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Fakulti Sains Kognitif dan Pembangunan Manusia
DEVELOPING SPEECH ASSISTIVE TOOLS FOR NEUROFEEDBACK TRAINING
Osvera Bella William
RJ 496 S7
Bachelor of Science with Honours (Cognitive Science) 2015
W719 2015
____ __ UNIVERSITI MALAYSIA SARAWAK
Grade: __~;1 Please tick one
Final Year Project Report ~
Masters 0 PhD 0
DECLARATION OF ORIGINAL WORK
This declaration is made on the 15 day of JUNE year 2015.
Student's Declaration:
I, OSVERA BELLA WILLIAM, 39945, FACULTY OF COGNITIVE SCIENCES AND HUMAN
DEVELOPMENT, hereby declare that the work entitled, DEVELOPING SPEECH ASSISTIVE TOOLS
FOR NEUROFEEDBACK TRAINING is my original work. I have not copied from any other students' work or from any other sources with the exception where due reference or acknowledgement is made explicitly in the text, nor has any part of the work been written for me by another person.
15TH JUNE 2015
Date Submitted Osvera Bella William (39945)
Supervisor's Declaration:
I, ASSOCIATE PROFESSOR DR. NURSIAH BTE FAUZAN , hereby certify that the work entitled, DEVELOPING SPEECH ASSISTIVE TOOLS FOR NEUROFEEDBACK TRAINING was prepared by the aforementioned or above mentioned student, and was submitted to the "FACULTY" as a *partiallfull fulfillment for the conferment of BACHELOR OF SCIENCE WITH HONOURS (COGNITIVE SCIENCE), and the aforementioned work, to the best of my knowledge, is the said student's work
15TH JUNE 2015 Received for examination by: Date: ___________
ESSORDR. NURSIAH BTE FAUZAN)
I declare this Project/Thesis is classified as (Please tick (-V»:
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I hereby duly affirmed with free consent and willingness declared that this said Project/Thesis shall be placed officially in the Centre for Academic Information Services with the abide interest and rights as follows:
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• No dispute or any claim shall arise from the student himself / herself neither a third party on this Project/Thesis once it becomes the sole property of UNlMAS.
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~. Student's signature: ___~~~---'-____
Date: 15TH JUNE 2015 Date:
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P. O. BOX 708, KAMPUNG TAGINAMBUR, 89158 KOTA BELUD, SABAH.
Notes: * If the Project/Thesis is CONFIDENTIAL or RESTRICTED, please attach together as annexure a letter from the organisation with the date of restriction indicated, and the reasons for the confidentiality and restriction.
Supervisor's signature: _---+--==_00<....---
I
I
Pusat Khidrnat Maklumat AkademH' UNlVERSm MALAYSIA SARAW-\J<
DEVELOPING SPEECH ASISSTIVE TOOLS FOR NEUROFEEDBACK TRAINING
OSVERA BELLA WILLIAM
This project is submitted in partial fulfilment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Faculty of Cognitive Sciences and Human Development UNIVERSITY MALAYSIA SARAWAK
(2015)
Pusat Khidmat Maklumat Akademik UNIVERSm MALAYSIA SARAVtAJ<
DEVELOPING SPEECH ASISSTIVE TOOLS FOR NEUROFEEDBACK TRAINING
OSVERA BELLA WILLIAM
This project is submitted in partial fulfilment of the requirements for a
Bachelor of Science with Honours (Cognitive Science)
Faculty of Cognitive Sciences and Human Development UNIVERSITY MALAYSIA -SARAWAK
(2015)
The project entitled 'Developing speech assistive tools for neurofeedback training' was prepared by Osvera Bella William and submitted to the Faculty of Cognitive Sciences and Human Development in partial fulfillment of the requirements for a Bachelor of Science with Honours (Cognitive Sciences)
Received for examination by:
~ (ASSOCIATE PROFESSOR DR~;:;-~5-;:~;;~)
Date: 15 JUNE 2015
Grade
A
11
ACKNOWLEDGMENTS
Firstly, I thank God for bringing this work to completion. I thank Him for giving me
the strength when I needed the most, courage when I thought that I could not go further
anymore, and knowledge when I lacked of confidence in my making decision. I am grateful to
Him for giving me the opportunity to study and work with my friends and lecturers who gives
me all kind of ideas and support me in finishing my thesis successfully.
To my supervisor, Associate Prof. Dr. Nursiah Fauzan, thank you for your guidance
for two semesters long and I appreciate your time, and effort that you have devoted in me
throughout this process. Thank you also for believing in me and for encouraging me
throughout this journey even though I always said that I do not have the confidence to
continue the research but you were there to support me and push me to my limits.
To my family especially to my parents, thank you for your unfailing love and support
to me. I would not have the urged to finish what I have started earlier. To my sisters and
brothers, thank you for your support and your understanding when I needed your help the
most. To my friend Fiqa, thank you for your loves and cares as my close friend, you always
there when I need your help, thank you for being such an understanding friend and mostly all
your encouragement when I felt down. My research partner Farhan, thank you for your
helped, kindness, patients and brilliant ideas when I am totally felt confused and completely
lost. And lastly, to all my friends and my relatives, thank you for all your endless help and
support in me. I greatly blessed to have you all in my life. God bless.
III
P~at Khidmat MakJumat Akademik flVERSm MALAYSIA SARAWA
TABLE OF CONTENTS
ACKNOWLEDGEMENTS ...................................................................................................... iii
LIST OF FIGURES ................................... ................................................................................. v
LIST OF TABLES .................................................................................................................... vi
ABSTRACT ............................................................................................................................. vii
ABSTRAK ................... ......................................... .. .................................................. .............. viii
CHAPTER ONE INTRODUCTION ....................... ................. .......... .. ..................................... 1
CHAPTER TWO LITERATURE REVIEW ............................................................................. 5
CHAPTER THREE METHOD................................................................................................ 17
CHAPTER FOUR RESULTS ..................................... .. ......... .............. .................................... 23
CHAPTER FIVE DISCUSSION .. .. ................................................. .. ...................................... 36
REFERENCES ........ .......... .................................................................................. ..................... 42
APPENDIX A INFORM CONSENT LETTER ...................................................... ........ ........ 46
APPENDIX B NEUROFEEDBACK RESULT TEST ............................................................ 48
IV
LIST OF FIGURES
Figure I Delta wave (0.1 to 3 Hz) ............................................................................................ 13
Figure 13 A numbers song to the ten little tunes designed to help children learn the names and
Figure 14 Participants' A Neurofeedback Training (NFT) result based on collected
Figure 15 Participants' B Neurofeedback Training (NFT) result based on collected
Figure I Theta wave(4-8 Hz)...... ....................... ........................................... ........................ 14
Figure 3 Alpha wave (8 - 12 Hz) ... ........... .. ................. ...... .... ............. .. .. ............. ......... .. ..... .... 15
Figure 4 Beta wave (above 12 Hz) .......................... ...................................... ....................... .... 16
Figure 5 Self-made Video Speech Toolkits for One Syllable in Bahasa Melayu ..... ... .......... .. 23
Figure 6 Self-made Video Speech Toolkits for Two Syllables in Bahasa Melayu ... ..... ......... 24
Figure 7 Self-made Video Speech Toolkits for Three Syllables in Bahasa Melayu ....... ...... ... 25
Figure 8 Five Little Ducks the traditional nursery rhyme .. ............................... ... ............ ........ 27
Figure 9 A song for children about some of the animals that you can see at the zoo ..... ........ 28
Figure 10 BINGO Song......... ...... .................. ......................... .. ........... ............ .. .... ...... ...... .... ... 29
Figure II A Phonics song to help children learn the letter sounds .... .................... .................. 30
Figure 12 A Shapes song for children ................................ ..... .. ..... ...... ........... .. .... ............ ...... . 31
the spelling of numbers ....... ........ ........ .................. ........................ ................ .. ....... ....... ........... 32
Electroencephalogram (EEG) data ... ......... ................. ... ...... .. .......... ... ......... ........ .. ....... ....... .. .. . 33
Electroencephalogram (EEG) data .................. ........ ......... .. ..... .. ........ ................ .................. ..... 34
v
LIST OF TABLES
Table 1 Procedures for Neurofeedback Training using Video Speech Toolkit ..... ........ .. ........ 20
Vl
ABSTRACT
Speech assistive tools are devices that help to enhanced children who are having a speech
delay problem. In this research, we developed a video speech toolkit that could help to
enhance the children speech. This study aims to determine the effectiveness of the speech
assistive tools in enhancing speech delay. The purpose of this study is to prove that there is
improvement in participant's speech after they undergoes several neurofeedback training
using the video speech toolkit. During training, participants were asking to watch and learn
according to the video speech toolkit, sing along while watch several video songs, and play
the neurofeedback games to train their relaxation during play. Both participants shows an
immense improvement in their speech and also changes in their behaviour during the
neurofeedback training. Both participants were also able to focus and give full attention
during the training which can be seen on their Electroencephalogram (EEG) neurofeedback
result.
Keywords: speech assistive tools, speech delay, video speech toolkit, neurofeedback training,
electroencephalogram (EEG)
Vll
ABSTRAK
"Speech assistive tools" merupakan salah satu alat yang dapat membantu menyelesaikan
sekaligus memperbaiki masalah pertuturan dalam kalangan kanak-kanak. Dalam kajian ini,
kami telah menyediakan satu video khas untuk kanak-kanak yang mempunyai masalah dalam
menghasilkan sesuatu pengucapan sebagai medium bagi memudahkan kanak-kanak tersebut
dapat menzahirkan pertuturan. Kajian ini dilaksanakan bertujuan mengkaji sejauh mana
keberkesanan sesuatu medium penghasilan pengucapan itu mampu memperbaiki masalah
dalam menzahirkan bahasa atau komunikasi dalam kalangan kanak-kanak. Selain itu, objektif
kajian ini juga untuk membuktikan bahawa terdapat penambahbaikkan dalam pertuturan pada
mereka yang mengalami masalah ini setelah menjalankan beberapa latihan tindak balas neuro
melalui kaedah video pertuturan ini. Sepanjang kajian ini dijalankan, subjek diminta untuk
menonton dan belajar menyebut sesuatu perkataan tersebut melalui video yang disediakan,
menyanyi bersama sambil menonton beberapa video berbentuk nyanyian, dan berrnain
permainan tindakbalas neuro bagi melatih ketenangan mereka ketika sedang berrnain. Hasil
kajian ini menunjukkan kedua-dua subjek memberikan keputusan yang positif dimana
terdapat penambahbaikkan dalam pertuturan dan juga terdapat perubahan pada tingkah laku
mereka setelah menjalankan latihan tindakbalas neuro ini. Tambahan itu, kedua-dua subjek
juga dapat memberikan tumpuan dan memberikan sepenuh perhatian sepanjang kaedah ini
dijalankan dimana dapat dilihat melalui output yang dihasilkan dan diinterpretasikan pada
Electroenpephalogram (EEG).
V III
CHAPTER ONE
INTRODUCTION
This study focuses on developing a speech assistive tool for neurofeedback training to
help children with speech disorder. Speech disorder also known as speech delay is the most
prevalent developmentally disabling disorder affecting children (Macias & Wegner, 2005).
Children with speech delays assumed by Macias & Wegner (2005) as 'late talkers' but soon
will catch up their language ability a bit later and it is not long-lasting. Around 30% of all
parents are concerned about their child speech and language skills when asked by their child's
physician despite the fact that their chi lid were naturally acquire normal language
understanding and expression (Macias & Wegner, 2005).
Early identification and management of this disorder is to minimize or eliminate the
social and educational problems that arise (Macias & Wegner, 2005). A long-term study
revealed by Macias & Wegner (2005) stated that 42.5% of young children whose early
language delays showed improvement in their speech. According to Macias & Wegner (2005)
also indicate that current prevalence estimates of speech and language delay in preschool
children range from 7 to 10% with significantly higher proportion of boys being affected.
One of the medium used to help in stimulating speech are Assistive Technology
(Proen~a, Quaresma, & Vieira, 2014). Producing an assistive tool for children with speech
disabilities is not necessarily the same as the one that built for the general public (Proen~a et
aI., 201 4). Journal of School Health article (as cited in Proen~a et aI., 2014) described that the
assistive tool should contribute in five keys areas which are generalizing, sequential skill
building, and control over the environment, continuous and efficient feedback and
multisensory approach to learning.
1
Brewer claimed (as cited in Isaila & Nicolau, 2010) that the existing of the Braille
display, the Braille keyboard, the electronic magnifiers and screen readers are people with
disabilities. Therefore a special category of assistive technology software were developed
based on general applications that seems useful and responsible in providing accessed to
computing and communication to several categories of users with difference disabilities
(Isaila & Nicolau, 2010). For this reason, there were two categories were included which are
voice recognition that function to allowed an automatic conversion of words given in the text,
and the vocal synthesis which together with screen reader is a way of interaction that offered a
countless of better information per time unit (Isaila & Nicolau, 2010).
PROBLEM STATEMENT
There are two problem statements found in this case study. The first one is an existing
speech assistive tools are developed for normal circumstances but not much are developed for
children with speech delay (Alper & Raharinirina, 2006) in which the development are
different from one another (Proenrya et aI., 2014).
Another problem statement found in this case study is almost every existing tool are
based on the western culture instead of local culture that consisted of our own language,
choice of words, and pronunciations (Moharir, Barnett, Taras, Cole, Ford-Jones, & Levin,
2014).
OBJECTIVES OF STUDY
The purpose of this study was to determine the effectiveness of implementing speech
assistive tools in enhancing speech among children with speech delay. Second objective is to
examine the improvement in children ability to enhance their speech after undergoing several
neurofeedback trainings with the help of speech assistive tools.
2
DEFINITION OF TERMS
Speecb Delay
Speech delay refer to problems in communication and related areas such as oral motor
function and it range from simple sound substitutions to the inability to understand or use
language or use the oral-motor mechanism for functional speech and feeding (Speech &
Language Impairments, 2004).
Assistive Tools
Any items, piece of equipment, or product system, whether acquired commercially,
modified or customized, that is used to increase, maintain, or improve functional capabilities
of individuals with disabilities (Alper & Raharinirina, 2006).
Neurofeedback Training
Neurofeedback training is a type of biofeedback that allows the individual to train and
influence brainwave patterns of the patients (McCulloch, 2011). It involves encouraging
desirable brain activity and inhibiting undesirable brain activity in patient's brain (Margetson,
2010).
Electroencephalogram (EEG)
According to Nunez study (as cited in Kaiser, 2005) EEG is a chaotic signal comprise
ofnon-periodic (spikes, 'random noise'), non-sinusoidal and periodic (mu), or sinusoidal and
periodic (alpha, delta) signals. EEG determines the electrical changes in our brain that
represent as spikes, transients, or seemingly random events and rhythms (Kaiser, 2006).
SIGNIFICANCE OF STUDY
This research will contribute in giving references to the area of special needs
education and specifically for speech disabilities children. It will also provide the parents with
3
a simpler and home based speech tool kits that will fill the gaps of the lack in speech
therapist. This research also will help to treat the children with speech disability using
appropriate assistive tools and also support into improving the awareness on the use of speech
tool kits with visual and auditory stimulus in stimulating speech production and phonology.
Apart from that, hopefully this research will also help those children whose suffers different
type ofdisorders and recognize this type of treatment as a new way to treat the disorders.
SCOPE OF STUDY
The scope of study in this research focused on two children diagnosed with speech
delay problem as our volunteered participants with the consent from their parents.
4
r
P~sat Khidmat MakJumat Akadem;tlJNJVERsm M,-\LAYSIA SARAW ,.
CHAPTER TWO
LITERATURE REVIEW
Speech and Language
Speech and language is a two difference basic understanding which Trevino-
Zimmerman (2006) explained that speech is the ability towards emitting a speech sound while
language is the cognitive system which allow a person to understand the language system.
According to NIDCD Fact Sheet: Speech and Language Development Milestones (2010),
speech refer to as talking which is one way to express language and it involve coordinated
muscle actions of the tongue, lips,jaw, and vocal tract to produce the recognizable sounds
that make up language.
Macias & Wegner (2005) explain that speech produced a complex acoustic signal that
conveyed a meaning and is the result of interactions involving the respiratory, laryngeal, and
oral structure. This acoustic signal according to Macias &Wegner (2005) differs with regard
to vocal pitch, intonation, and voice quality of a person. Macias & Wegner (2005) further
explained that language implied both expressive and receptive components where expressive
language involved the interaction between ideas, intentions and also emotions. In contrast,
receptive language have to with the interpretation and understanding what is said by someone
else which include the auditory comprehension (listening), literate decoding (reading), and
gain control of visual signing (Macias & Wegner, 2005).
Speech and Language Disability
A speech disorder based on Macias & Wegner (2005) described that it indicates the
difficulty in creating a proper sounds that corresponds to the language symbols (the words),
and as for that reason, communication is impaired. Several problems in speech disorder
5
include speech fluency disorder (stuttering), voice disorders, and articulation disorders but
then again speech disorder mayor may not also involve the weaknesses in expressive
language (Macias & Wegner, 2005). Hence, speech disability or speech disorder is when a
children having trouble producing speech sounds correctly or who hesistate or stutter when
talking to another person (NIDCD Fact Sheet: Speech and Language Development
Milestones, 2010). Other term refer to speech disability is apraxia of speech that makes the
person having the difficulty to put sound and syllables together in the correct order to form
words (NIDCD Fact Sheet: Speech and Language Development Milestones, 20 I0).
Based on Westerlund's study (as cited in Selassie, 2010), around 15% of all children
are affected by speech and language delay where parents had to take their children to be
referred to a speech language pathologist. In Law }'s research (as cited in Selassie, 2010) also
stated that several studies had showed a gender ratio of two boys to one girl were affected.
Several previous studies by Fernell, Westerlund, Conti-Ramsden and Hesketh, Webster and
Shevell, Bruce, and Miniscalco's (as cited in Selassie, 2010) have shown that subtle sign of
neurodevelopmental dsyfunction often follow the speech and language impairment.
Futhermore, Gilbert and Miniscalco's research (as cited in Selassie, 2010) also stated that
language disorder often found in children with attention deficit hyperactivity disorder
(ADHD) and autism spectrum disorder (ASD). In Cohen's study (as cited in Selassie, 2010)
also stated that ADHD is the most common additional disorder present in language
impairment.
Moharir et al. (2014) stated that there are four types of speech disorders are addressed
by the tool which are voice disorders, motor speech disorders, articulation delays, and
dysfluency (stuttering). These four types of speech disorders are described in the next
paragraph.
6
Voice Disorders. Voice disorder is an atypical change in voice quaility like rough and
harsh sound and / or a harsh vibrating noise when breathing, which may indicate vocal-fold
pathology (eg. Nodules, paralysis) or a more complex disease process (Moharir et aI., 2014).
At this moment, Moharir et ai. (2014) suggest that the childs are not encourage to reduce his
or her vocal abuse and stress.
Motor Speech Disorders. Motor speech disorder also called as childhood apraxia of
speech (CAS) which the child has difficulty producing sounds, syllables or words (Childhood
Speech and Language Disorders, n.d.). Instead of not having muscle weakness that affects the
speech production, according to Childhood Speech and Language Disorders, (n.d) there is a
breakdown in the childrens' center of the brain that plans the muscle movements needed for
speech.
Another causes of motor speech disorder is dysarthria which characterized by poor
strength and mascular control causing poor intelligibility and a slower rate of speech, and may
involve compromised velopharyngeal function resulting in hyper or hyponasal speech
(Moharir et aI., 2014). Patient history may include feeding difficulty, drooling, open-mouthed
posture and tongue protrusion and the cause of these impairment is characterized by
inaccurate and inconsistent orofacial movements critical to the production of intelligible
speech (Moharir et aI., 2014).
Articulation Delays. Articulation delays by means is a poor speech intelligibility
characterized by omissions, substitutions or additions of individual sounds, or that the child
has not acquired target sound by the appropriate age (Moharir et aI., 2014). In the study by
Moharir et al. (2014) stated that these delays are appropriate for clinical identification if they
remain present in children approaching three years of age, but if it is not present after the age
then an articulation delay is present.
7
Dsyfluency. Dsyfluency or stuttering usually associated with tension, struggle, and
sudden repetitive, nonrhythmic motor movements (tics), impediments to the flow of speaking,
and irregular rate, rhythm and repetition of words (Moharir et aI., 2014). According to
Moharir et aI., (2014) dysfluency are typically normal development variants in children with
onset before three years of age, but should be identified for referral and monitored if there is
an impairing communication function or onset occurs after three years ofage.
Assistive Tools Used for Speech Disability
Assistive tools device based on Individual with Disabilities Education Act (as cited in
Hasselbring & Bausch, 2005) describes it as any items, piece of equipment, or product system
that used to increase, maintain, or improve functional capabilities of individuals with
disabilities. Other terms of assistive devices or assistive technology can refer to any device
that helps a person with hearing loss or a voice, speech, or language disorder to communicate
(Assistive Devices for People with Hearing, Voice, Speech, or Language Disorders, 2011).
Based on Hasselbring & Bausch (2005), assistive technology devices and services
form such high-tech innovations as computer screen and readers for people with visual
impairments to lower-tech products, such as head pointers or pencil grips; have aided learning
for many students with physical impairments. Previous study from the National Assistive
Technology Research Institute (NA TRI) had examined the use of assistive technology in 10
states in United State of America in 2005 and found that. assistive technologies are much
likely to be used by students in low-incidence special education categories such as autism,
hearing impairment, or visual impairment than by students with learning disabilities
(Hasselbring & Bausch, 2005).
Based on the Assistive Technology Act's finding stated that substantial progress has
been made in the development of assistive technology devices, including adaptations to
8
existing devices that facilitate activities of daily living, which gives benefit to individuals with
disabilities (Alper & Raharinirina, 2006). The main purpose of assistive technology paradigm
is to help the children with multiple disabilities in their play, to be a useful tool in the context
ofrehabilitation and to facilitate this process also at home (Proen9a et aI., 2014).
However, despite the increased attention and awareness of the potential Assistive
Technology to help individuals with disabilities; there still several barriers remain according
to Alper & Raharinirina (2006). First, Zhang's study (as cited in Alper & Raharinirina, 2006)
stated that accessible technologyis unavailable to many students with disabilities and their
family. Norman's observation (as cited in Alper & Raharinirina, 2006) explained that not all
groups have equal access, primarily due to limitied financial resources. Second, Wehmeyer's
explained (as cited in Alper & Raharinirina, 2006) the high costs of equipment and lack of
funding to access devices or services, and also lack of information regarding Assistive
Technology for families of individuals with disabilities. Third, a professional's that lack of
knowledge about the assistive technology (Alper & Raharinirina, 2006). Fourth, lack of
ongoing support can constitute (Alper & Raharinirina, 2006); and fifth, according to
Wehmeyer (as cited in Alper & Raharinirina , 2006) the eligibility issues are often important
obstacles, and have led to the underutilization of Assistive Technology by individuals with
disabilities.
Yamada, Javkin, & Y oudelman (2000), explained that there are fews features of a
number ofexisting speech training system in the United States and Japan and the majority of
speech aids are designed to assist in the training or remediation of speech production.
According to Yamada et aI., (2000), the most comprehensive system available in the US is
Kay Elemetrics's set of programs that designed as much as for research at it is for therapy.
Fletcher's explained (as cited in Yamada et aI., 2000) that it is include the sophisticated tools
9
for the measurement of the acoustics of speech. There a few number of existing speech
training that had been use as decribed below.
Speech Viewer III (IBM). The system did not use separate instruments and it
includes games that provide practice for children in speech such as pitch, amplitude, duration,
and voicing (Yamada et al., 2000). Any phoneme can be included on the basis of the training
by the therapist (Yamada et al., 2000).
Idioma (Granot). Based on Yamada et al., (2000), ldioma (Granot) system were
designed for training in the articulation of phonemes and phonemic contrasts. The system also
uses speech recognition which is speaker independent within gender and age categories,
utilizing a switch for a male, female or child's voice (Yamada et al., 2000).
Dr. Speech (Tiger Electronic / Laureate). Yamada et al., (2000) explained that
thissystem is a suite programs, which avalible separately and require a separate pre-amplifier.
Similar to mM system, the system can be trained with models by the therapist, with the result
that any phoneme can be trained can be included (Yamada et al., 2000).
VideoVoice (Micro Video). According to Yamada et al., (2000), this system provides
a games for pitch, amplitude, duration, voice-onset, and permits the training of models created
by the therapist to be matched by the client and it is one of the few systems available for both
Macintosh and pc.
Video Prism (Language Vision). Yamada et al., (2000) described this system is
designed for sophisticated users and therapists where the waveform and spectrographic data
are displayed using various colors that correspond to pre-set colors on a vowel chart.
10
Neurofeedback Training & Quantitative Electro Encephalogram (QEEG)
Neurofeedback also name biofeedback or neurotheraphy is a form of modification of
electrical brain activity which involve in encouraging the desirable brain activity and
inhibiting undesirable brain activity (Margetson, 20 I 0). Neurofeedback training were
described as a painless, non-invasive method which helps the patient to modify their
brainwave activity to improve attention and concentration, reduce impulsivity, and to control
hyperactive behaviors, essentially the technique trains the brain to regulate and adjust itself to
function more effectively (Margetson, 20 I 0). Neurofeedback aims to teach the brain to help
to improve its ability to manage bodily functions, and to self-regulate (Margetson, 20 I 0) by
make use of brain-computer interface to rebalance the brain and central nervous system
(McCulloch, 20 II). Margetson (20 I 0) study also stated that by challenging the brain same as
like challenging the body during exercise suggest that the brain can be trained to learn to
function more effectively.
Neurofeedback training consists of three stages which are the initial assessment
includes a quantitative electro encephalogram (qEEG) assessment, a clinical interview, and a
nnge of standard neurophysiological tests and questionnaires (Margetson, 2010). When in
early training. patient will showed an improvement in energy and mood with the development
ofa more positive outlook, thus this rapid improvement can be seen in as few as three or four
training sessions (McCulloch, 2011). Training session usually required patient to attend a
eeldy training for two or three sessions which last for about 30 minutes each, but to get a
lasting improvement in result; there should be at least twenty sessions to be attended
(McCulloch, 2011).
Based on Hammond (2011) study, during neurofeedback training there will be one or
more electrodes are placed on the scalp and one or two are usually put on the earlobes. The
11
electrodes will records electrical activity within the brain from 24 channels which gives us the
ability to view the dynamic changes throughout the brain during processing tasks and assists
us in determining which areas of the brain are fully engaged and processing inefficiently
(QEEG Brain Mapping: An Innovative Diagnostic Tool for Neurological and Behavioral
Disorders, n.d.).
The advantage of using neurofeedback training with patient is that they frequently
report feeling greater resilience and flexibility. McCulloch (2011) study shows that improved
resilience means that they may be upset by a disturbing event, the duration of the upset
feelings will be shorter or the feeling may be mild. Another study also stated by McCulloch
(2011) that improved mental flexibility means decreased tendency to feel stuck in old patterns
and openness to new ideas which gives the brain the ability to react to new situations more
readily and efficiently.
A quantitative electroencephalogram (QEEG) in other means as topographic EEG, or
brain electrical activity mapping (BEAM), is a visual of enhancement of a traditional surface
EEG (Quantitative Electroencephalogram (QEEG), 2006). The EEG data were transformed
into a pictorial mapping then placed on schematic map of the brain, and the activity data is
analysed by comparing to a database of normal patient brainwave activity to determine
possible underlying medical conditions (Quantitative Electroencephalogram (QEEG), 2006).
Electroencephalogram (EEG) is a physiological indicator of brain activity and is a
non-invasive recording of the activity of the brain at different locations on the outside surface
of the scalp (Margetson, 2010). Electroencephalogram (EEG) is useful in the evaluation
involving patient with several types of neurological disorder namely seizure, encephalopathy,
andfocal cerebral abnormalities (Quantitative Electroencephalogram (QEEG), 2006).
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