Feasibility Randomized Controlled Trial of Real-Time fMRI Neurofeedback for Reading Rehabilitation in Aphasia.

backgroundReading impairments are common in stroke-induced aphasia and limit participation in functional and leisure activities. Traditional rehabilitation strategies show limited generalization, underscoring the need for novel interventions targeting residual neural networks.

methodsThis feasibility randomized controlled trial evaluated real-time functional magnetic resonance imaging (fMRI) neurofeedback intervention for poststroke reading deficits. Subacute left-hemisphere stroke survivors and healthy controls completed 3 weekly fMRI neurofeedback and 10 out-of-scanner practice sessions. Stroke participants were randomized to contingent neurofeedback (based on left supramarginal gyrus activity; n=4) or noncontingent neurofeedback (shuffled feedback from another participant; n=3). Healthy controls (n=4) received contingent neurofeedback and served as a normative reference. Primary outcomes were changes from baseline to postintervention (≈3 weeks) in task-based brain activity (motor imagery/word/nonword reading>baseline), resting-state connectivity, and reading aloud. Reading comprehension was a secondary outcome. Group×session effects were tested using repeated-measures analyses and planned contrasts.

resultsTask fMRI revealed training-related activation increases in the left supramarginal gyrus (z=4.7; cluster-corrected

conclusionsThese findings support the feasibility of targeting the residual reading network during early recovery using fMRI neurofeedback. Confirmation of these preliminary effects awaits completion of the ongoing randomized controlled trial. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04875936.