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
EG 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, Dsc Background. 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, systolic and diastolic pressures, pulse rate and fingertip temperature. Results. Extreme blood pressure values generally responded by up- and down-regulation toward normal values. Fingertip temperature (FT°) increased in both kinetic movement and amplitude from the beginning to the end of treatment and correlated directly with the rate of the patient's rehabilitation, reflecting an improvement of blood circulation. Blood pressure, pulse and FT° ranks in numerical values were compared by rank correlations. Conclusions. NBF in patients with brain injury results in beneficial physiological regulation in addition to initially targeted improvements in brain functions. Symptom associations versus the success or failure of EEG treatment and improvement rates reflected correction of symptoms as well as freedom from the bias of expectation in response to treatments.
Impact 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.
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.
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.
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.
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,