Stroke is the third leading cause of death worldwide and a major cause for long-term disability, with limited therapeutic options to support functional recovery. Many stroke survivors face persistent motor and cognitive impairments, highlighting the urgent need for innovative rehabilitation strategies. Non-invasive neuromodulation, including electrical and magnetic brain stimulation and neurofeedback, has emerged as a promising approach to enhance post-stroke recovery. By targeted modulation of brain activity, several approaches have shown promising effects that may improve functional outcomes, yet many questions remain about optimal protocols and mechanisms of action. This symposium will bring together leading researchers and early career scientists working at the intersection of stroke recovery and neuromodulation to discuss current challenges and opportunities in the field. Gesa Hartwigsen (Leipzig) will provide insights into longitudinal trajectories of language recovery after stroke, identifying general principles of neural reorganization. Rebekah Brückner (Oldenburg) investigates localization techniques for frontal midline theta activity using combined MEG and MRI data in older adults and stroke patients to optimize targeting for transcranial alternating current stimulation. Jennifer Decker (Oldenburg) will present pilot data of an intensive at home-based motor imagery neurofeedback training approach to enhance motor recovery. Sonja Kleih-Dahms (Würzburg) will discuss the role of neurofeedback-based approaches to enhance attention and the potential of brain-computer interfaces for post-stroke aphasia rehabilitation in patients with chronic symptoms. By addressing how neuromodulation strategies can support recovery across different stroke-related impairments, this symposium will provide an overview of current advances and highlight promising directions for future research and clinical application.

Language is organized in distributed networks in our brain. Stroke often severely affects language processing, leading to disrupted interactions within the language network. Previous work has demonstrated that language recovery relies on the contribution of perilesional and contralesional language areas as well as the recruitment of domain-general support functions for attention and cognitive control. However, it is unclear how the underlying large-scale networks interact during language recovery. In this talk, I will present new data highlighting longitudinal changes in task-related activity and connectivity during language processing across the time course of language recovery after stroke. I will demonstrate that language recovery is a dynamic process engaging different principles of reorganization: Early facilitation from domain-general to language regions is associated with later language improvement. Specific connectivity patterns depend on lesion location and time after stroke. Moreover, aside from such across-network reorganization, later recovery engages increased within-network connectivity between core language areas. Complementing these principles of network recovery, in a second study, we used a multivariate approach to identify factors of recovery, demonstrating that beyond age and lesion site, changes in task-related activity and task-related connectivity contribute to predicting favorable language recovery. Finally, I will discuss how these studies may inform future approaches of personalized treatment with non-invasive brain stimulation, informing a dynamic model of transcranial magnetic stimulation with different stimulation protocols at different phases of language recovery.

Frontal Midline Theta (FMΘ) activity has been shown to increase during more cognitively challenging executive functioning tasks in younger individuals and is linked to performance improvement. Older adults, however, have been shown to have a reduction in both FMΘ and executive functioning when compared to their younger counterparts.

Transcranial Alternating Current Stimulation (tACS) can enhance frequency-specific neural activity via entrainment, but its effectiveness is limited by individual variability, which may be greater in older adults due to age-related brain changes.

This study proposes an analysis pipeline for targeting FMΘ activity in older healthy adults using structural MRI and task-related (visual GoNoGo) MEG data. An MEG time series of each trial was projected into source space using an LCMV beamformer. Time-frequency representations were computed from these time series and grand averaged.

A dependent sample cluster permutation t-test was used to compare activity in FMΘ between the Go and NoGo conditions. A significant activation cluster (p < 0.05) was identified that was used as a target for E-field modeling.

Functional FMΘ source localization was combined with E-field modeling (SimNIBS) to determine individualized electrode placement and stimulation intensity. Modeling in both chronic stroke lesioned and healthy brains allows comparison of target performance, offering a novel method to potentially enhance cognitive function through FMΘ modulation in aging and post-stroke populations.

Motor imagery (MI) neurofeedback (NF) training is a promising approach for motor rehabilitation after stroke. MI-NF training offers a non-invasive method to promote neuroplasticity and motor recovery, even in the absence of residual movement. However, its implementation outside controlled laboratory settings remains challenging, and the underlying neural mechanisms are not yet fully understood.

In this talk we will introduce the MINTS study (Motor Imagery Neurofeedback Training in Stroke Survivors), which investigates the feasibility and neural effects of intensive, home-based MI-NF training with mobile EEG in chronic stroke survivors. Using an across-subjects multiple baseline design, participants engage in a structured MI-NF protocol over four weeks, accompanied by extensive pre- and post-assessments, including motor and cognitive testing, EEG, and fMRI. The primary objective is to examine MI-NF-related changes in resting-state functional connectivity, while secondary outcomes focus on lateralization shifts in brain activity, structural and functional brain adaptations, and motor function improvements. To evaluate the feasibility of the study design, we conducted a single-case pilot study with a reduced training duration and a subset of the MINTS protocol’s pre- and post-assessment points. The collected data will be presented and discussed with regard to the practical implementation of MI-NF training at home, including aspects such as participant adherence, technical feasibility and training practicability.

A detailed study protocol is currently in preparation for publication. Collected data and analysis scripts will be shared within the Research Training Group 2783 and the University of Oldenburg, and will be made accessible to the scientific community in the future.

Stroke is a major cause of disability and death worldwide. Although there are many interventions available for motor and cognitive rehabilitation during the sub-acute phase after a stroke, there are not many treatment options for people with chronic deficits. Once a patient in Germany has completed outpatient neuropsychological, or speech therapy training (covered by health insurance), no further treatment options are available. To address this gap in healthcare provision, we developed new interventions for cognitive rehabilitation after stroke for two groups of patients: patients with chronic post-stroke aphasia and patients with chronic post-stroke attention deficits. Both groups of patients had exhausted all other treatment options and had reported negative impact on of their chronic cognitive deficits on their daily lives. We showed a Brain-Computer Interface (BCI) spelling application based on event-related potentials for rehabilitating post-stroke aphasia to be feasible, however the specificity of the intervention to improve spontaneous speech remains uncertain. We also investigated a neurofeedback-based intervention for rehabilitation of post-stroke attention deficits and showed its feasibility and that behavioral indicators of attention improved after as compared to before the neurofeedback training. However, further research is required to corroborate the results of the presented rehabilitation approaches.