QEEG-guided neurofeedback is based on normalizing dysregulated brain regions that relate to specific clinical presentation. With ASD, this means that the approach is specific to each individual’s QEEG subtype patterns and presentation. The goal of neurofeedback with ASD is to correct amplitude abnormalities and balance brain functioning, while coherence neurofeedback aims to improve the connectivity and plasticity between brain regions. This tailored approach has implications that should not be underestimated. . . . Clinicians, including the authors, have had amazing results with ASD, including significant speech and communication improvements, calmer and less aggressive behavior, increased attention, better eye contact, and improved socialization. Many of our patients have been able to reduce or eliminate their medications after completion of QEEG-guided neurofeedback.

Preface by By James Neubrander, MD

Parents of children with autism know me (JN) as a physician who uses various biomedical treatments to help children move toward recovery. Several years ago, I was introduced to the powerful modality of QEEG-guided neurofeedback. This treatment uses EEG biofeedback, also known as neurofeedback, guided by the QEEG, or quantitative electroencephalogram. Neurofeedback has since become an important addition to my practice because it offers therapeutic options that are not possible through biomedical treatments alone.

To date, I have obtained QEEGs on hundreds of children with autism and have watched the neurofeedback process help them take one or more steps forward on their roads to recovery. That is why it pleases me to have been asked by Autism Science Digest to write this article to introduce QEEG and QEEG-guided neurofeedback for children with autism as one more important treatment option for parents to consider.

Although I have prescribed many neurofeedback sessions for my clients, I cannot claim to be an expert in QEEG interpretation. In that regard, I defer to those who evaluate my patients’ EEg tracings and subsequently recommend appropriate neurofeedback protocols that my neurofeedback technicians then implement. My coauthors (Ml, Jg, and Ck), whose biographies speak for themselves, are some of the most respected names in the field of QEEG and QEEG-guided neurofeedback. In this paper, they provide an overview of the science behind the process, a theoretical platform, and an outline of the benefits this treatment can offer to the many children who have attention-deficit or attention-deficit/hyperactivity disorder (ADD/ADHD), Asperger’s syndrome, pervasive developmental disorder-not otherwise specified (PDD-NOS), or autism spectrum disorder (ASD).

“I have obtained QEEGs on hundreds of children with autism and have watched the
neurofeedback process help them take one or more steps forward on their roads to recovery.”

Download or Read the full PDF here.

AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE – ISSUE 03

By: James Neubrander MD, Michael Liden PhD, Jay Gunkleman QEEGD, and Cynthia Kerson PhD.

QEEG-guided neurofeedback is based on normalizing dysregulated brain regions that relate to specific clinical presentation. With ASD, this means that the approach is specific to each individual’s QEEG subtype patterns and presentation. The goal of  neurofeedback with ASD is to correct amplitude abnormalities and balance brain functioning, while coherence neurofeedback aims to improve the connectivity and plasticity between brain regions. This tailored approach has implications that should not be underestimated …. Clinicians, including the authors, hove had amazing results with ASD, including significant speech and communication improvements, calmer and less aggressive behavior, increased attention, better eye contact, and improved socialization. Many of our patients have been able to reduce or eliminate their medications after completion of QEEG-guided neurofeedback.

PREFACE

Parents of children with autism know me (JN) as a physician who uses various biomedical treatments to help children move toward recovery. Several years ago. I was introduced to the powerful modality of QEEG-guided neurofeedback. This treatment uses EEG biofeedback, also known as neurofeedback, guided by the QEEG, or quantitative electroencephalogram. Neurofeedback has since become an important addition to my practice because it offers therapeutic options that are not possible through biomedical treatments alone.

To date, I have obtained QEEGs on hundreds of children with autism and have watched the neurofeedback process help them take one or more steps forward on their roads co recovery. That is why it pleases me to have been asked by Autism Science Digest to write this article to introduce QEEG and QEEG-guided neurofeedback for children with autism as one more important treatment option for parents to consider.

Although I have prescribed many neurofeedback sessions for my clients. I cannot claim to be an expert in QEEG interpretation. In that regard, I defer to those who evaluate my patients’ EEG tracings and subsequently recommend appropriate neurofeedback protocols that my neurofeedback technicians then implement. My coauthors (ML, JG, and CK), whose biographies speak for themselves, are some of the most respected names in the field of QEEG and QEEG-guided neurofeedback. In this paper, they provide an overview of the science behind the process, a theoretical platform, and an outline of the benefits this treatment can offer to the many children who have attention-deficit or attention-deficit/hyperactivity disorder (ADD/ADHD), Asperger’s syndrome, pervasive developmental disorder-not otherwise specified (PDD-NOS), or autism spectrum disorder (ASD).

Read the rest of the article [PDF File]

The two images below show the referential and sequential montage display of an active right temporal-parietal spike and slow wave focus, seen in a child clinically diagnosed with an attachment disorder. There was no history of convulsion, nor any suspicion of the actual underlying pathophysiological basis for the behavioral presentation.

The focus cortical area is normally involved in comprehension of facial expression and body language, as well as the prosodic (emotive) aspects of language. Any disturbance in that cortical area’s function generally has social contextual implications for behavior due to “prosodic blindness”. (see: Van Bloem, L. QEEG in Children with Reactive Attachment Disorder,

Journal of Neurotherapy, 4(4), 2001.

The implications for treatment option with this pathophysiological source for the behavioral presentation which could really only be discovered through the EEG are enormous. The use of an anticonvulsant or an approach with one of the proven efficacious applications of Neurofeedback in treating epilepsy can be used to target the underlying cause, rather than trying to effect some symptomatic control with antipsychotic or antidepressant medications so commonly used in these situations of severe attachment disorder. (see a review of SMR applied to epilepsy by Dr. M. Barry Sterman, Professor Emeritus, UCLA, from 2000 in Clinical Electroencephalography’s special edition on Neurofeedback)

In these images the referential focus is seen associated with the largest waveform, though in the sequential data the 180 degree phase reversal points to the focus.

EEG & Epilepsy - Referential Montage Display

EEG & Epilepsy - Sequential Montage Display

In modern neuroscience centers, the EEG is still the tool of choice in evaluation of convulsive epilepsy, as well as some other non-convulsive forms, such as staring episodes seen in “absence epilepsy” typically as a 3/second spike and wave dominant anteriorly, or temporal lobe epilepsy, which is seen as a “notched” slow wave discharge fronto-temporally.

The EEG can now be processed through algorithms, such as spike dipole localization software, to identify the “seizure focus” cortically, or spectral averaging to look for changes in the underlying EEG rhythmicity due to the disorder.

One of the difficulty with the two later categories is that they are not always identified as forms of epilepsy, and thus can be mis-diagnosed based on behavior alone as some other disorders, including ADD/ADHD in absence epilepsy “spells” where the attentional process is disturbed by the discharge taking segments of time out of the cognitive streaming of perception, or from discharge in sensory areas.  These segments being removed do not have any conscious awareness of the event for the person experiencing the blips missing from their cognitive process, and they will have trouble tracking on-going events, like driving or listening to a speech or lecture.  Imagine missing a few here and there, to tens of seconds from your awareness, and see if you don’t have “attentional deficits”.

The other major areas of misdiagnosis are of a “schizophrenic” or “psychotic” nature.  This occurs when the discharges are frontal or temporal and disturbing local cortical function, and may be seen as a range of presentations from hallucinations or emotional outbursts of rage, or even “fits of laughter” in “Gelastic seizures”.   Temporal Lobe Epilepsy (TLE) is a particularly difficult one to properly diagnose in the absence of the EEG.

The importance of these missed-diagnoses can be quite severe, with the use of medications to treat the symptoms often being contra-indicated by the epilepsy.  One example of this is TLE that is assumed to be psychosis, since antipsychotic medications lower the seizure threshold, and make the person worse, which can then be responded to with more antipsychotics, spiraling the person into a progressively worsened condition.  The use of stimulants in epilepsy is a controversial area, as the effect of stimulants for inattention in known and treated epileptics may be acceptable, though throwing a stimulant at an undiagnosed epileptic can have severe negative consequences.

The real issue is that IF YOU DO NOT LOOK, YOU WILL NOT SEE… and in epilepsy, looking requires the EEG, as the gold standard.

In surgical approaches, the EEG is used to identify whether there are multiple foci, which generally will preclude a good outcome (you remove the brain tissue and the seizures do not change).

I will post some images of the WIDE variety of morphologic presentation that epilepsy can take, so that some understanding of the task of the Electroencephalographer and Epileptologist can be better appreciated by those who think it is straight-forward.

Thanks for your attention to these obscure issues.

Jay

This may not surprise too many old-time NF practitioners, except that it is now being proven with well done studies in the traditional neuroscience literature!  Neurofeedback can induce changes in brain plasticity!

Jay

First Direct Evidence of Neuroplastic Changes Following Brainwave Training

ScienceDaily (Mar. 12, 2010) — Significant changes in brain plasticity have been observed following alpha brainwave training.

A pioneering collaboration between two laboratories from the University of London has provided the first evidence of neuroplastic changes occurring directly after natural brainwave training. Researchers from Goldsmiths and the Institute of Neurology have demonstrated that half an hour of voluntary control of brain rhythms is sufficient to induce a lasting shift in cortical excitability and intracortical function.

Remarkably, these after-effects are comparable in magnitude to those observed following interventions with artificial forms of brain stimulation involving magnetic or electrical pulses. The novel finding may have important implications for future non-pharmacological therapies of the brain and calls for a serious re-examination and stronger backing of research on neurofeedback, a technique which may be promising tool to modulate cerebral plasticity in a safe, painless, and natural way.

Continued at http://www.sciencedaily.com/releases/2010/03/100310114936.htm

An excellent story regarding the use of Neurofeedback in sports.  The Mind Room utilizes the Thought Technology Procomp Infiniti equipment. The follwing article from the Vancouver Sun gives us a bit of insight in to the 2011 Stanley Cup run of the Vancouver Canucks.

Canucks work on secret mind room where they can be programmed to think happy thoughts

In director Stanley Kubrick’s classic 1971 film A Clockwork Orange, a violent criminal named Alex DeLarge undergoes experimental aversion therapy as authorities try to psychologically reprogram him.

DeLarge, brilliantly played by Malcolm McDowell, has his eyelids clamped open and is forced to watch graphic nasty bits of ultra-violence on film while suffering drug-induced nausea all to the music of Beethoven. DeLarge quickly associates his suffering with violence and Beethoven’s Ninth Symphony and is cured. Completely disarmed psychologically, he returns to the community stripped of any coping skills and soon tries to kill himself.

Dr. Hal Myers, president of Thought Technology Ltd. hooked up to ‘Mind Room’, a physiological-psychological instrument that prepares athletes mentally to deal with nail-biting experiences. -Montreal Gazette MindRoom technology worked for the Italian national team at soccer’s last World Cup and it could soon be working for the Vancouver Canucks.

So far, the MindRoom people have yet to lose a European soccer player, yet the sports science company’s futuristic programming room sounds lifted from A Clockwork Orange, except it works in reverse.

Instead of inducing horror, technicians in the mind room create a soothing environment intended to reinforce positive feelings among meditative players, who are trained not to allow negative thoughts to consume them. They emerge from treatment, in theory, confident and better equipped psychologically to survive the stress and crisis of competition. If all goes well, they become masters of their emotions.

The National Hockey League team is building its own mind room, working with the Italian-based sports science firm that utilizes strategies developed by Thought Technology Ltd. Of Montreal.

It is part of Canuck general manager Mike Gillis’s sweeping initiative to push the conventional boundaries of player development and preparation in the NHL.

Gillis mentioned MindRoom Sports Science Inc. during an interview early last season but has since stopped talking about the program, wary the Canucks could too easily surrender whatever competitive advantages they gain from it.

Although there were plenty of skeptics last season when the Canucks hired Vancouver-based Global Fatigue Management to analyse players’ sleep patterns, Gillis said several other NHL teams are now conducting their own fatigue programs.

Gillis declined again Wednesday to talk about MindRoom, but the Canucks’ secret is getting out.

A fan forum on the team’s own website has been abuzz with chatter for more than a week.

It’s unclear at what stage of construction the Canucks mind chamber is at, or even if it will be operational this season.

But the team has been working for more than a year with Dr. Len Zaichkowsky, a renowned sports psychologist at Boston University who is originally from Alberta.

Zaichkowsky, a friend of Gillis who developed for the Canucks a new program to gauge potential draft picks’ aptitude for professional hockey, is listed as faculty on the MindRoom Sports Science website.

One of the company’s marquee clients is Chelsea Football Club in England, which signed on last summer.

According to The Daily Telegraph, up to six Chelsea players at a time visit the London club’s mind room, where electrodes are fitted to their heads, chest and hands to measure brain activity, muscle response and anxiety.

Guided into a meditative state, players are shown soothing images and short video clips from matches. They are trained to remain in a calm, relaxed state regardless of what they see and hear.

Chelsea sports psychologist Dr. Bruno Demichelis, also on the MindRoom faculty, told The Telegraph the mind room allows the players to improve their resiliency through mental training.

Or as MindRoom Sports Science claims on its website: Through this training, the person learns how to control his intrusive thoughts and worries, aiming towards a condition of improved presence, attention, concentration and vigilance.

Serenity now.

So, with any luck next season, Canuck Steve Bernier will not break into a cold sweat every time he gets the puck on his stick in a scoring position. Roberto Luongo will not look skyward with exasperation when he allows a bad goal. Shane O’Brien will never take another bad penalty. Maybe Vancouver will even win on the road.

After all, as Yogi Berra tried telling us, games are 90 per cent mental; the other half is physical.

imacintyre@vancouversun.com

© Vancouver Sun 2009

All of these new tools will require clinical validation prior to being able to be considered standard techniques within our field’s armamentarium of efficacious techniques and clinical applications. All of these techniques offer great hope at this time with preliminary results, but careful clinical outcome studies remain to be performed.

In this brief note I will discuss Z-score feedback. This promising technique offers to set normative boundaries around the mean of many features of the EEG, and allow feedback to be controlled by these parameters. This obviously offers great hope to clinical outliers, as their Z-score divergence should be related to their pathology. One difficulty is that database Z-scores also show divergence when an adaptive or counter-balancing feature is used to cope with an abnormal finding. A crutch is not a normal finding, but you can’t walk without it if you have a broken leg.

This suggests that the selection of which Z-score features to include as feedback contingencies and which to “ignore” will become an important feature in clinical decision making using these new tools. Training away an adaptive coping mechanism is not a proper NF Z-score targeting choice.

One area which is not very well discussed in the field of qEEG is how poorly the databases are at characterizing shifts in the frequency “tuning” of the EEG. The NeuroGuide database reports peak frequency, but the calculation is not for the peak, but for a “centroid” which is more related to the Mean than the Peak frequency. Nx-link does not report the peak, but uses a mean frequency calculation. BRC database uses a peak frequency of alpha statistic, but it is constrained to looking within the alpha predefined band.

Databases report “too much” and “not enough” amplitude/magnitude/power, but they do not tell you if this value would be normal at a different frequency tuning. An example is in order to illustrate this important concept. Take a normal amount of 9.5 Hz sinusoidal alpha seen dominant posteriorly, with normal coherence relationships… let’s arbitrarily say there is 50 microvolts of amplitude in the alpha spindles. Now, take this alpha tuning and shift it 2 Hz slower, so 7.5 Hz is the sinusoidal frequency, and what does the database tell you?

Databases will say there is too much 7.5 Hz power, and that it is hypercoherent, since the database does not expect alpha at 7.5 Hz. In reality, the alpha frequency is slow, but the fact that it is 50 microvolts is not too much power for the background, and it really is not hypercoherent, it is just too slow.

Frequency tuning issues are so poorly described in databases that the databases will not do a good job of normalizing the client’s function… dropping the background’s normal power and coherence relationships is not appropriate, but the database would use these values as their contingencies for NF based on the database.

This would suggest that frequency shifted clients may comprise another group that will require special adaptations for Z-score based feedback to be properly applied.

One other area that deserves some discussion is the use of NF in non-medical applications for “peak performance”. By definition, these peak states are not a common occurrence, as they are seen in uniquely gifted athletes, scholars, and business leaders that are not that common in the first place, and then these states are not always seen in these individuals in their average states. These states that are being trained for are not statistically “Mean-oriented” states, but rather exist as a unique pattern of outliers which are not capable of being reported in univariate statistics such as Z-scores. It requires a flexible nervous system to achieve these outlier states, and a resilient nervous system to “return” or “recover” and continue to function “normally”.

These observations suggest that peak performance may not be the best application for Z-score feedback, though this is hypothetical, and requires the validation only achieved with experience over the years.

The database selected also will become an issue, as the NeuroGuide is severely restricted in the frequency range, with the amplifier response stopping at 28Hz, as seen in the FRC curve(Fig 1). It is not possible to do gamma based feedback with Z-scores of the database used does not go to gamma.

Figure 1

What is clear at this time is that Z-score feedback remains experimental until the validation studies are performed, and though it is a promising new application utility, there are areas which deserve special attention even in this early stage of the evaluation of this emerging technique, including coping mechanisms, frequency shifts, peak performance applications, and database limitations.

The vendors who promote Z-score feedback are all adamant that the Z-score feedback does not preclude the need for client evaluation, but rather that is increases the complexity of the evaluation as various features are selected or de-selected for being feedback contingencies to account for client coping mechanisms, and the various frequency shifting issues and other database inadequacies.

Welcome to the New World of high tech clinical application tools, please check your expectation that this will be “quick and easy” at the door. More on LORETA and ICA based neurofeedback later.

In Part 2 you see how Noah parents learn there are alternatives to Ritalin and other drugs that may be given to their child. Learn about how Neurofeedback and EEG Brain Mapping may be able to help without the use of dangerous pharmaceutical drugs.

Dr. Linden is a Clinical Psychologist and Nationally Certified in Neurofeedback and Biofeedback. He is the director of The Attention Learning Center, which has offices located in San Juan Capistrano, Irvine and Carlsbad, California.

Dr. Linden is a regular contributor to the Journal of Neurotherapy and has been a speaker in many seminars and conferences related to ADD/ADHD and neurotherapy.

This video was recently shown again on CBS 60 Minutes. It is a great video talking about using brain controlled interfaces.

Brain Power – Harnessing the Power of the Brain

August 9, 2009 4:35 PM

People who are completely paralyzed due to illness or trauma are getting help communicating with a new technology that connects their brains to a computer. Scott Pelley reports.