EEG Biofeedback Abstracts
(including subsection on EEG Biofeedback and TBI)
A comprehensive bibliography of outcome literature in the field (downloadable):
Curr Opin Pediatr. 2004 Apr;16(2):217-26.
Update on attention-deficit/hyperactivity disorder.
Department of Medicine, Children's
OF REVIEW: Attention-deficit/hyperactivity disorder (ADHD) is present in 3% to
10% of children in the
Neuroimage. 2004 Jan;21(1):436-43.
Learned regulation of spatially localized brain activation using real-time fMRI.
deCharms RC, Christoff K, Glover GH, Pauly JM, Whitfield S, Gabrieli JD.
Department of Psychology, Stanford University, Stanford, CA 94305, USA. firstname.lastname@example.org
It is not currently known whether subjects can learn to voluntarily control activation in localized regions of their own brain using neuroimaging. Here, we show that subjects were able to learn enhanced voluntary control over task-specific activation in a chosen target region, the somatomotor cortex. During an imagined manual action task, subjects were provided with continuous direction regarding their cognitive processes. Subjects received feedback information about their current level of activation in a target region of interest (ROI) derived using real-time functional magnetic resonance imaging (rtfMRI), and they received automatically-adjusted instructions for the level of activation to achieve. Information was provided both as continously upated graphs and using a simple virtual reality interface that provided an image analog of the level of activation. Through training, subjects achieved an enhancement in their control over brain activation that was anatomically specific to the target ROI, the somatomotor cortex. The enhancement took place when rtfMRI-based training was provided, but not in a control group that received similar training without rtfMRI information, showing that the effect was not due to conventional, practice-based neural plasticity alone. Following training, using cognitive processes alone subjects could volitionally induce fMRI activation in the somatomotor cortex that was comparable in magnitude to the activation observed during actual movement. The trained subjects increased fMRI activation without muscle tensing, and were able to continue to control brain activation even when real-time fMRI information was no longer provided. These results show that rtfMRI information can be used to direct cognitive processes, and that subjects are able to learn volitionally regulate activation in an anatomically-targeted brain region, surpassing the task-driven activation present before training. (impact factor > .6)
EEG biofeedback of low beta band components: frequency-specific effects on variables of attention and event-related brain potentials.
Egner T, Gruzelier JH. . email@example.com
Clin Neurophysiol. 2004 Jan;115(1):131-9.
OBJECTIVE: To test a common assumption underlying the clinical use of electroencephalographic (EEG) biofeedback training (neurofeedback), that the modulation of discreet frequency bands is associated with frequency-specific effects. Specifically, the proposal was assessed that enhancement of the low beta components sensorimotor rhythm (SMR: 12-15 Hz) and beta1 (15-18 Hz) affect different aspects of attentional processing. METHODS: Subjects (n=25) were randomly allocated to training with either an SMR or beta1 protocol, or to a non-neurofeedback control group. Subjects were assessed prior and subsequent to the training process on two tests of sustained attention. The neurofeedback participants were also assessed on target P300 event-related potential (ERP) amplitudes in a traditional auditory oddball paradigm. RESULTS: Protocol-specific effects were obtained in that SMR training was associated with increased perceptual sensitivity 'd prime' (d'), and reduced omission errors and reaction time variability. Beta1 training was associated with faster reaction times and increased target P300 amplitudes, whereas no changes were evident in the control group. CONCLUSIONS: Neurofeedback training of SMR and beta1 band components led to significant and protocol-specific effects in healthy subjects. The data can be interpreted as indicating a general attention-enhancing effect of SMR training, and an arousal-enhancing effect of beta1 training.
Neurofeedback in Psychological Practice.
Masterpasqua, Frank; Healey, Kathryn N.
Professional Psychology - Research & Practice. 34(6):652-656, December 2003.
Advances in technology occasionally allow for innovations in the practice of psychology. Neurofeedback is one such modality; in it, individuals learn to change patterns of brain waves through operant conditioning. Research shows that a number of neurological and psychological disorders can be characterized by distinctive EEG patterns and that neurofeedback may help clients to change those patterns. The evidence regarding neurofeedback's efficacy for attention-deficit/hyperactivity disorder (ADHD), depression, and other disorders is reviewed. Using control group designs, four different research teams have found neurofeedback to be effective for ADHD participants; research on outcomes for other disorders is at a much more preliminary stage. Practicing psychologists are encouraged to explore the potential of this alternative and distinctly psychological modality.
Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate.
Fuchs T, Birbaumer N, Lutzenberger W, Gruzelier JH, Kaiser J.
Appl Psychophysiol Biofeedback. 2003 Mar;28(1):1-12.
Clinical trials have suggested that neurofeedback may be efficient in treating attention-deficit/hyperactivity disorder (ADHD). We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm (12-15 Hz) and betal activity (15-18 Hz) with stimulant medication. Participants were N = 34 children aged 8-12 years, 22 of which were assigned to the neurofeedback group and 12 to the methylphenidate group according to their parents' preference. Both neurofeedback and methylphenidate were associated with improvements on all subscales of the Test of Variables of Attention, and on the speed and accuracy measures of the d2 Attention Endurance Test. Furthermore, behaviors related to the disorder were rated as significantly reduced in both groups by both teachers and parents on the IOWA-Conners Behavior Rating Scale. These findings suggest that neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored a nonpharmacological treatment.
EEG and behavioral changes following neurofeedback treatment in learning disabled children.
Fernandez, T., Herrera, W., Harmony, T., Diaz-Comas, L.,
Clinical Electroencephalography, 34(3), 145-150.
Neurofeedback (NFB) is an operant conditioning procedure, by which the subject learns to control his/her EEG activity. On one hand, Learning Disabled (LD) children have higher values of theta EEG absolute and relative power than normal children, and on the other hand, it has been shown that minimum alpha absolute power is necessary for adequate performance. Ten LD children were selected with higher than normal ratios of theta to alpha absolute power (theta/alpha). The Test Of Variables of Attention (TOVA) was applied. Children were divided into two groups in order to maintain similar IQ values, TOVA values, socioeconomical status, and gender for each group. In the experimental group, NFB was applied in the region with highest ratio, triggering a sound each time the ratio fell below a threshold value. Noncontingent reinforcement was given to the other group. Twenty half-hour sessions were applied, at a rate of 2 per week. At the end of the 20 sessions, TOVA, WISC and EEG were obtained. There was significant improvement in WISC performance in the experimental group that was not observed in the control group. EEG absolute power decreased in delta, theta, alpha and beta bands in the experimental group. Control children only showed a decrease in relative power in the delta band. All changes observed in the experimental group and not observed in the control group indicate better cognitive performance and the presence of greater EEG maturation in the experimental group, which suggests that changes were due not only to development but also to NFB treatment.
Nelson, L. A. (2003).
Neurotherapy and the challenge of empirical support: A call for a neurotherapy practice research network.
Journal of Neurotherapy, 7(2), 53-67.
Ecological validity of neurofeedback: modulation of slow wave EEG enhances musical performance.
Egner T, Gruzelier JH. firstname.lastname@example.org
NeuroReport, 14(9), 1221-1224 (2003 Jul).
Biofeedback-assisted modulation of electrocortical activity has been established to have intrinsic clinical benefits and has been shown to improve cognitive performance in healthy humans. In order to further investigate the pedagogic relevance of electroencephalograph (EEG) biofeedback (neurofeedback) for enhancing normal function, a series of investigations assessed the training's impact on an ecologically valid real-life behavioural performance measure: music performance under stressful conditions in conservatoire students. In a pilot study, single-blind expert ratings documented improvements in musical performance in a student group that received training on attention and relaxation related neurofeedback protocols, and improvements were highly correlated with learning to progressively raise theta (5-8 Hz) over alpha (8-11 Hz) band amplitudes. These findings were replicated in a second experiment where an alpha/theta training group displayed significant performance enhancement not found with other neurofeedback training protocols or in alternative interventions, including the widely applied Alexander technique.
The effect of training distinct neurofeedback protocols on aspects of cognitive performance.
Vernon D, Egner T, Cooper N, Compton T, Neilands C, Sheri A, Gruzelier J. email@example.com
Int J Psychophysiol. 2003 Jan;47(1):75-85.
The use of neurofeedback as an operant conditioning paradigm has disclosed that participants are able to gain some control over particular aspects of their electroencephalogram (EEG). Based on the association between theta activity (4-7 Hz) and working memory performance, and sensorimotor rhythm (SMR) activity (12-15 Hz) and attentional processing, we investigated the possibility that training healthy individuals to enhance either of these frequencies would specifically influence a particular aspect of cognitive performance, relative to a non-neurofeedback control-group. The results revealed that after eight sessions of neurofeedback the SMR-group were able to selectively enhance their SMR activity, as indexed by increased SMR/theta and SMR/beta ratios. In contrast, those trained to selectively enhance theta activity failed to exhibit any changes in their EEG. Furthermore, the SMR-group exhibited a significant and clear improvement in cued recall performance, using a semantic working memory task, and to a lesser extent showed improved accuracy of focused attentional processing using a 2-sequence continuous performance task. This suggests that normal healthy individuals can learn to increase a specific component of their EEG activity, and that such enhanced activity may facilitate semantic processing in a working memory task and to a lesser extent focused attention. We discuss possible mechanisms that could mediate such effects and indicate a number of directions for future research.
Bearden, T. S., Cassisi, J. E., & Pineda, M. (2003). Neurofeedback training for a patient with thalamic and cortical infarctions. Applied Psychophysiology & Biofeedback, 28(3), 241-253.
Thompson, M., & Thompson, L. (2003). The Neurofeedback Book.
Appl Psychophysiol Biofeedback. 2002 Dec;27(4):231-49.
The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder.
Monastra VJ, Monastra DM, George S.
FPI Attention Disorders Clinic,
One hundred children, ages 6-19, who were diagnosed with attention-deficit/hyperactivity disorder (ADHD), either inattentive or combined types, participated in a study examining the effects of Ritalin, EEG biofeedback, and parenting style on the primary symptoms of ADHD. All of the patients participated in a 1-year, multimodal, outpatient program that included Ritalin, parent counseling, and academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants also received EEG biofeedback therapy. Posttreatment assessments were conducted both with and without stimulant therapy. Significant improvement was noted on the Test of Variables of Attention (TOVA; L. M. Greenberg, 1996) and the Attention Deficit Disorders Evaluation Scale (ADDES; S. B. McCarney, 1995) when participants were tested while using Ritalin. However, only those who had received EEG biofeedback sustained these gains when tested without Ritalin. The results of a Quantitative Electroencephalographic Scanning Process (QEEG-Scan; V. J. Monastra et al., 1999) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school.
Appl Psychophysiol Biofeedback. 2002 Dec;27(4):261-70.
EEG signature and phenomenology of alpha/theta neurofeedback training versus mock feedback.
Egner T, Strawson E, Gruzelier JH. firstname.lastname@example.org
Alpha/theta (a/t) neurofeedback training has in the past successfully been used as a complementary therapeutic relaxation technique in the treatment of alcoholism. In spite of positive clinical outcomes, doubts have been cast on the protocol's specificity when compared to alternative relaxation regimes. This study investigated the basic tenet underlying the a/t training rationale, that accurate a/t feedback representation facilitates the generation of these frequency components. Two groups of healthy volunteers were randomly assigned to either (a) real contingent a/t feedback training or (b) a noncontingent mock feedback control condition. The groups were compared on measures of theta/alpha (t/a) ratios within and across training sessions, as well as activational self-report scales after each session. The contingent a/t feedback group displayed significant within-session t/a ratio increments not evident in the mock control group, as well as higher overall t/a ratios in some but not all of the training sessions. No differences were found between the groups in terms of subjective activational phenomenology, in that both groups reported significantly lower levels of activation after training sessions. The data demonstrate that irrespective of considerations of clinical relevance, accurate a/t neurofeedback effectively facilitates production of higher within-session t/a ratios than do noncontingent feedback relaxation.
LaVaque, T. J., Hammond, D. C., Trudeau, D., Monastra, V., Perry, J., & Lehrer, P. (2002).
Template for Developing Guidelines for the evaluation of the clinical efficacy of psychophysiological interventions. Journal of Neurotherapy, 6(4), 11-243.
Appl Psychophysiol Biofeedback. 2002 Dec;27(4):273-81.
An essential function of both the Association for Applied Psychophysiology and Biofeedback (AAPB) and the Society for Neuronal Regulation (SNR) is the systematic evaluation of psychophysiological interventions that have been developed for the treatment of medical and psychiatric disorders. In order to address scientific concerns regarding the efficacy of specific clinical applications of biofeedback, these two societies formed and Efficacy Task Force. The process to be used in the assessment of treatment efficacy, specificity and clinical utility is presented in the form of a template that will serve as the foundation for a series of scientific reviews and practice guidlines to be published by both societies.
HNO. 2001 Jan;49(1):29-35.
[Neurofeedback in therapy of tinnitus] [Article in German]
Gosepath K, Nafe B, Ziegler E, Mann WJ.
Romerwallklinik, Klinik fur Neuroo
BACKGROUND AND OBJECTIVE: Biofeedback is known as a possibility to control physiologic processes like body temperature or heart frequency. Neurofeedback is a form of biofeedback linked to aspects of the electrical activity of the brain such as frequency, location or amplitude of specific EEG activity. It has been successfully used in patients with closed head injury, hyperactivity disorder or epilepsy. PATIENTS/METHODS: In this study 40 patients with tinnitus were treated with neurofeedback.They trained to upregulate the amplitude of their alpha-activity and downregulate the amplitude of beta-activity during muscle relaxation and acoustic orientation on sounds or music in order to suppress their tinnitus. RESULTS: After 15 sessions of training 24 patients with a duration of their tinnitus for an average of 1 year showed significant increase of alpha-amplitudes while 16 patients with duration of their tinnitus on an average of 7 years showed a decrease of beta-amplitudes without any change in alpha-activity. After the training all patients had a significant reduction of the score in the tinnitus questionaire of Gobel and Hiller. In a control-group of 15 persons without tinnitus we didn't see any changes of alpha- or beta-amplitudes during the same training. CONCLUSIONS: In conclusion neurofeedback is a new therapy for patients with tinnitus. Patients get the possibility of selfcontrol and therefore of influence on their disease.
Egner, T., & Gruzelier, J. H. (2001).
Learned self-regulation of EEG frequency components affects attention and event-related brain potentials in humans.
NeuroReport, 12, 4155-4159.
Learned enhancement of EEG frequency components in the lower beta range by means of biofeedback has been reported to alleviate attention deficit hyperactivity disorder (ADHD) symptoms. In order to elucidate frequency-specific behavioural effects and neurophysiological mediators, this study applied neurofeedback protocols to healthy volunteers, and assessed impact on behavioural and electrocortical attention measures. Operant enhancement of a 12-15 Hz component was associated with reduction in commission errors and improved perceptual sensitivity on a continuous performance task (CPT), while the opposite relation was found for 15-18 Hz enhancement. Both 12-15 Hz and 15-18 Hz enhancement were associated with significant increases in P300 event-related brain potential amplitudes in an auditory oddball task. These relations are interpreted as stemming from band-specific effects on perceptual and motor aspects of attention measures.
Sterman, M. B., & Lantz, D. (2001).
Changes in lateralized memory performance in subjects with epilepsy following neurofeedback training.
Journal of Neurotherapy, 5, 63-72.
Both seizure reduction and neuropsycho- logical improvements have been reported following neurofeedback training directed to normalization of the sensorimotor EEG. These findings could be interpreted as nonspecific effects rather than specific changes brought about by EEG training. The present study demonstrated neuropsychological changes of a selective nature that would be difficult to interpret as nonspecific. Epileptic subjects with unilateral temporal lobe lesions were administered memory tests prior to EEG training, after control training, and after sensorimotor EEG normalization training. Successfully trained subjects showed exclusive improvement on memory tasks specific to the hemisphere contralateral to their lesion, and no improvement on memory tasks specific to the hemisphere with the lesion. Such selective changes are difficult to interpret as nonspecific effects of participating in a study, and would seem to require genuine alteration of neural substrates as a result of EEG training.
Treatment of attention deficit hyperactivity disorder with neurotherapy.
Clin Electroencephalogr. 2000 Jan;31(1):30-7. Review.
Significant public health concerns exist regarding our current level of success in treating ADHD. Medication management is very helpful in 60-70% of patients. Side effects, lack of compliance and the fact that stimulant medications cannot be given late in the day limit the benefits largely to school hours. While stimulants improve behavior and attention, less of an effect has been noted on academic and social performance. Continuing concerns exist about long-term safety, and studies on long-term cardiovascular and neurophysiological effects have not been carried out. Neurotherapy for ADHD offers an effective alternate for patients whose treatment is limited by side effects, poor medication response and in cases in which the patients and/or their parents refuse to consider medications. Studies indicate clinical improvement is largely related to measurable improvements in the EEG signature, evidenced by declining theta/beta ratios over frontal/central cortex and/or reduced theta/alpha band amplitudes.
Treatment of chronic fatigue with neurofeedback and self-hypnosis.
A 21 year old patient reported a relatively rapid onset of serious chronic fatigue syndrome (CFS), with her worst symptoms being cognitive impairments. Congruent with research on rapid onset CFS, she had no psychiatric history and specialized testing did not suggest that somatization was likely. Neuroimaging and EEG research has documented brain dysfunction in cases of CFS. Therefore, a quantitative EEG was done, comparing her to a normative data base. This revealed excessive left frontal theta brainwave activity in an area previously implicated in SPECT research. Therefore, a novel treatment approach was utilized consisting of a combination of EEG neurofeedback and self-hypnosis training, both of which seemed very beneficial. She experienced considerable improvement in fatigue, vigor, and confusion as measured pre-post with the Profile of Mood States and through collaborative interviews with both parents. Most of the changes were maintained at 5, 7, and 9 month follow-up testing.
Appl Psychophysiol Biofeedback. 1998 Dec;23(4):243-63.
Neurofeedback combined with training in metacognitive strategies: effectiveness in students with ADD.
Thompson L, Thompson M.
A review of records was carried out to examine the results obtained when people with Attention Deficit Disorder (ADD) received 40 sessions of training that combined neurofeedback with the teaching of metacognitive strategies. While not a controlled scientific study, the results, including pre- and post-measures, are consistent with previously published research concerning the use of neurofeedback with children. A significant addition is that a description of procedures is included. The 111 subjects, 98 children (age 5 to 17) and 13 adults (ages 18 to 63), attended forty 50-min sessions, usually twice a week. Feedback was contingent on decreasing slow wave activity (usually 4-7 Hz, occasionally 9-11 Hz) and increasing fast wave activity (15-18 Hz for most subjects but initially 13-15 Hz for subjects with impulsivity and hyperactivity). Metacognitive strategies related to academic tasks were taught when the feedback indicated the client was focused. Some clients also received temperature and/or EDR biofeedback during some sessions. Initially, 30 percent of the children were taking stimulant medications (Ritalin), whereas 6 percent were on stimulant medications after 40 sessions. All charts were included where pre- and post-testing results were available for one or more of the following: the Test of Variables of Attention (TOVA, n = 76), Wechsler Intelligence Scales (WISC-R, WISC-III, or WAIS-R, n = 68), Wide Range Achievement Test (WRAT 3, n = 99), and the electroencephalogram assessment (QEEG) providing a ratio of theta (4-8 Hz) to beta (16-20 Hz) activity (n = 66). Significant improvements (p < .001) were found in ADD symptoms (inattention, impulsivity, and variability of response times on the TOVA), in both the ACID pattern and the full-scale scores of the Wechsler Intelligence Scales, and in academic performance on the WRAT 3. The average gain for the full scale IQ equivalent scores was 12 points. A decrease in the EEG ratio of theta/beta was also observed. These data are important because they provide an extension of results from earlier studies (Lubar, Swartwood, Swartwood, & O'Donnell, 1995; Linden, Habib, & Radojevic, 1996). They also demonstrate that systematic data collection in a private educational setting produces helpful information that can be used to monitor students' progress and improve programs. Because this clinical work is not a controlled scientific study, the efficacious treatment components cannot be determined. Nevertheless, the positive outcomes of decreased ADD symptoms plus improved academic and intellectual functioning suggest that the use of neurofeedback plus training in metacognitive strategies is a useful combined intervention for students with ADD. Further controlled research is warranted.
Biol Psychiatry. 1998 Dec 1;44(11):1196-9.
Neurofeedback treatment of pseudoseizure disorder.
BACKGROUND: Previous research has shown that the suppression of theta wave activity and the enhancement of sensorimotor rhythm (SMR) through electroencephalographic (EEG) biofeedback is an effective treatment for epilepsy. The current research reports the results of EEG biofeedback treatment for patients presenting with seizure behaviors in the absence of eliptiform EEG activity. METHODS: In addition to psychotherapy, 3 patients, 2 women and 1 man, were trained, using EEG feedback once per week, to reduce the ratio of theta band to SMR band EEG amplitudes. RESULTS: The results showed that reductions in (psuedo)seizure activity were related to reductions in the theta-SMR ratio. CONCLUSIONS: These findings support the view that theta-SMR feedback training, in conjunction with psychotherapy, is an effective adjunctive treatment for pseudoseizure disorder.
Biofeedback Self Regul. 1995 Sep;20(3):241-58.
Operant (biofeedback) control of left-right frontal alpha power differences: potential neurotherapy for affective disorders.
Rosenfeld JP, Cha G, Blair T, Gotlib IH.
Saxby E, Peniston EG.
Alpha-theta brainwave neurofeedback training: an effective treatment for male and female alcoholics with depressive symptoms.
J Clin Psychol. 1995 Sep;51(5):685-93.
Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance.
Biofeedback Self Regul. 1995 Mar;20(1):83-99.
TBI & EEG Biofeedback
The electrophysiological effects of a brain injury on auditory memory functioning. The QEEG correlates of impaired memory.
Arch Clin Neuropsychol 2003 May 18:363-78
The effect of a brain injury on the quantitative EEG (QEEG) variables during an auditory memory activation condition was examined with 56 normal subjects and 85 mild traumatic brain-injured (MTBI) subjects. An analysis was conducted on the different response patterns of the two groups, the variables which were correlated with memory performance in the brain-injured group, and the variables which predicted the memory score for the combined two groups (normal and brain injured). The three conditions included the input task, the immediate recall, and the delayed recall task. The consistent effect of a brain injury was a lowering of the connectivity patterns in the beta1 and beta2 frequencies (phase and coherences) and increases predominantly in the relative power of beta1 (13-32Hz), which were correlated with the differences in recall. There is a subtle shift to right hemisphere/right temporal functioning and employment of the higher beta1 and beta2 frequencies (phase and coherence) in the response pattern of the MTBI subject. Memory functioning is predominantly positively correlated with connection activity (phase and coherence) and negatively correlated with beta activation at specific locations.
Bearden, T. S., Cassisi, J. E., & Pineda, M. (2003).
Neurofeedback training for a patient with thalamic and cortical infarctions.
Applied Psychophysiology & Biofeedback, 28(3), 241-253.
One year after a left posterior and thalamic stroke, a 52-year-old male participant was treated with 14 weeks of theta reduction neurofeedback training. Imaging studies revealed left temporal, parietal, occipital, and bilateral thalamic infarctions along the distribution of the posterior cerebral artery. Neuropsychological testing demonstrated severe verbal memory, naming, visual tracking, and fine motor deficits. Additionally, alexia without agraphia was present. A pretraining quantitative electroencephalograph (QEEG) found alpha attenuation, lack of alpha reactivity to eye opening, and excessive theta activity from the left posterior head region. Neurofeedback training to inhibit 4-8 Hz theta activity was conducted for 42 sessions from left hemisphere sites. Over the course of the training, significant reductions in theta amplitude occurred from the training sites as assessed from the post-session baseline periods. Posttraining, a relative normalization of the QEEG was observed from the left posterior head region.
The improvement/rehabilitation of auditory memory functioning with EEG biofeedback.
Center for Health Psychology,
Five clinical case studies (1 normal, 3 brain injured and 1 subject who had a left frontal hematoma) are presented which addressed the effectiveness of EEG biofeedback for auditory memory impairment. A normative QEEG activation database of 59 right-handed subjects was developed, which delineated the QEEG variables which were positively related to auditory memory performance (paragraphs). Persons who had experienced a brain injury underwent the same procedure employed in the development of the database. The person's values on the effective parameters of memory functioning were determined. EEG biofeedback interventions were determined by the individual's deviation from the normative reference group in terms of the relevant QEEG parameters of effective auditory memory (paragraph recall). Improvements ranged from 39% subjects who had a follow up assessment that occurred from one month to one year following termination of treatment.
Neurotherapy, 6 (1), 23-38, 2002.
EEG NeuroBioFeedback Treatment of Patients with Brain Injury
Part 4: Duration of Treatments as a Function of Both the Initial Load of Clinical Symptoms and the Rate of Rehabilitation
Michel Bounias, DSc, Rima E. Laibow, MD, Albert N. Stubblebine, MSc, Henry Sandground, A. Bonaly, DSc
Background. Twenty-seven patients with brain injury, primarily from car accidents and stroke, were treated by computer-assisted electroencephalographic NeuroBioFeedback (EEG-NBF). Methods. Patients were distributed into five clinical classes, for which changes in power spectra and in cardiovascular parameters were surveyed. A rationale was proposed for the calculation of the load of symptoms for each patient of each class, which in turn provided indices of rehabilitation rates. Results. Statistically significant correlations were observed between the number of NeuroBioFeedback (NBF) treatment sessions (SN#) needed and both the initial load of symptoms (SL%) and the final rate of improvement of patient’s clinical status (IMP%). When patients were considered in all five classes of defined SL%, the relationship exhibited a hyperbolic shape, although linearity could not be totally rejected, due to the variability of data. The improvement rates could be subdivided into two major classes, in which number (SN#) was hyperbolically related to the improvement rates. In addition, finger temperature responsiveness exhibited a significant correlation with the number of NBF sessions. Conclusion. The work suggests a rationale for the prediction of the duration of treatment, by considering the patients' initial clinical status and the levels of improvement and rehabilitation considered achievable.
Journal of Neurotherapy, 6 (1), 5-21, 2002
EEG NeuroBioFeedback Treatment of Patients with Brain Injury:
Part 3: Cardiac Parameters and Finger Temperature Changes Associated with Rehabilitation
Rima E. Laibow,
MD, Albert N. Stubblebine, MSc,
Henry Sandground, Michel Bounias,
Twenty-seven patients with brain injury were treated by computer-assisted
electroencephalographic NeuroBioFeedback (EEG-NBF).
All patients were medication-free during treatment. Methods.
Parallel to targeted changes in EEG power spectra, secondary effects were
monitored for heart rate, sys
of qEEG-guided coherence training for patients with a
mild closed head injury.
Walker, Jonathan E.; Norman, Charles A.; Weber, Ronald K.
Journal of Neurotherapy. 2002 Vol 6(2) 31-43
mpact of qEEG-Guided Coherence Training for Patients With a Mild Closed Head Injury
Jonathan E. Walker, MD, Charles A. Norman, PhD, Ronald K. Weber, PhD
Background. Mild closed head injury (MHI) is a major problem in our society. Traditional methods of treatment such as cognitive rehabilitation or behavioral training are time consuming, expensive, and of questionable effectiveness. Anecdotal reports indicate that neurofeedback can remediate the symptoms of MHI in a rapid and cost effective way. The purpose of this study is to evaluate whether quantitative electroencephalography (qEEG) guided coherence training is effective in remediating residual symptoms of MHI.
Methods. Twenty-six patients with persistent post-traumatic symptoms (PTS) were seen by the first author 3 to 70 months after a MHI and had a quantitative EEG (qEEG). Neurofeedback therapy designed to normalize abnormal qEEG coherence scores was provided to determine the effectiveness of this approach. Five training sessions addressed each qEEG abnormality. Training continued until the patient, by self-report, indicated that significant improvement had occurred or until a total of 40 sessions were given.
Results. Significant improvement (>50%) was noted in 88% of the patients (mean =72.7%). All patients reported that they were able to return to work following the treatment, if they had been employed prior to the injury. On average, 19 sessions were required, less than the average of 38 sessions required using power training of Cz-Beta in our previous unpublished study.
Conclusions. In this uncontrolled open trial of qEEG guided coherence training, the majority of patients with MHI experienced substantial and rapid symptomatic improvement, including return to work. Further study with controls and additional outcome measures is warranted.
Journal of Neurotherapy, 5 (4), 23-44, 2001.
EEG NeuroBioFeedback Treatment of Patients with Brain Injury
Part 1: Typological Classification of Clinical Symptoms
Rima E. Laibow, MD, Albert N. Stubblebine, MSc, Henry Sandground, Michel Bounias, DSc
Background. A sample of 27 patients with brain-injury distributed in five clinical classes was examined for pre- and post-treatment symptoms and associated power spectra. Methods. Changes in electroencephalographic (EEG) compressed spectral arrays were analyzed with respect to the rate of rehabilitation and correlated with a checklist of symptoms for each patient and the group as a whole. Results. Targeted decreases in slower (3-7 Hz.), higher frequencies (24-32 Hz.), EMG (70-90 Hz.) and increases of alpha (8-12 Hz.) and mid-range Beta frequencies (15-18 Hz.) were achieved following NeuroBioFeedback (NBF) treatment using positive rewarding tones and a simultaneous visual reward. The impact of gender and age class influence was assessed against treatment results. Single lead EEG power spectra changes were analyzed for hemispherectomized patients, stroke, car accident and trauma patients. A common EEG pattern was observed for a group of patients exhibiting vertigo with two subgroups in which vertigo resolved or did not resolve showing EEG differences. Conclusions. EEG NeuroBioFeedback can successfully treat patients with brain injury with highly clinically meaningful clinical results. Changes in Cz power spectra generally occur, but do not always immediately follow resolution of symptoms. Since EEG-NBF is limited to recording cortical surface potentials, it is possible that changes induced by the treatment which result in clinical changes may not always be reflected at the cortical surface and hence may not be available for recording and analysis there, despite subcortical integration.
Journal of Neurotherapy, 5 (1/2), 19-32, 2001.
Neurofeedback Therapy of Attention Deficits In Patients with Traumatic Brain Injury.
Ingo Keller, PhD
Background. Impairments of attention are a frequent and well documented consequence of head injury. The purpose of this study was to evaluate if Neurofeedback Therapy (NFT) can enhance remediation of attention deficits in patients with closed head injuries (CHI) who are still in the phase of spontaneous recovery. Method. Feedback of beta-activity (13 - 20 Hz) was used for the treatment of attentional impairments in twelve patients with moderate closed head injuries. A matched control group of nine patients was treated with a standard computerized training. All patients were tested before and after treatment with a set of attention tests. Results. After ten sessions the analyses of beta activity showed that eight patients were able to increase their beta activity while the remaining four patients showed a decrease of beta activity. Mean duration of beta activity was prolonged about 50% after training. Patients who received NFT improved significantly more in the attention tests than control patients. Conclusion. The results suggest that neurofeedback is a promising method for the treatment of attentional disorders in patients with traumatic brain injuries. It is suggested that NFT should focus not only on the enhancement of beta activity, but also on the duration patients are able to hold beta activity. It is proposed to use NFT also with patients in the early phase of rehabilitation.
Sterman, M. B., & Lantz, D. (2001).
Changes in lateralized memory performance in subjects with epilepsy following neurofeedback training.
Journal of Neurotherapy, 5, 63-72.
Successfully trained subjects showed exclusive improvement on memory tasks specific to the hemisphere contralateral to their lesion, and no improvement on memory tasks specific to the hemisphere with the lesion. Such selective changes are difficult to interpret as nonspecific effects of participating in a study, and would seem to require genuine alteration of neural substrates as a result of EEG training.
of the reasons the brain damaged subject can't recall what they hear,
Archives of Clinical Neuropsychology, 2002, 17, 1-17
J Head Trauma Rehabil 2001 Jun;16(3):260-74
neurotherapy system in the treatment of traumatic
brain injury: an initial evaluation.
Schoenberger NE, Shif SC, Esty ML, Ochs L, Matheis RJ.
Kessler Medical Rehabilitation Research and Education Corporation,
Objective: To conduct a preliminary experimental evaluation of the potential efficacy of Flexyx Neurotherapy System (FNS), an innovative electroencephalography (EEG)-based therapy used clinically in the treatment of traumatic brain injury (TBI). Participants: Twelve people aged 21 to 53 who had experienced mild to moderately severe closed head injury at least 12 months previously and who reported substantial cognitive difficulties after injury, which interfered with their functioning. Design: Participants were randomly assigned to an immediate treatment group or a wait-list control group and received 25 sessions of FNS treatment. They were assessed at pretreatment, posttreatment, and follow-up with standardized neuropsychological and mood measures. Results: Comparison of the two groups on outcome measures indicated improvement after treatment for participants' reports of depression, fatigue, and other problematic symptoms, as well as for some measures of cognitive functioning. Most participants experienced meaningful improvement in occupational and social functioning. Conclusion: On the basis of these results, FNS appears to be a promising new therapy for TBI and merits more extensive evaluation.
Top Stroke Rehabil. 2001 Autumn;8(3):45-53.
Effect of neurofeedback on motor recovery of a patient with brain injury: a case study and its implications for stroke rehabilitation.
This case study showed the effect of neurofeedback (NFB) training in a patient with a brain tumor and co-existing traumatic brain injury. The patient received 40 sessions of NFB intervention. Tests and videotaped recordings evaluated pre- and post-NFB intervention. This study demonstrated minimal to significant improvements in several functional tasks. The conclusion is that the use of NFB for a person with a head injury and brain tumor can be generalized to be used with stroke survivors.
Laibow, R. E., Stubblebine, A. N., Sandground, H. & Bounias, M. (2001). EEG-NeuroBioFeedback treatment of patients with brain injury: Part 2: Changes in EEG parameters versus rehabilitation.
Journal of Neurotherapy, 5 (4), 45-71.
J Head Trauma Rehabil. 2000 Dec;15(6):1285-96.
Improvement/rehabilitation of memory functioning with EEG biofeedback.
Psychologist, Center for Health
This article presents a new approach to the remediation of memory deficits by studying the electrophysiological functioning involved in memory and applying biofeedback techniques. A Quantitative EEG (QEEG) activation database was obtained with 59 right-handed subjects during two auditory memory tasks (prose passages and word lists). Memory performance was correlated with the QEEG variables. Clinical cases were administered the same QEEG activation study to determine their deviations from the values that predicted success for the reference group. EEG biofeedback interventions were designed to increase the value (to normal levels) of the specific electrophysiological variable that was related to successful memory function and deviant in the subject. Case examples are presented that indicate the successful use of this intervention style in normal subjects and in subjects with brain injury; improvement cannot be fully explained by spontaneous recovery, given the time postinjury. Five cases (two normal, two subjects with brain injury, and one subject who had stereotactic surgery of the hippocampus for seizure control) are presented. Improvements ranged from 68% to 181% in the group of patients with brain injury, as a result of the interventions.
Journal of Neurotherapy, 4 (2), 27-44, 2000.
Changes after EEG Biofeedback and Cognitive Retraining in Adults with Mild Traumatic Brain Injury and Attention Deficit Hyperactivity Disorder
Timothy P. Tinius, Ph.D. and Kathleen A. Tinius, M.S.W
Introduction. Adults diagnosed with mild traumatic brain injury (mTBI) or Attention Deficit Hyperactivity Disorder (ADHD) were treated with EEG Biofeedback and cognitive retraining. Methods. Psychological and neuropsychological tests were completed at pre treatment and post treatment and compared to a normal control group that did not receive training, but tested on two occasions. Results. The results found significant improvement on full scale attention and full scale response accuracy of a continuous performance task in the mTBI and ADHD groups compared to the control group. A self report showed a significant decline in symptoms in the mTBI and ADHD groups compared to the control group. Errors on a problem solving task decreased only in the mTBI group. Discussion. The treatment model used in this study showed significant improvement in the sustained attention of individuals diagnosed with mTBI and ADHD after twenty treatment sessions.
Clin Electroencephalogr. 2000 Jan;31(1):38-44.
EEG operant conditioning (biofeedback) and traumatic brain injury. (Review)
Bay Pines VA
A review is presented of the currently sparse literature about EEG operant conditioning or biofeedback as a treatment to reduce symptomology and patient complaints following a traumatic brain injury. The paper also evaluates the general use of quantitative EEG (QEEG) to assess traumatic brain injury and to facilitate EEG biofeedback treatment. The use of an age matched reference normative QEEG database and QEEG discriminant function are presented as a method to evaluate the nature or neurological basis of a patient's complaints as well as to individualize an efficient and optimal feedback protocol and to help evaluate the efficacy of the biofeedback therapy. Univariate and multivariate statistical issues are discussed, different classes of experimental designs are described and then a "double blind" research study is proposed in an effort to encourage future research in the area of EEG biofeedback for the treatment and rehabilitation of traumatic brain injury.
Hoffman, D. A., Stockdale, S., Van Egren, L., et al. (1996a). EEG neurofeedback in the treatment of mild traumatic brain injury. [Abstract]. Clinical Electroencephalography, 27 (2), 6.
Hoffman, D. A., Stockdale, S., Van Egren, L., et al. (1996b). Symptom changes in the treatment of mild traumatic brain injury using EEG neurofeedback [Abstract]. Clinical Electroencephalography, 27 (3), 164.
Journal of Neurotherapy, 1, 1, 1995,
Diagnosis and Treatment of Head Injury
Daniel A. Hoffman, M.D., Steven Stockdale, Ph.D.,Lana L. Hicks, B.A., and Jill E Schwaninger, B.A.
Brain injury appears to affect from 132 to 367 people per 100,000. Traditional methods for diagnosing mild head injury, such as medical history, CAT scan and MRI, often show normal test results even though patients complain of significant neurocognitive dysfunctions. Robert Thatcher compiled a normative reference EEG database in 1979. The norms were replicated in several studies. These EEG databases allow a patient's EEG to be compared with a reference population. An emerging and promising treatment approach to mild head injury is the use of Quantitative EEG technology and EEG neurofeedback training.
Journal of Neurotherapy, 1 (1), 22-37, 1995,
Neurofeedback Therapy for a Mild Head Injury
Alvah P. Byers
The purpose of this study was to evaluate Neurofeedback Therapy (NFT) for a Mild Head Injury (MHI). The subject was a 58-year-old female who fell and struck her head in 1988. The NFT began in 1994 and was preceded and followed by neuropsychiatric and neuropsychological evaluations as well as quantified electroencephalograms (QEEG). The patient completed a symptom checklist and the Minnesota Multiphasic Personality Inventory 2 (MAPI- 2) before and after NFT. Treatment consisted of 31 sessions of NFT The NFT was designed to enhance the sensorimotor rhythm (SMR) of 12-15 Hertz (Hz) and the beta (15-18 Hz) frequency bands of the electroencephalogram (EEG) while at the same time suppressing the theta (4-7 Hz) frequency band. Twelve sessions were used for SMR NFT and 19 sessions for beta NFT. The comparison of the pre- and post-measures as well as the process measures suggests NFT is a promising intervention for the rehabilitation Of Patients wit MHI. Questions regarding these findings are explored together with suggestions for further research.
Ayers, M. E. (1993).
A controlled study of EEG neurofeedback training and clinical psychotherapy for right hemispheric closed head injury.
Biofeedback and Self Regulation, 18, 3.
Research on persistent closed head trauma symptomology of depression, mood swings, and/or anxiety attacks more than three years post injury has been in the area of cognitive psychology, behavioral modification, or psychotherapy. Often patients with persistent symptomology have been described as neurotic, depressed, anxious, and perhaps symptoms existed prior to head trauma. This controlled study of EEG neurofeedback training and clinical psycho-therapy for right hemispheric closed head injury attempted to determine if behavior could be altered.
frequencies have predominantly originated in humans and animals from the
hippocampus as Jung and Kornmuller first observed in
1938. Fujita and Sata in 1964, found membrane
intracellular potentials fluctuated in a regular "intracellular theta
rhythm" which they coupled to the extracellular hippocampal rhythmical slow activity theta in rabbits. Bremner analyzed changes in theta acti-vity
using power spectral analysis and found that total power of theta increases in visceroautonomic arousal and decreases in somato-motor readiness. Could it be possible that hippocampal control of the organization of arousal and
activation in closed head injured patients with their excessive production of 4
to 7 hertz activity and spikes are stuck in a constant visceroautonomic
arousal of anxiety and depression and unable to decrease the theta activity
which would allow for somatomotor readiness and behavior
change? Psychologists reported that
the six right head trauma indivi-duals who received
only psychotherapy did not improve in mood swings, explosive anger outbursts or
anxiety attacks. However, clients reported better understanding of how to cope with
their problem. According to testing with the Levin,
Standards for the use of QEEG in neurofeedback: A position paper of the International Society for Neuronal Regulation.
Journal of Neurotherapy, 8(1), 5-26.
D. Corydon Hammond, PhD, Jonathan Walker, MD, Daniel Hoffman, MD, Joel F. Lubar, PhD,
David Trudeau, MD, Robert Gurnee, MSW, Joseph Horvat, PhD
Background. This paper presents the findings of an interdisciplinary committee on standards for quantitative electroencephalography (QEEG) in neurofeedback which has been unanimously accepted by the International Society for Neuronal Regulation (ISNR) Board as a position paper of ISNR.
Method. The committee reviewed current standards for quantitative encephalography in other specialties as well as scholarly literature on QEEG.
Results. The panel reached the following conclusions:
1. Although clinical research indicates that a full 19 channel QEEG does not appear necessary for conducting successful neurofeedback training, an increasing number of clinicians are using comprehensive QEEG evaluations to guide their neurofeedback training.
2. An impressive body of peer reviewed scientific literature attests to the utility of the QEEG in providing a scientifically objective and clinically practical assessment of a wide range of psychiatric, psychological and medical conditions.
3. Many of the significant contributions to the field of QEEG have come from psychologists and the Board of Professional Affairs of the American Psychological Association has concluded that QEEG is within the scope of practice of psychologists trained in this specialty.
4. Unlike neurology and psychiatry, where QEEG is principally used for purposes of diagnosing medical pathology, neurotherapists who use QEEG primarily do so to guide EEG biofeedback training.
5. It is not necessary for a physician to screen raw EEG data as part of a QEEG evaluation for neurofeedback training.
Conclusions. For the purpose of encouraging high standards, recommendations are made for areas of training and study in this specialty, for certification, for equipment/software, and for procedures in data collection and analysis.
There are serious ethical questions about the use of
placebo controls when there is an established medical/psychological treatment
according to the