Article

Impact of qEEG-Guided Coherence Training for Patients with a Mild Closed Head Injury

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Abstract

Background. Mild closed head injury (MHI) is a major problem in our society. Traditional methods of treatment such as cognitive rehabilitation or behavioral training are time consuming, expensive, and of questionable effectiveness. Anecdotal reports indicate that neuro-feedback can remediate the symptoms of MHI in a rapid and cost effective way. The purpose of this study is to evaluate whether quantitative electroencephalography (qEEG) guided coherence training is effective in remediating residual symptoms of MHI.Methods. Twenty-six patients with persistent post-traumatic symptoms (PTS) were seen by the first author 3 to 70 months after a MHI and had a quantitative EEG (qEEG). Neurofeedback therapy designed to normalize abnormal qEEG coherence scores was provided to determine the effectiveness of this approach. Five training sessions addressed each qEEG abnormality. Training continued until the patient, by self-report, indicated that significant improvement had occurred or until a total of 40 sessions were given.Results. Significant improvement (>50%) was noted in 88% of the patients (mean = 72.7%). All patients reported that they were able to return to work following the treatment, if they had been employed prior to the injury. On average, 19 sessions were required, less than the average of 38 sessions required using power training of Cz-Beta in our previous unpublished study.Conclusions. In this uncontrolled open trial of qEEG guided coherence training, the majority of patients with MHI experienced substantial and rapid symptomatic improvement, including return to work. Further study with controls and additional outcome measures is warranted.

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... According to Gruzelier (2014b): "As yet little research has been undertaken in examining or training connectivity in EEG neurofeedback, though the approach is being undertaken by practitioners" (Gruzelier, 2014b, p. 19). For instance, quantitative EEG (QEEG)-based connectivity trainings, in which the individual EEG activity and coherence measures are compared to a normative database and areas that show a hypo-or hyper-coherence are used as target feedback area, are available and in use by practitioners (Walker et al., 2002;Coben et al., 2014Coben et al., , 2018, although there are many open elementary questions, such as: ...
... However, they only performed one session of NF training and, therefore, no predictions concerning possible between session changes are possible (Kajal et al., 2017). Studies reporting on QEEG-based coherence training do not report on the within-or between-session changes in EEG activity (Walker et al., 2002). Many NF training studies, in which the amplitude of the SMR should be increased over one electrode position, observed withinsession changes in SMR power but no between-session changes (Vernon et al., 2003;Vernon, 2005;Ros et al., 2010;Kober et al., 2015aKober et al., ,b, 2017bKober et al., , 2019Reichert et al., 2016). ...
... If a NF user already shows a low coherence at the beginning of the NF training, a further reduction of the coherence might be impossible. Other EEG studies in which participants successfully increased and decreased coherence values used QEEG in clinical samples, which showed pathological hyper-or hypo-connectivity (Walker et al., 2002;Coben, 2007;Thornton and Carmody, 2009;Coben et al., 2014Coben et al., , 2018. In our healthy sample of young adults, a linear and significant down-regulation of SMR coherence was not possible within or between NF training sessions. ...
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Modulating connectivity measures in EEG-based neurofeedback studies is assumed to be a promising therapeutic and training tool. However, little is known so far about its effects and trainability. In the present study, we investigated the effects of up- and down-regulating SMR (12–15 Hz) coherence by means of neurofeedback training on EEG activity and memory functions. Twenty adults performed 10 neurofeedback training sessions in which half of them tried to increase EEG coherence between Cz and CPz in the SMR frequency range, while the other half tried to down-regulate coherence. Up-regulation of SMR coherence led to between- and within-session changes in EEG coherence. SMR power increased across neurofeedback training sessions but not within training sessions. Cross-over training effects on baseline EEG measures were also observed in this group. Up-regulation of SMR coherence was also associated with improvements in memory functions when comparing pre- and post-test results. Participants were not able to down-regulate SMR coherence. This group did not show any changes in baseline EEG measures or memory functions comparing pre- and post-test. Our results provide insights in the trainability and effects of connectivity-based neurofeedback training and indications for its practical application.
... Whilst the participant is not doing this by subjectively altering their thoughts (Othmer et al., 2005), they are required to understand the concept and attend to the task (May et al., 2013). NFT has been reported to improve executive and cognitive functions, memory, attention, motor recovery and seizures following mild, moderate and severe TBI (Tinius and Tinius, 2000;Walker et al., 2002;Duff, 2004;Thornton and Carmody, 2005;Tan et al., 2009), migraine (Stokes and Lappin, 2010), depression (Choi et al., 2011;Linden et al., 2012), anxiety (Hammond, 2005), OCD (Surmeli and Ertem, 2011;Koprivova et al., 2013), and schizophrenia (Surmeli et al., 2012). NFT has also been shown to enhance fractional anisotropy, gray and white matter volume in moderate TBI (Munivenkatappa et al., 2014) and normal participants (Ghaziri et al., 2013). ...
... Neurofeedback was effective for reducing excessive delta wave EEG activity (Huang et al., 2017) as well as post-concussion symptom scores (Walker et al., 2002;Huang et al., 2017) and sleep disturbance (Huang et al., 2017). Improved rates of return to work were also seen with both rTMS and neurofeedback (Walker et al., 2002;Stilling et al., 2019b). ...
... Neurofeedback was effective for reducing excessive delta wave EEG activity (Huang et al., 2017) as well as post-concussion symptom scores (Walker et al., 2002;Huang et al., 2017) and sleep disturbance (Huang et al., 2017). Improved rates of return to work were also seen with both rTMS and neurofeedback (Walker et al., 2002;Stilling et al., 2019b). Anodal tDCS did not influence gamma-aminobutyric acid (GABA) concentration or receptor activity in the primary motor cortex (Wilke et al., 2017). ...
Article
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Background: Mild traumatic brain injury (mTBI) results from an external force to the head or body causing neurophysiological changes within the brain. The number and severity of symptoms can vary, with some individuals experiencing rapid recovery, and others having persistent symptoms for months to years, impacting their quality of life. Current rehabilitation is limited in its ability to treat persistent symptoms and novel approaches are being sought to improve outcomes following mTBI. Neuromodulation is one technique used to encourage adaptive neuroplasticity within the brain. Objective: To systematically review the literature on the efficacy of neuromodulation in the mTBI population. Method: A systematic review was conducted using Medline, Embase, PsycINFO, PsycARTICLES and EBM Review. Preferred Reporting Items for Systematic Reviews and the Synthesis Without Meta-analysis reporting guidelines were used and a narrative review of the selected studies was completed. Fourteen articles fulfilled the inclusion criteria which were published in English, investigating an adult sample and using a pre- and post-intervention design. Studies were excluded if they included non-mild TBI severities, pediatric or older adult populations. Results: Thirteen of fourteen studies reported positive reductions in mTBI symptomatology following neuromodulation. Specifically, improvements were reported in post-concussion symptom ratings, headaches, dizziness, depression, anxiety, sleep disturbance, general disability, cognition, return to work and quality of life. Normalization of working memory activation patterns, vestibular field potentials, hemodynamics of the dorsolateral prefrontal cortex and excessive delta wave activity were also seen. The studies reviewed had several methodological limitations including small, heterogenous samples and varied intervention protocols, limiting generalisability. Further research is required to understand the context in which neuromodulation may be beneficial. Conclusions: While these positive effects are observed, limitations included unequal representation of neuromodulation modalities in the literature, and lack of literature describing the efficacy of neuromodulation on the development or duration of persistent mTBI symptoms. Better clarity regarding neuromodulation efficacy could have a significant impact on mTBI patients, researchers, clinicians, and policy makers, facilitating a more productive post-mTBI population. Despite the limitations, the literature indicates that neuromodulation warrants further investigation. PROSPERO registration number: CRD42020161279.
... For the head-injured participants, memory function improvements ranged from 68% to 181%. Walker, Norman, and Weber (2002) evaluated QEEG-guided coherence training for the remediation of mild TBI symptoms including headaches, memory and cognitive disturbances, changes in mood and sleep, etc. Training targeted the normalization of coherence scores for intrahemispheric (Fp1-F3, Fp2-F4, T3-T5, T4-T6, C4-P4, F3-O1, and F4-O2) and interhemispheric (Fp1-Fp2, F3-F4, F7-F8, C3-C4, T5-T6, P3-P4, and O1-O2) electrode placements, and led to a 72% improvement in global functioning, accompanied by reductions in headache frequency and improvement to memory loss and confusion (Walker et al., 2002). Bounias, Laibow, Bonaly, and Stubblebine (2002) classified and tracked the improvement of 48 clinical symptoms reported by a group of 27 individuals enrolled in a neurofeedback training program for the treatment of TBI. ...
... For the head-injured participants, memory function improvements ranged from 68% to 181%. Walker, Norman, and Weber (2002) evaluated QEEG-guided coherence training for the remediation of mild TBI symptoms including headaches, memory and cognitive disturbances, changes in mood and sleep, etc. Training targeted the normalization of coherence scores for intrahemispheric (Fp1-F3, Fp2-F4, T3-T5, T4-T6, C4-P4, F3-O1, and F4-O2) and interhemispheric (Fp1-Fp2, F3-F4, F7-F8, C3-C4, T5-T6, P3-P4, and O1-O2) electrode placements, and led to a 72% improvement in global functioning, accompanied by reductions in headache frequency and improvement to memory loss and confusion (Walker et al., 2002). Bounias, Laibow, Bonaly, and Stubblebine (2002) classified and tracked the improvement of 48 clinical symptoms reported by a group of 27 individuals enrolled in a neurofeedback training program for the treatment of TBI. ...
... Research of neurofeedback applications for movement disorders revealed improvements in motor functioning of patients with cerebral palsy (Ayers, 2004;Bachers, 2004), Parkinson's disease (Erickson-Davis et al., 2012;Subramanian et al., 2011;Thompson & Thompson, 2002), and stroke Putman, 2002;Rozelle & Budzynski, 1995). Patients with a history of traumatic brain injury showed improvements in memory (Ayers, 1987;Thornton, 2000;Walker et al., 2002), cognition (Ayers, 1987;Bounias et al., 2002;Byers, 1995;Keller, 2001;Walker et al., 2002), and mood (Ayers, 1987;Bounias et al., 2002;Byers, 1995) following neurofeedback therapy. Contingent neurofeedback protocols have been found to produce greater clinical improvements than medication (Kayiran et al., 2010), computer attention training (Keller, 2001), treatment as usual and wait-list controls conditions (Caro & Winter, 2011;Siniatchkin et al, 2000), sham feedback (Erickson-Davis et al., 2012, deCharms et al., 2005, psychotherapy (Ayers, 1991), and imagery (Subramanian et al., 2011). ...
Chapter
Neurofeedback is the process of providing an individual with real-time information and reward of central nervous system activity in an operant conditioning paradigm. Brain–computer interfaces are assistive applications that classify real-time brain activity and user intention to communicate or control external devices. EEG, ERP, SCP, BOLD, and NIRS signal activity may be recorded, classified, and conditioned for neurofeedback therapy and BCI technology. Neurofeedback has been successful in the treatment of epilepsy, migraines, pain disorders, movement disorders, injuries of the CNS, and other general medical conditions. Brain–computer interfaces have been successful in assisting individuals with ALS, paralysis, and stroke in communication, assistive movement, and environmental control.
... Of these, only 2 were rated as high-quality studies, 45,46 and the remaining were rated as moderate quality. [47][48][49][50][51][52][53][54][55][56][57][58][59][60] Findings Ten experimental studies (see Table 1) and 7 descriptive studies (see Table 2) were synthesized in this review. ...
... All the included studies reported positive results for at least 1 fatigue or cognitive outcome as measured by a variety of standard self-rating questionnaires and cognitive task tests. Fourteen of the studies reported improvements in cognition, 41,45,[47][48][49][52][53][54][55][56][57][58][59][60] and 8 of the studies reported improvements in fatigue. 41,46,[49][50][51][54][55][56] Alpha/theta training demonstrated mixed results on cognitive performance in three experimental studies with healthy elderly subjects. ...
... A third, larger study by Thornton and Carmody 59 recorded 105% improvements in auditory memory and 143% improvements in reading memory among the traumatic brain injury subjects. Significant memory improvement (>50%) was noted in 88% of mild closed head injury patients as measured by the Global Improvement Score (GIS) in a pre-post study by Walker et al. 60 All the patients in the study reported being able to return to work following the QEEG neurofeedback therapy. ...
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Background: Many cancer survivors continue to experience ongoing symptoms, such as fatigue and cognitive impairment, which are poorly managed and have few effective, evidence-based treatment options. Neurofeedback is a noninvasive, drug-free form of brain training that may alleviate long-term symptoms reported by cancer patients. Objective: The purpose of this systematic review of the literature was to describe the effectiveness and safety of neurofeedback for managing fatigue and cognitive impairment. Methods: A systematic review of the literature was conducted using Joanna Briggs Institute (JBI) methodology. A comprehensive search of 5 databases was conducted: Medline, CINAHL, AMED, PsycInfo, and Embase. Randomized and nonrandomized controlled trials, controlled before and after studies, cohort, case control studies, and descriptive studies were included in this review. Results: Twenty-seven relevant studies were included in the critical appraisals. The quality of most studies was poor to moderate based on the JBI critical appraisal checklists. Seventeen studies were deemed of sufficient quality to be included in the review: 10 experimental studies and 7 descriptive studies. Of these, only 2 were rated as high-quality studies and the remaining were rated as moderate quality. All 17 included studies reported positive results for at least one fatigue or cognitive outcome in a variety of populations, including 1 study with breast cancer survivors. Neurofeedback interventions were well tolerated with only 3 studies reporting any side effects. Conclusions: Despite issues with methodological quality, the overall positive findings and few reported side effects suggest neurofeedback could be helpful in alleviating fatigue and cognitive impairment. Currently, there is insufficient evidence that neurofeedback is an effective therapy for management of these symptoms in cancer survivors, however, these promising results support the need for further research with this patient population. More information about which neurofeedback technologies, approaches, and protocols could be successfully used with cancer survivors and with minimal side effects is needed. This research will have significance to nurses and physicians in oncology and primary care settings who provide follow-up care and counseling to cancer survivors experiencing debilitating symptoms in order to provide information and education related to evidence-based therapy options.
... An example of connectivity training at rest, to normalize coherence values toward values measured in a group of healthy subjects, can be found in the study of Walker et al. (51). Twenty-six patients with TBI with symptoms interfering with daily activities for more than 3 months, including employment, were trained to increase their reduced coherence values and to decrease any elevated coherence values. ...
... Most prominently, how soon after a TBI the EEG biofeedback should be offered remains an open question. Starting too soon may overload existing resources, whereas waiting for a longer period of time may reduce the potential benefit (50)(51). Several studies point toward the absence of a link between the time since the TBI and EEG abnormalities or successful outcomes of EEG biofeedback (51,52,55). ...
... Starting too soon may overload existing resources, whereas waiting for a longer period of time may reduce the potential benefit (50)(51). Several studies point toward the absence of a link between the time since the TBI and EEG abnormalities or successful outcomes of EEG biofeedback (51,52,55). These observations contribute to the notion that the brain does not spontaneously repair the damage caused by the TBI but instead allocates different resources to accomplish the task with variable results (49). ...
... Many researchers have found the use of two channel coherence training to be efficacious and a good alternative to traditional methods that are often more time consuming and expensive. In a 2002 study, participants with mild head injury were able to improve their self-reported symptoms using quantitative electroencephalography (QEEG) guided two channel coherence training in an average of 19 sessions (Walker et al., 2002). Two channel coherence training was shown in a 2015 randomized control trial to improve the reading scores of children when compared to children who attended traditional resource room style reading programs. ...
... Single and two channel neurofeedback (EEG) has been shown to lead to significant improvements in functioning across clinical conditions such as ADHD (Arns et al., 2014), learning disabilities (Coben et al., 2015), ASD (Coben, 2013), and traumatic brain injuries (Bennett et al., 2017). Two channel coherence training has previously been implemented with demonstrated efficacy (Thornton, 2000;Walker et al., 2002;Thornton and Carmody, 2005;Walker, 2008;Mottaz et al., 2015). In fact, Coben and Myers (2010) have shown this approach to have greater efficacy than single channel training. ...
Article
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As the field of neurofeedback and neuromodulation grows, trends toward using neurofeedback to treat problems of brain dysfunction have emerged. While the use of connectivity based fMRI guided neurofeedback has shown itself to be efficacious, the expense related to the treatment calls for a more practical solution. The use of QEEG guided neurofeedback in the treatment has shown promise as an emerging treatment. To date, EEG based neurofeedback approaches have used technology with limited sophistication. We designed a new form of neurofeedback that uses four channels of EEG with a multivariate calculation of coherence metrics. Following a mathematical presentation of this model, we present findings of a multi-site study with clinical subjects with various diagnoses. We compared this form of multivariate coherence neurofeedback to the more standard two channel coherence training. Findings showed that there was a significant difference between the groups with four channel multivariate coherence neurofeedback leading to greater changes in EEG metrics. Compared to two channel coherence training, four channel multivariate coherence neurofeedback led to a greater than 50% change in power and 400% in coherence values per session. The significance of these findings is discussed in relation to complex calculations of effective connectivity and how this might lead to even greater enhancements in neurofeedback efficacy.
... This study investigated relative brain wave and ADL changes hemiplegic stroke patients following NFB or CACR train- ing. Attention and judgment related tasks mainly activate the frontal area of the brain, and tasks requiring language and spatiotemporal information mainly activate the parietal region 15) . The prefrontal area of the brain is mainly involved in cognitive activities, such as direct attention on new situations, and the frontoparietal area is involved in attention for space and control of intentional movement 16) . ...
... This study found that in terms of ADL performance, as measured by the FIM score, all three groups showed significant improvements in motor and cognition subtotal scores, and their FIM total score, and that self-care showed especially significant improvement as part of the motor skill area (p<0.01). Walker et al. examined the effect of intervention using QEEG in patients with mild brain damage and found that 88% of patients showed an overall improvement in ADLs, and all of them returned to their occupations 15) . Kado et al. revealed that CACR therapy for brain damaged patients improved ADLs such as activity at home, occupational performance, and driving ability 3) . ...
Article
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[Purpose] This study investigated the effects of neurofeedback (NFB) and computer-assisted cognitive rehabilitation (CACR) on the relative brain wave ratios and activities of daily living (ADL) of stroke patients. [Subjects and Methods] Forty-four participants were randomly allocated to the NFB (n=14), CACR (n=14), or control (CON) (n=16) groups. Two expert therapists provided the NFB, CACR, and CON groups with traditional rehabilitation therapy in 30-minute sessions, 5 times a week, for 6 weeks. NFB training was provided only to the NFB group and CACR training was provided only to the CACR group. The CON group received traditional rehabilitation therapy only. Before and after 6 weeks of intervention, brain wave and ADL evaluations were performed, and the results were analyzed. [Results] The relative ratio of beta waves, only showed a significant increase in the frontal and parietal areas of the NFB group. Significant changes in ADL were shown by all three groups after the intervention. However, there were no significant differences between the NFB and CACR groups and the CON group. [Conclusion] Our results suggest that CACR and NFB are effective at improving cognitive function and ADL of stroke patients.
... NFT sessions continued until the patient reported improvement as measured by the Global Improvement Scale or a total of 40 sessions were given. Results indicated significant improvement in 88% of the patients (Walker, Norman, & Weber, 2002). Pre-and post-NFT, cognitive abilities were assessed with the Repeatable Battery for the Assessment of Neuropsychological Status for moderate to severe brain injury. ...
... Activation and arousal of the central nervous system are related to the rhythmic activity of neuronal firing patterns. The findings of the present study are corroborated by studies where NFT was found to be effective in enhancing cognitive functions (Ayers, 1991;Keller, 2001;Moore Sohlberg, 2000;Thornton, 2000;Vernon, 2003;Walker et al., 2002). ...
Article
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Traumatic brain injury (TBI) is a “silent epidemic” that creates a significant burden on health care resources across the globe. TBI is a dynamic process that involves damage to the brain, thus leading to behavioral, cognitive, and emotional consequences and poor quality of life. Neurofeedback training (NFT) was employed as an intervention to study its efficacy in postconcussion symptoms, cognitive deficits, and quality of life. A pre-post design was adopted in which the intervention group underwent NFT and the other waitlist group served as a control. NFT was found to be efficacious in ameliorating postconcussion symptoms and cognitive dysfunctions and improving quality of life.
... These connectivity patterns were determined based on research studies we have conducted as well as clinical observation and experience. QEEG analysis measures functional connectivity between different areas of the brain based on phase synchrony, or the degree to which two signals maintain a phase locked relationship over time (Walker, Norman, & Weber, 2002). Another, more pure view of coherence is defined by Otnes and Enochson (1972) as the squared cross-correlation between two waveforms within a given frequency band that has been normalized for amplitude. ...
... Increased coherence between brain regions may be downtrained, whereas decreased coherence between brain regions may be uptrained. Studies have shown that in addition to changing coherence as assessed by EEG, coherence training produces behavioral and functional improvements (Walker & Kozlowski, 2005;Walker et al., 2002). We propose and provide evidence that by identifying the specific coherence anomaly in Autism, neurofeedback can be used to remedy the aberrant connectivity pattern, resulting in cognitive and behavioral improvements as well. ...
Article
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Background. Autism is a disorder characterized by deficits in communication, social interaction, a limited range of interests, and repetitive stereotypical behavior. Although it is believed that changes in the brain leading to Autism occur early on in prenatal and early postnatal development, there is no definitive test for a diagnosis of Autism. The diagnosis is made on the basis of behavioral signs and symptoms alone and is usually not made until age 2 or later. There have been numerous neuroanatomical abnormalities noted in Autism, some of which can be linked to neuropsychological dysfunction. Recently a new theory has become prominent which suggests the disorder may be due to aberrant neural connectivity patterns. Evidence in support of this theory has come from anatomical studies of white matter as well as functional neuroimaging studies.Methods. Most studies have employed functional magnetic resonance imaging to investigate connectivity, or electroencephalography (EEG) coherence studies. The high temporal resolution of EEG lends itself well to the investigation of cerebral connectivity. Research suggests there may be patterns of both hyper- and hypoconnectivity between various brain regions. Seven different patterns of abnormal connectivity which can be analyzed with EEG are proposed.Results. Patterns of hyperconnectivity may be found in frontotemporal and left hemispheric regions, whereas patterns of hypoconnectivity are often seen in frontal (orbitofrontal), right posterior (occipital/parietal-temporal), frontal-posterior, and left hemispheric regions. In addition to these patterns of hypo- and hyperconnectivity, a mu rhythm complex has been identified. Treatment goals may be based on coherence anomalies identified by quantitative EEG analysis. Increased coherence between brain regions may be downtrained, whereas decreased coherence between brain regions may be uptrained. Clinical examples of each pattern and a discussion of their neurofeedback treatment are provided.Conclusion. A theory of autistic disorders is presented that has at its' core neural connectivity disturbances. Multivariate EEG connectivity indices are utilized to formulate a typology of connectivity anomalies or patterns that have been observed over a series of autistic patients. These represent phenotypic expressions of the underlying pathology that leads to autistic symptoms. Examples demonstrate how these connectivity metrics can be used to understand autistic disturbances and formulate neurofeedback strategies for remedying these difficulties.
... 20 (Coherence in QEEG is defined as ''a measure of phase synchrony or shared activity between spatially distant generators.'') 19,21 Functional assessment commonly includes a continuous performance test. The Tests of Variables of Attention (TOVA 1 ) is an individually administered set of computerized choice reaction time tests developed to assess attention, maintenance of vigilance, impulse control, and consistency of nervous system functioning. ...
... The reported benefits of neurofeedback in managing neurological disorders such as autism syndromes, attention deficit hyperactivity disorder, postconcussion syndromes and insomnia without the need for pharmacotherapy 7,11,12,21 suggest that current neurological services would be augmented by this modality. The therapy offers a nonpharmacologic intervention similar to the ketogenic diet for children with epilepsy who do not tolerate or respond well to established antiepileptic drugs. ...
Article
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Trends in alternative medicine use by American health care consumers are rising substantially. Extensive literature exists reporting on the effectiveness of neurofeedback in the treatment of autism, closed head injury, insomnia, migraine, depression, attention deficit hyperactivity disorder, epilepsy, and posttraumatic stress disorder. We speculated that neurofeedback might serve as a therapeutic modality for patients with medically refractory neurological disorders and have begun referring patients to train with clinical neurofeedback practitioners. The modality is not always covered by insurance. Confident their child's medical and neurological needs would continue to be met, the parents of 3 children with epilepsy spectrum disorder decided to have their child train in the modality. The children's individual progress following neurofeedback are each presented here. A proposed mechanism and practice implications are discussed.
... Specifically, we propose that EEG biofeedback can be utilized to remedy aberrant coherence patterns. Although there have been only a few studies investigating the use of neurofeedback in the treatment of autism, there is ample evidence documenting the efficacy of neurofeedback for various other neuropsychological disorders, including ADHD (Fuchs et al. 2003; Heinrich et al. 2004; Lubar and Lubar 1984), epilepsy (Lubar et al. 1981; Monderer et al. 2002; Sterman 2000; Sterman and Friar 1972; Walker and Kozlowski 2005), traumatic brain injury (TBI) (Byers 1995; Hoffman et al. 1996; Keller 2001; Schoenberger et al. 2001; Walker et al. 2002), anxiety disorders (Moore 2000), and substance abuse disorders (Trudeau 2005). Furthermore, neurofeedback (NF) appears to have long lasting effects, something that pharmacological therapies often lack (Ayers 1995). ...
... The majority of these studies have utilized symptom based neurofeedback protocols, which has been the traditional form of treatment. Quantitative electroencephalograph guided neurofeedback studies have recently demonstrated efficacy for treating obsessive-compulsive disorder (Hammond 2003 ), behavioral difficulties found in children who have been abused and/or neglected (Huang-Storms et al. 2007), post-traumatic symptoms (Walker et al. 2002) of traumatic brain injury; as well as learning disabilities (Thornton and Carmody 2005). These accumulated studies are adding evidence in support of the efficacy of QEEG guided neurofeedback protocols. ...
Article
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Autism is a neurodevelopmental disorder characterized by deficits in communication, social interaction, and a limited range of interests with repetitive stereotypical behavior. Various abnormalities have been documented in the brains of individuals with autism, both anatomically and functionally. The connectivity theory of autism is a recently developed theory of the neurobiological cause of autisic symptoms. Different patterns of hyper- and hypo-connectivity have been identified with the use of quantitative electroencephalogray (QEEG), which may be amenable to neurofeedback. In this study, we compared the results of two published controlled studies examining the efficacy of neurofeedback in the treatment of autism. Specifically, we examined whether a symptom based approach or an assessment/connectivity guided based approach was more effective. Although both methods demonstrated significant improvement in symptoms of autism, connectivity guided neurofeedback demonstrated greater reduction on various subscales of the Autism Treatment Evaluation Checklist (ATEC). Furthermore, when individuals were matched for severity of symptoms, the amount of change per session was significantly higher in the Coben and Padolsky (J Neurother 11:5-23, 2007) study for all five measures of the ATEC. Our findings suggest that an approach guided by QEEG based connectivity assessment may be more efficacious in the treatment of autism. This permits the targeting and amelioration of abnormal connectivity patterns in the brains of people who are autistic.
... Active neurofeedback, often referred to simply as neurofeedback, uses neurophysiological technologies (most commonly EEG) to assess brain activity, and then provides patients with feedback to help them increase desirable or decrease undesirable brain activity [48,49]. Neurofeedback training was used by Walker et al. [50] where they studied quantitative EEG (qEEG)-guided coherence training in patients with mild closed head injuries. They found significant changes in a global improvement score for PCS, with greatest benefits seen in symptoms of headache and memory loss/confusion. ...
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Purpose of Review Mild traumatic brain injury (mTBI) can result in prolonged post-concussive symptoms (e.g., depression, headaches, cognitive impairment) that are debilitating and difficult to treat. This article reviews recent research on neuromodulation for mTBI. Recent Findings Transcranial magnetic stimulation (TMS) is the most studied neuromodulation approach for mTBI (four studies for depression, four for headache, one for cognitive impairment, and two for global post-concussive symptoms) with promising results for post-concussive depression and headache. Transcranial direct current stimulation (tDCS) has also been evaluated (one study for post-traumatic headache, and three for cognitive impairment), with more mixed results overall. Summary TMS appears to be a potentially promising neuromodulation treatment strategy for post-concussive symptoms; however, integration into clinical practice will require larger sham-controlled randomized trials with longer and more consistent follow-up periods. Future studies should also explore new stimulation protocols, personalized approaches, and the role of placebo effects.
... TBI patients present abnormalities to their quantitative electroencephalography (EEG) profiles, varying according to the severity of their injury [32]. Neurorehabilitation interventions based on quantitative EEG-driven neurofeedback have been considered for treating mild TBI symptoms, improving quality of life and cognitive function [33][34][35]. Cognitive functions-namely, attention, inhibition, and memory-can be also the target of robotic neurorehabilitation. Versatile affective robotics for TBI patients, especially for children, have been employed to improve cognitive impairments [36]. ...
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Recent advances in the field of neural rehabilitation, facilitated through technological innovation and improved neurophysiological knowledge of impaired motor control, have opened up new research directions. Such advances increase the relevance of existing interventions, as well as al-low novel methodologies and technological synergies. New approaches attempt to partially overcome long-term disability caused by spinal cord injury, using either invasive bridging tech-nologies or non-invasive human-machine interfaces. Muscular dystrophies benefit from electro-myography and novel sensors that shed light on underlying neuromotor mechanisms in people with Duchenne. Novel wearable robotics devices are being tailored to specific patient popula-tions, such as traumatic brain injury, stroke, and amputated individuals. In addition, develop-ments in robot-assisted rehabilitation may enhance motor learning and generate movement repe-titions by decoding the brain activity of patients during therapy. This is further facilitated by ar-tificial intelligence algorithms coupled with faster electronics. The practical impact of integrating such technologies with neural rehabilitation treatment can be substantial. They can potentially empower non-technically trained individuals, namely family members and professional carers, to alter the programming of neural rehabilitation robotic setups, to actively get involved and in-tervene promptly at the point of care. This narrative review considers existing and emerging neu-ral rehabilitation technologies through the perspective of replacing or restoring functions, en-hancing, or improving natural neural output, as well as promoting or recruiting dormant neuro-plasticity. Upon conclusion, we discuss the future directions for neural rehabilitation research, diagnosis and treatment based on the discussed technologies and their major roadblocks. This future may eventually become possible through technological evolution and convergence of mutu-ally beneficial technologies to create hybrid solutions.
... [61][62][63] Based on the studies reported to date, TBI NF training can be classified as level 3-probably efficacious-indicating the availability of multiple observational studies, clinical studies, wait list controlled studies, and within subject and intrasubject replication studies that demonstrate efficacy. This classification was based on studies conducted by Keller, 64 Schoenberger et al, 65 Tinius and Tinius, 42 Thornton,66 and Walker et al. 43 studies. However, in a review of NF studies, May et al 67 concluded that all studies demonstrated positive findings, in that NF led to improvement in measures of impairment, whether subjective, objective, or both. ...
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Postconcussion syndrome (PCS) has been used to describe a range of residual symptoms that persist 12 months or more after the injury, often despite a lack of evidence of brain abnormalities on magnetic resonance imaging and computed tomography scans. In this clinical case series, the efficacy of quantitative EEG–guided neurofeedback in 40 subjects diagnosed with PCS was investigated. Overall improvement was seen in all the primary (Symptom Assessment-45 Questionnaire, Clinical Global Impressions Scale, Hamilton Depression Scale) and secondary measures (Minnesota Multiphasic Personality Inventory, Test of Variables for Attention). The Neuroguide Traumatic Brain Index for the group also showed a decrease. Thirty-nine subjects were followed up long term with an average follow-up length of 3.1 years (CI = 2.7-3.3). All but 2 subjects were stable and were off medication. Overall neurofeedback treatment was shown to be effective in this group of subjects studied.
... There is much evidence for this in functional imaging, and we only allude here to by reference (Hoffman, 1996;Thornton, 2005). The excellent recovery achieved through neurofeedback further supports the functional model of MTBI (Walker, 2002). ...
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Introduction and foundation This chapter describes a novel approach to understanding and treating addictions. This approach involves the use of EEG biofeedback (neurofeedback) as a modality for treating addictions. In the case of EEG biofeedback, the data generated the model. It is preferable, however, for an explanation of the model to precede the data. Addictions can result from both psychological and physiological factors. Neurofeedback lies at the nexus between them. Though it is tempting (and perhaps traditional) to leave the realm of brain behavior entirely to neurophysiology, doing so could omit or minimize some critical elements. Medical science has supplied a great deal of knowledge about structural deficits in brain function; additionally, however, the functional domain of brain behavior is crucially relevant. Cognitive neuroscience – which concerns itself with brain function – has only begun to engage the challenge of psychopathology. Neuronal networks organize behavioral repertoires. These networks exhibit a high level of integration and hierarchical organization. On the operational level, as in all communication networks, timing is crucial. Whenever a system is compelled to operate under tight constraints, there is opportunity for departure from functional integrity. A key assumption is that psychopathology in general, and addiction in particular, arises from deficits in network relations. Recent thinking posits “connectivity deficits” as central to disorders such as schizophrenia, autism, and Alzheimer's disease. These clinical syndromes aside, this model may also help explain less acute or more “characterological” problems.
... Walker has reported on mild closed head injury (Walker, Norman, & Weber, 2002), anxiety associated with posttraumatic stress (Walker, 2009), migraine headaches (Walker, 2011), enuresis (Walker, 2012a), dysgraphia (Walker, 2012b), and anger control issues (Walker, 2013). His qNF protocol development centers on tailoring the protocol to the individual clinical and qEEG data, with some restrictions of either increasing or decreasing the amplitude of certain frequency ranges. ...
Article
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While there are literature reviews and meta-analytic coverage of neurofeedback (NF) studies that focus on traditional amplitude NF and slow cortical potential NF, the same is not true for quantitative electroencephalographic (qEEG)-guided NF (qNF). To that end, this is a literature review of several qNF research articles. Generally, most are found in clinical settings, address a wide variety of symptoms and diagnoses, use clinical assessments as outcome measures, employ individualized NF protocols based on qEEG findings, and define efficacy in terms of improvement on pre-post outcome measures. However, few report pre-post qEEG metrics as outcome measures. Suggestions for future research are presented.
... Traumatic Brain Injury has been the focus of many in the mental health field who developed neurofeedback for brain injury to supplement the sparse treatment options of traditional medicine. Jonathan Walker, a neurologist and pioneer in the neurofeedback field, has been instrumental in developing neurofeedback strategies for the brain injured [77]. ...
Chapter
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Neurofeedback is a form of brain wave training that makes use of the principle of learning, defined as the general process by which an organism alters its behavior according to certain goals. By measuring and providing feedback related to brain wave activity, the process of neurofeedback provides an additional channel of information that increases awareness of brain behavior by creating subjective experiences that are derived from electroencephalography (EEG).
... sLORETA has been extensively validated against MRI with regard to the accuracy of its localization methods, and can be used to not only evaluate parahippocampal activity relative to age-referenced normative values, but also to provide feedback to the brain based exclusively on activation patterns Coherence training has been used as a form of neurofeedback for over 10 years. Empirical findings have shown it to be effective in the treatment or management of Traumatic Brain Injury (Walker, Norman & Weber, 2002), Autism Spectrum Disorder (Coben & Padolsky, 2007), Learning Disabilities (Nazari, Masanezhad, Hashemi, & Jahan, 2012), and potentially many more conditions including Epilepsy (Coben, Wyckoff, & Hudspeth, 2014). However, all such coherence training is based on training coherence in pairs (sets of two electrode signals). ...
Conference Paper
Background: With a life time prevalence estimated at 16%, major depression (MD) is a major public health issue. Previous studies have shown that depression has been associated with a variety of cognitive impairments. In addition to cognitive impairments, major depression is usually accompanied by alterations of cortical activity, especially in prefrontal areas. Recent studies have highlighted the importance of noninvasive brain stimulation as a means of modulating cortical excitability. Recent studies on major depression (MD) have revealed that transcranial direct current stimulation induces cortical excitability which facilitates memory and especially working memory. On the other hand visual aspects of memory in MD have not been yet investigated. Objective: This study aimed to investigate whether anodal and cathodal tDCS applied over dorsolateral prefrontal cortex (DLPFC), would significantly improve visual memory in patients with major depression. Methods: Thirty (N=30) patients with major depression were randomly assigned to receive either experimental(active) or control (sham) tDCS. The participants underwent a series of visual memory tasks before and after 10 sessions of tDCS. The parameters of active tDCS included 2 mA for 20 minutes per day for 10 consecutive days, anode over the left DLPFC (F3), cathode over the right DLPFC (F4) region. Results: After 10 sessions of anodal and cathodal tDCS, patients showed significantly improved performance in visual and spatial aspects of memory tasks. Specifically, anodal stimulation improved visual memory perfo rmance for the experimental group relative to baseline, whereas sham stimulation did not differentiate performance from baseline in the control group. Conclusion: This study showed that anodal tDCS over DLPFC concurrently with cathodal tDCS over right DLPFC improved visual and spatial aspects of memory in patients with MD. This finding is in generally consistent with previous findings about effectiveness of tDCS on cognition in major depression, while additionally provides support for effectiveness of tDCS on visual memory in MD. Keywords: Major depression, memory, tDCS, visual memory
... I would do a QEEG on my failures and frequently found that the symptom based protocol had not addressed the abnormalities on the QEEG (for example, training to increase beta for ADHD might be ineffective and might show the patient already had excessive beta). After I began to use QEEG to guide the neurofeedback, my success rate improved and the number of sessions needed for improvement decreased (Walker, Norman, & Weber, 2002). Most neurofeedback therapists who use QEEG say that they think they do better training based on the QEEG abnormalities that they find (Sterman, 1999). ...
Article
I am a practicing neurologist. I graduated from medical school in 1960 and finished my residency in 1965. I had the usual electroencephalography (EEG) training during my residency which involved three months of reading EEGs side by side with an electroencephalographer (Ralph Druckman). I learned EEG by the apprentice method. At first, he would point out what was real and what was artifact. Then he began to point out various transients and to ask what they represented (artifact, normal physiology, or some type of pathol- ogy). At first, he would dictate the reports, always emphasizing the clinical relevance of the findings and suggesting possible treatment. Recognition of epileptiform activity was strongly emphasized, as well as recognition of focal or generalized slow wave activity. The importance of digital analyses and da- tabases was not yet recognized (paper EEG only). When I finished my resi- dency, I entered academic medicine and the EEGs were read by more thoroughly trained (board certified) electroenephalographers. Later I became associated with an epilepsy monitoring unit, took additional training in EEG, and became board certified in EEG. Then, I began to read EEGs on a daily ba- sis, eventually interpreting several thousand. When the first QEEG machines came out, I got one and learned about the additional difficulties of using and interpreting QEEGs. The QEEG databases and discriminants developed by E. Roy John (John, Prichep, Fridman, & Easton, 1988) proved more helpful than raw EEG in differential diagnosis of nonepileptic problems (dementia versus depression, unipolar versus bipolar depression, multi-infarct dementia versus Alzheimer's, performance anxiety versus ADD, etc.). Later work by Suffin and Emory (1995) showed that QEEG
... In ihrer Übersichtsarbeit schlagen Thornton und Carmody weiterhin vor, die räumliche Verteilung der EEG-Frequenzmuster für verschiedene kognitive Aufgaben (Gedächtnis, Problemlçsen, etc.) bei Gesunden zu messen und auf der Basis dieser Daten abweichende EEG-Muster in Richtung "Normalisierung" zu trainieren. Dabei erscheint es außerdem sinnvoll, neben den Frequenzen auch die Phasenverschiebung des EEG-Signals zwischen verschiedenen Elektrodenpostionen (Kohärenz) zu berücksichtigen (Tinius & Tinius, 2000;Walker, Norman & Weber, 2002). ...
Article
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In the present study, we compared the performance in a test for sustained attention with different EEG parameters in a group of healthy subjects and a group of patients suffering from different kinds of brain injury. We wanted to prove in particular if the quotient of theta- and beta-activity (theta-beta ratio) is a suitable variable for neurofeedback therapy. A correlation analysis revealed statistically significant correlations above 0.7 between the theta-beta ratio and error rate and the theta beta ratio and number of correct reactions in healthy subjects. The correlation between theta-beta ratio and reaction time was lower (r = 0.466), but still statistically significant. For patients, we found a statistically significant correlation between the theta-beta ratio and error rate. Correlations between beta-amplitudes and test performance on the one hand and sensori motor rhythm and test performance on the other hand were lower and statistically not significant. Our results suggest that the theta-beta ratio seems to be a good indicator for attention in healthy subjects and brain-injured patients with attention deficits. It is proposed to use the theta-beta ratio for neurofeedback training.
... The cognitive problems of 26 patients with MTBI were treated with QEEG biofeedback that employed the NX Link database (John et al. 1988). The interventions focused on the coherence abnormalities for an average of 19 sessions to a maximum of 40 sessions (Walker et al. 2002). Patients with coherence values that were above the reference group were trained to lower the values while patients with coherence values that were below the reference group were trained to increase the coherence measure. ...
Article
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Interventions for improvement of cognitive problems in patients with traumatic brain injury (TBI) include electroencephalography biofeedback, also known as neurofeedback. Quantitative electroencephalography (QEEG) patterns are assessed in TBI patients and then compared to a database obtained from a normative population. Deviations in QEEG patterns from the normative group are the basis for an intervention plan. While QEEG patterns, obtained under an eyes closed, resting condition, provide information about deviations at rest, QEEG patterns obtained while the patient engages in cognitive tasks reflect specific deficiencies in brain functioning. This paper reviews and assesses QEEG patterns collected under both resting conditions as well as cognitive tasks. The article provides a theoretical and empirical base for QEEG interventions with TBI.
... Walker et al [66] studied 26 patients with MTBI within 3 to 70 days of injury with an eyes-closed QEEG. EEG biofeedback treatment protocols (average of 19 sessions) that addressed the deviations from the normative database for the abnormal coherence values were then implemented. ...
Article
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Five clinical case studies (1 normal, 3 brain injured and 1 subject who had a left frontal hematoma) are presented which addressed the effectiveness of EEG biofeedback for auditory memory impairment. A normative QEEG activation database of 59 right-handed subjects was developed, which delineated the QEEG variables which were positively related to auditory memory performance (paragraphs). Persons who had experienced a brain injury underwent the same procedure employed in the development of the database. The person's values on the effective parameters of memory functioning were determined. EEG biofeedback interventions were determined by the individual's deviation from the normative reference group in terms of the relevant QEEG parameters of effective auditory memory (paragraph recall). Improvements ranged from 39% subjects who had a follow up assessment that occurred from one month to one year following termination of treatment.
... Walker et al [66] studied 26 patients with MTBI within 3 to 70 days of injury with an eyes-closed QEEG. EEG biofeedback treatment protocols (average of 19 sessions) that addressed the deviations from the normative database for the abnormal coherence values were then implemented. ...
Article
The application of electroencephalogram (EEG) biofeedback with reading disability and traumatic brain injury (TBI) is relatively recent. There are many studies regarding the effectiveness (improving attention and IQ scores) of EEG biofeedback in patients with attention deficit hyperactivity disorder, who are known to have a high rate of comorbidity for learning disabilities. This suggests the possibility that EEG biofeedback specifically aimed at remediating reading disability and TBI would be effective. This article provides strong initial support for this idea and provides reason to believe that assessment and training under task conditions are likely to be fruitful. Given the significance of these problems and the absence of very effective alternatives for remediation of these conditions, efforts to complete the needed research seem warranted. Clinical use of this intervention seems to be warranted with informed consent.
Article
Objective: To examine the effectiveness of rehabilitation on physical symptoms in patients of all ages with persistent concussion symptoms. Data source: PubMed, MEDLINE, Cochrane library, CINAHL and Embase were searched from January 1, 2012 to September 1, 2023 using terms related to physical postconcussion symptoms. Study selection and extraction: Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) and the Quality Assessment Tool. Grading of Recommendations Assessment, Development, and Evaluation system was applied to rate the quality of evidence. 32 articles were included. Data synthesis: Preliminary evidence suggests Transcranial Magnetic Stimulation improves symptoms in adults, specifically headaches. Young adults reported a significant decrease in physical symptoms following sub-symptom aerobic training as well as cervical spine manual therapy. Tentatively, adults demonstrated changes in symptoms following neurofeedback sessions, and progressive muscle relaxation resulted in a decrease in monthly headaches. Multimodal therapy in adults showed significant change in physical symptoms when compared to usual care. However, no further reduction in physical symptoms were observed when adult patients received a program of care that afforded cervicovestibular rehabilitation with symptom limited exercise compared to symptom limited exercise program alone. Cognitive behavioural therapy demonstrated inconsistent findings for its effects on physical symptoms, specifically headaches. Veterans had a significant change in postconcussive symptoms following 3-month use of an interactive smartphone application as compared to standard care. Finally, in a pediatric population the use of melatonin did not demonstrate any changes in physical persistent concussion symptoms as compared to placebo. Conclusion: Preliminary evidence suggests that various forms of rehabilitative therapies can improve persistent physical concussive symptoms. However, given the methodological limitations in the majority of trials, interpretation of the results needs to be taken with caution.
Article
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Objective: To examine the evidence levels, study characteristics, and outcomes of nonpharmacologic complementary and integrative medicine (CIM) interventions in rehabilitation for individuals with traumatic brain injury (TBI). Data sources: MEDLINE (OvidSP), PubMed (NLM), EMBASE (Embase.com), CINAHL (EBSCO), PsycINFO (OvidSP), Cochrane Library (Wiley), and National Guidelines Clearinghouse databases were evaluated using PRISMA guidelines. The protocol was registered in INPLASY (protocol registration: INPLASY202160071). Data extraction: Quantitative studies published between 1992 and 2020 investigating the efficacy of CIM for individuals with TBI of any severity, age, and outcome were included. Special diets, herbal and dietary supplements, and counseling/psychological interventions were excluded, as were studies with mixed samples if TBI data could not be extracted. A 2-level review comprised title/abstract screening, followed by full-text assessment by 2 independent reviewers. Data synthesis: In total, 90 studies were included, with 57 001 patients in total. This total includes 2 retrospective studies with 17 475 and 37 045 patients. Of the 90 studies, 18 (20%) were randomized controlled trials (RCTs). The remainder included 20 quasi-experimental studies (2-group or 1-group pre/posttreatment comparison), 9 retrospective studies, 1 single-subject study design, 2 mixed-methods designs, and 40 case study/case reports. Guided by the American Academy of Neurology evidence levels, class II criteria were met by 61% of the RCTs. Included studies examined biofeedback/neurofeedback (40%), acupuncture (22%), yoga/tai chi (11%), meditation/mindfulness/relaxation (11%), and chiropractic/osteopathic manipulation (11%). The clinical outcomes evaluated across studies included physical impairments (62%), mental health (49%), cognitive impairments (39%), pain (31%), and activities of daily living/quality of life (28%). Additional descriptive statistics were summarized using narrative synthesis. Of the studies included for analyses, 97% reported overall positive benefits of CIM. Conclusion: Rigorous and well experimentally designed studies (including RCTs) are needed to confirm the initial evidence supporting the use of CIM found in the existing literature.
Article
Traumatic brain injury is a frequently occurring event. Often it is not diagnosed in a timely manner. Neurofeedback interventions have not yet been recognized as a treatment of choice. This lack of acceptance of neurofeedback as a treatment of choice may well be due to a scarcity of published control group studies. In addition, the use of the quantitative electroencephalography, one of the most promising diagnostic and treatment planning tools, has been opposed by the American Academy of Neurology (AAN). Yet sufficient clinical and published research data exist to warrant the use of the quantitative electroencephalography as a supplemental tool for diagnostic and treatment planning purposes and the use of various neurofeedback interventions for overcoming many of the symptoms of traumatic brain injury. Practitioners must remain current on both clinical and research data if they are to practice both ethically and competently. In addition, they must attend to other ethical issues such as informed consent, competence, and practice guidelines and standards.
Chapter
A review of recent research utilizing neurofeedback in the treatment of post-traumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) establishes the clinical efficacy of this approach and indicates that with improved methods good clinical outcome can be achieved in fewer sessions. Preliminary studies show that improved clinical outcome can be achieved in 10 sessions or less if a symptom checklist is used to identify nodes and connections between nodes related to anxiety, memory, and frontal lobe function using low-resolution EEG tomographic analysis (LORETA) Z-score neurofeedback (LZN). PTSD is becoming understood as a set of functional neural network disturbances through the advancement of increasingly accurate and available neuroimaging techniques. Likewise, these same techniques are contributing to the understanding and treatment of mTBI. Both PTSD and mTBI involve a wide range of possible neural dysregulations, and thus, maximal treatment outcome will result from optimal specificity of assessment and treatment. Combat veterans often suffer from both PTSD and mTBI resulting in numerous complex, difficult to treat, and often disabling symptoms. This study reports on an ongoing project providing treatment to US combat veterans utilizing the 3D tomographic electroencephalogram (tEEG) technique of LZN driven by a symptom checklist, functional neural network match (SCL-FNM) method. Eleven cases are analyzed, one with a single session showing increasingly large effects of successive 2-min training rounds on the current source density of a targeted cortical region of training. Each of the other 10 cases also demonstrates specific neurophysiological normalization in the regions of training along with specific quantified progressive reduction in symptoms. Paired t-tests demonstrate learning occurred in every case. Cohen's d analyses of current source density improvements quantified large effect sizes in 9 of 10 cases and a moderate effect size in one case. A negative correlation between effect size and psychotropic medication was found along with a trend toward needing less medication as training progressed. These interactions between LZN and psychotropic drugs provide a rationale for optimal cooperation among the trainee, LZN trainer, and prescribing physicians to maximize treatment efficacy. LZN based on the SCL-FNM method is evidently both effective and specific in the treatment of PTSD and mTBI.
Chapter
Studies have supported the observation that neurofeedback can be as effective as stimulant medication in reducing the symptoms of ADHD. There is also evidence of significant improvements in measures of intelligence, academic performance, and behavior. Even as further research is awaited meeting stringent criteria regarding random assignment of subjects, and more follow-up studies regarding maintaining gains, neurofeedback (NFB) has established itself as a key component in the treatment of ADHD that adds to positive outcomes. It is not easy work and it needs to be done carefully, always keeping in mind that there should be evidence of learning, as measured by EEG parameters as well as transfer of the self-regulation skills to everyday life. Neurofeedback fits into the twenty-first century Zeitgeist concerning health maintenance and self-regulation; that is, skills, not just pills. The real power of NFB, and the reason it should become the preferred intervention for ADHD, is that it empowers the child, or adult for that matter, to achieve changes through their own efforts, and thus gain the means and motivation to realize their full potential.
Article
Introduction: Major depression is one of the most common psychiatric disorders that is with depressed mood and characterized by feelings of sadness, low self esteem and lack of interest or pleasure in daily activities. Objective: The main aim of this article is comparison of efficacy of real neurofeedback therapy versus sham (unreal or placebo) in adolescents with major depressive disorder in Iran, Mashhad. Material&Method: This study included 28 adolescents with major depression that were diagnosed by psychiatric interview according to DSM -V and Hamilton scale. They were randomly divided into two groups. All patients were treated with 20 mg of fluoxetine. Half received neurofeedback treatment on F3 region and the other half received unreal neurofeedback treatment or sham (placebo). Immediately after the 20th session Hamilton test was conducted. Results: The efficacy of treatment with real and unreal neurofeedback on adolescents' depression shows difference in scores. The differences between pre-test and post-test scores within each group and finally between the two groups were compared using independent t-test. According to the results, the index calculated t (-0.9) is not significant. So there is no significant difference between real and unreal neurofeedback effects. Conclusion: This study shows that real neurofeedback therapy was effective; but this efficacy was not significantly different from unreal neurofeedback therapy in adolescent depression. This means that in F3 region, the effect of real neurofeedback therapy was not any different from unreal neurofeedback on adolescents' depression. Experiments on other regions are suggested.
Book
The fields of neurobiology and neuropsychology are growing rapidly, and neuroscientists now understand that the human brain has the capability to adapt and develop new living neurons by engaging new tasks and challenges throughout our lives, essentially allowing the brain to rewire itself. In Neurotherapy and Neurofeedback, accomplished clinicians and scholars Lori Russell-Chapin and Ted Chapin illustrate the importance of these advances and introduce counselors to the growing body of research demonstrating that the brain can be taught to self-regulate and become more efficient through neurofeedback (NF), a type of biofeedback for the brain. Students and clinicians will come away from this book with a strong sense of how brain dysregulation occurs and what kinds of interventions clinicians can use when counseling and medication prove insufficient for treating behavioral and psychological symptoms.
Book
Throughout time, people have explored the ways in which they can improve some aspect of their performance. Such attempts are more visible today, with many working to gain an 'edge' on their performance, whether it is to learn a new language, improve memory or increase golf handicaps. This book examines a range of techniques that are intended to help improve some aspect of performance, and examines how well they are able to achieve this. The various performance enhancing techniques available can be divided into those where the individual remains passive (receiving a message, suggestion or stimulus) and those where the individual needs to take a more active approach. Human Potential looks at a range of techniques within each of these categories to provide the reader with a sense of the traditional as well as the more contemporary approaches used to enhance human performance. The techniques covered include hypnosis, sleep learning, subliminal training and audio and visual cortical entrainment as well as mnemonics, meditation, speed-reading, biofeedback, neurofeedback and mental imagery practice. This is the first time such a broad range of techniques has been brought together to be assessed in terms of effectiveness. It will be useful to all psychology and sports science students, practicing psychologists, life coaches and anyone else interested in finding out about the effectiveness of performance enhancement techniques.
Article
Neurofeedback is a form of biofeedback whereby a patient can learn to control measurements of brain activity such as those recorded by an electroencephalogram. It has been explored as a treatment for sequelae of traumatic brain injury, although the use of neurofeedback remains outside the realm of routine clinical practice. Google Scholar™ was used to find 22 examples of primary research. Measures of symptom improvement, neuropsychological testing, and changes in subjects' quantitative electroencephalogram were included in the analysis. A single reviewer classified each study according to a rubric devised by 2 societies dedicated to neurofeedback research. All studies demonstrated positive findings, in that neurofeedback led to improvement in measures of impairment, whether subjective, objective, or both. However, placebo-controlled studies were lacking, some reports omitted important details, and study designs differed to the point where effect size could not be calculated quantitatively. Neurofeedback is a promising treatment that warrants double-blind, placebo-controlled studies to determine its potential role in the treatment of traumatic brain injury. Clinicians can advise that some patients report improvement in a wide range of neuropsychiatric symptoms after undergoing neurofeedback, although the treatment remains experimental, with no standard methodology.
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ABSTRACT. Introduction. Changes in quantitative EEG during and in response to neurofeedback (NF) training was explored in patients with traumatic brain injury (TBI). Data from 19 adults with a TBI of moderate mechanical nature, non-drug-related, and without severe posttraumatic stress disorder or seizure disorder were analyzed (14 male and 5 female). Methods. EEG was evaluated before, during, and after ROSHI NF training. Data were collected as duplicate samples of 6 min each during eyes open and eyes closed conditions, but only the eyes closed condition was analyzed. Results. Significant changes in connectivity occurred during and in response to NF training. Conclusion. Results showed significant changes in real-time QEEG connectivity. An evaluation of a larger subject population will clarify gender differences in connectivity responses to NF training. KEYWORDS. Acquired brain injury, brain injury, coherence, connectivity, neurofeedback training, NeuroRep, QEEG, synchrony, traumatic brain injury (TBI)
Article
Introduction. This study was done to see to what extent power training would correct coherence abnormalities in head-injured patients and to what extent coherence training would correct power abnormalities in a similar group of head-injured patients.Method. Ten patients had power training first, and 10 patients had coherence training first (4 protocols with 5 sessions/protocol in each case).Results. Either power or coherence training first resulted in normalization of most power and coherence abnormalities. Coherence training first resulted in significantly more new power abnormalities (10/client vs. 5/client for new power abnormalities). Power training first resulted in significantly more new coherence abnormalities (6/client vs. 2/client).Conclusion. We did not find a clear-cut advantage for doing either power or coherence training first. However, we would recommend a repeat QEEG after doing either power or coherence first, since most original abnormalities will have resolved and there are likely to be several new abnormalities to be remediated.
Article
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Introduction. An investigation into the relationships between Quantitative EEG (QEEG) and memory scores for reading material was conducted employing 38 normal subjects.Method. There were three conditions during which QEEG data was collected: (a) subject reading a story silently, (b) subject engaging in an immediate recall period, followed by subject's oral recall, and (c) delayed recall assessment, followed by the same methodology of quiet recall and subsequent oral recall. The reading and recall performances were correlated with QEEG variables.Generator patterns were determined as a set of significant phase or coherence relationships, which all emanate from one location. The concept of emanate is an assumption based, in part, on previous literature of generator patterns and on the statistical need to reduce the number of variables. Degrees of activation values were determined as the differences in QEEG variables between two conditions (a relevant condition and the task condition). For the reading condition, a visual attention task served as the relevant condition, while for the recall tasks, the eyes closed served as the relevant control condition.Results. During the input (reading) condition absolute levels of F7 beta generator and T5 coherence alpha generator activity were associated with higher memory scores. Degree of activation (visual attention vs. reading) values indicated significant relationships (increased activation positively correlated with recall) between recall and eight generator patterns (coherence) in the alpha range.Immediate recall was positively associated with absolute levels of generator activity (coherence beta2, 32 to 64 Hz) from the F4 location and with the absolute level of activations in the theta frequency predominantly at frontal locations. Degree of activation (from eyes closed) analysis indicated that increased memory scores were associated with activations in the theta frequency range in diffuse locations, activations of beta frequencies at posterior locations and generator activity predominantly in the beta2 frequency from right hemisphere locations.Higher long-term recall was associated with higher absolute levels of generator activity (alpha set at .10) from right frontal locations and frontal theta activity. The higher the degree of activation (from eyes closed) of posterior beta activity and beta generator activity from several sites, the higher the long-term memory score.Discussion. The results provide a new perspective on brain functioning, which cannot be accounted for by any present day theories of brain functioning.
Article
Background. The electroencephalogram provides a myriad of opportunities to detect and assess brain function and brain connectivity.Method. This article describes the relationship between local and non-local brain activation and synchrony, and discusses the use of appropriate connectivity measures to study and train functional brain connectivity. Specific connectivity measures are described including coherence, phase, synchrony, correlation, and comodulation. The measures are contrasted and compared in terms of their ability to detect particular aspects of connectivity and their usefulness for neurofeedback training.Results. Connectivity metrics for example EEG data are calculated and shown graphically, to illustrate relevant principles.Conclusion. It is possible to assess brain connectivity and integrated function for both assessment and training, through the use of appropriate metrics and display methods.
Article
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Background. Research reviewing the epidemiology of Autism (Medical Research Council, 2001) indicated that approximately 60 per 10,000 children (1/166) are diagnosed with Autistic Spectrum Disorder (ASD). Jarusiewicz (2002) published the only controlled study documenting the effectiveness of neurofeedback for Autism based on one outcome measure. The present study extended these findings with a larger sample size, broader range of assessments, and physiological measures of brain functioning.Methods. Assessment-guided neurofeedback was conducted in 20 sessions for 37 patients with ASD. The experimental and control groups were matched for age, gender, race, handedness, other treatments, and severity of ASD.Results. Improved ratings of ASD symptoms reflected an 89% success rate. Statistical analyses revealed significant improvement in Autistics who received Neurofeedback compared to a wait list control group. Other major findings included a 40% reduction in core ASD symptomatology (indicated by ATEC Total Scores), and 76% of the experimental group had decreased hyper-connectivity. Reduced cerebral hyperconnectivity was associated with positive clinical outcomes in this population. In all cases of reported improvement in ASD symptomatology, positive treatment outcomes were confirmed by neuropsychological and neurophysiological assessment.Conclusions. Evidence from multiple measures has demonstrated that neurofeedback can be an effective treatment for ASD. In this population, a crucial factor in explaining improved clinical outcomes in the experimental group may be the use of assessment-guided neurofeedback to reduce cerebral hyperconnectivity. Implications of these findings are discussed.
Article
Cognitive Rehabilitation is an umbrella term which encompasses a number of restorative and compensatory techniques commonly and widely applied to assist with the sequelae following traumatic brain injury (TBI). Such techniques have been well established within the literature. More recently, an increasing body of research has emerged suggesting that electroencephalography (EEG) biofeedback is an effective intervention for sequelae following TBI. The purpose of the study was to investigate the effectiveness of cognitive rehabilitation and EEG biofeedback as treatments for moderate to severe TBI. It aimed to determine the effectiveness of each intervention in treating cognitive, emotional, and behavioural sequelae following TBI. Methods: A multiple single case study cross-over (ABBA) design was used with six adult participants, no less than one year post TBI. Three of the participants received the two treatments in the opposite order to the remaining participants, each serving as their own controls. Over ten weeks, each participant received 20 hours of Treatment A. Then, following a ten week break they received 20 hours of Treatment B, with a final ten week follow-up. A number of cognitive, emotional, and behavioural measures were administered pre-post treatments. Quantitative electroencephalographs (qEEG) were also administered pre-post treatments to evaluate any change in the electrophysiological dynamics of the brain. Results: EEG biofeedback appeared to be more effective than cognitive rehabilitation in improving information processing impairments, namely, complex attentional control, response inhibition, and speed of language and comprehension. Cognitive rehabilitation appeared to be more effective than EEG biofeedback in improving visual memory. Both treatments were effective in reducing depression, anxiety, anger, and neurobehavioural symptomatology. Although both treatments were effective in reducing depression, greater reductions were evident following EEG biofeedback. A number of self-reported functional changes were also noted by each participant. EEG biofeedback was more effective than cognitive rehabilitation in the normalisation of dysregulated EEG (as measured by qEEG). Conclusions: Overall, EEG biofeedback appeared to be more effective in improving information processing skills, while cognitive rehabilitation was more effective in improving visual memory. Both treatments were effective in the treatment of emotional and behavioural sequelae following TBI. EEG biofeedback was more effective in normalising the participants'. However, the clinical meaningfulness of the qEEG finding is questioned. Speculations are made about the possible functional brain changes which may occur following rehabilitation.
Article
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Evidence for a role for drugs of abuse in the development of chronic psychotic syndromes is scattered throughout 40 years of literature. Electrophysiological studies examining groups believed to have chronic drug-induced psychotic symptoms yielded interesting findings. To our knowledge, no studies directly compared schizophrenia patients whose drug use preceded and those whose drug use followed the onset of psychotic symptoms. Twenty-six schizophrenia patients and 10 healthy control subjects were recruited for the study. Based on the SCID interview, schizophrenia subjects were classified into a Psychosis First (Psy 1st) group (N=11), Drugs First (Drugs 1st; N=8), and No Drug Use (No Drugs; N=7). Schizophrenia subjects were administered the Positive and Negative Symptoms Scale (PANSS). The P300 evoked response and sensory gating were measured for all subjects. Despite the small sample sizes significant differences were found between the groups. Most significantly, the P300 amplitude was smallest in the Drugs 1st as compared to the No Drugs groups, while sensory gating deficit was worst in the Psy 1st group. The data suggest that significant clinical and electrophysiological differences between these groups can be identified. Further research to better define these differences seems warranted.
Article
With electroencephalographic (EEG) biofeedback (or neurofeedback), it is possible to train the brain to de-emphasize rhythms that lead to generation and propagation of seizure and emphasize rhythms that make seizures less likely to occur. With recent improvements in quantitative EEG measurement and improved neurofeedback protocols, it has become possible in clinical practice to eliminate seizures or reduce the amount of medication required to control them. In this article, the history of neurofeedback for epilepsy is presented followed by discussions of the relevant neurophysiology of epilepsy. A model of how neurofeedback might raise the seizure threshold is then presented. Clinical experience using a quantitative EEG-guided approach is described, including a representative case study.
Article
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As part of a prospective study of closed head injury, 54 relatives were interviewed within a month of the patient's accident and again six and twelve months later. The degree of stress on the relatives was measured by means of the Wakefield Depression Scale and by interview questions. The worst period of stress for the majority of relatives appeared to be during the first month after the accident. However, the degree of stress appeared to level off by the sixth month and no further diminution was found at twelve months. Stress was apparently mediated by the relatives' perception of personality changes and subjective defects. It was not affected by the severity of the head injury or associated disabilities, nor by whether the patient had resumed work and leisure activities. The nature of the stress is analysed and methods of alleviating it discussed.
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The efficacy of a computer-assisted attention retraining program was evaluated with 29 outpatients suffering from moderate to severe traumatic brain injury. Ss who were at least 12 months postinjury were randomly assigned either to the attention training program or a memory training program that served as a control condition. Training lasted 9 weeks with two 2-hr sessions per week for both groups. The experimental design evaluated outcome by juxtaposing a multiple baseline procedure for a 1st set of measures of attention and memory with a pre and post group comparison that relied on a 2nd set of neuropsychological tests. The experimental group improved significantly in comparison with the control group on measures of attention. The reversed pattern for the memory measures was not observed. None of the treatment effects generalized to the 2nd set of dependent variables.
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Self-appraisal of cognitive difficulties by a sample of 63 male patients with closed-head injury (CHI) was examined in relation to their performance on the Wechsler Memory Scale - Revised (WMS-R; Wechsler, 1987), WAIS-R Digit Span (Wechsler, 1981), and to their scores on MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) measures of anxiety and depression. In an initial step, the Cognitive Difficulties Scale (CDS; McNair & Kahn, 1983), consisting of 39 self-report items, was factor analyzed using a sample of 255 consecutive neuropsychological referrals with documented brain impairment. Seven orthogonal dimensions emerged: Attention and Concentration, Orientation and Memory, Praxis, Domestic Activities, Facial Recognition, Task Efficiency, and Errand and Name Recall. Within a sample subset consisting of 63 patients with CHI, subjective complaints on the CDS were predictive of WMS-R Logical Memory performance (r = -.51, p < .0005). In contrast, CDS scores were generally poor predictors of Digit Span and Visual Reproduction scores (rs < .31). Cognitive complaints were also associated with emotional distress on the MMPI-2. The CDS appears to be a useful measure of self-appraised cognitive difficulties in patients with CHI, and may assist in the assessment of their self-reflective insight.
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To confirm that patients admitted to hospital with a head injury benefit from a routinely offered early intervention service. A mixed rural and urban Health District of 560000 people with two accident and emergency departments provided the setting. Existing routine services for most patients with head injury are minimal. All patients aged 16-65 years admitted to hospital after a head injury of any severity, with or without other injuries entered the trial. Prospective randomisation, with a block randomisation procedure was used to allocate all eligible patients to either: a group offered an additional service by a specialist team; or a group receiving existing standard services. Patients were assessed at follow up six months after injury. The primary outcome measure was the Rivermead head injury follow up questionnaire, a validated and reliable measure of social disability. The Rivermead post-concussion symptoms questionnaire was used to estimate severity of post-concussion symptoms. Each patient in the trial group was contacted 7-10 days after injury, and offered assessment and interventions as needed. These initially focused on the provision of information, support, and advice. Forty six per cent of patients in the trial group also received further outpatient intervention or additional support by telephone. 314 patients were registered: 184 were randomised into the trial group, 130 into the control group. For prognostic data, the groups were comparable at randomisation, and remained comparable when assessed at six months. 132 trial and 86 control patients were followed up at six months after injury. Patients' posttraumatic amnesia ranged from mild (n=79, 40%), and moderate (n=62, 32%), to severe (n=38, 19%) and very severe (n=17, 9%). The trial group patients had significantly less social disability (p=0.01) and significantly less severe post-concussion symptoms (p=0.02) at follow up at six months after injury than the control group patients. The early interventions offered by a specialist service significantly reduced social morbidity and severity of post-concussion symptoms in trial group patients at six months after head injury. Recommendations about how specialist services should be targeted are made both in the light of these results and those from a previous randomised controlled trial.
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This compendium was intended as a comprehensive resource concerned primarily with engaging psychiatrists in the care and rehabilitation of patients with traumatic brain injury and their families. Many of the contributors are outstanding in their careers. The work, however, is poorly gathered, replete with redundancies, and lacking in structural sequencing and progression. Chapters often stand alone and the discrepant data from one section to another are not evaluated. There is a volume of data but it lacks organization and prioritization. Often, data become a concern because of questions from otherreferences, lack of controls, and a small number of observations as they pertain to complex multifaceted elements of behavior and pharmacology. There is concern for proper diagnosis but relatively little attention to premorbid personality, substance abuse, previous head injury, and previous medical and orthopedic problems that may alter diagnosis. Warnings against labeling patients "functional borderline personality," caution regarding use of drugs
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In ancient healing traditions and in contemporary indigenous societies, the education of healers is deeply experiential as well as didactic. It is understood that knowledge of specific therapies and the power that comes with the position of healer must be tempered by self-knowledge and wisdom.
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Postconcussive symptomatology was studied in 587 patients with uncomplicated mild head injury. There was a linear decrease in symptomatology over the 1-year follow-up period. Headache was the most frequently reported postconcussive symptom. Symptom constellations consistent with postconcussive syndrome were rare. A number of patients reported symptoms at 1 year follow-up. Interventions designed to provide education and support appeared to be associated with symptom resolution in some patients. Implications of these findings are discussed. (C) Williams & Wilkins 1993. All Rights Reserved.
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EEG coherence was computed from 8 left and 8 right intrahemispheric electrode pairs from 253 children ranging in mean age from 6 months to 7 years. The first derivative of mean coherence was computed in order to study growth spurts or rapid changes in mean coherence over the early childhood period. Growth spurts in EEG coherence were approximately 6 months to 1 year in duration and involved a cyclical process composed of a sequential lengthening of intracortical connections in the left hemisphere and a sequential contraction of intracortical connections in the right hemisphere. Each growth spurt cycle had a period of approximately 2 to 4 years and involved both a rostral-caudal expansion and contraction as well as a lateral-to-medial rotation. Data support the view that the functions of the left and right hemisphere are established early in human development through complementary developmental sequences and that these sequences appear to recapitulate differences in adult hemispheric function.
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This article presents a review of work that my colleagues and I have been doing during the past 15 years developing a rationale for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and treatment of ADHD employing EEG biofeedback techniques. The article first briefly reviews the history of research and theory for understanding ADHD and then deals with the development of EEG and event-related potential (ERP) assessment paradigms and treatment protocols for this disorder, including our work and that of others who have replicated our results. Illustrative material from our current research and child case studies is included. Suggestions for future experimental and clinical work in this area are presented and theoretical issues involving the understanding of the neurophysiological and neurological basis of ADHD are discussed.
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Normative developmental equations provide reliable descriptors of brain electrical activity in people 6 to 90 years old. Healthy persons display only chance deviations beyond predicted ranges. Patients with neurological impairment, subtle cognitive dysfunctions, or psychiatric disorders (including dementia and primary depression) show a high incidence of abnormal values. The magnitude of the deviations increases with clinical severity. Different disorders are characterized by distinctive profiles of abnormal values of brain electrical features. Computerized differential classification of some of these disorders can be achieved with high accuracy. Such classification, providing objective corroboration of brain dysfunctions, may be a useful adjunct to psychiatric diagnosis, which relies primarily on subjective clinical impressions. These methods may provide independent criteria for diagnostic validity, evaluations of treatment efficacy, and more individualized therapy.
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The authors studied 538 patients who had sustained minor head trauma, which was defined as a history of unconsciousness of 20 minutes or less, a Glasgow Coma Scale score of 13 to 15, and hospitalization not exceeding 48 hours. Of these patients, 424 were evaluated 3 months after injury. The follow-up evaluation included a history of events since the accident, assessment of subjective complaints and objective measures such as employment status, a neurological examination, a psychosocial assessment designed for estimating life stress, and a neuropsychological test battery to measure higher cortical function. Of these 424 patients, 79% complained of persistent headaches, and 59% described problems with memory. Of the patients who had been gainfully empolyed before the accident, 34% were unemployed 3 months later. Comparisons were then made between the employed and the unemployed groups. Three explanations for the high rate of unemployment were examined. (a) Evidence of organic brain damage: Although the neurological examination was completely normal in nearly all patients, neuropsychological testing demonstrated some problems with attention, concentration, memory, or judgment in most of the 69 patients evaluated. (b) Psychological responses to the injury: Emotional stress caused by persistent symptoms seems to be a significant factor in the long term disability of these patients. (c) Litigation and compensation: These factors have a minimal role in determining outcome after minor head injury. In conclusion, the most striking observations of these studies are the high rates of morbidity and unemployment in patients 3 months after a seemingly insignificant head injury and the evidence that many of these patients may have, in fact, suffered organic brain damage.
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The coherence function quantifies the association between pairs of signals as a function of frequency and has been shown to be useful for measuring changes in EEG topography related to cognitive tasks, psychopathology, and other aspects of brain organisation. For a narrow frequency band, its magnitude is analogous to the correlation coefficient between the signals limited by that band, but its value may differ because of the way that smoothing over frequency is achieved. The coherence function is described in physical terms using simple waveforms.
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The classification systems currently utilized to categorize closed-head injury (CHI) patients are all based on severity levels. However, these scales are unable to account for the wide variability among CHI patients. Another way to classify these patients is to use the clinical picture independent of the overall severity level. That approach is used with aphasic patients but not with the CHI population. These preliminary data indicate that there are distinct subgroups in the CHI population. These subgroups can be identified by their overall pattern of performance on a battery of tests covering language, memory, visuospatial, cognitive and discourse skills. The characteristics of the tentative subgroups are described, but a more extensive study is needed to confirm the robustness of this classification.
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The symptoms experienced by people with mild closed-head injury (mCHI) and by people with attention deficit disorder (ADD) are similar in many aspects. We examined the performance of 26 adults with mCHI, 23 adults with ADD, and 25 matched controls on four functional areas: (1) simple motor response, (2) response speed and attention, (3) complex perceptual-motor performance, and (4) memory and learning. Analyses of variance and multivariate analyses of variance were used to compare the performance of the three groups. Test results were also plotted to examine patterns of performance and similarities between the groups. Both groups with mCHI and ADD had significantly more difficulty than controls with sustained attention. However, whereas the group with mCHI was characterized by generalized slowness in their response times, the group with ADD was characterized by impulsivity or an inability to regulate their attention and responses.
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Traumatic brain injury (TBI) refers to a broad range of neurological, cognitive and emotional factors that result from the application of a mechanical force to the head. Mechanical force can be applied on a continuum from none to very severe, and the extent of brain injury is related to the severity of this force. A review of the literature reveals that, while considerable research has been done on minor head injury, there remain several major sources of confusion. First, one of the most noticeable problems relates to the fact that the mild head injury has lower limits which are vaguely defined. This leads to individuals being categorized as having sustained a mild TBI despite minimal or no neurological damage being present. A second source of confusion in the literature is related to the failure to differentiate between cognitive consequences of TBI and post-concussion symptoms (PCS). Since PCS can occur in the absence of head injury, and are often present beyond the period of cognitive recovery from mild TBI, the two clearly result from different factors. Researchers have often failed to separate these two factors when studying recovery of function, and this has led to varying findings on outcome. Finally, many pre-injury factors (age, education, emotional adjustment) and post-injury factors (pain, family support, stress) interact with cognitive functioning and significantly affect recovery from TBI. These problems are reviewed and discussed.
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224 (21%) of 1067 persons in a nonclinical population surveyed had one or more head injuries resulting in unconsciousness. They had a total of 306 head injuries with 113 (31%) of them resulting in lasting neurological effects. Both in a pilot project and in the main study, headache was the most commonly reported of an array of symptoms that are essentially a postconcussion syndrome.
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Using conventional MRI procedures, nuclear magnetic resonance (NMR) of brain water proton (1H) T2 relaxation times and EEG coherence were obtained from two independent groups of closed head injured (CHI) patients and a group of normal control subjects. Statistically significant intercorrelations were observed between 1H T2 relaxation times of the cortical gray and white matter and EEG coherence. The analyses showed that lengthened 1H T2 relaxation times of the cortical gray and white matter were related to: (1) decreased EEG coherence between short interelectrode distances (e.g., 7 cm) and increased EEG coherence between long interelectrode distances (e.g., 28 cm), (2) differences in EEG frequency in which T2 relaxation time was most strongly related to the gray matter in the delta and theta frequencies in CHI patients, and (3) increased T2 relaxation time and decreased short-distance EEG coherence were related to reduced cognitive function. The results were interpreted in terms of reduced integrity of protein/lipid neural membranes and the efficiency and effectiveness of short- and long-distance neural synchronization following traumatic brain injury.
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A review is presented of the currently sparse literature about EEG operant conditioning or biofeedback as a treatment to reduce symptomology and patient complaints following a traumatic brain injury. The paper also evaluates the general use of quantitative EEG (QEEG) to assess traumatic brain injury and to facilitate EEG biofeedback treatment. The use of an age matched reference normative QEEG database and QEEG discriminant function are presented as a method to evaluate the nature or neurological basis of a patient's complaints as well as to individualize an efficient and optimal feedback protocol and to help evaluate the efficacy of the biofeedback therapy. Univariate and multivariate statistical issues are discussed, different classes of experimental designs are described and then a "double blind" research study is proposed in an effort to encourage future research in the area of EEG biofeedback for the treatment and rehabilitation of traumatic brain injury.
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This article presents a new approach to the remediation of memory deficits by studying the electrophysiological functioning involved in memory and applying biofeedback techniques. A Quantitative EEG (QEEG) activation database was obtained with 59 right-handed subjects during two auditory memory tasks (prose passages and word lists). Memory performance was correlated with the QEEG variables. Clinical cases were administered the same QEEG activation study to determine their deviations from the values that predicted success for the reference group. EEG biofeedback interventions were designed to increase the value (to normal levels) of the specific electrophysiological variable that was related to successful memory function and deviant in the subject. Case examples are presented that indicate the successful use of this intervention style in normal subjects and in subjects with brain injury; improvement cannot be fully explained by spontaneous recovery, given the time postinjury. Five cases (two normal, two subjects with brain injury, and one subject who had stereotactic surgery of the hippocampus for seizure control) are presented. Improvements ranged from 68% to 181% in the group of patients with brain injury, as a result of the interventions.
Cognitive rehabilitation
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