Role: PI
Funding Agency: Foundation For Neurofeedback and Neuromodulation Research (FNNR), USA (2025)
Stroke is a leading cause of adult disability, with middle cerebral artery (MCA) infarcts being especially common and often resulting in cognitive deficits. Nearly 60% of stroke survivors experience post-stroke cognitive impairment (PSCI), affecting various cognitive domains. The severity and nature of these deficits depend on various factors, such as the type of stroke, lesion size, and location. For instance, ischemic stroke affecting the hippocampus often leads to significant short- and long-term memory deficits. Executive dysfunction, including difficulties with multitasking, planning, and problem-solving, is another common post-stroke issue. In addition, survivors may experience impairments in sustained and divided attention. Language difficulties, such as aphasia, are often observed in individuals with left-hemisphere strokes. Visuospatial impairments can also pose significant challenges, affecting facial recognition, spatial navigation, and distance judgment, thereby increasing the risk of falls and accidents. These enduring deficits can compromise survivors' independence and overall quality of life (QoL).
In clinical practice, most stroke rehabilitation focuses on motor recovery. In contrast, neuropsychological rehabilitation is relatively scarce, which plays a critical role in stroke recovery by addressing cognitive, emotional, and behavioral challenges. The rehabilitation process typically begins with a comprehensive neuropsychological evaluation to identify specific deficits, which then informs the development of personalised intervention plans. One such promising rehabilitation technique is EEG neurofeedback (NF), wherein patients receive real-time EEG feedback and learn to regulate specific brainwave frequencies. It uses operant conditioning to reinforce desired EEG patterns, thereby stimulating the brain’s plastic reorganization.
Previous studies suggest that in stroke survivors, EEG-NF may improve cognitive scores. However, the existing studies are heterogeneous, and no standardized protocol has been established. Moreover, these studies focus predominantly on motor recovery, with considerably less emphasis on cognitive or neuropsychological rehabilitation, specifically for MCA stroke. Therefore, the current study aims to fill this gap by rigorously evaluating whether adding SMR-based EEG neurofeedback to standard cognitive rehabilitation can yield greater cognitive gains in MCA stroke patients.
Role: PI
Funding Agency:
SERB – DST, India, under the NPDF scheme (2018)
*Foundation For Neurofeedback and Neuromodulation Research (FNNR), USA (2019)
*Partially funded
Traumatic Brain Injury (TBI) is an injury to the head that disrupts the normal functioning of the brain and can be caused by a bump, blow or jolt to the head. It is a critical public health problem that needs the attention of the world health community. These head injuries result in a large number of deaths or survivors with impairments and associated disabilities. The major etiological factors of TBI are Road Traffic Accidents (RTA), falls, and violence. The study suggests that by 2020 road traffic injuries will be the 3rd leading cause of disability-adjusted life years lost in the world.
Head injury results in various adverse aftereffects, which give rise to behavioural, cognitive, emotional, and physical changes that affect a person’s quality of life (QOL). Post-concussion symptoms are the most reported complaints after mild to moderate head injury. These symptoms include dizziness, headache, and impaired memory. Many post-injury studies indicate that individuals with head injuries have increased the risk of depression, Alzheimer’s disease, and dementia, as compared to the normal population. Population-based studies report that post-head-injury patients are more likely to develop epilepsy and binge alcohol. A study suggested that one year post-injury, 31% of patients reported a psychiatric disorder i.e. depression, anxiety, post-traumatic stress disorder (PTSD), and agoraphobia and 22% rose up a psychiatric disorder they had never experienced before. Therefore, there is no exaggeration to say that TBI is a major public health issue.
Other than the overt consequences of TBI, it also leads to the disruptions and alterations of brain function including changes in electrophysiological and brain activation patterns. These alterations have been found to be associated with poor functional outcomes and hence importance needs to be given to these alterations. A considerable amount of studies have shown the correspondence of EEG and Quantitative-EEG (qEEG) changes after the concussion. The most common qEEG findings of persons with mTBI are attenuated alpha frequency in the posterior region and increased theta activity 13-15. Modern imaging technologies i.e. fMRI, diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS) have opened the way to bring out the important information regarding both structural and functional alterations in the brain following the concussion. Previous evidence indicates a variety of functional deficits correlated with brain imaging in concussed individuals.
Studies have shown EEG-Neurofeedback Training (EEG-NFT) to be effective in bringing down cognitive, behavioural, and emotional dysfunctions and thereby enhancing the quality of life. Also, research indicates that EEG-NFT may induce functional and anatomical brain changes as seen on EEG and fMRI under physiological conditions, drastically reducing the adverse effect.
Despite being an effective intervention modality, the process by which NFT brings about the change remains unclear. Also, there is a dearth of studies assessing moderate or severe TBI; instead, most of the researches have been documented for mild TBI. Moreover, to the best of our knowledge, there are no studies comparing the TBI patients with normal healthy control on electrophysiological and fMRI correlates. Therefore, the present study aims at the effectiveness of EEG-NFT in moderate/severe TBI to bring about changes in electrophysiological and brain activation patterns. The findings from the study will hold an implication for clinical decision-making as to which interventions should be offered to TBI patients.