{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:49:39Z","timestamp":1791355779279,"version":"4.3.1"},"reference-count":80,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Post-stroke upper-limb recovery remains challenging, especially in the presence of sensory impairments. Conventional brain\u2013computer 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\u2019 efficacy in motor function, self-reported numbness, and cognitive functions using a multiple-baseline design (MBD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All participants demonstrated significant improvement during the intervention. FMA-UE increased by 6\u201316 points. The BBT showed large effects (integrated Tau-U\u202f=\u202f0.75). Body cognition improved significantly in both sense of agency (Tau-U\u202f=\u202f0.80) and ownership (Tau-U\u202f=\u202f0.89). Numbness was reduced in affected cases (Tau-U\u202f=\u202f\u22120.85). Neurophysiological changes correlated with functional gains, with some patterns suggesting increased neural efficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnhum.2026.1938622","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:52:03Z","timestamp":1791352323000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Graded multisensory neurofeedback via the iNems system for comprehensive upper limb recovery after stroke: a multiple baseline study"],"prefix":"10.3389","volume":"20","author":[{"given":"Takayuki","family":"Kodama","sequence":"first","affiliation":[{"name":"Graduate School of Health Sciences, Kyoto Tachibana University","place":["Kyoto, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Kitai","sequence":"additional","affiliation":[{"name":"Graduate School of Health Sciences, Kyoto Tachibana University","place":["Kyoto, 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