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TOVA results following inter-hemispheric bipolar EEG training
Abstract
Introduction. This study examines recovery of attentional measures among a heterogeneous group of clients in a pre-and post-comparison using inter-hemispheric EEG training at homologous sites. A continuous performance test was used as an outcome measure. The client population was divided into three categories: (a) primarily attentional deficits, (b) primarily psychological complaints, and (c) both.Method. Neurofeedback protocols included T3-T4, Fp1-Fp2, F3-F4, C3-C4 and P3-P4. A wide range of reward frequencies was used, and these were individually selected to optimize the subjective experience of the training. Participants were 44 males and females, 7 to 62 years old, who underwent treatment for a variety of clinical complaints. Dependent variables were derived from a continuous performance test, the Test of Variables of Attention (TOVA), which was administered prior to EEG training and 20 to 25 sessions thereafter.Results. After EEG training a clear trend towards improvement on the impulsivity, inattention, and variability scales of the TOVA was evident. Participants with normal pre-training scores showed no deterioration in their performance, indicating that homologous site inter-hemispheric EEG training had no deleterious effect on attention. In addition reaction time was predominately in the normal range for this population and remained unchanged following training.Conclusion. Normalization of attentional variables was observed following training irrespective of the primary clinical complaint. These results suggest that inter-hemispheric training at homologous sites provides another “generic” EEG biofeedback protocol option for addressing attentional deficits. Inter-hemispheric training likely serves as a general challenge to the regulation of cerebral timing, phase, and coherence relationships. Such a challenge may result in more effective regulation of cerebral networks, irrespective of whether these are involved in attentional or affective regulation.
... Frontal placement {F3 -F4} played a role mainly in the anxiety-depression spectrum. Continuous performance test data, which we had been acquiring systematically on our clients since 1990, continued to yield satisfactory results [68]. Nevertheless, over the course of two years the addition of lateralized placements was indicated, as shown in Figure 3b. ...
... The term activation then remains available to refer to more localized excitation, either within regions or within functional domains. A contemporary perspective on arousal is given by Ross and Van Bockstaele [68]. The intimate connection of arousal level with infra-slow fluctuations is reinforced in a recent report by Sihn and Kim [70]. ...
Clinical work conducted over the last seventeen years at the EEG Institute in Los Angeles and by other neurofeedback providers around the world has demonstrated the utility of extending frequency-based neurofeedback deep into the infra-low frequency (ILF) region, using the method of endogenous neuromodulation described herein. The method is characterized by the absence of any overt reinforcements, which makes it possible to extend the clinical reach to extremely low frequencies. As the training frequency is lowered, the signal becomes more difficult to discriminate, and ultimately it can only be discerned by the brain itself, in the process of endogenous neuromodulation. The method emulates how the brain does skill learning in general: It must observe itself performing the skill, with feedback on its performance. While the immediate target of ILF neurofeedback is enhanced self-regulatory competence--with symptomatic relief and functional recovery the secondary consequences, progressive lowering of the target frequencies has led to improved outcomes in application to challenging dysfunctions such as episodic suicidality, migraine, seizures, and bipolar mood swings. The work has also yielded insights into how the frequency domain is organized. The training proceeds best at frequencies that are specific to each individual, and these are referred to as optimal response frequencies (ORFs). These frequencies differ for various placements but stand in two fixed relationships to one another, one that holds over the EEG spectral range, and another that holds over the entire ILF range. Training in the ILF region engages the dynamics of the glial-neuronal networks, which govern tonic, resting state regulation. The collective clinical experience with ILF neuromodulation within a large practitioner network supports the case for making protocol-based, individualized ‘homeodynamic’ regulation a therapeutic priority, particularly for our most impacted clinical populations: addiction, trauma formations, traumatic brain injury, and the dementias. The case is made for further outcome studies and foundational research.
... As a result, the individual tends to be in an anxious state consistently and encounters poor sleep quality (Ramsawh, Stein, Belik, Jacobi & Sarreenm 2009). The pioneer researchers in the neurofeedback field (Putman, Othmer, Othmer & Pollock, 2005) have highlighted that the neurofeedback training conducted on the temporal lobes (i.e., T3, T4, T5 & T6 site), which is effective in promoting general calmness and generalisation of moods. ...
A case report on enhancing self-regulation skills through QEEG-guided neurofeedback was conducted for a subject who has been diagnosed with Wilson Disease (WD). The trauma-informed neurofeedback training protocols were developed to improve the client’s self-regulation skills in order to address his psychological symptoms and cognitive impairment. The protocols were developed based on the findings of the prior empirical research as well as the QEEG brain mapping assessment of the client. In this case report, the utilisation of expressive art therapy application was highlighted in facilitating the therapeutic process for the clients having difficulty in verbal communication. The QEEG brain mapping assessment result pre-and-post intervention were compared to determine the progress of the client’s brainwave activity pattern. Meanwhile, the self-report diary of the client’s parent was used to follow up his conditions. The outcome indicated that the developed protocols of trauma-informed neurofeedback training and expressive art application were helpful in improving the self-regulation skills of the client.
... The technology provides bipolar asymmetry training, which regulates the distribution of frequencies of different intensity. For example, multidirectional changes in the relative EEG intensity in the brain hemispheres can cause cognitive activity and attention processes to be enhanced [44], as well as the improvement of executive functions [45,46]. Studies have shown that the effectiveness of biofeedback is determined by many factors such as: motivation [47,48], training [49], respiration [50], and some individual characteristics [51,52]. ...
In the current pilot study, we attempt to find out how double neurofeedback influences functional hemispheric asymmetry and activity. We examined 30 healthy participants (8 males; 22 females, mean age = 29; SD = 8). To measure functional hemispheric asymmetry and activity, we used computer laterometry in the ‘two-source’ lead-lag dichotic paradigm. Double biofeedback included 8 min of EEG oscillation recording with five minutes of basic mode. During the basic mode, the current amplitude of the EEG oscillator gets transformed into feedback sounds while the current amplitude of alpha EEG oscillator is used to modulate the intensity of light signals. Double neurofeedback did not directly influence the asymmetry itself but accelerated individual sound perception characteristics during dichotic listening in the preceding effect paradigm. Further research is needed to investigate the effect of double neurofeedback training on functional brain activity and asymmetry, taking into account participants’ age, gender, and motivation.
... The technology provides bipolar asymmetry training, during which regulates the distribution of frequencies of different intensity. For example, multidirectional changes in the relative EEG intensity in the brain hemispheres can cause enhancement of cognitive activity and attention processes (Putman, 2005) (Suter, 1979;Li et al., 2019). In general, by unlocking the body's full potential and mobilizing resources to achieve the goal, one can eliminate excessive psycho-emotional tension and improve the efficiency and rationality of activities not only during biofeedback trainings, but also thereafter. ...
In the current pilot study, we attempt to find out how double neurofeedback influences functional hemispheric asymmetry and activity. We examined 30 healthy participants (8 males; 22 females, mean age = 29; SD= 8). To measure functional hemispheric asymmetry and activity, we used computer laterometry in the ‘two-source’ lead-lag dichotic paradigm. Double biofeedback included 8 minutes of EEG oscillation recording with five minutes of basic mode. During the basic mode, the current amplitude of the EEG oscillator gets transformed into feedback sounds while the current amplitude of alpha EEG oscillator is used to modulate the intensity of light signals. Double neurofeedback did not directly influence the asymmetry itself but accelerated individual sound perception characteristics during dichotic listening in the preceding effect paradigm. Further research is needed to investigate the effect of double neurofeedback training on functional brain activity and asymmetry taking into account participants’ age, gender, and motivation.
... The technology provides bipolar asymmetry training, during which regulates the distribution of frequencies of different intensity. For example, multidirectional changes in the relative EEG intensity in the brain hemispheres can cause enhancement of cognitive activity and attention processes (Putman, 2005) (Suter, 1979;Li et al., 2019). In general, by unlocking the body's full potential and mobilizing resources to achieve the goal, one can eliminate excessive psycho-emotional tension and improve the efficiency and rationality of activities not only during biofeedback trainings, but also thereafter. ...
In the current pilot study, we attempt to find out how double neurofeedback influences functional hemispheric asymmetry and activity. We examined 30 healthy participants (8 males; 22 females, mean age = 29; SD= 8). To measure functional hemispheric asymmetry and activity, we used computer laterometry in the 'two-source' lead-lag dichotic paradigm. Double biofeedback included 8 minutes of EEG oscillation recording with five minutes of basic mode. During the basic mode, the current amplitude of the EEG oscillator gets transformed into feedback sounds while the current amplitude of alpha EEG oscillator is used to modulate the intensity of light signals. Double neurofeedback did not directly influence the asymmetry itself but accelerated individual sound perception characteristics during dichotic listening in the preceding effect paradigm. Further research is needed to investigate the effect of double neurofeedback training on functional brain activity and asymmetry taking into account participants' age, gender, and motivation.
... The approach was fi rst investigated with inter-hemispheric placements at homotopic sites, which we used rather exclusively for some years . Clinical results in terms of continuous performance tests have been published for this method, demonstrating improved outcomes with respect to earlier data (Putman, Othmer, Othmer, and Pollock, 2005). ...
This chapter addresses the question of how to classify the neuromodulation effects resulting from widely differing neurofeedback approaches developed over the last four decades. A proliferation of targets and objectives has been observed to which attention is directed in the training. With regard to clinical outcomes, however, one encounters a broad zone of commonality. Why is it that the premises and technological approaches within the neurofeedback network of scholars and clinicians are so disparate, yet they largely achieve common clinical goals? This in-depth analysis may lead one closer to the "essence" of neurofeedback and provide focus for further development efforts. This chapter attempts to appraise the "state of the field" at this moment. The objective is to discern the commonalities among the various approaches on the one hand, and among the clinical findings on the other. This will lead to a codification of a "minimal set of claims" that could serve to cover the commonalities among the techniques, and it will lead to a simple classification scheme for the various clinical findings. The evidence in favor of such a minimal set of claims will be adduced largely by reference.
... The starting frequency was in the 12-18 Hz range depending on the targeted hemisphere. The Othmers and others (Putman, Othmer, Othmer, & Pollock, 2005;Stokes & Lappin, 2010), modified this technique to include inter-hemispheric placements beginning on the temporal lobes. Instead of set reward bands, a 3 Hz window was shifted up or down contingent upon client response. ...
Infra-slow Fluctuation (ISF) electroencephalogram (EEG) biofeedback is a recent development in neurofeedback training. This form of training is focused on the lowest energy the brain produces (< 0.1 Hz). The intervention is performed with a Direct Current (DC) coupled neurofeedback amplifier. It is distinct from Slow Cortical Potential (SCP) training and Infra-Low Frequency (ILF) training. It shares a similar optimization process with ILF that focuses on emergent state shifts within sessions. These state shifts require frequency adjustments that optimize client response to the training in real time. Due to the technical difficulties inherent in recording these frequencies, EEG investigators largely neglected this low energy until recently. As DC amplifiers improved, the slow frequencies became a signal of increasing interest to researchers. Research has demonstrated an important role for the infra-slow oscillations in clinical work. Positive clinical case outcomes suggest that a larger controlled study is warranted. The technical, clinical, and equipment requirements of the intervention make this form of neurofeedback unique in the pantheon of EEG biofeedback interventions. The traditional method of recording the electroencephalogram (EEG) with an Alternating Current (AC) amplifier and a " corner " or cutoff frequency of approximately 0.5 Hz is more than half a century old (Collura, 1993). These AC amplifiers produced attenuated signals that allowed researchers to focus on the faster oscillations, considered the most salient features in the human EEG at that time. Before that time, attempts to record slow events produced electrode drifts that tended to saturate the amplifiers and so hastened the advent of
... The critical drivers in this development were instability and severe dysregulation. A broad generalization has been consolidated over the years that brain stability is best promoted with inter-hemispheric placements (Othmer S, 2007;Putman et al., 2005). The placement offering the strongest effects and greatest breadth of clinical impact is T3-T4. ...
Neuromodulation in the bioelectrical domain is an attractive option for the remediation of functionally based deficits. Most of the interest to date has focused on exogenous methods, such as repetitive transcranial magnetic stimulation, transient direct current stimulation, vagus nerve stimulation, and deep brain stimulation. Much less attention has been given to endogenous methods of exploiting latent brain plasticity. These have reached a level of sophistication and maturity that invites attention. Over the last 7 years, the domain of infralow frequencies has been exploited productively for the enhancement of neuroregulation. The principal mechanism is putatively the renormalization of functional connectivity of our resting-state networks. The endogeneous techniques are particularly attractive for the pediatric population, where they can be utilized before dysfunctional patterns of brain behavior become consolidated and further elaborated into clinical syndromes.
A previous comprehensive bibliography of neurofeedback outcome studies was published by the author in 2001. Since that time there have been many new publications as the field of neurofeedback continues maturing, and a few older references were discovered. Therefore a new update of references under categories for various clinical conditions is provided.
Background: Neurofeedback studies have been criticized for including small numbers of subjects. The effect of SMR-beta neuro-feedback training on the Test of Variables of Attention was evaluated in more than 1,000 subjects from thirty-two clinics.Methods: 1089 subjects (726 children, 324 females, 186 with ADHD or ADD diagnoses) underwent twenty or more sessions of SMR-beta neurofeedback training for attentional and behavioral complaints at thirty-two clinical settings affiliated with EEG Spectrum, Inc. Subjects were evaluated prior to training and at training completion. One hundred and fifty-seven subjects who elected extensive training (forty sessions or more) were tested after both twenty and forty training sessions.Results: Neurofeedback training produced significant improvement in attentiveness, impulse control, and response variability. Significant clinical improvement in one or more measures was seen in eighty-five percent of those subjects with moderate pre-training deficits.Conclusions: Neurofeedback training is effective in remediating atten-tional dysfunction. Nevertheless, large-scale studies with greater control (e.g., wait-list designs) are sorely needed.
Reduced seizure incidence coupled with voluntary motor inhibition accompanied conditioned increases in the sensorimotor rhythm(SMR), a 12–14 Hz rhythm appearing over rolandic cortex. Although SMR biofeedback training has been successfully applied to various forms of epilepsy in humans, its potential use in decreasing hyperactivity has been limited to a few cases in which a seizure history was also a significant feature. The present study represents a first attempt to explore the technique's applicability to the problem of hyperkinesis independent of the epilepsy issue. The results of several months of EEG biofeedback training in a hyperkinetic child tend to corroborate and extend previous findings. Feedback presentations for SMR were contingent on the production of 12–14-Hz activity in the absence of 4–7-Hz slow-wave activity. A substantial increase in SMR occurred with progressive SMR training and was associated with enhanced motor inhibition, as gauged by laboratory measures of muscular tone(chin EMG) and by a global behavioral assessment in the classroom. Opposite trends in motor inhibition occurred when the training procedure was reversed and feedback presentations were contingent on the production of 4–7 Hz in the absence of 12–14-Hz activity. Although the preliminary nature of these results is stressed, the subject population has recently been increased to establish the validity and generality of the findings and will include the use of SMR biofeedback training after medication has been withdrawn.
This study examined the clinical effects of central cortical EEG feedback training in 8 patients with poorly controlled seizures. After base‐line recordings, patients were trained in the laboratory and then initiated on a double or triple crossover design using portable equipment at home, with bimonthly laboratory test sessions. Performance at home was monitored by a strip chart recorder with the portable unit. Training was based on the simultaneous detection of two central cortical (C 3 ‐T 3 ) EEG frequency bands (6–9 Hz and either 12–15 or 18–23 Hz), with reward provided for the occurrence of one in the absence of the other. The design consisted of successive 3 month periods of training, with reward contingencies reversed after each period without the subject's knowledge. Seizure incidence records were compared statistically before, during, and after the design. Six of the 8 patients reported significant and sustained seizure reductions, which averaged 74%, following reward for either 12–15 or 18–23 Hz in the absence of 6–9 Hz. Response to positive reward for 12–15 Hz was specific, with seizure rates returning to base line when reinforcement contingencies were reversed. Reduced seizure rates following positive reward for 18–23 Hz were not altered with contingency reversals. A nonspecific interpretation of these effects is rejected in favor of an EEG normalizing hypothesis.
RÉSUMÉ
Cette étude envisage les effets cliniques de lapprentissage par rétroaction biologique (biofeedback) à renforcer l'EEG des régions centrales chez 8 épileptiques dont les crises étaient mal contrôlées par la thérapeutique. L'apprentissage a eu lieu au domicile des malades après un entrainement initial puis des contrôles bimensuels au laboratoire. L'unité portative comprenait un enregistreur sur papier pour surveiller la performance du malade. L'apprentissage avait pour but de permettre aux sujets de reconnaiire simultanément deux bandes de fréquences de l'EEG de la région centrale (6–9 Hz et 12–15 ou 18–23 Hz), la récompense étant donnée en présence d'une de ces fréquences et en l'absence de l'autré. On a utilise des périodes successives d'apprentissage durant 3 mois, avec une inversion des récompenses après chaque période, les inversions étant faites à l'insu du sujet. La fréquence des crises a été comparée statistiquement avant, pendant et après l'expérience. Six des huit malades ont rapporté une réduction significative de la fréquence des crises, avec une moyenne de 74%, dans le cas d'une récompense pour 12–15 ou 18–23 Hz en l'absence de 6–9 Hz. La réponse à une récompense positive pour 12–15 Hz était spécifique, avec un retour à la ligne de base lors de l'inversion des récompenses. La réduction de frequence des crises après une récompense positive pour 18–23 Hz n'a pas changé avec l'inversion des récompenses. L'interprétation non‐spécifique de ces résultats est rejetée, en faveur de l'hypothèse dune normalisation de l'EEG.
RESUMEN
En este estudio se han examinado los resultados clinicos en un grupo de ocho epilépticos mal controla‐dos que habian sido entrenados para la realización de un feedback electroencefalográfico central cortical. Después de practicar los registros de control, los enfermos fueron entrenados en el laboratorio y, posteriormente, iniciados en un plan de investigacibn con doble o triple superposición utilizando, en su domicilio, un equipo portatil de registro y estudios bimensuales en el laboratorio. Los resultados obtenidos en el domicilio se registraron en un registrador en banda portatil. El entrenamiento se basó en la detec‐ción simultánea de dos bandas de frecuencias elec‐troencefalograficas corticales centrales (C 3 ‐T 3 ) de 6–9 Hz y también de 12–15 6 18–23 Hz, dando una recompensa al sujeto cuando una banda de frecuencia apareciera en ausencia de la otra. El plan utilizado consistió en tres periodos sucesivos de entrenamiento, de tres meses cada uno, con contingencias de recompensa alternadas en cada periodo sin conocimiento del sujeto. Los registros de incidencia de los ataques se compararon estadisticamente antes, durante y después del plan. Seis de los ocho enfermos mostraron una reducción significativa y mantenida de los ataques que promedió un 74%, tras la recompensa de 12–15 ó 18– 23 Hz, en ausencia de 6–9 Hz. La respuesta a la recompensa positiva para 12–15 Hz fué especifica, con restauración de la frecuencia de ataques a los niveles previos cuando el refuerzo de las contingencias se alternaba. La reducción de la frecuencia de ataques conseguida con la recompensa positiva para 18–23 Hz no se modificó con la inversión de las contingencias. En favor de la hipótesis de la normalización del EEG se rechaza una interpretación inespecifica de los efectos descritos.
ZUSAMMENFASSUNG
Untersuchung über die klinischen Wirkungen des zentralen corticalen EEG feedback Trainings bei einer Gruppe von 8 schlecht kontrollierten Epileptikem. Nach Ableitung des Ausgangs‐EEGs wurden die Patienten im Labor geschult. Dann begann eine ambu‐lante Doppel‐ oder Dreifachcrossover‐Studie mit einer tragbaren Ausrilstung und 2‐monatlichen Labortests. Das Verhalten zu Hause wurde durch Lochstreifen‐aufzeichnungen mit der tragbaren Einheit festgehalten. Das Training beruhte auf der gleichzeitigen Ent‐deckung von 2 corticalen (C 3 ‐T 3 ) EEG‐Frequenz‐bandern(6‐9Hzundentweder 12–15 oder 18–23 Hz) mit Belohnungen fur das Erscheinen des einen in Abwesenheit des anderen Frequenzbandes. Der Ver‐suchszeitraum bestand aus aufeinanderfolgenden 3‐Monatstrainingsperioden mit Belohnungsquoten, die nach jeder Periode ohne Wissen des Patienten umge‐kehrt wurden. Die Häufigkeit der Anfälle wurde aufgezeichnet und statistisch verglichen vor während und nach dem Versuch. 6 von 8 Patienten berichteten signifikante und anhaltende Anfallsreduktionen (im Durchschnitt 74%) nach einer Belohnung für entweder 12–15 oder 18–23 Hz in Abwesenheit von 6–9 Hz. Die Reaktion auf eine Belohnung fur 12–15 Hz war spezifisch; die Anfallshäufigkeit kehrte zum Aus‐gangswert zurück, wenn die Verstärkerantwort umge‐kehrt wurde. Eine veränderte Häufigkeit nach Belohnung für die Erkennung von 18–23 Hz wurde nicht durch Umkehr der Belohnung geändert. Eine Interpretation dieser Wirkungen als nicht spezifisch wird zu Gunsten einer Hypothese der EEG‐Normalisierung zürtickgestellt.
EEG coherence was computed from 19 scalp locations from 189 children ranging in age from 5 to 16 years. Tests of spatial homogeneity of EEG coherence were conducted by comparing EEG coherence as a function of different interelectrode distances in the anterior-to-posterior versus posterior-to-anterior directions. Highly significant inhomogeneities were observed since greater coherence was present in the anterior-to-posterior direction than in the posterior-to-anterior directions. Greater coherence was also present in frontal derivations than in posterior derivations and from the right hemisphere in comparison to the left hemisphere. These data indicate that at least two separate sources of EEG coherence were present (1) coherence produced through the action of short length axonal connections, and (2) coherence produced through the action of long distance connections. Measures of phase delays as a function of interelectrode distance supported the development of a 'two-compartmental' model of EEG coherence in which different features of coherence are produced by different length fiber systems. Based on this model a number of hypotheses were developed to explain differences in connectivity between left and right hemispheres and frontal versus occipital cortex.
The EEG is modelled as the superposition of two component processes: the xi and the alpha processes. In the frequency domain, the xi process is always present and appears as a spectral peak with maximum amplitude at very low frequencies, while the alpha process is characterized by a spectral peak with its maximum located in the traditional alpha band (7-13 Hz), and is not necessarily always present. The multivariate properties of EEG spectra are adequately modelled with frequency independent coherence matrices for each process. Multichannel EEG studies reveal interesting properties: (1) the generalized coherence for alpha is much larger than for xi, indicating increased functional coupling for the alpha process; (2) the alpha coherence matrix has reduced dimensionality, possibly related to a small number of generators; (3) xi coherences are zero phase with magnitudes that decrease exponentially with interelectrode distance; and (4) alpha coherences have significant nonzero phase shifts.