Transcript Presentation on Neurofeedback

Neurotherapy
Iza Boesler, MD
Betty Jarusiewicz, PhD
EEG Spectrum
732-801-4505
E-mail: [email protected]
Contents
• Background/Overview
– What is Neurofeedback/Neurotherapy/EEG
Biofeedback
– How it Differs From Biofeedback
– Types/Frequency Ranges/Uses/With Other
Therapies
– Why NT and Brain Regulation Works
– Research Basis (Thumbnail sketch)
Contents (cont’d)
Relationship to Genetics and Environment
Immune System
Important Current Research
- QEEGs
- Loretta
- HBOT
- Blood Flow Analysis
Background
• Other Names
– EEG Biofeedback
– Neurotherapy (NT)
– Neurotraining (NT)
• How it Differs from Biofeedback
Contents (cont’d)
• Delivery of NT
– What it looks like
– Places of delivery
– Types of measurement
• Our Research
- Various Efficacy trials
- Use of new measurement equipment
- School use
- Particular Protocols
Contents Cont’d
• Assistance to Families and/or Schools
– Neurotherapy
– Counseling during NT training
– Group information sessions
Background: What is
Neurofeedback and What does
it do?
(Neuroregulation)
• the process of operant conditioning
which changes one’s state (stabilizes
CNS) and improves behavior
• using equipment that monitors and
measures the electrical activity of the
brain and TRAINS the brain to be
more available to life’s requirements
Background: Types of
Neurofeedback
• Beta/SMR
– Eyes Open
– Frequency Range 12-18 Hz
• Alpha/Theta
– Eyes Closed
– Frequency Range 0-11 Hz
Background - Terminology :
Brainwave Frequencies
(Brain States)
35Hz+
Some evidence of association with
peak performance states
High Beta
18-35 Hz
High correlation with anxiety, when
dominant
Mid Beta
15-18 Hz
Active, external attention
SMR Beta
12-15 Hz
Relaxed, external attention
Alpha
8-12 Hz
Theta
4-7 Hz
Delta
0.5-3 Hz
GAMMA
Very relaxed, passive attention
Deeply relaxed, inwardly focused
Sleep
Some Documented Uses of
Neurofeedback
(See www.isnr.org for Comprehensive Bibliography)
• Beta/SMR
– ADD/ADHD
– Learning Disabilities
– Sleep
– Anxiety, Impulsivity
- Depression
- Epilepsy
- Autism
• Alpha/Theta (after Beta/SMR)
– Emotional and behavioral instability
– Addiction
(Note: NFB is approved by FDA for relaxation)
Integration with other
Therapies/Approaches
• ADHD, Learning Disabilities, Autism,
Epilepsy
– Behavioral Therapies
– Speech Therapies
– Occupational Therapies
– Counseling
– Other (I.e. Assistive Learning)
• Headaches (Migraines), Sleep, Anxiety,
Impulsivity, Emotional and Behavioral
Instability
– Counseling
– Medication
• Addictions, Peak Performance
– Counseling
Research Basis
• 1974: Sterman, MacDonald, & Stone
– Noted: seizures reduced by 66% on 4
individuals
– Used SMR combined with inhibition of excessive
slow wave activity (6-9 Hz)
• 1976 SMR: Lubar
– Hyperactivity Effects noted:
– subsided during training for epileptic seizure
reduction
– reduced even in absence of seizures
– More effective than stimulant medication alone
Research Basis (cont’d)
• 1984: Lubar
– SMR,with inhibits technique extended to
attentional deficits and learning disabilities
– Significant academic performance enhanced by
use of Beta (12-15 Hz)
• 1989: Penniston & Kulkowsky
–
–
–
–
Addition of Alpha Theta Work
Operant conditioning with eyes closed
For use in meditation and mental imagery
Useful for Addiction, PTSD, and Peak Performance
work
Research Basis (cont’d)
• 1989 – Othmer
– Initial work with Epilepsy
– Development of Software/Hardware for
Operant Conditioning Process
– Development of EEG Spectrum Inc.
– Expansion to other conditions, setting up
protocols, training practitioners
Research Basis (Cont’d)
– Disregulated Brains
• Jarusiewicz – initial control pilot study
• Coben – use of supplemental devises
– Blood flow, QEEGs
– Mirror Neurons
• San Diego Jaime P
Why Neurofeedback Works
(Operant Conditioning)
– Brain can change with assistance directed
by rewards: light, movement, and sound
– Brain assists in finding best/better
approach (New pathways? More
dendrites?)
– Brain will remain in new state as it “feels
better”
– Brain is continually used, maintaining “new
skill”
Disregulated vs Regulated Brain
Example of Similar Exercise Model
• Cardio respiratory Exercise
– Stronger heart and improved regulation
– Sleep improved
– Mood improved
– Lower basal metabolism
With thanks to Harold Burke, Ph.D.
In Summary, EEG
Biofeedback:
• Enhances the ability of an individual to access
and maintain different states of physiological
arousal and to navigate from high-vigilance to
rest. (trains the brain to regulate itself better)
• Hence, the treatment of disorders, such as
ADHD, depression, and anxiety.
With thanks to Harold Burke, Ph.D.
Summary (cont.)
• Enhances and supports the mechanisms by
which the brain manages cortical hyper
excitability and promotes stability.
• Hence, stabilization against “minor” problems,
such as temper tantrums, vertigo, tics, OCD,
bipolar disorder, panic attacks, and PMS; and
against even lesser disruptions, such as
attention problems, sequential and parallel
processing, and normal sleep.
Summary (cont.)
• Reinforces equilibrium states.
• Hence, normalization of pain thresholds,
appetite, and blood glucose levels.
What about the Placebo Effect?
• The effects of the training are highly specific
to electrode placement and to training
frequency band.
• Training protocols exist which can commonly
elicit effects opposite to those desired.
• The effects of training with one protocol can
be reversed with another.
With thanks to Harold Burke, Ph.D.
What Brain Training Sessions
Look Like:
Client “Hookup”
Universal 10 20 Chart
for Electrode Placement
Brain Training Session
Screens
Therapist (EEG)
Client (Game)
Therapist’s Screen
• Measurement of total
EEG signal at the scalp
with electrode or two
• Amplification of
microvolt-level signals
for computer
processing;
• Extraction of low,
medium, and high
frequencies
How is it done? (cont.)
• Progress is monitored every session;
• Initial sessions should be at a rate of 23 per week until progress is seen
(probably by 20 sessions).
Research study: B. Jarusiewicz
Control by Right and Left Brain*
The left brain “Style”:
Analytic
The right brain “Style”:
Holistic
- Speech/language
specialization
- Processing
- Focus
– Superior visuospatial
performance
– Emotions/tension
– Anxiety
And
Left Brain/Right Brain 5th Ed 1998, Springer, S &
Deutsch, G
Brain Frequencies
“Spectrals”
(Note: Every person is different)
Autistic *
Typical
* (note extensive delta, theta and alpha frequencies)
Measurement of Change
• By Client
– Establish changes client wishes to make
– Develop reporting mechanism
Measurement of Change
• By Therapist
– Review behavior changes (checklists,
drawings)
– Review how client feels
– Review brain activity (measured averages
etc)
– Review spectrals
Child’s Family Drawing at
Beginning of NF - 8/3/94
(with thanks to L. Hirshberg)
Drawing after Twenty Sessions 9/8/94
Drawing after forty sessions 11/25/94
Hill and Castro ADD/HD Checklist
Measurement of Change
• For Research
– Use of “standard” tests (ADI, ADOS,
Checklists, IQ, memory and reading)
– Corroborative Evidence (videos, interviews,
school or other therapy reporting tests)
Autism Study
Average Behavior Changes
(ATEC) by Type
•
•
•
•
Sociability
Speech/language/communication
Health
Sensory/cognitive awareness
p <. 010 for sociability
p < .015 for health
p < .000 for speech
p <. 000 for sensory
33%
30%
26%
16%
Behavior Improvement
Interview Results
Treatment Effectiveness Survey
Results
• 1. Behavior Modification
• 2. Speech Therapy
• 3. Occupational Therapy
Sensory Integration
Neurofeedback
*based on parents reports received to date, considering all
types of therapies in their experience
What you can do for your child
• Be clear as to assessment of talents, skills,
and issues to overcome (Full assessment
with history, and videos)
• Determine a method of on-going
measurement (per session, per time period)
• Choose one new approach at a time
• Measure, measure, measure
What you can do for your child
• Determine impact of and plan
accordingly for
– Family issues
• Diet
• Schedule/Rules
– School issues
• Placement
• Simultaneous therapies
– Social issues