Presented at a Bangladesh Child and Adolescent Mental Health (BACAMH) Conference at Bangabandhu Sheikh Medical University(BSMMU), Dahaka, Bangladesh to inform Health Professionals about Neurofeedbackand its therapeutic importance.

1. Neurofeedback:
A New Dimension of Treatment in
Neurobehavioral Disorders
Prof. Dr. MOK Wahedi
MRCP(UK), MRCPCH, MSc ECD, FRCPE

2. Child Development Experiences
 MSc in Early childhood development from BU
 Certified Training from Singapore in Neurofeedback
 Basic and Advanced level
 Qeeg and Brain Mapping
 Certified Training in Counseling by Parvartan (Bangalore, India)
 Basic and Advanced level
 Two year Neurofeedback experiences with special cases.
 Refresher training after one year in Singapore
 Affiliation with Spectrum Neurofeedback Institute, Singapore

3.  Computer Feedback Can Help Students With ADHD Train
Their Brains
 2/17/2014 For Release: February 17, 2014
 Neurofeedback, a type of training using a computer
program for children with attention-deficit/hyperactivity
disorder (ADHD), can contribute to lasting improvements for
these children, according to a study in the March 2014 issue of
Pediatrics, “In-School NeurofeedbackTraining for ADHD:
Sustained Improvement From a Randomized Control Trial,”
published online Feb. 17.

4.  CONCLUSIONS: Neurofeedback participants made more
prompt and greater improvements in ADHD symptoms,
which were sustained at the 6-month follow-up, than did
CT participants or those in the control group. This finding
suggests that neurofeedback is a promising attention
training treatment for children with ADHD.
Article
In-School Neurofeedback Training for ADHD: Sustained
Improvements From a Randomized Control Trial
Naomi J. Steiner, MDa, Elizabeth C. Frenette, MPHa, Kirsten M.Rene,
MAa,Robert T. Brennan, EdDb, and Ellen C. Perrin, MDa

5.  Neurofeedback (also called
Neurotherapy or EEG biofeedback) is a
way of training the brain to use more
productive patterns of brainwaves.
 Neurofeedback is direct training of
brain function by which the brain learns
to function more efficiently.
What is Neurofeedback ?

6.  It is the voluntary regulation of brain activity e.g.
arousal sleep/wake cycle, cognitive process, sensory
information, motor responses , mood and emotions,
memory etc.
 It is a non-invasive treatment, which teaches the
brain to self-regulate, strengthening neural pathways
increasing mental endurance and flexibility.
What is Neurofeedback ?

7. When we become aware of our own brain
activity – we can also change it .
When we are aware of Breathing,
Heart rate, Muscle tension
- we can change it.

8. Changing brain activity is a type
of brain exercise
Neurofeedback is the computer
based Brain exercise to improve
its own regulation

9. Brain regulates:
 Attention
 Behavior
 Mood
 Headaches/migraines
 Anxiety
Impulsivity
Thoughts
Anger
Empathy
Sleep

10. Frontal Lobe
Sensory Motor Strip
Temporal Lobe
Occipital cortex
Primary visual
cortex
Parietal Lobe
Broca’s area
Expression
Wernicke’s Area
Language and
speech
comprehension
Brainstem Cerebellum
Sensory Cortex
Motor Cortex

11. Attention, organization,
planning,
inhibition of impulsivity, focus
on task at hand, ability to
learn from experience
Pre-frontal lobe
Executive Functions
Emotional inhibition,
speech

13. Some problems of regulation
Inattentiveness
Impulsivity
Disorganization
Learning
disabilities
Poor social skills
Chronic stress
Depression
Anxiety
Fearfulness
Violent behavior

14. Neurofeedback
addresses problems of
Brain Deregulation.

15. • ADHD
•ASD and PDD.
• Learning Disorder
•Seizures
•Headache/ Migraine
• Anxiety/Depression
•PTSD
•Suicidal Behaviour
Neurofeedback works in

16. •Bed wetting
•Sleep walking, sleep talking
•Teeth grinding
•Nightmares
•Night terrors
Neurofeedback works in
Sleep problems :

17.  Within every human brain can be found different types of
brainwave patterns.
 Several types of brainwaves are present at any given time, but
each brain area has a predominant pattern reflective of the
current mental state.
 These patterns can be measured and recorded by an
electroencephalogram (EEG), which can then be used to make
a ‘map’ of an individual’s mental function.
Basis of Neurofeedback

18.  Beta waves: These are fast waves which occur when an individual is
attentive and focused.
 SMR waves: These are a subcategory of beta waves and are found in the
sensorimotor cortex when a person is quietly focused to prepare for a
physical challenge.
 Alpha waves: These are slower brainwaves which are commonly found
during relaxation. Alpha waves indicate the brain is ‘idling’
 Theta waves: These waves are slower than alpha and occur when an
individual is daydreaming or almost at the point of falling asleep.
 Delta waves: These are the slowest brain waves which occur during deep
sleep.
The five types of brain wave patterns

19. Basic EEG Morphology

20. Excesses or deficits of certain brainwaves in
different brain areas usually indicate a problem in
mental functioning.
Distinctive patterns are found in individuals with
problems such as ADHD, ASD, Learning
disorder ,Depression and Anxiety etc.
Basis of Neurofeedback

21. Distributions of Brain Wave in Disorders
 LD often appears as posterior
elevated delta
 ADHD often appears as elevated
frontal theta
 Depression often appears as
elevated central or frontal alpha
 Anxiety often appears as
elevated frontal beta often in
conjunction with diminished
alpha
 Depression often also appears as
more slowing on the left, while
anxiety appears as increased
activity on the right

22. Basis of Neurofeedback
Changing the EEG, brain waves
improves the brain regulation
When the brain works better, the
individual functions better

23.  ADHD often appears as elevated frontal
theta and the theta beta ratio is higher.
 Neurofeedback targets to reduce
frontal theta and the theta beta ratio.
Neurofeedback protocol: ADHD

24.  In a typical Neurofeedback session a client sits in front of a
computer screen.
 an electrode placed on the trainee’s head, with one or more
sensors positioned depending on the training protocol
enabling the computer to read the trainee’s brainwave
activity.
 The protocol means which frequency to be rewarded and which to
be inhibited, area of the brain to be trained.
 The frequencies targeted , and the specific locations on the
scalp listened in on the brain, are specific to the conditions
trying to address, and specific to the individual.
How Neurofeedback work?

26.  The trainee is instructed to watch on a computer screen and
make a game work.
 The video display on the computer will work while the
correct patterns of brainwaves are detected, and will stop or
fade if the unproductive patterns are being used.
 In this way, trainee’s brainwave activity, of which they are
usually unaware, becomes ‘visible’ to them.
 Gradually, learning of new brainwave patterns takes place –
one which is closer to that normally observed in individuals
without the problem.
How does Neurofeedback work?

27. Neurofeedback Equipments

28.  With repeated practice sessions, trainees become
more readily able to produce "healthier" brainwaves,
alleviating their symptoms.
 Once learned and solidified in training, the ability to
access these productive patterns of brain activity
generalises to everyday life, with changes in most
cases being permanent.
How does Neurofeedback work?

29. The good news is that almost any
brain, regardless of its level of
function, can be trained to function
better.
Neurofeedback

30. 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)

31. 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 the TOVA and an
ADD evaluation scale while taking Ritalin, only those
who had EEG biofeedback sustained those
improvements after discontinuing Ritalin.

32. Studies of Neurofeedback and
ADHD (continued)
The most study, in China (Xiong, Shi and Xu, 2005):
 60 ADHD children studied
 40 sessions of neurofeedback
 Over 90% significantly improved their scores on the
IVA-CPT (Integrated Visual and Auditory
Continuous Performance Test)

33. 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)

34. 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

35. 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)

36. 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).

37. 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 photic stimulation
 Sustained remission of the depression in all
25 patients in 20- 25 sessions
 All reduced or discontinued medication

38. Remember
 The function of your brain
determines your level of
consciousness and your
experience of the world.
 YOU are not your brain, not a
product of its collective
function nor its learned and
habitually expressed patterns
of behavior—these will
change over time.
 You should be running your
brain, not the other way
round!