Treating Dementia and Traumatic Brain Injury with EEG Biofeedback and 1072nm IR Stimulation

1. Treating Dementia and Traumatic Brain Injury with EEG Biofeedback and 1072nm IR Stimulation

2. Combat Veterans and TBI • 2/3 of injuries caused by IEDs • TBI afflicts • >25% of bomb blast survivors (Walter Reed Army Medical Center) • 2/3 of IED survivors (Veterans Administration) • 40% of injured soldiers (Defense and Veterans Brain Injury Coalition)

3. Combat Veterans and TBI • “Evidence-based guidelines for diagnosis and treatment are limited.” • Roughly half of severe TBI “will regain some function, but will be left with significant disability.” • Half may be left in a permanent vegetative state Annals of Neurology

4. Combat Veterans and TBI • Mild TBI Symptoms can include • depression, ADHD-like symptoms, headaches, anxiety, fatigue, irritability, temper outbursts and aggression, problems with memory, problems with memory, sleep disorders, and sexual dysfunction. • Defense & Veterans Head Injury Program Report (1998) showed no effect of cognitive rehabilitation.

5. Biofeedback/Neurofeedback • A method of training increased conscious awareness and control of physiological processes • e.g., pulse oximeter, GSR, EMG or thermometer • Mechanism of Action: operantly rewarding EEG phase, amplitude and/or coherence. • Measurement/Intervention technologies: • 1072nm IR + EEG, surface cortical oxygenation • Adjunctive Tools: ROSHI A-V Entrainment, HBOT

6. ROSHI A-V Entrainment

7. Neurofeedback for TBI • Ayers, 1987 • 250 head injured clients • Decrease 4-7 Hz, Increase 15-18 Hz, 24 sessions • A return to premorbid function in most clients • Normalization of phasic spikes, 4-7 Hz activity

8. Neurofeedback for TBI • Ayers, 1991 • 12 right-hemisphere CHI cases • Six received NF + psychotherapy • Decrease 4-7 Hz, Increase 15-18 Hz, 24 sessions • Showed significant improvement in symptoms • Six controls received psychotherapy alone • no improvement

9. Neurofeedback for TBI • Hoffman et al. (1996a; 1996b) • treated 50 patients with mild TBI • average of 40 sessions • observing a clear trend of significant improvement in 24 physical, emotional, and cognitive symptoms

10. Neurofeedback for TBI • Ingo, 2001 • Twelve moderate TBI patients received NF • Rewarded increased 13-20 Hz amplitude • Ten sessions • Nine control patients received computer based attention training (CBT) • NF group > improvement in attentional tasks

11. Neurofeedback for TBI • Tinius and Tinius (2000) • 16 MTBI patients, 15 controls • rewarded normalizing QEEG abnormalities: • Theta and SMR over C3, Cz, and C4 • Coherence • Significant improvement was observed in • Attentional measures (IVA) • Neuropsychological symptoms (NIS) • Wisconsin Card Sorting Task

12. Areas of Positive Impact • Modulation of arousal levels • Regulation of sleep/wake cycle • Organization of cognitive processes • Normalization of sensory processing • Inhibiting inappropriate motor responses • Management of mood and emotions

13. Athletic Performance Enhancement Kaman is enjoying a breakout season, in this his fifth year in the NBA. He ranks among the league leaders in rebounds, blocked shots and double-doubles, and is one of the leading candidates for the league’s most improved player award. “It’s definitely from the neurofeedback I’ve been doing,”

14. Mind Games:Several members of Italy's World Cup-winning team, including Andrea Pirlo, second from lower left, did extensive neurofeedback in the runup to the tournament.’WSJ,July 29, 2006

15. QEEGe.g,Trudeau et al (1998) showed high discrimant validity for evaluating combat veterans with a history of blast injury

16. The female brain

17. The male brain

18. Sterman conducted a meta-analysis of 30 years on neurofeedback efficacy with epilepsy 82% of studies showed clinical improvement 66% showed positive changes to the EEG There was an average of 70% seizure reduction for both intensity and frequency Epilepsy

19. Coma Recovery • Ayers, 1999 • 32 clients in a level 2 coma for > 2 months • Green light brightened as 4-7 Hz decreased • Speakers beeped when both 4-7 Hz decreased and 15-18 Hz increased • 25 of 32 clients came out in one or two sessions • 2 of 32 came out after additional sessions • 5 were unresponsive to six sessions

20. Neurofeedback for TBI • Bounais et al. (2001; 2002) • Classified 27 cases in to seven symptom groups • Treatment mode depended on pre-treatment QEEG • Trained to normalize statistically abnormal measures • Groups’ improvement ranged from 59 to 87% • Improvement correlated significantly to # sessions

21. Neurofeedback for TBI • Walker et al. (2002) MTBI patients • Rewarded normalizing abnormal coherence deviations from the QEEG • Up to 40 sessions • >50% improvement in 88% (mean 72.7%). • All patients returned to work.

22. Other Studies: PTSD • Peniston et al. (1993) reduced symptoms of combat-related posttraumatic stress disorders and alcohol abuse • Training alpha-theta synchronization • Six months of group therapy

23. DSM-IV Criteria for Post Concussive Disorder Head trauma hx of significant cerebral concussion. Evidence quantified cognitive assessment of difficulty in attention (concentrating, shifting focus of attention, performing simultaneous cognitive tasks), or memory (learning or recalling information).

24. Three or more occur shortly after trauma and last > 3 months: Becoming fatigued easily Disordered sleep Headache Vertigo or dizziness Irritability/aggression w/o provocation Anxiety, depression, or affective lability Changes in personality (eg, social or sexual inappropriateness) Apathy or lack of spontaneity

25. DSM-IV Post Concussive Disorder (cont.) Symptom onset follows head trauma or represent a substantial worsening of preexisting symptoms. The disturbance causes significant impairment in social or occupational functioning and represents a significant decline from a previous level of functioning.

26. DSM-IV Post Concussive Disorder (cont.) The symptoms do not meet criteria for dementia due to head trauma and are not better accounted for by another mental disorder (eg, amnestic disorder due to head trauma, personality change due to head trauma).

27. Clinical Applications

28. Quietmind Foundation Research Agenda • ICAD (2009) studied impact of 40 sessions of EEG biofeedback on executive functioning (N=27). • 1072nm IR stimulation for treating dementia • 1072nm IR stimulation for Parkinson’s Disease

29. Prevention Gains Priority “we can’t wait to try to do prevention until we are absolutely certain what causes the disease. This public health emergency is just going to get out of control if we don’t do something.” Neil Buckholtz,Chief of Dementias of Aging, National Institute on Aging. New York Times, June 2, 2010

30. Literature Cited • Ayers, M. E. (1987). Electroencephalic neurofeedback and closed head injury of 250 individuals. Head Injury Frontiers. National Head Injury Foundation, 380-392. • Ayers, M. E. (1991). A controlled study of EEG neurofeedback training and clinical psychotherapy for right hemispheric closed head injury. Paper presented at the National Head Injury Foundation, Los Angeles, 1991. • Ayers, ME (1999) Assessing and treating open head trauma, coma, and stroke using real-time digital EEG neurofeedback. Introduction to quantitative EEG and neurofeedback. Evans, James R. (Ed); Abarbanel, Andrew (Ed); pp. 203-222. • Bounias, M., Laibow, R. E., Bonaly, A., & Stubblebine, A. N. (2001). EEG-neurobiofeedback treatment of patients with brain injury: Part 1: Typological classification of clinical syndromes. Journal of Neurotherapy, 5.(4), 23-44. • Bounias, M., Laibow, R. E., Stubbelbine, A. N.,Sandground, H., & Bonaly, A. (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. Journal of Neurotherapy,Q.( 1), 23 -38. • Carmen, J.A. (2004) Passive Infrared Hemoencephalography: Four Years and 100 Migraines . Journal of Neurotherapy, 8(3): 23 – 51 • DeCharms RC, Maeda F, Glover GH, et al. Control over brain activation and pain learned by using real-time functional MRI. Proc NatlAcadSci2005; 102:18626-18631.Hoffman, D. A., Stockdale, S., & Van Egren, L. (1996a). Symptom changes in the treatment of mild traumatic brain injury using EEG neurofeedback [Abstract]. Clinical Electroencephalography, 27(3),164. • Hoffman, D. A., Stockdale, S., & Van Egren, L. (1996b). EEG neurofeedback in the treatment of mild traumatic brain injury [Abstract]. Clinical Electroencephalography, 27(2),6. • Ingo, K (2001). Neurofeedback Therapy of Attention Deficits in Patients with Traumatic Brain Injury. Journal of Neurotherapy, Vol 5(1-2), 2001. pp. 19-32. • Salazar AM, Warden, DL, Schwab K, et al. The efficacy of traumatic brain injury cognitivityrehabilityation: a prospective, controlled, randomized Trial. Defense & Veterans Head Injury Program Report, October 20, 1998. • Thatcher, 2000. EEG operant conditioning (biofeedback) and traumatic brain injury. Clinical Electroencephalography, 31(1):38-43. • Tinius, T. P., & Tinius, K. A (2001). Changes after EEG biofeedback and cognitive retraining in adults with mild traumatic brain injury and attention deficit disorder. Journal of Neurotherapy, 1(2), 27-44. • Toomim, Hershel; Mize, William; Kwong, Paul C. (2004). Intentional Increase of Cerebral Blood Oxygenation Using Hemoencephalography (HEG): An Efficient Brain Exercise Therapy. Journal of Neurotherapy, Vol 8(3), 2004. pp. 5-21. • Trudeau DL, Anderson J, Hansen LM, et al. Findings of mild traumatic brain injury in combat veterans with PTSD and a history of concussion. J Neuropsychiatry ClinNeurosci 1998; 10(3):308-313. • Walker, Jonathan E.; Norman, Charles A.; Weber, Ronald K (2002). Impact of qEEG-guided coherence training for patients with a mild closed head injury. Journal of Neurotherapy, 6(2):31-43