Clinical applications of real time functional magnetic resonance imaging (rtfMRI) biofeedback

Abstract

Biofeedback allows learning voluntary control over otherwise involuntary autonomous physiological parameters by means of operant training. The basic principle is to measure and provide real-time feedback of the parameter of interest. Biofeedback was first demonstrated for the autonomous nervous system (heart rate and skin conductance) in the 1950s. In the nervous system, biofeedback (also called neurofeedback) classically uses electroencephalography (EEG), for example in severely paralyzed patients, epilepsy or tinnitus.

Recently, real time functional magnetic resonance imaging (rtfMRI) neurofeedback was introduced. This non-invasive technique has a substantially higher spatial resolution compared to EEG. We reason that this high spatial resolution of rtfMRI implies a substantial clinical power because it is possible to learn voluntary control over neuronal activations in exact brain regions. The majority of the few available rtfMRI biofeedback studies investigated the principal feasibility of rtfMRI neurofeedback and the neuronal mechanisms of neurofeedback in healthy volunteers. To date, only one controlled rtfMRI group study in patients is available that demonstrates a beneficial effect of rtfMRI neurofeedback in chronic pain patients.