baseline design (MBD).Methods  Four participants with post-stroke upper-limb motor and sensory impairments underwent a multiple baseline design. The baseline phase (phase A) used random feedback; the intervention (phase B) used adaptive iNems. iNems quantified motor intention via sensorimotor EEG event-related desynchronization (ERD) and delivered graded visual and electrical feedback. Primary outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Box and Block Test (BBT). Secondary outcomes included body cognition, numbness, and neurophysiological (ERD/ERS) changes.Results  All participants demonstrated significant improvement during the intervention. FMA-UE increased by 6-16 points. The BBT showed large effects (integrated Tau-U = 0.75). Body cognition improved significantly in both sense of agency (Tau-U = 0.80) and ownership (Tau-U = 0.89). Numbness was reduced in affected cases (Tau-U = -0.85). Neurophysiological changes correlated with functional gains, with some patterns suggesting increased neural efficiency.Conclusion  This first MBD-validated demonstration shows that graded, multisensory graded neurofeedback based on ERD magnitude can improve motor, self-reported numbness, and cognitive domains after stroke. These findings support adaptive closed-loop therapy as a promising, multifaceted rehabilitation strategy.
SN  - 1662-5161
ER  -