On the feasibility of an online brain-computer interface-based neurofeedback game for enhancing attention and working memory in stroke and mild cognitive impairment patients

<i>Background</i>. Neurofeedback training (NFT) using Electroencephalogram-based Brain Computer Interface (EEG-BCI) is an emerging therapeutic tool for enhancing cognition.<i>Methods</i>. We developed an EEG-BCI-based NFT game for enhancing attention and working memory of stroke and Mild cognitive impairment (MCI) patients. The game involves a working memory task during which the players memorize locations of images in a matrix and refill them correctly using their attention levels. The proposed NFT was conducted across fifteen participants (6 Stroke, 7 MCI, and 2 non-patients). The effectiveness of the NFT was evaluated using the percentage of correctly filled matrix elements and EEG-based attention score. EEG varitions during working memory tasks were also investigated using EEG topographs and EEG-based indices.<i>Results</i>. The EEG-based attention score showed an enhancement ranging from 4.29-32.18% in the Stroke group from the first session to the third session, while in the MCI group, the improvement ranged from 4.32% to 48.25%. We observed significant differences in EEG band powers during working memory operation between the stroke and MCI groups.<i>Significance</i>. The proposed neurofeedback game operates based on attention and aims to improve multiple cognitive functions, including attention and working memory, in patients with stroke and MCI.<i>Conclusions</i>. The experimental results on the effect of NFT in patient groups demonstrated that the proposed neurofeedback game has the potential to enhance attention and memory skills in patients with neurological disorders. A large-scale study is needed in the future to prove the efficacy on a wider population.