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  2. 2. Biofeedback  Uses sensitive electronic instruments to detect physiological changes with far greater sensitivity than a person can alone.  This information is used to teach the individual to control their physiology
  3. 3. Biofeedback Modalities  Muscle (EMG)  Temperature  Heart rate  Respiration  Skin Conductance (GSR)  Brainwave (Neurofeedback)
  4. 4. Neurofeedback Training the electrical activity and timing of the brain to improve brain functioning
  5. 5. The first major neurofeedback study was done with cats by Dr. Barry Sterman …
  6. 6. Experimental Work of Barry Sterman, Ph.D.  Sterman trained cats to increase their SMR (12-15hz) through operant conditioning  Showed that cats could be trained to increase SMR  Published in Brain Research, 1967
  7. 7. Dr. Sterman’s Next Study  Studied seizure thresholds for cats’ exposure to rocket fuel.  Some of the cats did not have seizures at the known threshold levels.  Dr. Sterman checked his records and found the seizure resistant cats were the ones who had SMR training.
  8. 8. Sterman’s Work With Humans  Dr. Sterman then decided to investigate whether neurofeedback would help humans with seizure disorders.  His studies showed a decrease in seizure severity and frequency with SMR training.  Patients with seizure disorders who also had ADHD showed an improvement in ADHD symptoms, which led to studies of neurofeedback with people with ADHD.
  9. 9. Characteristics of Brainwaves  Frequency (hertz)  Amplitude (microvolts)  Coherence (under or over- differentiation)  Location (10-20 System)
  10. 10. 10-20 system  The International 10-20 System of Electrode Placement is the most widely used method to describe the location of scalp electrodes.  Each site has a letter (to identify the lobe) and a number or another letter to identify the hemisphere.  
  11. 11. 10-20 System
  13. 13. A disregulated brain often has too much slow activity.
  14. 14. This individual’s eyes are open. Their brain isn’t very alert and awake.
  15. 15. This brain is alert and awake. In EEG terms, smaller means more regulated, better functioning.
  16. 16. Delta .5-4 Hz  Predominant in sleep  Should be low while awake  High delta can interfere with emotional or cognitive processing One second
  17. 17.  Pre-sleep, trance  Inattentive  Distractible  Lack of focus One second Theta 4-8 Hz
  18. 18.  Relaxed (parietal)  Spacey  Unmotivated  Inattentive and depressed One second Alpha 8-12 Hz
  19. 19.  Calm, external attention  Regulates impulsivity and hyperactivity  Promotes body awareness  Helps control anxiety; anger  Movement Inhibition SMR 12-15 Hz One second
  20. 20.  Active, external attention  Enhances cognitive processing  Improves concentration, attentiveness, focus One second Beta 15-20 Hz
  21. 21. One second  Body tension  High state of arousal  Excited / anxious / stressed High Beta 22-36 Hz
  22. 22. Ultra-Low Frequency Training  Bipolar training at less than 1hz, sometimes as low as .001hz  Dealing with brain “tides” rather than waves  Primitive brain stem rhythm has global effects on brain functioning  Still controversial in the field  Excellent results for chronic, severe overarousal and brain dysregulation in general
  23. 23. Protocol Selection Functional  Based on presenting symptoms and areas of the brain known to be related to these symptoms or based on functions you want to improve. QEEG  Measurement of amplitudes, frequencies and connectivity measures at 19 sites  Results compared to normative data bases  Sites 2 standard deviations or more from the mean are targeted for training if they relate to symptoms or functional improvements desired.
  24. 24. Current Clinical Uses  ADHD  Seizure disorders  Alcoholism/substance abuse  Traumatic brain injury  PTSD  Anxiety  Depression  Chronic Fatigue Syndrome  Fibromyalgia  Chronic Pain  OCD  Tourette’s Syndrome  Sleep disorders  Autism  Asperger’s  Bipolar disorder  Reactive attachment disorder  Peak Performance  Age related memory loss  Parkinson’s  Migraines  PMS  Schizophrenia
  25. 25. Studies of Neurofeedback and ADHD  Several uncontrolled studies showed that neurofeedback:  Improved attentiveness and impulse control  Decreased hyperactivity  Raised intelligence scores  Improved academic performance (Grein-Yatsenko et al., 2001; Lubar, Swartwood, Swartwood & O’Donnell, 1995; Thompson & Thompson, 1998)
  26. 26. Controlled studies comparing neurofeedback to other treatments for ADHD Alhambra, Fowler and Alhambra (1995):  After 30 sessions of neurofeedback, 16 of 24 patients taking medications were able to lower their dose or discontinue medications totally Monastra, Monastra and George (2002)  studied 100 children with ADHD receiving Ritalin, parent counseling and academic support. 50 children also received neurofeedback.  While all children improved on tests of attention and an ADD evaluation scale while taking Ritalin, only those who had EEG biofeedback sustained those improvements after discontinuing Ritalin.
  27. 27. Studies of Neurofeedback and ADHD (continued) Chinese study (Xiong, Shi and Xu, 2005):  60 ADHD children studied  40 sessions of neurofeedback  Over 90% significantly improved their scores on standardized attention tests
  28. 28. Meta-analysis of studies of neurofeedback treatment of ADHD  Arns et al, 2009  Evaluated 15 well designed studies involving 1194 children with ADHD  Found neurofeedback to be effective for inattention, impulsivity and hyperactivity  Concluded that neurofeedback is a proven treatment for ADHD at the highest scientific level
  29. 29. Compare results to multimodal treatment study of ADHD  Long term study funded by NIMH of psychotherapy and stimulant medication (Molina et al, 2009)  Study now in eighth year  In 2009, reported that children who received stimulant medication and/or psychotherapy were no better off after two years than children with ADHD who were never treated  Stimulants were found to stunt growth  FDA requires stimulants to have warning labels for increased suicidality and sudden cardiac death
  30. 30. Safe and permanent  Neurofeedback has no adverse effects when administered by an appropriately trained professional  Effects appear to be permanent
  31. 31. A Meta-Analysis of 19 Studies of EEG Biofeedback for Epilepsy (Sterman MB, 2000)  82% of studies demonstrated significant seizure reduction  Average reduction exceeded 50%  Studies reported reduction in seizure severity  About 5% of patients had complete control at one year follow-up
  32. 32. QEEG-guided Neurofeedback for Seizure Disorders  Johnathan Walker, MD “trains away” QEEG-identified abnormalities of power (amplitude) and coherence and reports a 100% success rate in patients with partial complex seizures  All patients became seizure free and many were able to stop their anticonvulsant treatment (Walker and Kozlowski, 2005)
  33. 33. Studies of Neurofeedback for Traumatic Brain Injury  Neurofeedback appears to improve memory in persons with brain injury (Thornton, 2000).  Neurofeedback improves attention and response accuracy of a performance task and decreases errors in a problem solving task (Tinius & Tinius, 2000).  Another study showed significant improvement in attention deficits in those receiving neurofeedback compared to a matched control group (Keller, 2001).
  34. 34. Studies of Neurofeedback for Autistic Spectrum Disorders  12 children receiving an average of 36 sessions of neurofeedback based on functional deficits reduced autistic symptoms by 26% (Jarusiewicz, 2002)  37 children receiving 20 sessions of QEEG-guided neurofeedback showed a 40% decrease in autistic symptoms compared to a control group (Coben and Padolsky, 2007)  7 children receiving 40 sessions of SMR/beta biofeedback significantly improved executive function, communication and social behavior (Kouijzer, 2008)
  35. 35. Clinical Reports - Depression Cory Hammond, Ph.D., Professor of Physical Medicine & Rehabilitation, University of Utah School of Medicine:  Treated 25 patients with moderate to severe depressive disorder  Reduced left frontal alpha and increased 12- 20hz. Also utilized light stimulation  Sustained remission of the depression in all 25 patients in 20- 25 sessions  All reduced or discontinued medication
  36. 36. Clinical Reports – Bipolar Disorder Ed Hamlin, Ph.D., at the Pisgah Institute in Asheville, North Carolina:  Treated about 40 patients with bipolar disorder  Interhemispheric protocol, increasing 11-14 or 13-16hz while inhibiting low frequency and high frequency brainwaves.  All of his patients have been able to stabilize mood and improve functioning while decreasing or eliminating medication.
  37. 37. Peak Performance Applications  Improves concentration and memory  Enhances creativity and problem solving  Calms performance anxiety  Reduces extraneous movement  Builds confidence
  38. 38. Enhancement of learning in normal subjects  Improved attention in normal college students (Rasey 1996)  Improved memory and attention in normal adults (Vernon 2003)  Improved cognitive processing speed and executive function in the elderly (Angelakis 2007)
  39. 39. Enhanced Musical Performance  Alpha/theta training significantly improved musical performance by music students, as judged by independent raters (Egner & Gruzelier, 2003)
  40. 40. Enhanced surgical skills  SMR training of National Health Service trainee opthalmic microsurgeons produced significant improvement in surgical technique and reduced surgical time by 26% (Ros, 2009)
  41. 41. Improved Athletic Performance  The Italian soccer team has a “Mind Room” where players routinely go to practice neurofeedback for performance enhancement. They credit neurofeedback for helping them win the World Soccer Cup.
  42. 42. Improved Athletic Performance  NBA player Chris Kaman was misdiagnosed with ADHD at age 2 and was on Ritalin from age 2-1/2 through high school. He hated taking it and it didn’t help  Discovered through neurofeedback assessment that he had an anxiety disorder, not ADHD  Credits neurofeedback with significantly improving his game  Finds it helps him be less impulsive off the court too
  43. 43. Typical Neurofeedback Session  Twice a week sessions  30-45 minutes of feedback  Auditory and visual rewards (video game, animation or movie)when achieving thresholds  Typically 20-50 sessions to complete treatment
  44. 44. Game: Space Race
  45. 45. "In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used…It is a field to be taken seriously by all." (Editorial, Clinical Electroencephalography, January 2000) Frank H. Duffy, M.D., Professor and Pediatric Neurologist, Harvard Medical School, wrote about neurofeedback:
  46. 46. Time Magazine, 1/19/07  “For decades the prevailing dogma in neuroscience was that the adult human brain is essentially… hardwired, fixed in form and function so that by the time we reach adulthood we are pretty much stuck with what we have….The doctrine of the unchanging human brain has had profound ramifications. For one thing, it lowered expectations about the value of rehabilitation for adults who had suffered brain damage from a stroke or about the possibility of fixing the pathological wiring that underlies the psychiatric diseases….But research in the past few years has overthrown the dogma. In its place has come the realization that the adult brain retains impressive powers of ‘neuroplasticity’—the ability to change its structure and function in response to experience. The brain can be rewired.”
  47. 47. : International Society for Neurofeedback and Research. This site contains a comprehensive bibliography of outcome research in neurofeedback, organized by disorder, as well as journal articles, provider list and other information. National credentialing organization for biofeedback providers. Includes information on providers and standards. Association for Applied Psychophysiology and Biofeedback is the national biofeedback organization. Includes information and a provider list. Resources: Web Sites
  48. 48. Resources: More websites   
  49. 49. Resources – Books  A Symphony in the Brain by Jim Robbins,  Getting Rid of Ritalin by Robert W. Hill, Ph.D and Eduardo Castro, M.D  ADD: the 20 Hour Solution by Mark Steinberg, Ph.D. and Siegfried Othmer, Ph.D., Robert D.  Awakening the Mind: A Guide to Mastering the Power of Your Brain Waves by Anna Wise
  50. 50. Contact Information Cindy Perlin, L.C.S.W. (518) 439-6431
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