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