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HEALING THE BRAIN WITH NEUROFEEDBACK. Cindy Perlin, LCSW. Biofeedback. Uses sensitive electronic instruments to detect physiological changes with far greater sensitivity than a person can alone. This information is used to teach the individual to control their physiology.

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    2. Biofeedback • Uses sensitive electronic instruments to detect physiological changes with far greater sensitivity than a person can alone. • This information is used to teach the individual to control their physiology

    3. Biofeedback Modalities • Muscle (EMG) • Temperature • Heart rate • Respiration • Skin Conductance (GSR) • Brainwave (Neurofeedback)

    4. Neurofeedback Training the electrical activity and timing of the brain to improve brain functioning

    5. The first major neurofeedback study was done with cats by Dr. Barry Sterman …

    6. Experimental Work of Barry Sterman, Ph.D. • Sterman trained cats to increase their SMR (12-15hz) through operant conditioning • Showed that cats could be trained to increase SMR • Published in Brain Research, 1967

    7. Dr. Sterman’s Next Study • Studied seizure thresholds for cats’ exposure to rocket fuel. • Some of the cats did not have seizures at the known threshold levels. • Dr. Sterman checked his records and found the seizure resistant cats were the ones who had SMR training.

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

    9. Sterman’s Work With Humans • Dr. Sterman then decided to investigate whether neurofeedback would help humans with seizure disorders. • His studies showed a decrease in seizure severity and frequency with SMR training. • Patients with seizure disorders who also had ADHD showed an improvement in ADHD symptoms, which led to studies of neurofeedback with people with ADHD.

    10. Characteristics of Brainwaves • Frequency (hertz) • Amplitude (microvolts) • Coherence (under or over-differentiation) • Location (10-20 System)

    11. 10-20 system • The International 10-20 System of Electrode Placement is the most widely used method to describe the location of scalp electrodes. • Each site has a letter (to identify the lobe) and a number or another letter to identify the hemisphere. 

    12. 10-20 System

    13. A disregulated brain often has too much slow activity.

    14. This individual’s eyes are open. Their brain isn’t very alert and awake.

    15. This brain is alert and awake. In EEG terms, smaller means more regulated, better functioning.

    16. Delta .5-4 Hz One second • Predominant in sleep • Should be low while awake • High delta can interfere with emotional or cognitive processing

    17. Theta 4-8 Hz One second • Pre-sleep, trance • Inattentive • Distractible • Lack of focus

    18. Alpha 8-12 Hz One second • Relaxed (parietal) • Spacey • Unmotivated • Inattentive and depressed

    19. SMR 12-15 Hz One second • Calm, external attention • Regulates impulsivity and hyperactivity • Promotes body awareness • Helps control anxiety; anger • Movement Inhibition

    20. Beta 15-20 Hz One second • Active, external attention • Enhances cognitive processing • Improves concentration, attentiveness, focus

    21. High Beta 22-36 Hz One second • Body tension • High state of arousal • Excited / anxious / stressed

    22. Protocol Selection Functional • Based on presenting symptoms and areas of the brain known to be related to these symptoms. QEEG • Measurement of amplitudes, frequencies and coherence at 19 sites • Results compared to normative data bases • Sites 2 standard deviations or more from the mean are targeted for training.

    23. ADHD Seizure disorders Alcoholism/substance abuse Traumatic brain injury PTSD Anxiety Depression Chronic Fatigue Syndrome Fibromyalgia Chronic Pain OCD Tourette’s Syndrome Sleep disorders Autism Asperger’s Bipolar disorder Reactive attachment disorder Peak Performance Age related memory loss Parkinson’s Migraines PMS Schizophrenia Current Clinical Uses

    24. Studies of Neurofeedback and ADHD • Several uncontrolled studies showed that neurofeedback: • Improved attentiveness and impulse control • Decreased hyperactivity • Raised intelligence scores • Improved academic performance (Grein-Yatsenko et al., 2001; Lubar, Swartwood, Swartwood & O’Donnell, 1995; Thompson & Thompson, 1998)

    25. Controlled studies comparing neurofeedback to other treatments for ADHD Alhambra, Fowler and Alhambra (1995): • After 30 sessions of neurofeedback, 16 of 24 patients taking medications were able to lower their dose or discontinue medications totally Monastra, Monastra and George (2002) • studied 100 children with ADHD receiving Ritalin, parent counseling and academic support. 50 children also received neurofeedback. • While all children improved on the TOVA and an ADD evaluation scale while taking Ritalin, only those who had EEG biofeedback sustained those improvements after discontinuing Ritalin.

    26. Studies of Neurofeedback and ADHD (continued) The most recent study, in China (Xiong, Shi and Xu, 2005): • 60 ADHD children studied • 40 sessions of neurofeedback • Over 90% significantly improved their scores on the IVA-CPT (Integrated Visual and Auditory Continuous Performance Test)

    27. A Meta-Analysis of 19 Studies of EEG Biofeedback for Epilepsy(Sterman MB, 2000) • 82% of studies demonstrated significant seizure reduction • Average reduction exceeded 50% • Studies reported reduction in seizure severity • About 5% of patients had complete control at one year follow-up

    28. QEEG-guided Neurofeedback for Seizure Disorders • Johnathan Walker, MD “trains away” QEEG-identified abnormalities of power (amplitude) and coherence and reports a 100% success rate in patients with partial complex seizures • All patients became seizure free and many were able to stop their anticonvulsant treatment (Walker and Kozlowski, 2005)

    29. Studies of Neurofeedback for Traumatic Brain Injury • Neurofeedback appears to improve memory in persons with brain injury (Thornton, 2000). • Neurofeedback improves attention and response accuracy of a performance task and decreases errors in a problem solving task (Tinius & Tinius, 2000). • Another study showed significant improvement in attention deficits in those receiving neurofeedback compared to a matched control group (Keller, 2001).

    30. Studies of Neurofeedback for Autistic Spectrum Disorders • 12 children receiving an average of 36 sessions of neurofeedback based on functional deficits reduced autistic symptoms by 26% (Jarusiewicz, 2002) • 37 children receiving 20 sessions of QEEG-guided neurofeedback showed a 40% decrease in autistic symptoms compared to a control group (Coben and Padolsky, 2007)

    31. Clinical Reports - Depression Cory Hammond, Ph.D., Professor of Physical Medicine & Rehabilitation,University of Utah School of Medicine: • Treated 25 patients with moderate to severe depressive disorder • Reduced left frontal alpha and increased 12-20hz. Also utilized photic stimulation • Sustained remission of the depression in all 25 patients in 20- 25 sessions • All reduced or discontinued medication

    32. Clinical Reports – Bipolar Disorder Ed Hamlin, Ph.D., at the Pisgah Institute in Asheville, North Carolina: • Treated about 40 patients with bipolar disorder • Interhemispheric protocol, increasing 11-14 or 13-16hz while inhibiting low frequency and high frequency brainwaves. • All of his patients have been able to significantly stabilize mood and improve functioning while decreasing or eliminating medication.

    33. Case Report - ADHD • 10 y.o. female with severe hyperactivity even though medicated with Ritalin • So hyperactive, it was doubtful at first she could do neurofeedback • 90 sessions over about 50 weeks • Complete remission of hyperactivity with improved school performance w/o medication • Now age 16, retained improvements without medication

    34. Case Report – Sleep Disorder • 65 y.o. male with 50 year history of delayed sleep onset of 4-5 hours nightly, following month long coma at age 15 due to measles encephalitis • After 8 sessions of SMR neurofeedback, rapid sleep onset even in unfamiliar environments

    35. Case Report – TBI • 29 y.o. male, seen 12 years after TBI from auto accident, 3 months in coma • Premorbid severe ADHD • Active alcohol abuse at time of referral, with history of multiple DWI arrests • Problems with memory, concentration, word retrieval, coordination, tremor, headaches, balance and weakness on the left side of his body, as well as frequent temper outbursts

    36. Case Report – TBI (continued) • Approximately 250 sessions in 3 years, with a 6 month break in treatment to attend a court mandated alcohol treatment program • 1 session Thought Field Therapy for trauma • Significant improvement in all presenting symptoms, as reported by client and family members, including: • Over 4 years sobriety • Absence of temper outbursts • Improved memory and focus • Improved strength, balance and coordination • Willing to read aloud in public

    37. Case Report – Bipolar Disorder • 10 y.o. male, also diagnosed with intermittent explosive disorder • Multiple psychiatric hospitalizations, special school placement, almost daily explosive episodes • Medications: Lithobid and Abilify • 60 sessions • Elimination of explosive episodes, improvement and stabilization of mood, while significantly reducing medication

    38. Typical Neurofeedback Session • Twice a week sessions • 20-45 minutes of feedback • Auditory and visual rewards when achieving thresholds • 70%-90% reward frequency

    39. Game provides client feedback Mazes

    40. Space Race

    41. Frank H. Duffy, M.D., Professor and Pediatric Neurologist, Harvard Medical School, wrote about neurofeedback: "In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used…It is a field to be taken seriously by all." (Editorial, Clinical Electroencephalography, January 2000)

    42. Time Magazine, 1/19/07 • “For decades the prevailing dogma in neuroscience was that the adult human brain is essentially… hardwired, fixed in form and function so that by the time we reach adulthood we are pretty much stuck with what we have….The doctrine of the unchanging human brain has had profound ramifications. For one thing, it lowered expectations about the value of rehabilitation for adults who had suffered brain damage from a stroke or about the possibility of fixing the pathological wiring that underlies the psychiatric diseases….But research in the past few years has overthrown the dogma. In its place has come the realization that the adult brain retains impressive powers of ‘neuroplasticity’—the ability to change its structure and function in response to experience. The brain can be rewired.”

    43. Resources: Web Sites www.isnr.org : International Society for Neurofeedback and Research. This site contains a comprehensive bibliography of outcome research in neurofeedback, organized by disorder, as well as journal articles, provider list and other information. www.eegspectrum.com: EEG Spectrum provides training, information, equipment and an affiliate network for information sharing, consultation and referral. www.aapb.org: Association for Applied Psychophysiology and Biofeedback is the national biofeedback organization.

    44. Resources – Books • A Symphony in the Brain by Jim Robbins, Atlantic Monthly Press, New York, 2000 • Getting Rid of Ritalin by Robert W. Hill, Ph.D and Eduardo Castro, M.D., Hampton Roads Publishing Co., Charlottesville, VA, 2002 • ADD: the 20 Hour Solution by Mark Steinberg, Ph.D. and Siegfried Othmer, Ph.D., Robert D. Reed Publishers, Brandon, OR, 2004

    45. Contact Information Cindy Perlin, L.C.S.W. Phone: (518) 439-6431 E-Mail: cperlin@nycap.rr.com www.peakmindbody.com

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