International Hypnosis Research Institute - Biofeedback

Effect of biofeedback-assisted autogenic training on headache activity and mood states in Korean fem

Thu, 02 Sep 2010 12:44:00 -0500

Biofeedback with or without combined autogenic training is known to be effective for the treatment of migraine. This study aimed to examine the effect of biofeedback treatment on headache activity, anxiety, and depression in Korean female patients with migraine headache. Patients were randomized into the treatment group (n=17) and monitoring group (n=15). Mood states including anxiety and depression, and psychophysiological variables such as mean skin temperature of the patients were compared with those of the normal controls (n=21). We found greater treatment response rate (defined as > or =50% reduction in headache index) in patients with biofeedback-assisted autogenic training than in monitoring group. The scores on the anxiety and depression scales in the patients receiving biofeedback-assisted autogenic training decreased after the biofeedback treatment. Moreover, the decrease in their anxiety levels was significantly related to the treatment outcome. This result suggests that the biofeedback-assisted autogenic training is effective for the treatment of migraine and its therapeutic effect is closely related to the improvement of the anxiety level. J Korean Med Sci. 2009 Oct;24(5):936-40. Kang EH, Park JE, Chung CS, Yu BH. Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Biofeedback effectiveness to reduce upper limb muscle activity during computer work...

Thu, 26 Aug 2010 11:04:00 -0500

Full Title: Biofeedback effectiveness to reduce upper limb muscle activity during computer work is muscle specific and time pressure dependent Continuous electromyographic (EMG) activity level is considered a risk factor in developing muscle disorders. EMG biofeedback is known to be useful in reducing EMG activity in working muscles during computer work. The purpose was to test the following hypotheses: (1) unilateral biofeedback from trapezius (TRA) can reduce bilateral TRA activity but not extensor digitorum communis (EDC) activity; (2) biofeedback from EDC can reduce activity in EDC but not in TRA; (3) biofeedback is more effective in no time constraint than in the time constraint working condition. Eleven healthy women performed computer work during two different working conditions (time constraint/no time constraint) while receiving biofeedback. Biofeedback was given from right TRA or EDC through two modes (visual/auditory) by the use of EMG or mechanomyography as biofeedback source. During control sessions (no biofeedback), EMG activity was (mean+/-SD): 2.4+/-1.1, 2.5+/-2.1, and 9.1+/-3.1%max-EMGrms for right and left TRA and EDC, respectively. During biofeedback from TRA, activity was reduced in right TRA (1.7+/-1.6%max-EMGrms) and left TRA (1.2+/-2.0%max-EMGrms) compared to control. During biofeedback from EDC, activity in EDC was reduced (8.3+/-3.3%max-EMGrms) compared with control. During time constraint, activity was reduced in right TRA (1.9+/-1.3%max-EMGrms), left TRA (1.5+/-1.5%max-EMGrms), and EDC (8.4+/-3.2%max-EMGrms), during biofeedback compared to control. Conclusion: biofeedback reduced muscle activity in TRA by approximately 30-50% and in EDC by approximately 10% when given from the homologous or bilateral muscle but not from the remote muscle, and was significant in the time constraint condition; while feedback source and presentation mode showed only minor differences in the effect on reducing homologous muscle activity. This implies that biofeedback should be given from the most affected muscle in the occupational setting for targeting relief and prevention of muscle pain most effectively. Copyright © 2010. Published by Elsevier Ltd. J Electromyogr Kinesiol. 2010 Jul 9. Vedsted P, Søgaard K, Blangsted AK, Madeleine P, Sjøgaard G. Alectia A/S, Sofiendalsvej 9, 9200 Alborg, Denmark.

Long-term results of biofeedback treatment for faecal incontinence

Thu, 19 Aug 2010 11:03:00 -0500

Full Title: Long-term results of biofeedback treatment for faecal incontinence: a comparative study with untreated controls AIM: Long-term results of biofeedback for faecal incontinence are controversial. Moreover, its value compared with standard care has been recently questioned. The study aimed to analyse the long-term efficacy of biofeedback therapy for faecal incontinence to formed stool and to compare it with no treatment. METHOD: Seventy-nine patients with faecal incontinence to solid stool were evaluated at baseline and 1, 6, 36 and 60 months after treatment. To compare the long-term results with no treatment, 40 patients initially evaluated but not referred for therapy were used as controls. RESULTS: More than 80% of patients recovered continence or had a reduction in the number of episodes of incontinence greater than 75% at 1, 6, 36 and 60 months, indicating that the success rate of biofeedback was maintained over time. At 60 months, 86% of patients treated with biofeedback were fully continent or had a > 75% reduction in the number of incontinent episodes compared to 26% of the untreated patients (P < 0.001). CONCLUSION: Biofeedback therapy is effective in patients with faecal incontinence to formed stool compared with no treatment. Overall, clinical improvement is maintained in the long term.. Colorectal Dis. 2010 Aug;12(8):742-9. Epub 2009 Apr 10. Lacima G, Pera M, Amador A, Escaramís G, Piqué JM. Digestive Motility Unit, Digestive Diseases Institut, Hospital Clinic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain. glacima@clinic.ub.es

First non-contingent respiratory biofeedback placebo versus contingent biofeedback...

Thu, 12 Aug 2010 10:59:00 -0500

Full Title: First non-contingent respiratory biofeedback placebo versus contingent biofeedback in patients with chronic low back pain: a randomized, controlled, double-blind trial Previous studies reported that respiratory feedback (RFB) aids in alleviating chronic pain. However, to date, this adjunct treatment has not been rigorously tested against non-contingent (placebo) feedback. Forty-two patients with chronic low back pain were randomized to either RFB or non-contingent RFB. Both groups performed a daily 30-min home training for 15 consecutive days. A respiratory associated relaxation index (RI) was measured. Pain levels and a somatosensory profile were assessed before and after intervention. Additionally, pain levels were assessed 3 months after the end of intervention. Secondary outcome parameters included daily functioning, psychopathology, and suggestibility. T-tests showed higher and significant pain reductions for RFB, compared to non-contingent RFB. Between-group comparisons reached no significance. However, changes were more pronounced in the RFB condition, which was also true for the course of the RI and the psychopathological scores. This is the first study using a non-contingent respiratory placebo feedback in a randomized, controlled design. Within this design previous positive findings of symptom reductions in patients treated with RFB could partially replicated. Nonetheless, tendencies suggest that contingent feedback patients compared to placebo patients profit more from RFB in the long run regarding reduction of chronic pain and psychological distress. Appl Psychophysiol Biofeedback. 2010 Sep;35(3):207-17. Kapitza KP, Passie T, Bernateck M, Karst M. Department of Anesthesiology, Pain Clinic, Hannover Medical School, 30625, Hannover, Germany.

Biofeedback of heart rate variability and related physiology: a critical review

Thu, 05 Aug 2010 10:53:00 -0500

Low heart rate variability (HRV) characterizes several medical and psychological diseases. HRV biofeedback is a newly developed approach that may have some use for treating the array of disorders in which HRV is relatively low. This review critically appraises evidence for the effectiveness of HRV and related biofeedback across 14 studies in improving (1) HRV and baroreflex outcomes and (2) clinical outcomes. Results revealed that HRV biofeedback consistently effectuates acute improvements during biofeedback practice, whereas the presence of short-term and long-term carry-over effects is less clear. Some evidence suggests HRV biofeedback may result in long-term carry-over effects on baroreflex gain, which is an area most promising for future investigations. On the other hand, concerning clinical outcomes, there is ample evidence attesting to efficacy of HRV biofeedback. However, because clinical and physiological outcomes do not improve concurrently in all cases, the mechanism by which HRV biofeedback results in salutary effects in unclear. Considerations for the field in addressing shortcomings of the reviewed studies and advancing understanding of the way in which HRV biofeedback may improve physiological and clinical outcomes are offered in light of the reviewed evidence. Appl Psychophysiol Biofeedback. 2010 Sep;35(3):229-42. Wheat AL, Larkin KT. Psychology Department, West Virginia University, 53 Campus Drive, 1124 Life Sciences Building, Morgantown, WV 26506-6040, USA. Amanda.wheat@mail.wvu.edu

Post WISC-R and TOVA improvement with QEEG guided neurofeedback training in mentally retarded

Mon, 28 Jun 2010 11:28:00 -0500

Full Title: Post WISC-R and TOVA improvement with QEEG guided neurofeedback training in mentally retarded: a clinical case series of behavioral problems According to the DSM-IV, Mental Retardation is significantly sub-average general intellectual functioning accompanied by significant limitations in adaptive functioning in at least two of the following skill areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety. In pilot work, we have seen positive clinical effects of Neurofeedback (NF) applied to children with Trisomy 21 (Down Syndrome) and other forms of mental retardation. Given that many clinicians use NF in Attention Deficit Hyperactivity Disorder and Generalized Learning Disability cases, we studied the outcomes of a clinical case series using Quantitative EEG (QEEG) guided NF in the treatment of mental retardation. All 23 subjects received NF training. The QEEG data for most subjects had increased theta, alpha, and coherence abnormalities. A few showed increased delta over the cortex. Some of the subjects were very poor in reading and some had illegible handwriting, and most subjects had academic failures, impulsive behavior, and very poor attention, concentration, memory problems, and social skills. This case series shows the impact of QEEG-guided NF training on these clients' clinical outcomes. Fourteen out of 23 subjects formerly took medications without any improvement. Twenty-three subjects ranging from 7-16 years old attending private learning centers were previously diagnosed with mental retardation (severity of degree: from moderate to mild) at various university hospitals. Evaluation measures included QEEG analysis, WISC-R (Wechsler Intelligence Scale for Children-Revised) IQ test, TOVA (Test of Variables of Attention) test, and DPC-P (Developmental Behaviour Checklist) were filled out by the parents. NF trainings were performed by Lexicor Biolex software. NX-Link was the commercial software reference database used to target the treatment protocols, along with the clinical judgment of the first author. QEEG signals were sampled at 128 samples per second per channel and electrodes were placed according to the International 10-20 system. Between 80 and 160 NF training sessions were completed, depending on the case. None of the subjects received any special education during NF treatment. Two subjects with the etiology of epilepsy were taking medication, and the other 21 subjects were medication-free at the baseline. Twenty-two out of 23 patients who received NF training showed clinical improvement according to the DPC-P with QEEG reports. Nineteen out of 23 patients showed significant improvement on the WISC-R, and the TOVA. For the WISC-R test, 2 showed decline on total IQ due to the decline on some of the subtests, 2 showed no improvement on total IQ although improvement was seen on some of the subtests, however even these cases showed improvement on QEEG and DPC-P. This study provides the first evidence for positive effects of NF treatment in mental retardation. The results of this study encourage further research. Clin EEG Neurosci. 2010 Jan;41(1):32-41. Surmeli T, Ertem A. Living Mental Healthy Center for Research and Education, Istanbul, Turkey. neuropsychiatry@yahoo.com

Effectiveness of respiratory-sinus-arrhythmia biofeedback on state-anxiety in patients...

Mon, 21 Jun 2010 11:26:00 -0500

Full Title: Effectiveness of respiratory-sinus-arrhythmia biofeedback on state-anxiety in patients undergoing coronary angiography AIM: This study is a report of a study conducted to evaluate the value of psychological assistance including respiratory-sinus-arrhythmia biofeedback training in its ability to reduce the level of anxiety in patients undergoing coronary angiography. BACKGROUND: Coronary angiography has been reported to cause anxiety and emotional stress. METHODS: Between March 2004 and January 2005, 212 patients undergoing routine elective coronary angiography for the evaluation of stable coronary artery disease were randomized into two groups. In the psychological support group (n = 106) a structured psychological conversation and respiratory-sinus-arrhythmia biofeedback training were offered prior to coronary angiography. In the control group (n = 106) standard care and information was provided without psychological support. State-anxiety was measured (scale 20-80) 1 day prior to and after coronary angiography, along with blood pressure and heart rate. FINDINGS: Prior to coronary angiography, state-anxiety was 54.8 +/- 11.5 (mean +/- SD) in the control group and 54.8 +/- 12.6 in the psychological support group. After coronary angiography, state-anxiety was 47.9 +/- 18.5 in the control group but 28.3 +/- 12.5 in the psychological support group (Wilcoxon rank sum test W = 7272, P < 0.001). Blood pressure was statistically significantly lower in the psychological support group prior to the intervention and the day after coronary angiography. CONCLUSION: Psychological support including respiratory-sinus-arrhythmia biofeedback is an effective and simple tool that could be used by nurses to reduce state-anxiety and emotional stress in patients undergoing coronary angiography. J Adv Nurs. 2010 May;66(5):1101-10. Mikosch P, Hadrawa T, Laubreiter K, Brandl J, Pilz J, Stettner H, Grimm G. Department of Internal Medicine 2, General Hospital Klagenfurt, Austria. peter.mikosch@tele2.at

Correcting abnormal flexion-relaxation in chronic lumbar pain

Mon, 14 Jun 2010 11:24:00 -0500

Full Title: Correcting abnormal flexion-relaxation in chronic lumbar pain: responsiveness to a new biofeedback training protocol OBJECTIVES: Lumbar flexion-relaxation is a well-known phenomenon that can reliably be seen in normal participants, but not in most chronic low back pain (CLBP) participants. No earlier studies have investigated any specific clinical intervention designed to correct abnormal flexion-relaxation. The objective of this study was to evaluate the contribution of a surface EMG-assisted stretching (SEMGAS) biofeedback training protocol, within a functional restoration treatment program, on flexion range of motion (ROM) and erector spinae surface EMG (SEMG) during maximum voluntary flexion (MVF). METHODS: Lumbar flexion ROM and MVF SEMG were assessed in 2 groups of CLBP patients at the beginning and end of rehabilitation. One group participated in functional restoration only, whereas the other group participated in functional restoration plus SEMGAS biofeedback training. Both treatment groups were compared with a separate control group of normal, pain-free participants. RESULTS: Pretreatment ROM and MVF SEMG measures were similar in both treatment groups, but were very different than the control group. At posttreatment, the functional restoration only group remained statistically different than the control group on MVF SEMG and some ROM measures, but the SEMGAS group was statistically equivalent to the control participants on all posttreatment measures, including the ability to show flexion-relaxation. DISCUSSION: Interdisciplinary functional restoration rehabilitation of CLBP participants is effective for increasing ROM and other functional measures, but the addition of a SEMGAS biofeedback training protocol can result in normalization of the flexion-relaxation phenomenon, so that these participants are comparable with a pain-free control group. Clin J Pain. 2010 Jun;26(5):403-9. Neblett R, Mayer TG, Brede E, Gatchel RJ. PRIDE Research Foundation, Dallas, TX, USA.

Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial

Mon, 07 Jun 2010 11:22:00 -0500

Neurofeedback (NF) could help to improve attentional and self-management capabilities in children with attention-deficit/hyperactivity disorder (ADHD). In a randomised controlled trial, NF training was found to be superior to a computerised attention skills training (AST) (Gevensleben et al. in J Child Psychol Psychiatry 50(7):780-789, 2009). In the present paper, treatment effects at 6-month follow-up were studied. 94 children with ADHD, aged 8-12 years, completed either 36 sessions of NF training (n = 59) or a computerised AST (n = 35). Pre-training, post-training and follow-up assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents. Follow-up information was analysed in 61 children (ca. 65%) on a per-protocol basis. 17 children (of 33 dropouts) had started a medication after the end of the training or early in the follow-up period. Improvements in the NF group (n = 38) at follow-up were superior to those of the control group (n = 23) and comparable to the effects at the end of the training. For the FBB-HKS total score (primary outcome measure), a medium effect size of 0.71 was obtained at follow-up. A reduction of at least 25% in the primary outcome measure (responder criterion) was observed in 50% of the children in the NF group. In conclusion, behavioural improvements induced by NF training in children with ADHD were maintained at a 6-month follow-up. Though treatment effects appear to be limited, the results confirm the notion that NF is a clinically efficacious module in the treatment of children with ADHD. Eur Child Adolesc Psychiatry. 2010 May 25. Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H. Child and Adolescent Psychiatry, University of Göttingen, v.Siebold-Str. 5, 37075, Göttingen, Germany.

Long-term efficacy of biofeedback therapy for dyssynergic defecation

Wed, 26 May 2010 12:51:00 -0500

Full Title: Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial OBJECTIVES: Although biofeedback therapy is effective in the short-term management of dyssynergic defecation, its long-term efficacy is unknown. Our aim was to compare the 1-year outcome of biofeedback (manometric-assisted pelvic relaxation and simulated defecation training) with standard therapy (diet, exercise, laxatives) in patients who completed 3 months of either therapy. METHODS: Stool diaries, visual analog scales (VASs), colonic transit, anorectal manometry, and balloon expulsion time were assessed at baseline, and at 1 year after each treatment. All subjects were seen at 3-month intervals and received reinforcement. Primary outcome measure (intention-to-treat analysis) was a change in the number of complete spontaneous bowel movements (CSBMs) per week. Secondary outcome measures included bowel symptoms, changes in dyssynergia, and anorectal function. RESULTS: Of 44 eligible patients with dyssynergic defecation, 26 agreed to participate in the long-term study. All 13 subjects who received biofeedback, and 7 of 13 who received standard therapy, completed 1 year; 6 failed standard therapy. The number of CSBMs per week increased significantly (P<0.001) in the biofeedback group but not in the standard group. Dyssynergia pattern normalized (P<0.001), balloon expulsion time improved (P=0.0009), defecation index increased (P<0.001), and colonic transit time normalized (P=0.01) only in the biofeedback group. CONCLUSIONS: Biofeedback therapy provided sustained improvement of bowel symptoms and anorectal function in constipated subjects with dyssynergic defecation, whereas standard therapy was largely ineffective. Am J Gastroenterol. 2010 Apr;105(4):890-6. Epub 2010 Feb 23. Rao SS, Valestin J, Brown CK, Zimmerman B, Schulze K. Department of Gastroenterology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1009, USA. satish-rao@uiowa.edu

Biofeedback is superior to electrogalvanic stimulation and massage for treatment...

Wed, 19 May 2010 12:42:00 -0500

Full Title: Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome BACKGROUND & AIMS: Levator ani syndrome (LAS) might be treated using biofeedback to teach pelvic floor relaxation, electrogalvanic stimulation (EGS), or massage of levator muscles. We performed a prospective, randomized controlled trial to compare the effectiveness of these techniques and assess physiologic mechanisms for treatment. METHODS: Inclusion criteria were Rome II symptoms plus weekly pain. Patients were categorized as "highly likely" to have LAS if they reported tenderness with traction on the levator muscles or as "possible" LAS if they did not. All 157 patients received 9 sessions including psychologic counseling plus biofeedback, EGS, or massage. Outcomes were reassessed at 1, 3, 6, and 12 months. RESULTS: Among patients with "highly likely" LAS, adequate relief was reported by 87% for biofeedback, 45% for EGS, and 22% for massage. Pain days per month decreased from 14.7 at baseline to 3.3 after biofeedback, 8.9 after EGS, and 13.3 after massage. Pain intensity decreased from 6.8 (0-10 scale) at baseline to 1.8 after biofeedback, 4.7 after EGS, and 6.0 after massage. Improvements were maintained for 12 months. Patients with only a "possible" diagnosis of LAS did not benefit from any treatment. Biofeedback and EGS improved LAS by increasing the ability to relax pelvic floor muscles and evacuate a water-filled balloon and by reducing the urge and pain thresholds. CONCLUSIONS: Biofeedback is the most effective of these treatments, and EGS is somewhat effective. Only patients with tenderness on rectal examination benefit. The pathophysiology of LAS is similar to that of dyssynergic defecation. 2010 AGA Institute. Published by Elsevier Inc. All rights reserved. Gastroenterology. 2010 Apr;138(4):1321-9. Epub 2010 Jan 4 Chiarioni G, Nardo A, Vantini I, Romito A, Whitehead WE. Division of Gastroenterology, University of Verona at Verona, Italy. chiarioni@tin.it

Relative Efficacy of Connectivity Guided and Symptom Based EEG Biofeedback for Autistic Disorders

Wed, 24 Feb 2010 09:51:00 -0500

Full Title: The Relative Efficacy of Connectivity Guided and Symptom Based EEG Biofeedback for Autistic Disorders Autism is a neurodevelopmental disorder characterized by deficits in communication, social interaction, and a limited range of interests with repetitive stereotypical behavior. Various abnormalities have been documented in the brains of individuals with autism, both anatomically and functionally. The connectivity theory of autism is a recently developed theory of the neurobiological cause of autisic symptoms. Different patterns of hyper- and hypo-connectivity have been identified with the use of quantitative electroencephalogray (QEEG), which may be amenable to neurofeedback. In this study, we compared the results of two published controlled studies examining the efficacy of neurofeedback in the treatment of autism. Specifically, we examined whether a symptom based approach or an assessment/connectivity guided based approach was more effective. Although both methods demonstrated significant improvement in symptoms of autism, connectivity guided neurofeedback demonstrated greater reduction on various subscales of the Autism Treatment Evaluation Checklist (ATEC). Furthermore, when individuals were matched for severity of symptoms, the amount of change per session was significantly higher in the Coben and Padolsky (J Neurother 11:5-23, 2007) study for all five measures of the ATEC. Our findings suggest that an approach guided by QEEG based connectivity assessment may be more efficacious in the treatment of autism. This permits the targeting and amelioration of abnormal connectivity patterns in the brains of people who are autistic. Appl Psychophysiol Biofeedback. 2009 Aug 1. Coben R, Myers TE. Neurorehabilitation & Neuropsychological Services, 1035 Park Blvd., Suite 2B, Massapequa Park, NY, 11762, USA, robcoben@optonline.net.

Functional Neuroanatomy and the Rationale for Using EEG Biofeedback for Clients...

Thu, 18 Feb 2010 09:53:00 -0500

Full Title: Functional Neuroanatomy and the Rationale for Using EEG Biofeedback for Clients with Asperger's Syndrome This paper reviews the symptoms of Asperger's Syndrome (AS), a disorder along the autism continuum, and highlights research findings with an emphasis on brain differences. Existing theories concerning AS are described, including theory of mind (Hill and Frith in Phil Trans Royal Soc Lond, Bull 358:281-289, 2003), mirror neuron system (Ramachandran and Oberman in Sci Am 295(5):62-69, 2006), and Porges' (Ann N Y Acad Sci 1008:31-47, 2003, The neurobiology of autism, Johns Hopkins University Press, Baltimore, 2004) polyvagal theory. (A second paper, Outcomes using EEG Biofeedback Training in Clients with Asperger's Syndrome, summarizes clinical outcomes obtained with more than 150 clients.) Patterns seen with QEEG assessment are then presented. Single channel assessment at the vertex (CZ) reveals patterns similar to those found in Attention-Deficit/Hyperactivity Disorder. Using 19-channel data, significant differences (z-scores > 2) were found in the amplitude of both slow waves (excess theta and/or alpha) and fast waves (beta) at various locations. Differences from the norm were most often found in mirror neuron areas (frontal, temporal and temporal-parietal). There were also differences in coherence patterns, as compared to a normative database (Neuroguide). Low Resolution Electromagnetic Tomography Analysis (Pascual-Marqui et al. in Methods Find Exp Clin Pharmacol 24C:91-95, 2002) suggested the source of the abnormal activity was most often the anterior cingulate. Other areas involved included the amygdala, uncus, insula, hippocampal gyrus, parahippocampal gyrus, fusiform gyrus, and the orbito-frontal and/or ventromedial areas of the prefrontal cortex. Correspondence between symptoms and the functions of the areas found to have abnormalities is evident and those observations are used to develop a rationale for using EEG biofeedback, called neurofeedback (NFB), intervention. NFB training is targeted to improve symptoms that include difficulty reading and mirroring emotions, poor attention to the outside world, poor self-regulation skills, and anxiety. Porges' polyvagal theory is used to emphasize the need to integrate NFB with biofeedback (BFB), particularly heart rate variability training. We term this emerging understanding the Systems Theory of Neural Synergy. The name underscores the fact that NFB and BFB influence dynamic circuits and emphasizes that, no matter where we enter the nervous system with an intervention, it will seek its own new balance and equilibrium. Appl Psychophysiol Biofeedback. 2009 Jul 1. Thompson L, Thompson M, Reid A. ADD Centre, 50 Village Centre Place, Mississauga, ON, L4Z 1V9, Canada, addcentre@gmail.com.

Traumatic brain injury rehabilitation: QEEG biofeedback treatment protocols

Wed, 17 Feb 2010 09:47:00 -0500

Interventions for improvement of cognitive problems in patients with traumatic brain injury (TBI) include electroencephalography biofeedback, also known as neurofeedback. Quantitative electroencephalography (QEEG) patterns are assessed in TBI patients and then compared to a database obtained from a normative population. Deviations in QEEG patterns from the normative group are the basis for an intervention plan. While QEEG patterns, obtained under an eyes closed, resting condition, provide information about deviations at rest, QEEG patterns obtained while the patient engages in cognitive tasks reflect specific deficiencies in brain functioning. This paper reviews and assesses QEEG patterns collected under both resting conditions as well as cognitive tasks. The article provides a theoretical and empirical base for QEEG interventions with TBI. Appl Psychophysiol Biofeedback. 2009 Mar;34(1):59-68. Epub 2009 Feb 6. Thornton KE, Carmody DP. Brain Foundation, 2 Ethel Road, Edison, NJ 08817, USA. ket@chp-neurotherapy.com

Meta-analysis of EEG biofeedback in treating epilepsy

Mon, 25 Jan 2010 09:11:00 -0500

About one third of patients with epilepsy do not benefit from medical treatment. For these patients electroencephalographic (EEG) biofeedback is a viable alternative. EEG biofeedback, or neurofeedback, normalizes or enhances EEG activity by means of operant conditioning. While dozens of scientific reports have been published on neurofeedback for seizure disorder, most have been case series with too few subjects to establish efficacy. The purpose of this paper is to meta-analyze existing research on neurofeedback and epilepsy. We analyzed every EEG biofeedback study indexed in MedLine, PsychInfo, and PsychLit databases between 1970 and 2005 on epilepsy that provided seizure frequency change in response to feedback. Sixty-three studies have been published, 10 of which provided enough outcome information to be included in a meta-analysis. All studies consisted of patients whose seizures were not controlled by medical therapies, which is a very important factor to keep in mind when interpreting the results. Nine of 10 studies reinforced sensorimotor rhythms (SMR) while 1 study trained slow cortical potentials (SCP). All studies reported an overall mean decreased seizure incidence following treatment and 64 out of 87 patients (74%) reported fewer weekly seizures in response to EEG biofeedback. Treatment effect was mean log (post/pre) where pre and post represent number of seizures per week prior to treatment and at final evaluation, respectively. Due to prevalence of small groups, Hedges's g was computed for effect size. As sample heterogeneity was possible (Q test, p=.18), random effects were assumed and the effect of intervention was -0.233, SE = 0.057, z = -4.11, p<.001. Based on this meta-analysis, EEG operant conditioning was found to produce a significant reduction on seizure frequency. This finding is especially noteworthy given the patient group, individuals who had been unable to control their seizures with medical treatment. Clin EEG Neurosci. 2009 Jul;40(3):173-9. Tan G, Thornby J, Hammond DC, Strehl U, Canady B, Arnemann K, Kaiser DA. Michael E. DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, Texas, USA. tan.gabriel@va.gov