Real-Time Functional Magnetic Resonance Imaging as a Tool for Neurofeedback: Present and Future Applications

Neurofeedback allows participants to voluntarily control their own brain activity. Consequently, neurofeedback is a potential intervention tool in diverse clinical domains. Different brain signals can be fed back to the neurofeedback users, such as the hemodynamic response of the brain using functional magnetic resonance imaging (fMRI) and near-infrared spectroscopy (NIRS) or electrophysiological brain signals as measured with electroencephalography (EEG). Each of these neuroscientific methods has its advantages and disadvantages. For instance, using fMRI all brain regions can be targeted, while in EEG and NIRS signals from deeper regions cannot be precisely differentiated. Hence, fMRI-based neurofeedback allows treatment of mental and physical diseases, which are associated with activation patterns in deeper brain regions. Until now, only the blood oxygen level dependent signal (BOLD) has been used as feedback signal in fMRI-based neurofeedback studies. However, we have started to develop a neurofeedback pipeline using a different fMRI signal, namely arterial spin labeling (ASL), which will be introduced in this article. ASL neurofeedback enables a direct modulation of the cerebral blood flow and, consequently, might improve rehabilitation of disorders caused by perfusion imbalance in the future.