Neurotherapy

1. Neurotherapy Iza Boesler, MD Betty Jarusiewicz, PhDEEG Spectrum 732-801-4505 E-mail: bjarus@comcast.net

2. Contents • Background/Overview • What is Neurofeedback/Neurotherapy/EEG Biofeedback • How it Differs From Biofeedback • Types/Frequency Ranges/Uses/With Other Therapies • Why NT and Brain Regulation Works • Research Basis (Thumbnail sketch)

3. Contents (cont’d) Relationship to Genetics and Environment Immune System Important Current Research - QEEGs - Loretta - HBOT - Blood Flow Analysis

4. Background • Other Names • EEG Biofeedback • Neurotherapy (NT) • Neurotraining (NT) • How it Differs from Biofeedback

5. Contents (cont’d) • Delivery of NT • What it looks like • Places of delivery • Types of measurement • Our Research - Various Efficacy trials - Use of new measurement equipment - School use - Particular Protocols

6. Contents Cont’d • Assistance to Families and/or Schools • Neurotherapy • Counseling during NT training • Group information sessions

7. Background: What is Neurofeedback and What does it do?(Neuroregulation) • the process of operant conditioning which changes one’s state (stabilizes CNS) and improves behavior • using equipment that monitors and measures the electrical activity of the brain and TRAINS the brain to be more available to life’s requirements

8. Background: Types of Neurofeedback • Beta/SMR • Eyes Open • Frequency Range 12-18 Hz • Alpha/Theta • Eyes Closed • Frequency Range 0-11 Hz

9. Background - Terminology : Brainwave Frequencies (Brain States)

10. Some Documented Uses of Neurofeedback(See www.isnr.org for Comprehensive Bibliography) • Beta/SMR • ADD/ADHD • Learning Disabilities • Sleep • Anxiety, Impulsivity • Depression • Epilepsy • Autism

11. Alpha/Theta (after Beta/SMR) • Emotional and behavioral instability • Addiction (Note: NFB is approved by FDA for relaxation)

12. Integration with other Therapies/Approaches • ADHD, Learning Disabilities, Autism, Epilepsy • Behavioral Therapies • Speech Therapies • Occupational Therapies • Counseling • Other (I.e. Assistive Learning)

13. Headaches (Migraines), Sleep, Anxiety, Impulsivity, Emotional and Behavioral Instability • Counseling • Medication • Addictions, Peak Performance • Counseling

14. Research Basis • 1974: Sterman, MacDonald, & Stone • Noted: seizures reduced by 66% on 4 individuals • Used SMR combined with inhibition of excessive slow wave activity (6-9 Hz) • 1976 SMR: Lubar • Hyperactivity Effects noted: • subsided during training for epileptic seizure reduction • reduced even in absence of seizures • More effective than stimulant medication alone

15. Research Basis (cont’d) • 1984: Lubar • SMR,with inhibits technique extended to attentional deficits and learning disabilities • Significant academic performance enhanced by use of Beta (12-15 Hz) • 1989: Penniston & Kulkowsky • Addition of Alpha Theta Work • Operant conditioning with eyes closed • For use in meditation and mental imagery • Useful for Addiction, PTSD, and Peak Performance work

16. Research Basis (cont’d) • 1989 – Othmer • Initial work with Epilepsy • Development of Software/Hardware for Operant Conditioning Process • Development of EEG Spectrum Inc. • Expansion to other conditions, setting up protocols, training practitioners

17. Research Basis (Cont’d) • Disregulated Brains • Jarusiewicz – initial control pilot study • Coben – use of supplemental devises • Blood flow, QEEGs • Mirror Neurons • San Diego Jaime P

18. Why Neurofeedback Works(Operant Conditioning) • Brain can change with assistance directed by rewards: light, movement, and sound • Brain assists in finding best/better approach (New pathways? More dendrites?) • Brain will remain in new state as it “feels better” • Brain is continually used, maintaining “new skill”

19. Disregulated vs Regulated Brain

20. Example of Similar Exercise Model • Cardio respiratory Exercise • Stronger heart and improved regulation • Sleep improved • Mood improved • Lower basal metabolism With thanks to Harold Burke, Ph.D.

21. In Summary, EEG Biofeedback: • Enhances the ability of an individual to access and maintain different states of physiological arousal and to navigate from high-vigilance to rest. (trains the brain to regulate itself better) • Hence, the treatment of disorders, such as ADHD, depression, and anxiety. With thanks to Harold Burke, Ph.D.

22. Summary (cont.) • Enhances and supports the mechanisms by which the brain manages cortical hyper excitability and promotes stability. • Hence, stabilization against “minor” problems, such as temper tantrums, vertigo, tics, OCD, bipolar disorder, panic attacks, and PMS; and against even lesser disruptions, such as attention problems, sequential and parallel processing, and normal sleep.

23. Summary (cont.) • Reinforces equilibrium states. • Hence, normalization of pain thresholds, appetite, and blood glucose levels.

24. What about the Placebo Effect? • The effects of the training are highly specific to electrode placement and to training frequency band. • Training protocols exist which can commonly elicit effects opposite to those desired. • The effects of training with one protocol can be reversed with another. With thanks to Harold Burke, Ph.D.

25. What Brain Training Sessions Look Like:Client “Hookup”

26. Universal 10 20 Chartfor Electrode Placement

27. Brain Training SessionScreensTherapist (EEG) Client (Game)

29. Therapist’s Screen • Measurement of total EEG signal at the scalp with electrode or two • Amplification of microvolt-level signals for computer processing; • Extraction of low, medium, and high frequencies

30. How is it done? (cont.) • Progress is monitored every session; • Initial sessions should be at a rate of 2-3 per week until progress is seen (probably by 20 sessions). Research study: B. Jarusiewicz

31. The left brain “Style”: Analytic Speech/language specialization Processing Focus The right brain “Style”: Holistic Superior visuospatial performance Emotions/tension Anxiety And Control by Right and Left Brain* Left Brain/Right Brain 5th Ed 1998, Springer, S & Deutsch, G

32. Brain Frequencies“Spectrals”(Note: Every person is different)Autistic * Typical* (note extensive delta, theta and alpha frequencies)

33. Measurement of Change • By Client • Establish changes client wishes to make • Develop reporting mechanism

34. Measurement of Change • By Therapist • Review behavior changes (checklists, drawings) • Review how client feels • Review brain activity (measured averages etc) • Review spectrals

35. Child’s Family Drawing at Beginning of NF - 8/3/94(with thanks to L. Hirshberg)

36. Drawing after Twenty Sessions - 9/8/94

37. Drawing after forty sessions -11/25/94

38. Hill and Castro ADD/HD Checklist

39. Measurement of Change • For Research • Use of “standard” tests (ADI, ADOS, Checklists, IQ, memory and reading) • Corroborative Evidence (videos, interviews, school or other therapy reporting tests)

40. Autism StudyAverage Behavior Changes (ATEC) by Type • Sociability 33% • Speech/language/communication 30% • Health 26% • Sensory/cognitive awareness 16% p <. 010 for sociability p < .000 for speech p < .015 for health p <. 000 for sensory

41. Behavior Improvement Interview Results

42. Treatment Effectiveness Survey Results • 1. Behavior Modification • 2. Speech Therapy • 3. Occupational Therapy Sensory Integration Neurofeedback *based on parents reports received to date, considering all types of therapies in their experience

43. What you can do for your child • Be clear as to assessment of talents, skills, and issues to overcome (Full assessment with history, and videos) • Determine a method of on-going measurement (per session, per time period) • Choose one new approach at a time • Measure, measure, measure

44. What you can do for your child • Determine impact of and plan accordingly for • Family issues • Diet • Schedule/Rules • School issues • Placement • Simultaneous therapies • Social issues