NeuroRehabilitation. 2002;17(1):69-80.
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.
Electrophysiology
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
Flexyx
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
Psychology,
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)
Thatcher RW.
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.
Theta
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,