Figure 4. Changes in Gait Imagery–Related Cortical Activation and Resting-State Connectivity From the Supplementary Motor Area (SMA) After Neurofeedback.

(A) There was a significant group difference in cortical activation changes after neurofeedback intervention. Functional near infrared spectroscopy neurofeedback intervention facilitated gait imagery–related SMA activation. (B) Clinical improvement of balance ability correlated significantly with the individual gait-related cortical activation changes, suggesting an effect of SMA facilitation on balance ability. (C) Resting-state fMRI analysis revealed that SMA facilitation by neurofeedback enhances functional connectivity between the SMA and several motor-related cortical areas, including the affected anterior cingulate gyrus and the unaffected inferior frontal gyrus (IFG). (D) Resting-state functional connectivity changes between the SMA and the unaffected IFG significantly correlated with individual balance improvement. BA = Brodmann area; BBS = Berg Balance Scale; Ch = channels in functional near infrared spectroscopy recording; FDR = false discovery rate; MNI = Montreal Neurologic Institute.