NEUROFEEDBACK Treats Neurodevelopment Disorders

NEUROFEEDBACK
New Dimension of Treatment of
Neurodevelopment Disorders
including AUTISM

Professor of Paediatrics
Certified in Paediatric Neurology,
British Paediatric Neurology Association (BPNA)
Neurofeedback Clinician, SBCIA, Singapore
Consultant Paediatrics and Early Childhood Development
Guest Professor, BRAC University ,
Institute of Education Development
Email: mokwahedi@gmail.com
https://wahedimok.wordpress.com
Presented By
Prof. Dr. MOK Wahedi
MBBS(BD), DCH(Hon’s)Ire, MRCP(UK), MSc ECD,
MRCPCH(UK), FRCP(Edin)

 Affiliated with Spectrum Learning Asia,
Singapore
 Member Asia Pacific Neuro-Biofeedback Association
(APNA)
 Member Institute of Neural Regulation and
Research(ISNR), USA
 Affiliate Member Brain Master Technologies, USA
 Contact: Tel: +8801977226840
 Email: Spectrumneurology@gmail.com
Spectrum Neurology & Neurofeedback
Centre (SNNC)
Started on 12/12/12

“The whole of man’s life stands
in need of a right rhythm.”

 In the late 1960s and 1970s, researchers discovered
that it was possible to recondition, retrain or learn
different brainwave patterns.
 Some of this work began with training to increase
alpha brainwave activity to increase relaxation, while
other work originating at UCLA focused on
uncontrolled epilepsy.
This brainwave training is called
Neurofeedback or EEG biofeedback .
Introduction

In 1926, Hans Berger developed
one of the first devices to record an
EEG. The device virtually filled a
room and made a rudimentary
recording. It was known that the
brain produces electrical signals in
an oscillating wave form, though the
process was not clearly understood.
Basis of Neurofeedback

 BRAIN WAVES
 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.

Predominantly there are five types of Brain waves
 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.
Types of brain wave patterns

Basic EEG Associations
 Beta waves 15-36hz
 High beta is associated with
anxious hyperactive thinking
 Low beta is associated with alert
active things
 SMR 12-15 hz
 Associated with external focus
 Alpha waves 8-12hz
 Associated with relaxed awareness
 Theta waves 4-7hz
 Associated with internal focus
 Delta waves .5-4hz
 Associated with deep, dreamless
sleep

Arousal Theory & EEG
 Alpha Waves
- Thalamus
- Attention & self awareness
 Beta Waves
- Cortex
- Processing
 Theta Waves
- Limbic System
- Memory & emotions
- Coordination of processing
 Delta Waves
- Brain stem
- Continuity & sleep

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

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

Brain Surface Locations
10-20 systems

10-20 International System of Electrode Placement

*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.

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

•When the brain is not functioning well, evidence of this
often shows up in the EEG (Electroencephalogram).
•EEG reveals not what is thought, but shows the context
in which thinking takes place –state of arousal, state of
vigilance and alertness, etc.
•Neurofeedback is a technique in which one trains the
brain to help improve its ability to regulate all bodily
functions and to take care of itself.
What does EEG tell us?

 Individual trains their brains to produce optimal brain
waves in definite functional brain areas through
neurofeedback and corrects spectral power, asymmetry,
coherences and phase differences in all frequency Bands
How Brain is Regulated

Some cats that were in a research study
related to NASA got it started

Experimental Work of
Barry Sterman, Ph.D.
 Barry Sterman trained
cats (and later
monkeys) to increase
their SMR through
operant conditioning.
 Cats could increase
an EEG rhythm in the
range of 12-15 Hz, with
a peak at 14 Hz (Brain
Research, 1967)

Sterman’s original 1967 Study for NASA -
Cats exposed to rocket fuel
NASA Rocket fuel
Avg 2 hours+ for seizures
with EEG trained cats
vs. 1 hour for normal cats
Time

 Neurofeedback or is a direct training of brain waves by which
the brain learns to function more efficiently. It's based on the
idea that you can consciously alter the way your brain functions
using real-time displays of your brain's electrical activity (known
as brainwaves). It is also called EEG (Electroencephalogram)
Biofeedback.
 It is non-invasive and a drug-free treatment , it teaches the
brain to self-regulate, strengthening neural pathways while
increasing mental endurance and flexibility.
What is Neurofeedback ?

Sterman’s Research On Alpha & Arousal
 Pilots who were able to
consistently return to a
resting alpha state after
engaging a task had greater
stamina and performed better
than pilots who did not
(Sterman, 1995)

 Neurofeedback (NF) is a technique of a self-regulation,
the current parameters of EEG recorded from a
subject’s head is presented to the subject through
visual, auditory, or tactile modality, where the subject
is supposed voluntary or involuntary alter these
parameters to reach a more efficient mode of brain
functioning.

 It is a kind of biofeedback, which teaches self-control
of brain functions to subjects by measuring brain
waves and providing a feedback signal.
 Neurofeedback usually provides the audio and or
video feedback. Positive or negative feedback is
produced for desirable or undesirable brain activities,
respectively.

 Over the last 20 years, neurofeedback has been used to treat
various neurological and psychiatric conditions, and to improve
cognitive function in various contexts.
 It has been found to produce symptom relief and changes in
brain activity that endure over time in neuropsychological
disorders.
What is neurofeedback?

 Neurofeedback is an approach that aims to help
individuals alter brain activation without introducing
electrical or magnetic activity, or pharmacological
compounds into the brain. It alters brain activity
intrinsically.
What is neurofeedback?

 Neurofeedback
•Teaches clients how to control their brain waves. This
procedure yields permanent results.
•Once a person is taught to control their brain waves,
they have control over them indefinitely.
What Neurofeedback does

 •The brain is highly adaptable and has great
plasticity. Thus it has an innate capacity to change,
learn and improve performance.
 •EEG makes information available to the brain about
how it is functioning and thus making adjustments.
Basis of Neurofeedback

 Nerofeedback trains voluntary regulation of brain
activity e.g. arousal sleep/wake cycle, cognitive
process, sensory information, motor responses ,
mood and emotions, memory etc.
Basis of Neurofeedback

 Biofeedback is a technique for achieving voluntary control of
functions which are normally regulated autonomously( without
conscious awareness) e.g. pulse ,BP, hear trate.
 EEG biofeedback is the voluntary regulation of brain activity e.g.
 Modulation of levels of arousal sleep/wake cycle
 Organization of cognitive process
 Normalization of processing of sensory information
 Inhibition of inappropriate motor responses
 Management of mood and emotions
 Organizations of memory
Biofeedback-Neurofeedback
NEUROBIOFEEDBACK

 •Managing attention (ADHD) and emotions
(traumatic experience)
 •Developmental disabilities in children (ASD)
 •Improvement of IQ and academic performance
 •Help with anxiety and depression
 •Migraine, sleep disorders or chronic pain
 •Addictions, post traumatic stress disorder
 •Can be utilized without limit to enhance
performance –professional athletes, corporate
executives and performing arts
Where neurofeedback is applied?

Organic injury to the brain
•Stroke, traumatic brain injury, birth injury, seizures,
dementia, cerebral palsy, and fetal alcohol syndrome.
•Neurofeedback doesn’t claim to cure the ailment but
rather to improve towards normal functioning

When we become aware of our own brain
activity – we can also change it .
The is the essence of Biofeedback
When we are aware of Breathing,
Heart rate, Muscle tension
- we can change it.

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

What Brain regulates?
 Attention
 Behavior
 Mood
 Emotions
 Anxiety
 Consciousness
 Arousal
Impulsivity
Thoughts
Anger
Empathy
Sleep

Neurofeedback
addresses problems of
Brain Deregulation
Training the electrical activity and
timing of the brain to improve brain
functioning

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

• ADHD•ASD. • Learning Disorder
•Epilepsy & Seizures
• Depression• Suicidal Behaviour
•PTSD • Anxiety Disorders
•Cerebral Palsy •Downs Syndrome
• Strokes, Alzheimer's & Dementia
•Headache/ Migraine
•Addiction & Drug Abuse
• Insomnia & Sleep disorder
Neurofeedback works in

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

 •Can be utilized without limit to enhance
performance –professional athletes, corporate
executives and performing arts
 Organic injury to the brain
 •Stroke, traumatic brain injury, birth injury, seizures,
dementia, cerebral palsy, and fetal alcohol syndrome.
 •Neurofeedback don’t claim to cure the ailment but
rather to improve towards normal functioning
What neurofeedback can do

Neurofeedback Process
How neurofeedback is Given

 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?

 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?

 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?

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

Research & Publications
What neurofeedback Treats

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)

 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.

 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

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.

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)

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)

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

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)

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).

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

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!

Neurofeedback in Bangladesh
NEUROFEEDBACK
?????
UNKNOWN IN
BANGLADESH

Outcome of My experience
ADHD :Very good response; Increases attention, Reduces
Hyperactivity, Improves School performances
AUTISM: Rewarding. Reduces Hyperactivity and Tantrum
to minimum, Improves cognition, Social Adaptation;
Alleviates repetitive behavior's; Improves Speech and
nonveral communication
EPILEPSY: Reduces frequency of Seizure, prolongs seizuire
free periods
Depression, Anxiety Disorder: Heals almost completely
C P & Downs Syndrome: Improves Cognition, speech and
Vocabulary

Comments of My Experience
Peopledoes not know about Neurofeedback
 Parents to take up anything that would help their
children.
 Neurofeedback is expensive
Long duration Therapy
 Results not always obvious, feel hesitant

 Autism a national priority in Bangladesh.
 Government Child Neurology and Autism Centre
(CNAC) in Bangabandhu Sheikh Mujib Medical University
(BSMMU)
Bangladesh Army has specialized disability Centre and
school “Proyash”
 Prevalence of AUTISM and ADHD increasing
 No Centers have facility of Neurofeedback.
Opportunity of Neurofeedback in
Bangladesh

Scope of Neurofeedback in
Bangladesh
 Bangladesh is a low income country but some are very rich and afford
Neurofeedback.
 If Neurofeedback available children would be highly
benefited
 Going abroad is time consuming and NF is long therapy, they will be
interested if it is provided at home.
 Bangladesh government has given emphasis on child development
disorder mostly on Autism.
 There is an opportunity to integrate Neurofeedback with other services.
 Many National and international NGOs are also working in Autism and
other developmental disorder
 Neurofeedback It can be a new HOPE in the Darkness

Challenges
 The major limitations whole population including health professionals
unaware of Neurofeedback
 Brain Stimulation like, dTCS, rTMS, NF, fMRI nf, HEG is gaining popularity
in the treatment of Neurological and psychiatric Disorders and diseases
but not available in Bangladesh.
 The therapy is quiet expensive and needs longer time.
 Minimum interest of Pharmaceutical companies–Treatment is free of
Medication

ACKNOWLEDGEMENTS
I must acknowledge my heart felt gratitude to Dr. Kenneth Kang
from whom I learned Neurofeedback and who gave much time
answering many of my questions and clarify many of understandings.
He also reviewed my cases and suggested the treatment. I also thank
the staffs of Spectrum Learning, especially Kathy, Stacy and
Ting Ming on whom I really practiced my first sessions. I am also
grateful to my first three cases who volunteered in taking up the
therapy without knowing much about it and in confidence on me.

Case History - CASE-1
Practical Experiences of Neurofeedback

19 years old girl
Case of ADHD: Inattentive type
Major problem school failure
Changed few school
Very poor grade
 Parent Disappointed
Practical Experiences of
Neurofeedback

Observations: Her Delta Theta high and Beta is small.
Aim of therapy: Delta Theta should reduce during activity and Beta
should go higher.
 Neurofeedback : Theta Beta Training
Outcome:
 After 20 and 30
 Attention increased, vocabulary and comprehension improved.
 Task completion , drawing of geometric and biology figures were
complete.
 School performance improved

 After one year of therapy started passing
regularly.
 Appeared 10th grade and was unsuccessful
before Neurofeedback

 The child could not complete the home tasks and pass the
regular class exams
 Successfully passed Secondary School Certificate-10th grade
 Parents highly satisfied calls it unbelievable
 going to appear 12th grade in 2015
 Teachers and mother hopes that she will pass at once. (passed all
subjects in test exams with good grade)
 Teachers comments remarkable improvement
Example in the school –if one tries then one can

Figure-999: Trend Analysis of EEG frequency amplitude (ADHD) on 29/8/13

Figure-7c: Trend Analysis of EEG frequency amplitude (ADHD) on 5/12/14

CASE - 2
A diagnosed case of Autism
 Age/DOB- 16th September 1999, Weight- 27 Kg, Height- 4.5 feet.
 Major Problems:
 Obsession: Severely obsessed. He walks in a line, Keeping
particular doors and windows open/closed.
 Repetitive speech
 Run away

Evaluation Questions
When you first thought that he has problem?
 Around age 2.5 to 3 years
What were those problems?
 He was not communicating much.
 His stock of words were reducing.
 He had a tendency to run away.
 He was not making conversation

What treatment or therapy you have provided:
 On January 2003. Homeopathic medications.
 On 2007, at age of 8 years: Occupational therapy from
school.
 Received supplements like GABA, TMG, and Omega three
from KIRKMAN, USA for 2 years
 On 2010 and 2011: Speech therapy.

Does he go to special school, which class? Is he attentive?
 He is going to a special school.
 Learning Math (counting, additions),
 Science (general knowledge on animals, fruits, sun,
earth, food, healthy, colors etc.
 English literature. Can read easy English
 Write free hand with a poor handwriting.
 He plays computer games of cooking, dressing,
restaurant games, puzzles (both paper and computer)

Initial Measures and Reactions
 Did not allow putting the clips on ear or head.
 After explaining and persuasion for several times by
his father he actually started accepting the clips and
went on taking NF.
 Since he was restless and not willing to sit ideally we
started giving him to play games on computer.
 He enjoyed games on computer so we started some
Beta Theta training and as in ADHD to reduce his
impulsivity.

 It worked the child calmed and started taking
Neurofeedback regularly.
 Mother Reported very positively. Kept School was unaware
of the NF therapy and asked mother about teacher’s
comments.
 Teachers Report: he was cooperating them much more than
before in school, and also sitting in the chair more quietly. I
was thrilled with the experiences. One day mother said that
now he is asking for food in full sentences.
Initial Measures and Reactions

Outcome of Neurotherapy
After 20 session
The result was immense: Compared and found very positive
response mostly in vocabulary, speech, attention and impulsivity
 Occasionally the child became violent two or three times with her
sister and bitten her but later he realized and apologize which he
never did before.
 His hand writing and drawing also improved.
 He became more cooperative and took part in household choirs.
Parent’s expectations were also to have some improvements on
bowel and bladders control which the child did not improve.

Positive Observations
 The range of ‘Choice of food’ has been increased
 Communication-Providing small answers in one o two words
2/3 times this week (new improvement).
 Paying Salam when asked to perform. (more spontaneously
than before).
 Cooperation: Carrying order more than 1st week of NF, but
less than the time before starting NF- better.
 Helped mom to carry grocery in his back pack. More
cooperative.
 Response to conversation and counseling improved.

 Showed very much happiness while eating; (laughed loudly
after finishing eating and said complementary words
 Tolerance on sisters crying seems to be improved. – same.
 Refused the RDI (relationship development Intervention)
program saying “RDI finish” –so mom did not create pressure
and let him get away.
 Choosing Food: Asked for Khichuri, Dale halua etc. Was very
happy to get.
 Joined in morning walk with mom this morning.
 Teacher from school said today, urination and obsession
problems are reduced. Speech is less but more meaningful.
Positive Observations

Case 2: Trend analysis of frequency
amplitude
Figure-8b: Trend Analysis of EEG frequency amplitude of Shimana (Autism).

Case 2: Trend analysis of frequency
amplitude
Figure-8a: Trend Analysis of EEG frequency amplitude of Shimana (Autism).

Scope of Neurofeedback in
Bangladesh
 Bangladesh is a low income country but some are very rich and afford
Neurofeedback.
 Going abroad is time consuming and NF is long therapy, they will be
interested if it is provided at home.
 Bangladesh government has given emphasis on child development
disorder mostly on Autism.
 There is an opportunity to integrate Neurofeedback with other services.
 Many National and international NGOs are also working in Autism and
other developmental disorder,
 Neurofeedback can be a new HOPE

Challenges
 In Bangladesh we are Unaware of Non Invasive Brain Stimulation
like; rtMS, Neurofeedback, FMRI neurofeedback, HEG, MEG etc
 If Neurofeedback is available many children and family would be highly
benefited.
 The major limitations - whole population including health professionals are
unaware of Neurofeedback.
 The therapy is quiet expensive and not easily available.
 People will be interested - Who is going to inform ??

Conclusion
 I believe Neurofeedback will be applied
extensively in treating many of the
Neurological Diseases in future.
 It will also be easily available to people in
Bangladesh and NIBS will be practiced in
Medical Institutes very soon.

NEUROFEEDBACK Treats Neurodevelopment Disorders

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