Regulating brain activity in the Visual Word Form Area with real-time fMRI neurofeedback in adults with typical and poor reading skills

Reading proficiency is essential for everyday life, with the Visual Word Form Area (VWFA) of the brains reading network playing a key role in fluent reading. Reduced VWFA activation has been linked to impaired reading. Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback allows individuals to learn to regulate brain activity in targeted brain areas. While our previous study demonstrated the feasibility of VWFA regulation in adults with typical reading skills, this study investigated whether adults with poor reading skills could similarly upregulate VWFA activity using rt-fMRI neurofeedback. Participants with typical (n = 20) and poor (n = 19) reading skills were trained to upregulate their VWFA activity during six runs of rt-fMRI neurofeedback training. Before and after training, no-feedback runs were conducted where the same regulation task had to be performed without receiving feedback. Feedback on activation was provided based on each participants individually defined VWFA, determined through a functional localizer task. Our study yielded two key findings: First, upregulation of the VWFA through rt-fMRI neurofeedback can be learned irrespective of an individuals reading proficiency. Even participants with poor reading skills, who exhibited lower VWFA activation and employed fewer reading-related mental strategies, achieved upregulation of this region through neurofeedback. Second, upregulating the VWFA through rt-fMRI neurofeedback resulted in increased VWFA activity after training, even without feedback, compared to pre-training in both adults with typical and poor reading skills. Overall, the feasibility of regulating VWFA activity, regardless of reading skills, provides a promising foundation for developing brain-based interventions to address reading impairments through rt-fMRI-based regulation training.