Evaluation of a neurofeedback-based cognitive telerehabilitation system for neurological patients

Aim of this study was to provide a proof-of-principle for a neurofeedback-based cognitive telerehabilitation system. Here we describe the implementation of the system and its application and evaluation in two neurological patients with multiple sclerosis suffering from cognitive deficits. The portable telerehabilitation system consists of a small EEG amplifier, an easy-to-use semi-dry EEG headset and a laptop enabling home-based neurofeedback training. The patients performed ten home-based neurofeedback training sessions, which were supervised remotely by an EEG expert. During neurofeedback training, participants tried to voluntarily increase the amplitude of the sensorimotor rhythm (SMR, 12-15 Hz) in the EEG. Before and after neurofeedback training, cognitive functions were assessed using standardized neuropsychological tests. Results demonstrate the feasibility and efficacy of the neurofeedback-based cognitive telerehabilitation system on different levels. On the technical level, we could show that the system works flawlessly and can be easily used by neurological patients on their own at the patients' home. On the behavioral level, our results indicate that the effects of the home-based neurofeedback training are comparable to effects of conventional neurofeedback training performed in a standard lab or clinical environment. The patients were able to voluntarily modulate their own brain activity in the desired direction and they showed cognitive improvements after neurofeedback training compared to a pre-measurement. Hence, our study demonstrates the great potential value of such a neurofeedback-based telerehabilitation system for future cognitive rehabilitation.