Neuromotor Rehabilitation Research Articles

Movement Sonification Techniques to Improve Balance in Parkinson's Disease: A Pilot Randomized Controlled Trial.

Movement sonification has been recently introduced into the field of neuromotor rehabilitation alongside Neurologic Music Therapy and music-based interventions. This study introduces the use of musical auditory cues encompassing the melodic-harmonic aspect of music. Nineteen patients with Parkinson's disease were randomly assigned to the experimental (n = 10) and control (n = 9) groups and underwent thrice-weekly sessions of the same gait training program, with or without sonification. Functional and motor parameters, as well as fatigue, quality of life, and the impact of intervention on patients' well-being, were assessed at baseline (PRE), the end of treatment (POST), and at follow-up (FU). Between-group differences were assessed for each outcome measure using linear mixed-effects models. The outcome measure was entered as the dependent variable, group and time as fixed effects, and time by group as the interaction effect. Mini BESTest and Dynamic Gait Index scores significantly improved in the experimental group (p = 0.01 and p = 0.03, respectively) from PRE to FU, demonstrating a significant impact of the sonification treatment on balance. No other significant differences were observed in the outcome measures. Larger sample sizes are needed to confirm the effectiveness of sonification approaches in Parkinson's disease, as well as in other neurological disorders.

Investigating the Effect of Neuro-Motor Rehabilitation on Myelin Regeneration after Spinal Cord Injury Model in Rats

Investigating the Effect of Neuro-Motor Rehabilitation on Myelin Regeneration after Spinal Cord Injury Model in Rats

A Narrative Review on Multi-Domain Instrumental Approaches to Evaluate Neuromotor Function in Rehabilitation.

In clinical scenarios, the use of biomedical sensors, devices and multi-parameter assessments is fundamental to provide a comprehensive portrait of patients' state, in order to adapt and personalize rehabilitation interventions and support clinical decision-making. However, there is a huge gap between the potential of the multidomain techniques available and the limited practical use that is made in the clinical scenario. This paper reviews the current state-of-the-art and provides insights into future directions of multi-domain instrumental approaches in the clinical assessment of patients involved in neuromotor rehabilitation. We also summarize the main achievements and challenges of using multi-domain approaches in the assessment of rehabilitation for various neurological disorders affecting motor functions. Our results showed that multi-domain approaches combine information and measurements from different tools and biological signals, such as kinematics, electromyography (EMG), electroencephalography (EEG), near-infrared spectroscopy (NIRS), and clinical scales, to provide a comprehensive and objective evaluation of patients' state and recovery. This multi-domain approach permits the progress of research in clinical and rehabilitative practice and the understanding of the pathophysiological changes occurring during and after rehabilitation. We discuss the potential benefits and limitations of multi-domain approaches for clinical decision-making, personalized therapy, and prognosis. We conclude by highlighting the need for more standardized methods, validation studies, and the integration of multi-domain approaches in clinical practice and research.

Motor cortex hemodynamic response to goal-oriented and non-goal-oriented tasks in healthy subjects.

Motor disorders are one of the world's major scourges, and neuromotor rehabilitation is paramount for prevention and monitoring plans. In this scenario, exercises and motor tasks to be performed by patients are crucial to follow and assess treatments' progression and efficacy. Nowadays, in clinical environments, quantitative assessment of motor cortex activities during task execution is rare, due to the bulkiness of instrumentation and the need for immobility during measurements [e.g., functional magnetic resonance imaging (MRI)]. Functional near-infrared spectroscopy (fNIRS) can contribute to a better understanding of how neuromotor processes work by measuring motor cortex activity non-invasively in freely moving subjects. Exploit fNIRS to measure functional activation of the motor cortex area during arm-raising actions. All subjects performed three different upper limbs motor tasks: arm raising (non-goal-oriented), arm raising and grasping (goal oriented), and assisted arm raising (passive task). Each task was repeated ten times. The block design for each task was divided into 5 seconds of baseline, 5 seconds of activity, and 15 seconds of recovery. Sixteen healthy subjects (11 males and 5 females) with an average (+/- standard deviation) of 37.9 (+/- 13.0) years old. Cerebral hemodynamic responses have been recorded in two locations, motor cortex (activation area) and prefrontal cortex (control location) exploiting commercial time-domain fNIRS devices. Haemodynamic signals were analyzed, separating the brain cortex hemodynamic response from extracerebral hemodynamic variations. The hemodynamic response was recorded in the cortical motor area for goal-oriented and not-goaloriented tasks, while no response was noticed in the control location (prefrontal cortex position). This study provides a basis for canonical upper limb motor cortex activations that can be potentially compared to pathological cerebral responses in patients. It also highlights the potential use of TD-fNIRS to study goal-oriented versus non-goaloriented motor tasks. Impact: the findings of this study may have implications for clinical rehabilitation by providing a better understanding of the neural mechanisms underlying goal-oriented versus non-goal-oriented motor tasks. This may lead to more effective rehabilitation strategies for individuals with motor disorders and a more effective diagnosis of motor dysfunction supported by objective and quantitative neurophysiological readings.

Neuromotor rehabilitation of the child with infantile cerebral palsy - spastic paraparesis

Neuromotor rehabilitation of the child with infantile cerebral palsy - spastic paraparesis

Inclusive design in electrical stimulation technologies and neurorehabilitation for clinician and patient end users.

Dr. Tamsyn Street is an interdisciplinary researcher working for the National Health Service (NHS) in the UK with a background in motor neurorehabilitation. In the last couple of decades there has been a rapid advancement in assistive technology solutions using electrical stimulation for neurorehabilitation. This editorial examines whether these advancements have translated into good inclusive design performance for clinician and patient end users. Suggestions for overcoming some of the existing challenges are proposed.

Hand rehabilitation based on the RobHand exoskeleton in stroke patients: A case series study.

Introduction: The RobHand (Robot for Hand Rehabilitation) is a robotic neuromotor rehabilitation exoskeleton that assists in performing flexion and extension movements of the fingers. The present case study assesses changes in manual function and hand muscle strength of four selected stroke patients after completion of an established training program. In addition, safety and user satisfaction are also evaluated. Methods: The training program consisted of 16 sessions; two 60-minute training sessions per week for eight consecutive weeks. During each session, patients moved through six consecutive rehabilitation stages using the RobHand. Manual function assessments were applied before and after the training program and safety tests were carried out after each session. A user evaluation questionnaire was filled out after each patient completed the program. Results: The safety test showed the absence of significant adverse events, such as skin lesions or fatigue. An average score of 4 out of 5 was obtained on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale. Users were very satisfied with the weight, comfort, and quality of professional services. A Kruskal-Wallis test revealed that there were not statistically significant changes in the manual function tests between the beginning and the end of the training program. Discussion: It can be concluded that the RobHand is a safe rehabilitation technology and users were satisfied with the system. No statistically significant differences in manual function were found. This could be due to the high influence of the stroke stage on motor recovery since the study was performed with chronic patients. Hence, future studies should evaluate the rehabilitation effectiveness of the repetitive use of the RobHand exoskeleton on subacute patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05598892?id=NCT05598892&draw=2&rank=1, identifier NCT05598892.

Biopsychosocial effects and experience of use of robotic and virtual reality devices in neuromotor rehabilitation: A study protocol.

Robot-assisted therapy (RAT) and virtual reality (VR)-based neuromotor rehabilitation have shown promising evidence in terms of patient's neuromotor recovery, so far. However, still little is known on the perceived experience of use of robotic and VR devices and the related psychosocial impact. The present study outlines a study protocol aiming to investigate the biopsychosocial effects and the experience of use of robotic and non-immersive VR devices in patients undergoing neuromotor rehabilitation. Adopting a prospective, two-arm, non-randomized study design, patients with different neuromotor diseases (i.e., acquired brain injury, Parkinson's Disease, and total knee/hip arthroplasty) undergoing rehabilitation will be included. In a real-world clinical setting, short- (4 weeks) and long-term (6 months) changes in multiple patient's health domains will be investigated, including the functional status (i.e., motor functioning, ADLs, risk of falls), cognitive functioning (i.e., attention and executive functions), physical and mental health-related quality of life (HRQoL), and the psychological status (i.e., anxiety and depression, quality of life satisfaction). At post-intervention, the overall rehabilitation experience, the psychosocial impact of the robotic and VR devices will be assessed, and technology perceived usability and experience of use will be evaluated through a mixed-methods approach, including both patients' and physiotherapists' perspectives. Repeated measures within-between interaction effects will be estimated, and association analyses will be performed to explore the inter-relationships among the variables investigated. Data collection is currently ongoing. The biopsychosocial framework adopted will contribute to expanding the perspective on patient's recovery within the technology-based rehabilitation field beyond motor improvement. Moreover, the investigation of devices experience of use and usability will provide further insight into technology deployment in neuromotor rehabilitation programs, thereby maximising therapy engagement and effectiveness. ClinicalTrials.gov ID: NCT05399043.

Gamification of Post-Stroke Neuromotor Rehabilitation Exercises Using Hand Tracking In VR

Abstract The main goal of this study is to develop a gaming platform for people who have had a stroke and are going through various stages of neuromotor rehabilitation. The main idea is that regular recovery activities are boring and repetitive, which might make people less interested in being in therapy. By including enjoyable but practical games into workout routines, there is potential to enhance patients’ motivation. To ensure the accuracy and reliability of the system, a validation process was conducted with the help of two stroke patients now undergoing rehabilitation at the Clinical Rehabilitation Hospital in Iași. The parameters were adjusted based on individual patient characteristics, and a total of 12 tests were conducted, from which various results were obtained. At the end of the clinical trial, feedback was gathered from patients in order to get first-hand perspectives from the intended users of the system and identify areas for potential system enhancement. In the end, this research has demonstrated some of the benefits and potential uses of virtual reality (VR) technology in patient rehabilitation, and the participants in the clinical study have found it to be positive and useful.

Technology Acceptance Model for Exoskeletons for Rehabilitation of the Upper Limbs from Therapists' Perspectives.

Over the last few years, exoskeletons have been demonstrated to be useful tools for supporting the execution of neuromotor rehabilitation sessions. However, they are still not very present in hospitals. Therapists tend to be wary of this type of technology, thus reducing its acceptability and, therefore, its everyday use in clinical practice. The work presented in this paper investigates a novel point of view that is different from that of patients, which is normally what is considered for similar analyses. Through the realization of a technology acceptance model, we investigate the factors that influence the acceptability level of exoskeletons for rehabilitation of the upper limbs from therapists' perspectives. We analyzed the data collected from a pool of 55 physiotherapists and physiatrists through the distribution of a questionnaire. Pearson's correlation and multiple linear regression were used for the analysis. The relations between the variables of interest were also investigated depending on participants' age and experience with technology. The model built from these data demonstrated that the perceived usefulness of a robotic system, in terms of time and effort savings, was the first factor influencing therapists' willingness to use it. Physiotherapists' perception of the importance of interacting with an exoskeleton when carrying out an enhanced therapy session increased if survey participants already had experience with this type of rehabilitation technology, while their distrust and the consideration of others' opinions decreased. The conclusions drawn from our analyses show that we need to invest in making this technology better known to the public-in terms of education and training-if we aim to make exoskeletons genuinely accepted and usable by therapists. In addition, integrating exoskeletons with multi-sensor feedback systems would help provide comprehensive information about the patients' condition and progress. This can help overcome the gap that a robot creates between a therapist and the patient's human body, reducing the fear that specialists have of this technology, and this can demonstrate exoskeletons' utility, thus increasing their perceived level of usefulness.

A Versatile Embedded Platform for Implementation of Biocooperative Control in Upper-Limb Neuromotor Rehabilitation Scenarios

Biocooperative control uses both biomechanical and physiological information of the user to achieve a reliable human-robot interaction. In the context of neuromotor rehabilitation, such control can enhance rehabilitation experience and outcomes. However, the high cost and large volume of the commercial systems for physiological signal acquisition are major limitations for the development of such control. We present a highly versatile, low-cost and wearable embedded system that integrates the most commonly used sensors in this field: inertial measurement unit (IMU), electrocardiography (ECG), electromyography (EMG), galvanic skin response (GSR) and skin temperature (SKT) sensors. Additionally, the compact system combines wireless communication for data transmission and a high-efficiency microcontroller for real-time signal processing and control. We tested the system in two common neuromotor rehabilitation scenarios. The first is an upper-limb rehabilitation VR-based exergame, in which the patient must collect as many coins as possible. Movement recognition of the hand and arm is performed based on EMG and IMU information, respectively. The second is adaptive assistive control that adjusts the level of assistance of a wrist rehabilitation robot according to the physiological state and motor performance of the patient using GSR, ECG and SKT data. The quality of the recorded signals and the processing capacity of the system meet the needs of the two upper-limb rehabilitation applications. The wearable system is highly versatile, open, configurable and low cost, and it could promote the development of real-time biocooperative control for a wide range of neuromotor rehabilitation applications.

Training-dependent plasticity and far transfer effect enhanced by Bobath rehabilitation in Multiple Sclerosis

BackgroundMultiple Sclerosis (MS) is a disease that often results in motor and/or cognitive disability. Despite the increasing availability of effective drug therapies, rehabilitation is very important means of counteracting the progression of disability and improving physical function, impacting social participation and improving quality of life. Several rehabilitation approaches can be used in the context of neuro-motor rehabilitation, but there is insufficient evidence for them in the literature. ObjectivesThis study has the twofold purpose of: (i) investigate whether rehabilitation according to Bobath Concept can improve balance and some aspects of cognitive function in MS patients; (ii) explore whether the ability to improve postural control, an indirect index of adaptive neuroplasticity, is preserved in MS patients and whether it can be improved with rehabilitation. MethodThis is an independent wait-listed study. Forty people with MS (pwMS) were enrolled: patients in the Bobath group underwent 8 weeks of rehabilitation according to the Bobath Concept. For aim 1, pwMS were assessed at baseline (T0), at the end of the 8 weeks of treatment (T1) and after 8 weeks of observation (T2) with motor and cognitive scales. For aim 2, the same 40 pwMS were matched with healthy controls and were subjected to a postural learning task using the force platform at T0, T1 and T2. ResultsPatients in Bobath group scored better on balance and cognitive function at T1, but this improvement was not maintained at T2. All patients were less accurate than controls in the postural learning task at each assessment; however, patients also demonstrated an increase in accuracy after training, similar to that of healthy controls. The learning curve was better for patients randomized to the active group than the waitlist at T1 time, but this advantage was not maintained at the T2 assessment. ConclusionIn light of the results, this study supports the use of rehabilitation according to Bobath Concept to improve balance control and some executive functions in MS. Despite worse baseline performance, pwMS were able to learn a postural control task on par with healthy controls. Also, supports the hypothesis that adaptive plasticity is preserved despite MS and can be promoted by rehabilitation.

Neuromotor Rehabilitation Interventions After Pediatric Stroke: A Focused Review

Pediatric stroke is a condition that often results in life-long motor, cognitive, or sensory deficits for children. The purpose of this focused review is to compile the most recent literature on pediatric stroke neuromotor interventions and summarize evidence for use by rehabilitation providers and researchers. Terms including stroke, pediatric, and neuromotor were searched with appropriate MeSH terms. Information was collected regarding interventions conducted and outcome measures used for each article. Interventions and outcome measures were organized based on ICF components (Body Structure and Function, Activity, Participation, and Environmental Factors). 16 articles were included after full-text screens. From these 16 articles, a large majority of them included some form of neuromodulation as a part of intervention. Results identified a potentially problematic gap between domains addressed by interventions and measured by outcomes, with a need to include more expansive outcome measures in research studies. There are several areas of potential growth in pediatric stroke literature. Research studies should be precise when describing included samples. As interventions for pediatric stroke shift toward neuromodulation and other neurologic treatments, there is a need for well-defined populations, both clinically in the community as well as in research studies. There is also a need for US guidelines for rehabilitation after pediatric stroke. Overall, the trend in the literature seems to suggest that combining some form of neuromodulatory technique with existing recommended rehabilitation technique (ex: CIMT) may promote overall recovery for children after stroke, though further research is needed.

Virtual/Augmented Reality for Rehabilitation Applications Using Electromyography as Control/Biofeedback: Systematic Literature Review

Virtual reality (VR) and augmented reality (AR) are engaging interfaces that can be of benefit for rehabilitation therapy. However, they are still not widely used, and the use of surface electromyography (sEMG) signals is not established for them. Our goal is to explore whether there is a standardized protocol towards therapeutic applications since there are not many methodological reviews that focus on sEMG control/feedback. A systematic literature review using the PRISMA (preferred reporting items for systematic reviews and meta-analyses) methodology is conducted. A Boolean search in databases was performed applying inclusion/exclusion criteria; articles older than 5 years and repeated were excluded. A total of 393 articles were selected for screening, of which 66.15% were excluded, 131 records were eligible, 69.46% use neither VR/AR interfaces nor sEMG control; 40 articles remained. Categories are, application: neurological motor rehabilitation (70%), prosthesis training (30%); processing algorithm: artificial intelligence (40%), direct control (20%); hardware: Myo Armband (22.5%), Delsys (10%), proprietary (17.5%); VR/AR interface: training scene model (25%), videogame (47.5%), first-person (20%). Finally, applications are focused on motor neurorehabilitation after stroke/amputation; however, there is no consensus regarding signal processing or classification criteria. Future work should deal with proposing guidelines to standardize these technologies for their adoption in clinical practice.

Family caregivers of children with cerebral palsy

Background Cerebral palsy (CP) is a group of permanent movement disorders that appear early in life. So, having a child with disability is a major event that negatively affects families and forces families to evaluate their plans, goals, and relationships in light of restrictions and limitations associated with child disability. Aim and objectives The present study aimed to assess the burden and self-efficacy level of family caregivers of children with CP. Patients and methods This study was conducted at the National Institute of Neuro Motor Rehabilitation, Embaba, Giza Governorate. Result Overall, 72% of family caregivers experience moderate to severe burden and 16% experience mild to moderate burden, whereas 12% experience severe burden. Moreover, 94% of family caregivers can control thinking of how unfair they have to put up with taking care of their children with CP and 90% cannot ask a friend or family member to stay with the children with CP, whereas 88% cannot control their anger or answer their children with CP without raising their voice. Conclusion These results suggest caring for a child with CP may put the family caregivers at risk of moderate to severe burden and affect their relationships with other family members or friends in a negative way, and they might feel angry when they are around their relatives.

A systematic review on the usability of robotic and virtual reality devices in neuromotor rehabilitation: patients\u2019 and healthcare professionals\u2019 perspective

BackgroundThe application of virtual reality (VR) and robotic devices in neuromotor rehabilitation has provided promising evidence in terms of efficacy, so far. Usability evaluations of these technologies have been conducted extensively, but no overviews on this topic have been reported yet.MethodsA systematic review of the studies on patients' and healthcare professionals' perspective through searching of PubMed, Medline, Scopus, Web of Science, CINAHL, and PsychINFO (2000 to 2021) was conducted. Descriptive data regarding the study design, participants, technological devices, interventions, and quantitative and qualitative usability evaluations were extracted and meta-synthetized.ResultsSixty-eight studies were included. VR devices were perceived as having good usability and as a tool promoting patients' engagement and motivation during the treatment, as well as providing strong potential for customized rehabilitation sessions. By contrast, they suffered from the effect of learnability and were judged as potentially requiring more mental effort. Robotics implementation received positive feedback along with high satisfaction and perceived safety throughout the treatment. Robot-assisted rehabilitation was considered useful as it supported increased treatment intensity and contributed to improved patients' physical independence and psychosocial well-being. Technical and design-related issues may limit the applicability making the treatment difficult and physically straining. Moreover, cognitive and communication deficits were remarked as potential barriers.ConclusionsOverall, VR and robotic devices have been perceived usable so far, reflecting good acceptance in neuromotor rehabilitation programs. The limitations raised by the participants should be considered to further improve devices applicability and maximise technological rehabilitation effectiveness.Trial registrationPROSPERO registration ref. CRD42021224141.

Design Approaches of an Exoskeleton for Human Neuromotor Rehabilitation

This paper addresses a design for an exoskeleton used for human locomotion purposes in cases of people with neuromotor disorders. The reason for starting this research was given by the development of some intelligent systems for walking recovery involved in a new therapy called stationary walking therapy. This therapy type will be used in this research case, through a robotic system specially designed for functional walking recovery. Thus, the designed robotic system structure will have a patient lifting/positioning mechanism, a special exoskeleton equipped with sensors and actuators, a treadmill for walking, and a command and control unit. The exoskeleton’s lower limbs will have six orthotic devices. Thus, the exoskeleton’s lower limbs’ motions and orthoses angle variations will be generated by healthy human subjects on the treadmill with the possibility of memorizing these specific motions for obtaining one complete gait cycle. After this, the memorized motions will be performed to a patient with neuromotor disorders for walking recovery programs. The design core is focused on two planar-parallel mechanisms implemented at the knee and ankle joints of each leg’s exoskeleton. Thus, numerical simulations for the design process were carried out to validate the engineering feasibility of the proposed leg exoskeleton.

High-wearable EEG-based transducer for engagement detection in pediatric rehabilitation

ABSTRACT A method for high-wearable EEG-based assessment of pediatric emotional and cognitive engagement in neuro-motor rehabilitation is proposed. A specific easy calibration is provided in the perspective of a personalized medicine. Due to the lack of studies evaluating pediatric multidimensional engagement, an observational non-interventional protocol was adopted for collecting the EEG data related to the high/low levels of engagement. The experimental validation of the proposed method involved four children performing a rehabilitation exercise in five 8-min sessions. Due to the age and frailty of the subjects, no negative emotions were expressly induced and an unbalanced dataset was obtained. Different Synthetic Minority Oversampling Technique (SMOTE)-based strategies for unbalanced dataset management and classification methods were compared. The highest performances were achieved by combining Artificial Neural Network (ANN) models with the KMeansSMOTE oversampling method. Balanced accuracies of 71.2 % and 74.5 % for the emotional engagement and the cognitive engagement are obtained, respectively.

Combined Use of EMG and EEG Techniques for Neuromotor Assessment in Rehabilitative Applications: A Systematic Review

Electroencephalography (EEG) and electromyography (EMG) are widespread and well-known quantitative techniques used for gathering biological signals at cortical and muscular levels, respectively. Indeed, they provide relevant insights for increasing knowledge in different domains, such as physical and cognitive, and research fields, including neuromotor rehabilitation. So far, EEG and EMG techniques have been independently exploited to guide or assess the outcome of the rehabilitation, preferring one technique over the other according to the aim of the investigation. More recently, the combination of EEG and EMG started to be considered as a potential breakthrough approach to improve rehabilitation effectiveness. However, since it is a relatively recent research field, we observed that no comprehensive reviews available nor standard procedures and setups for simultaneous acquisitions and processing have been identified. Consequently, this paper presents a systematic review of EEG and EMG applications specifically aimed at evaluating and assessing neuromotor performance, focusing on cortico-muscular interactions in the rehabilitation field. A total of 213 articles were identified from scientific databases, and, following rigorous scrutiny, 55 were analyzed in detail in this review. Most of the applications are focused on the study of stroke patients, and the rehabilitation target is usually on the upper or lower limbs. Regarding the methodological approaches used to acquire and process data, our results show that a simultaneous EEG and EMG acquisition is quite common in the field, but it is mostly performed with EMG as a support technique for more specific EEG approaches. Non-specific processing methods such as EEG-EMG coherence are used to provide combined EEG/EMG signal analysis, but rarely both signals are analyzed using state-of-the-art techniques that are gold-standard in each of the two domains. Future directions may be oriented toward multi-domain approaches able to exploit the full potential of combined EEG and EMG, for example targeting a wider range of pathologies and implementing more structured clinical trials to confirm the results of the current pilot studies.

Predicting motor behavior: an efficient EEG signal processing pipeline to detect brain states with potential therapeutic relevance for VR-based neurorehabilitation

Virtual reality (VR)-based motor therapy is an emerging approach in neurorehabilitation. The combination of VR with electroencephalography (EEG) presents further opportunities to improve therapeutic efficacy by personalizing the paradigm. Specifically, the idea is to synchronize the choice and timing of stimuli in the perceived virtual world with fluctuating brain states relevant to motor behavior. Here, we present an open source EEG single-trial based classification pipeline that is designed to identify ongoing brain states predictive of the planning and execution of movements. 9 healthy volunteers each performed 1080 trials of a repetitive reaching task with an implicit two-alternative forced choice, i.e., use of the right or left hand, in response to the appearance of a visual target. The performance of the EEG decoding pipeline was assessed with respect to classification accuracy of right vs. left arm use, based on the EEG signal at the time of the stimulus. Different features, feature extraction methods, and classifiers were compared at different time windows; the number and location of informative EEG channels and the number of calibration trials needed were also quantified, as well as any benefits from individual-level optimization of pipeline parameters. This resulted in a set of recommended parameters that achieved an average 83.3% correct prediction on never-before-seen testing data, and a state-of-the-art 77.1% in a real-time simulation. Neurophysiological plausibility of the resulting classifiers was assessed by time–frequency and event-related potential analyses, as well as by Independent Component Analysis topographies and cortical source localization. We expect that this pipeline will facilitate the identification of relevant brain states as prospective therapeutic targets in closed-loop EEG-VR motor neurorehabilitation.