Effectiveness of neurofeedback interventions in cerebral palsy: A systematic review

Aim

To synthesise existing evidence on the effectiveness of neurofeedback (NF) interventions in individuals with cerebral palsy (CP).

Method

A systematic search was conducted in nine databases in October 2023, December 2023, and November 2024, without language restrictions. Studies were eligible if they investigated NF interventions in individuals with CP, irrespective of intervention type, study design, or participant characteristics (e.g. diagnosis, sex, age). Study quality was appraised using the Downs and Black checklist and the Single-Case Experimental Design (SCED) Scale. Risk of bias was assessed with the revised Cochrane risk-of-bias tool (RoB 2), the Cochrane Risk of Bias in Non-randomised Studies of Intervention (ROBINS-I V2), and the Single-Case Design RoB tool.

Results

Eighteen studies (n=439, age range 4-47 years) were included: seven randomised controlled trials (RCTs), seven non-RCTs, and four SCED studies. All interventions used electroencephalography (EEG)-based NF, with some integrating brain–computer interfaces (BCIs) or external devices such as powered wheelchairs and robotic hands. Reported benefits included improvements in brain activity, motor outcomes, and cognitive functions. However, not all studies confirmed these effects, and findings were inconsistent across protocols. The use of multiple tools and external devices appeared to strengthen intervention effects in some cases.

Interpretation

NF interventions in CP show potential, but their effectiveness remains inconclusive, largely due to heterogeneity in intervention protocols (i.e., frequency bands targeted, electrode placement, feedback modalities, and intervention intensity) and limited follow-up data. Future studies should prioritise rigorously designed RCTs, incorporate personalised approaches, and consider multimodal NF interventions.

What this paper adds

• Individuals with cerebral palsy are capable of learning to regulate their neural activity through neurofeedback.

• Neurofeedback interventions show potential to improve motor, cognitive, and functional outcomes, although findings remain inconsistent.

• The use of brain–computer interfaces and external devices may enhance the effectiveness of neurofeedback.

• Protocol heterogeneity and limited follow-up remain key barriers to establishing neurofeedback effectiveness.