Investigations in Neuromodulation

Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience Selected Abstracts of Conference Presentations at the 2010 International Society for Neurofeedback and Research (ISNR) 18th Annual Conference, Denver, Colorado Published online: 25 Nov 2010.

To cite this article: (2010) Selected Abstracts of Conference Presentations at the 2010 International Society for Neurofeedback and Research (ISNR) 18th Annual Conference, Denver, Colorado, Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience, 14:4, 321-371, DOI: 10.1080/10874208.2010.523353

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Selected Abstracts of Conference Presentations at the 2010 International Society for Neurofeedback and Research (ISNR) 18th Annual Conference, Denver, Colorado

ORAL PRESENTATIONS to test the hypothesis of gamma band abnormalities at early stages of visual processing in Low-Frequency Repetitive Transcranial Mag- ASD by investigating relative evoked (i.e., netic Stimulation (rTMS) Modulates Evoked- 100 ms) gamma power in a visual oddball Gamma Frequency Oscillations in Autism task using Kanizsa illusory figures. Our results Spectrum Disorder (ASD) indicate that in individuals with ASD-evoked gamma activity is not discriminative of stimu- Joshua M. Baruth, MS lus type, whereas in controls early gamma University of Louisville School of Medicine power differences between target and nontarget stimuli are highly significant. Following 12 sessions of bilateral ‘‘slow’’ rTMS treatment It has been reported that individuals with to the dorsolateral prefrontal cortex indivi- Autism Spectrum Disorder (ASD) have duals with ASD showed significant improve- abnormal reactions to the sensory environment in discriminatory gamma activity ment and visuo-perceptual abnormalities. between relevant and irrelevant visual stimuli Electrophysiological research has provided with few, if any, side effects reported. We evidence that gamma band activity (30– propose that slow rTMS may have increased 80 Hz) is a physiological indicator of the cortical inhibitory tone and decreased the ratio coactivation of cortical cells engaged in proof cortical excitation to inhibition, which cessing visual stimuli and integrating differ- improved discriminatory gamma activity at ent features of a stimulus. A number of early stages of visual processing. We also studies have found augmented and indis- found significant improvement in behavioral criminative gamma band power at both early questionnaires (i.e., irritability, repetitive beha- (i.e., evoked gamma) and late (i.e., induced vior) as a result of rTMS. Contrary to avail- gamma) stages of visual processing in ASD; able pharmacological interventions, rTMS this may be related to decreased inhibitory has shown significant benefits in treating core processing and an increase in the ratio of cor- symptoms of ASD with few, if any, side effects. tical excitation to inhibition. Low frequency or ‘‘slow’’ (¼1 Hz) repetitive transcranial REFERENCES magnetic stimulation (rTMS) has been shown to increase inhibition of stimulated cortex by Boroojerdi, B., Prager, A., Muellbacher, W., Cohen, the activation of inhibitory circuits. We wanted L. G. (2000). Reduction of human visual cortex 322 JOURNAL OF NEUROTHERAPY

excitability using 1-Hz transcranial magnetic stimu- and executive function tasks, and parents and lation. Neurology, 54, 1529–1531. teachers filled out behavior questionnaires Brown, C., Gruber, T., Boucher, J., Rippon, G., & Brock, again. Data collection ends in July 2010. J. (2005). Gamma abnormalities during perception of We hope that the results of this study can illusory figures in autism. Cortex, 41, 364–376. be presented for the first time at the ISNR Charman, T. (2008). Autism spectrum disorders. Psychiatry, 7, 331–334. conference in Denver. Grice, S. J., Spratling, M. W., Karmiloff-Smith, A., Halit, H., Csibra, G., De Haan, M., et al. (2001). Disordered visual processing and oscillatory brain REFERENCES activity in autism and Williams syndrome. NeuroReport, 12, 2697–2700. Kouijzer, M. E. J., De Moor, J. M. H., Gerrits, B. J. Pascual-Leone, A., Walsh, V., & Rothwell, J. (2000). Tran- L., Buitelaar, J. K., & Van Schie, H. T. (2009). scranial magnetic stimulation in cognitive neuroscience– Long-term effects of neurofeedback treatment in virtual lesion, chronometry, and functional connec- autism. Research in Autism Spectrum Disorders, 3, tivity. Current Opinion in Neurobiology, 10, 232–237. 496–501. Tallon-Baudry, C., Bertrand, O., Delpuech, C., & Kouijzer, M. E. J., De Moor, J. M. H., Gerrits, B. J. Pernier, J. (1996). Stimulus specificity of phase- L., Congedo, M., & Van Schie, H. T. (2009). Neu- locked and non-phase-locked 40 Hz visual responses rofeedback improves executive functioning in chil- in human. Journal of Neuroscience, 16, 4240–4249. dren with autism spectrum disorders. Research in Autism Spectrum Disorders, 3, 145–162. Kouijzer, M. E. J., Van Schie, H. T., De Moor, J. M. The Effects of Neurofeedback in Children H., Gerrits, B. J. L., & Buitelaar, J. K. (in press). with Autism: Results of a Randomized Single Neurofeedback treatment in autism. Preliminary Blind Attention Placebo-Controlled Study findings in behavioral, cognitive, and neurophysiological functioning. Research in Autism Spectrum Mirjam Kouijzer, MSc Disorders. Advance online publication. doi:10.1016= Radboud University Nijmegen j.rasd.2009.10.007 EEG Connectivity Assessment and Training: While writing this conference abstract in A Multichannel Directed Information Flow March 2010, a study investigating the effects Perspective of neurofeedback in autism is running in the Netherlands. After accomplishing two smal- David Joffe, BA ler studies with promising results (Kouijzer, EEG Dynamics de Moor, Gerrits, Congedo, & van Schie, 2009; Kouijzer, van Schie, de Moor, Gerrits, & Buitelaar, in press), we now try to prevent Classical coherence analysis methods pro- our results from attention and expectancy vide insufficient information to explicitly biases. In addition to the EEG feedback characterize the direction of information group and the waiting list control group, we flow between two or more EEG scalp elec- included a Skin Conductance (SC) feedback trode locations, as a function of frequency. group. All participants of the present study In addition, it is impossible to determine (n ¼ 41) were pretested with EEG and execu- the extent to which the coherence measured tive function tasks and parents and teachers between any two particular scalp electrode filled out behavior questionnaires. Then, the sites may be due to the influence of one or EEG and SC feedback groups had identical more additional scalp electrode sites, using sessions of EEG or SC feedback without coherence analysis alone. Additional knowl- knowing which type of feedback they edge in both of these areas may improve a received. EEG and SC feedback sessions were neurotherapist’s ability to assess QEEG identical with electrodes attached to the scalp dynamics more completely, and also improve (measuring EEG) and to the fingers (measur- the efficacy of treatment. ing SC). After 40 sessions of EEG or SC feed- One class of methods that may be back, all participants were retested with EEG employed to address both of these concerns Proceedings of the 2010 ISNR Conference 323 in the context of multichannel QEEG assess- designs from the literature in order to illus- ment and neurofeedback training, involves trate their use and value as an approach to what are known as multivariate autoregres- testing the causal relations between treat- sive (MVAR) estimators. However, direct ment and outcomes. measures of EEG information flow direction and influence based on MVAR methods are Alcohol Addiction: A Clinical Pathophysiolo- not currently utilized in either QEEG assess- gical Approach ment or neurofeedback due to the lack of available turnkey research and=or clinical Dirk De Ridder, MD, PhD tools, as well as a lack of familiarity regard- University Hospital Antwerp ing the potential clinical efficacy of these tools, on the part of neurotherapists. Building on his 2008 Journal of Neurother- It has recently become clear that alcohol addic- apy article ‘‘Connectivity Assessment and tion might be related to a brain dysfunction, in Training: A Partial Directed Coherence which a genetic background and environmen- Approach,’’ the author focuses on three tal factors shape brain mechanisms involved MVAR-derived measures known as Granger with alcohol consumption. Craving, a major Causality, Partial Directed Coherence, and component determining relapses in alcohol the Directed Transfer Function, using intuit- abuse, has been linked to abnormal activity ive graphical displays to convey the potential in the orbitofrontal cortex, dorsal anterior power of these methods for both QEEG cingulated cortex (dACC), and amygdala. assessment and neurofeedback training. Also rTMS targeting the dACC using a double included are examples based on multichannel cone coil in an attempt to suppress very EEG data sets for the purposes of comparing severe intractable alcohol craving can be and contrasting the unique perspectives applied. Functional imaging studies consist- afforded by each of these three methods, as ing of fMRI and resting state EEG can be well as highlighting the strengths and weak- performed before rTMS, after successful nesses of the three methods with respect to rTMS, and after unsuccessful rTMS. classical coherence analysis. Craving was associated with beta activity and connectivity between the dACC and PCC, which disappeared after successful REFERENCE rTMS. Cue induced worsening of craving activated the vmPFC and PCC on fMRI as Joffe, D. (2008). Connectivity assessment and training: well as the nucleus accumbens area, DMPFC A partial directed coherence approach. Journal of and inferior parietal area, with associated Neurotherapy, 12, 111–122. suppression of the VLPFC. Relapse was associated with recurrence of Single-Case Experimental Designs: A Valu- ACC and PCC activity, but in gamma band able Method for Evaluating Neurofeedback and nucleus accumbens and DMPFC in Clinical Practice activity on fMRI. Linking functional imaging changes to Matthew Nock, PhD craving intensity permits to build a patho- Harvard University physiological model of alcohol craving that can be applied clinically using neuromodulation in the broad sense, whether by neuro- This presentation will introduce single-case feedback, rTMS, tDCS, or implants. experimental designs, distinguish them from case studies, describe the conceptual basis for such designs, outline in detail three dif- REFERENCES ferent types of single-case designs that are likely to be valuable for use in neurofeed- Degenhardt, L., Chiu, W. T., Sampson, N., Kessler, R. back research, and provide examples of such C., Anthony, J. C., Angermeyer, M., et al. (2008). 324 JOURNAL OF NEUROTHERAPY

Toward a global view of alcohol, tobacco, canna- activation and behavior. Application of simi- bis, and cocaine use: Findings from the WHO lar methods in animal models enables true World Mental Health Surveys. PLoS Med., 5, e141. translational mourse-to-human approaches, Grant, B. F., Dawson, D. A., Stinson, F. S., Chou, S. bridging mechanistic and clinical investi- P., Dufour, M. C., & Pickering, R. P. (2004). The gation. 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, Noninvasive brain stimulation with 1991–1992 and 2001–2002. Drug and Alcohol Transcranial Magnetic Stimulation (TMS) Dependency, 74, 223–234. or Transcranial Direct Current Stimulation Hayward, G., Mehta, M. A., Harmer, C., Spinks, T. J., (tDCS) can interfere with activity in a spe- Grasby, P. M., & Goodwin, G. M. (2007). Explor- cific cortical brain region and modulate ing the physiological effects of double-cone coil brain network dynamics. These techniques TMS over the medial frontal cortex on the anterior can both be combined with brain mapping cingulate cortex: An H2(15)O PET study. European methods. For example, PET or fMRI can Journal of Neuroscience, 25, 2224–2233. identify information about brain areas asso- Koob, G. F. (2006). The neurobiology of addiction: A ciated with behavior and TMS can transi- neuroadaptational view relevant for diagnosis. ently deactivate a region of the brain, thus Addiction, 101(Suppl. 1), 23–30. Koob, G. F., & le Moal, M. (2006). Neurobiology of creating a ‘‘virtual patient’’ and explore cau- addiction. Amsterdam: Academic Press-Elsevier. sal relations. EEG, MEG, and ERPs can provide further chronometric information. Repetitive TMS or tDCS allows the nonin- Multimodal Brain Imaging: Combining Brain vasive modulation of activity in a specified Stimulation and Functional Neuroimaging to cortical target in the brain convexity and its Understand a Changing Brain functionally connected cortico-subcortical neural network. MRI and EEG can guide Alvaro Pascual-Leone, MD, PhD such application of rTMS. Depending on Berenson-Allen Center for Noninvasive stimulation parameters cortical excitability Brain Stimulation, Harvard Medical School of the directly targeted brain region can be increased or decreased beyond the duration of the rTMS train. Network effects can result The human brain is intrinsically plastic, in behavioral benefits through paradoxical changing across the lifespan. Such changes functional facilitation, induction of desirable may proof adaptive and lead to functional plastic changes, or release of specific neuro- benefits, or may be the very cause of disease transmitters. Such combinations of noninva- and disability. The challenge is to learn sive brain stimulation and brain mapping enough about the mechanisms of brain plas- methods can lead to clinically relevant thera- ticity to guide them, enhancing some and peutic effects in neuropsychiatry and neuro- suppressing others, to promote the best func- rehabilitation and provide unique insights tional outcome for a given individual. This into brain plasticity mechanisms in health requires insights about causal relations and disease across the lifespan. between brain activity and behavior. Functional brain imaging provides corre- lational information about brain activity Cognitive Improvement Following Z-Score and behavior. Establishing causal links Neurofeedback Therapy of 20 Moderate to requires intervention and brain stimulation Severe Brain Injury Patients: Preliminary techniques enable this, thus offering the Results of a Pilot Study potential of adding another dimension to functional brain imaging. Multimodal brain Victor Zelek, PhD imaging, combining brain imaging and neu- Northeast Center for Special Care rophysiologic measuring and noninvasive stimulation methodologies, allows the estab- lishment of a causal relationship and a pre- Although neurofeedback (EEG Biofeedback) cise chronometry between regional brain has been shown to be an effective treatment Proceedings of the 2010 ISNR Conference 325 modality for a variety of psycho-cognitive REFERENCES disorders, its application for brain injury patients has been slow and mostly limited Byers, A. P. (1995). Neurofeedback therapy for a to mild TBI. Lengthy treatments, poor com- mild head injury. Journal of Neurotherapy, 1(1), pliance, and inconsistent results have been 22–37. cited among the reasons. The current pro- Doppelmayr, M., Nosko, H., Pecherstorfer, T., & spective pilot study examined Z-score neuro- Fink, A. (2007). An attempt to increase cognitive feedback treatment efficacy in improving performance after stroke with neurofeedback. Biofeedback, 35, 126–130. cognitive functioning of 20 adult patients Duff, J. (2004). The usefulness of quantitative EEG with a history of moderate to severe brain (QEEG) and neurotherapy in the assessment and injury (defined as duration of unconscious- treatment of post-concussion syndrome. Clinical ness more than 30 min and 24 hr, respect- EEG & Neuroscience, 35, 198–209. ively). All patients were residing at a Ham, L. P., & Packard, R. C. (1996). A retrospective, subacute inpatient brain injury rehabilitation follow-up study of biofeedback-assisted relaxation facility (Northeast Center for Special Care). therapy in patients with posttraumatic headache. They were 3 months to several years post- Biofeedback & Self-Regulation, 21, 93–104. injury. The etiology of brain injury included Hoffman, D. A., Stockdale, S., & Van Egren, L. TBI, CVA, Infectious Encephalopathy, and (1996a). EEG neurofeedback in the treatment of Anoxic Encephalopathy. Their cognitive mild traumatic brain injury [Abstract]. Clinical Electroencephalography, 27(2), 6. abilities were evaluated using Repeatable Hoffman, D. A., Stockdale, S., & Van Egren, L. Battery for the Assessment of Neuro- (1996b). Symptom changes in the treatment of mild psychological Status (RBANS) before and traumatic brain injury using EEG neurofeedback after Neurofeedback treatment course. All [Abstract]. Clinical Electroencephalography, 27(3), had QEEG analyses done before and after 164. treatment. Neurofeedback was given 2 to Keller, I. (2001). Neurofeedback therapy of attention 3 times a week for the total of 20 to 30 deficits in patients with traumatic brain injury. sessions. Cognitive improvement was mea- Journal of Neurotherapy, 5(1,2), 19–32. sured using RBANS. Electrophysiological Laibow, R E., Stubblebine, A. N., Sandground, H., & improvement was reflected by the normaliza- Bounias, M. (2001). EEG Neurobiofeedback treat- tion of Z-score Amplitude and Coherence ment of patients with brain injury: Part 2: Changes in EEG parameters versus rehabilitation. Journal of values that were abnormal at the outset of Neurotherapy, 5(4), 45–71. treatment. Thatcher, R. W. (2000). EEG operant conditioning For most patients in the study RBANS (biofeedback) and traumatic brain injury. Clinical Total Scale Score (TSS) improved following Electroencephalography, 31(1), 38–44. the course of neurofeedback, but only one Thornton, K. E., & Carmody, D. P. (2005). Electroen- third showed statistically significant cognitive cephalogram biofeedback for reading disability and improvement. It is estimated that with a traumatic brain injury. Child & Adolescent Psychi- greater number of neurofeedback sessions atric Clinics of North America, 14(1), 137–162. the patients are likely to continue making Thornton, K. E., & Carmody, D. P. (2008). Efficacy of cognitive gains. The cognitive improvement traumatic brain injury rehabilitation: Interventions correlated with the normalization of brain- of QEEG-guided biofeedback, computers, strategies, and medications. Applied Psychophysiology & wave Amplitude and Coherence but not Biofeedback, 33(2), 101–124. always at the injury site. TBI patients showed Tinius, T. P., & Tinius, K. A. (2001). Changes after more improvement and EEG normalization EEG biofeedback and cognitive retraining in adults than other diagnostic categories in the study. with mild traumatic brain injury and attention Brainwave Z-score normalization patterns deficit disorder. Journal of Neurotherapy, 4(2), were examined from session to session as well 27–44. as within each session. The study also focused Walker, J. E. (2007). A neurologist’s experience with and provided recommendations on practical QEEG-guided neurofeedback following brain ways to overcome many challenges of using injury. In J. R. Evans (Ed.), Handbook of neurofeed- neurofeedback with moderate and severe back, (pp. 353–361). Binghamton, NY: Haworth brain injury patients. Medical. 326 JOURNAL OF NEUROTHERAPY

Laplacian Z-Score Neurofeedback: A Unique Collura, T. F., Guan, J. G., Tarrant, J., Bailey, J., & Option in The Realmof Multi-Channel Starr, F. (2010). EEG Biofeedback Case Studies Z-Score Neurofeedback Using Live Z-Score Training and a Normative Database. Journal of Neurotherapy, 14, 22–46. Nancy Wigton, MA Collura, T. F, Thatcher, R. W., Smith, M. L., Lambos, W. A., & Stark, C. R. (2009). EEG biofeedback Applied Neurotherapy Center training using live Z-scores and a normative database. In T. Budzynski, H. Budzynski, J. Evans, & A. Abarbanel (Eds.), Introduction to QEEG and This presentation reviews a newly available neurofeedback: Advanced theory and applications Z-Score Neurofeedback technique whereby (pp. 103–141). New York, NY: Academic Press. the real-time Laplacian montage Z-score Saab, M. (2008, April). Z-score biofeedback with values are able to be directly trained. Various thought technology’s infiniti system. NeuroConnec- case studies are presented, complete with tions, 26–30. pre- and post-QEEG data as well as clinical Stark, C. R. (2008, April). Consistent dynamic Z-score outcome measures when available. patterns observed during Z-score training sessions. Until 2006 the main Neurofeedback NeuroConnections, 37–38. Tegan, E. (2008, July). Z-score training case review approach was limited to 2-channel amplitude of severe mood instabilities. NeuroConnections, training. In 2006 a new 4-channel Neuro- 33–34. feedback technique, called Z-Score Neuro- Thatcher, R. W. (2008). Z-Score EEG Biofeedback: feedback (ZNF), became available that uses Conceptual Foundations. NeuroConnections. real-time Z-scores from an age-matched nor- April, 9–11. mative database. Since its introduction many Thatcher, R. W. (2009). Multi-channel Z-score EEG bio- clinicians report that the ZNF approach pro- feedback: Laplacian, average reference, phase reset vides for faster clinical outcomes. However, and discriminant functions. Paper presented at the until recently, the maximum number of 17th Annual ISNR Conference, Indianapolis, IN. channels that could be trained at one time Wigton, N. (2008). Does Z-score NF work better than was 4 and training was limited to the non Z-score NF? Poster presented at the 16th Annual ISNR Conference, San Antonio, TX. linked-ears normative database. Wigton, N. (2009). First impressions of neuroguide The use of Multi-Channel ZNF greatly real-time Z-score training. In J. Demos (Ed.), expands the number of scalp locations and Getting started with dynamic Z-score training measures and includes the ability to train (pp. 81–89). Neurofeedback of S.VT LLC. real-time Z-scores using not only linked-ears montage data (as well as coherence and phase measures) but also the Laplacian mon- What Are We Training When We Train tage data. In cases where the Laplacian mon- SMR? tage data reveals more relevant clinical issues to address, it is now possible to directly train Michael O’Bannon, PhD these values. Although results are prelimi- Private practice nary, and more study is needed to replicate results, this new approach may turn out to give the clinician a great advantage in more Neurofeedback training of the sensory- efficiently addressing clinical issues within motor rhythm (SMR; 12–15 Hz along the the realm of Multi-Channel ZNF. sensorimotor strip) has a long and well-established history. It is one of the most commonly used types of training in clinical REFERENCES practice. Current software and hardware allow wide variation in the actual implemen- Collura, T. F. (2008a, April). Whole-head normalization using live Z-scores for connectivity training, tation of SMR training protocols in both Part 1. NeuroConnections, 12–18. clinical practice and the laboratory, how- Collura, T. F. (2008b, July). Whole-head normaliza- ever. These variations may produce unin- tion using live Z-scores for connectivity training, tended consequences for outcomes of Part 2. NeuroConnections, 9–12. treatment and research. Proceedings of the 2010 ISNR Conference 327

This presentation reviews SMR protocol clients, at some point in their lives, may even variations that arise from differences in have gone to an emergency room because an bandpass filter characteristics, choices of incident occurred in which a mild TBI needed feedback signal ‘‘inhibit’’ bands, and use of to be ruled out, and were told their MRI was autothresholding. In addition, it provides fine and so were they. Other clients, as well as an analysis of the vulnerability of traditional any previous medical and mental health SMR protocols to high amplitude out-of- providers, may be completely unsuspecting band signals that are often present in the of a possible mild TBI. Uncovering probable typical EEG records of clients. mild TBI(s) is important in indicating the First, responses of several commercial need for further assessment, properly diag- software=hardware systems to identical nosing the client (correcting misdiagnoses EEG records will be examined and their dif- when appropriate), and in providing the ferences compared. Second, high-resolution proper treatment. It is also frequently a relief contingency analyses of several client ses- for the client in understanding the reason for sions will be presented to differentiate EEG his or her symptoms. events that trigger feedback signals over the course of SMR training. These results illustrate some of the unanticipated responses Method of the EEG to traditional SMR protocols designs. Finally, several recommendations Over many years of doing psychotherapy, will be offered to assist selection of appropri- biofeedback and neurofeedback evaluations ate protocols in the future. and treatment, red flags indicating probable mild TBIs have become apparent in the initial evaluation of clients with various presenting REFERENCES problems. A brief over view of mild TBIs is presented, the red flags to look for in chil- Collura, T. F. (2000). Filter comparison—BrainMaster dren=adolescents and adults are discussed, and EEG Spectrum systems. Bedford, PH: Brain- and cases illustrating the initial red flags and Master Technologies. subsequent assessments are presented. Sterman, M. B., Macdonald, L. R., & Stone, R. K. (1974). Biofeedback training of the sensorimotor EEG rhythm in man: Effects on epilepsy. Epilepsia, Results and Conclusions 15, 395–416. Vernon, D., Egner, T., Cooper, N., Compton, T., There are some patterns in presenting Neilands, C., Sheri, A., et al. (2003). The effect of problems=history of children=adolescents and training distinct neurofeedback protocols on adults that are red flags of possible mild TBIs aspects of cognitive performance. International indicating the need for further assessment. Journal of Psychophysiology, 47, 75–85.

Clinical Red Flags of Undiagnosed Mild Traumatic Brain Injuries REFERENCES

Kay Sheehan, EdD Bounias, M., Laibow, R. E., Stubbelbine, A. N., Sandground, H., & Bonaly, A. (2002). EEG- ADD Center of Colorado 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 Introduction of rehabilitation. Journal of Neurotherapy, 6, 23–38. Duff, J. (2004). The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and Many psychotherapists and neurofeed- treatment of post-concussion syndrome. Clinical back providers have clients who are unsus- EEG & Neuroscience, 35, 198–209. pecting of having sustained a mild Gasquoine, P. G. (1997). Post concussion symptoms. traumatic brain injury (TBI). Some of these Neuropsychology Review, 7, 77–85. 328 JOURNAL OF NEUROTHERAPY

Prigatano, G. P. (1992). Personality disturbances track migraine frequency and intensity as associated with traumatic brain injury. Journal of well as intervention progress. This presen- Consulting and Clinical Psychology, 60, 360–368. tation provides enough information to allow Reitan, R. M., & Wolfson, D. (1999). Two faces of the participant to pursue further information mild head injury. Archives of Clinical Neuropsychol- within the headache literature. ogy, 14, 191–202. Thatcher, R. W., Walker, R. A., Gerson, I., & Geisler, F. H. (1989). EEG discriminant analysis of mild head trauma. Electroencephalography and Clinical REFERENCES Neurophysiology, 73, 94–106. Tinius, T. P., & Tinius, K. A. (2000). Changes after International Headache Society Classification System. EEG biofeedback and cognitive retraining in adults (n.d.). Available from http://ihs-classification. with mild traumatic brain injury and attention defi- org/en/ cit hyperactivity disorder. Journal of Neurotherapy, Sacks, O. (1992). Migraine. Berkeley: University of 4, 27–44. California Press.

Atypical Migraine Aura: Clinical Presen- Gorak Video Game in the Resocialization of tation and Clinical Implications Infants in Situations of Social Risk Jeffrey Carmen, PhD Dirce Maria Navas Perissinotti, DSc, and Private practice Yusaku Soussumi, MD Sa˜o Paulo Federal University Introduction

Migraine headaches are very common, Introduction with estimates as high as 20% of the normal population. They are sometimes preceded by This study examines the humanistic video an aura that is obvious to the migraine suf- game Gorak, created by the Center of Study ferer. However, the aura can present itself and Investigation in Neuro-psychoanalysis in uncommon ways that, although still to Virada Project of Rukha Institute, based important, are more difficult to detect. This on Soussumi’s Theory, applied as adjuvant oral presentation covers these less typical approach to reintegrate children in social aura presentations. risk. Prior studies indicate that the performance in tasks mediated by affective functions increase cognitive tasks. Gorak was created Method to reflect the affective relations’ training in the adjustment of social abilities, socializa- There will be a 15-min lecture with Power- tion and social adjustment, empathy, social Point slides, followed by a 5-min Q=A period. assertiveness copping, self-control, and better social participation. The game would Results allow better attentional processing and verbal cognition related to the prefrontal cortex. Participants will acquire a greater understanding of the subtle variables of migraine Objective brain events. The purpose is to test the effectiveness of Conclusion the Gorak applied in children under social risk, particularly to exam cognitive activity The migraine aura is a significant part of (WISC-III), social abilities (IHS-Del Prete the migraine mechanism. It is critical to & Del Prete), and EEG signals (bipolar understand the aura variables in order to Fp1-Fp2). Proceedings of the 2010 ISNR Conference 329

Method Brain Functions. Retrieved from http://www.beha- vioralandbrainfunctions.com/content/4/1/33 Thirty children (6–9 years of age) were Fonagy, P. (1999). Guest editorial: Memory and thera- evaluated pre- and postplaying, in a period peutic action. International Journal of Psycho- of 10 weeks, being applied the instruments Analysis, 80, 215–223. Gilleade, K. M., Dix, A., & Allanson, J. (2006). Affect- cited. Gorak was presented to the children ive videogames and modes of affective gaming: twice weekly across 20 sessions of 1 hr each Assist me, challenge me, emote me. Proceedings of in a controlled environment, each child DiGRA 2005 Conference: Changing Views – Worlds utilizing one computer individually. in Play. Vancouver: University of Vancouver. Soussumi, Y. (2006). Tentativa de Integraçaõ entre algumas Concepço˜es Ba´sicas da Psicana´lise e da Results Neurocieˆncia. Psic. Clin., Rio De Janeiro, 18(1), 63–82. The results showed strong statistical posi- Wickramasekera, I. (1991). The unconscious, somati- tive correlation and significance for the sub- zation, psychophysiological psychotherapy and tests Picture Completion, Similarities, threat perception: Footnotes to cartography of the Picture Arrangement, and Comprehension. unconscious mind. Biofeedback, 19, 18–23. In the HIS, and also was obtained for items involving negotiation, persuasion, and Effectiveness of Neurofeedback in Youth with acceptance, not meaning passivity, but better ADHD Problems and Comorbid Disorders capacity to choose the adequate social copping. Discrete cognitive difficulties related to Marleen Bink, MSc, and Chijs van the attentional processing (Theta in Fp1-Fp2) Nieuwenhuizen, PhD arose. Inhibition of attention was associated Tilburg University with the increase on Theta and electric activity slowed. In the posttest there was discrete improvement of the standards of Theta. Background

Discussion Youngsters in (forensic) mental health care often display ADHD-problems with inatten- We conclude that Gorak enabled the chil- tion and=or hyperactivity-impulsivity. A dren to improve the capacity to establish majority of them also experience problems logical relations and to form verbal concepts on other domains. Co-occurrence of externa- and provided improvement of the capacity to lizing disorders and=or internalizing disor- synthesize and integrate knowledge. ders is the rule rather than the exception. At Improved acknowledgment of social this moment, best practices for treatment of relationship rules and facility of argument ADHD consist of behavioural intervention was also noticed. and medication. But this best practice appears to be less effective for youngsters with comorbid disorders. In the majority of REFERENCES the youngsters with ADHD an underactivity of the frontal and central brain region can be Arroyo-Palacio, J., & Romano, D. M. (2008). observed. Neurofeedback is a training Towards a standardization in the use of physiologi- method which intends to (partially) correct cal signals for affective recognition systems. In A. J. this brain activity by giving direct feedback Spink, M. R. Ballintijn, N. D. Bogers, F. Grieco, L. to the brain. W. S. Loijens, L. P. J. J. Noldus, et al. (Eds.), Proceedings of measuring behavior 2008 (pp. 121– 124). Maastricht, The Netherlands. Methods Beeli, G., Casutt, G., Baumgartner, T., & Ja¨ncke, L. (2008). Modulating presence and impulsiveness by The objective is to investigate whether external stimulation of the brain. Behavioral and neurofeedback is an effective intervention 330 JOURNAL OF NEUROTHERAPY for youngsters with AD(H)D-problems and children: Antisocial activities and drug use. Journal comorbid disorders. This is done by looking of Child Psychology and Psychiatry, 45, 195–211. at an ongoing study with a randomized con- Barry, R. J., Clarke, A. R., & Johnstone, S. J. (2003). trolled design. The aim is to include 100 A review of electrophysiology in attention deficit= youngsters in the experimental condition hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clinical Neurophysiol- and 50 youngsters in the control condition. ogy, 114, 171–183. In this study, the experimental condition Clarke, A. R., Barry, R. J., McCarthy, R., & consists of treatment as usual in combination Selikowitz, M. (2001a). EEG-defined subtypes of with 40 neurofeedback sessions. These ses- children with attention-deficit=hyperactivity dis- sions aim to inhibit theta (4–7 Hz) activity order. Clinical Neurophysiology, 112, 2098–2105. and reward beta (12–15 Hz) activity. The Clarke, A. R., Barry, R. J., McCarthy, R., & control condition consists of treatment as Selikowitz, M. (2001b). Excess beta activity in chil- usual. dren with attention-deficit=hyperactivity disorder: An atypical electrophysiological group. Psychiatry Research, 103, 205–218. Results Lubar, J. F. (1997). Neocortical dynamics: Implica- tions for understanding the role of neurofeedback Measurements are taken pretreatment and related techniques for the enhancement of attention. Applied Psychophysiology and Biofeed- (t1), direct posttreatment (t2), 6 months back, 22, 111–126. posttreatment (t3), and 1 year posttreatment (t4). At t1 thru t4, EEG-measurements, neu- Adult ADHD: Physiological Arousal During ropsychological tests, clinical interviews, Resting State and Task Conditions and=or behavioural questionnaires are administered. In this presentation, preliminary Marie Gonzales, BS, Sarah Wyckoff, MA, pre-and direct postmeasurements of the first and Ute Strehl, PD, PhD, MSc inclusion group are presented. University of Tu¨bingen Conclusion Objective The hypothesis is that neurofeedback will improve the capability of the brain to pro- Recent research on Attention-Deficit= cess information and will reduce attention, Hyperactivity Disorder (ADHD) has hyperactivity, and impulsivity symptoms. focused on central nervous system (CNS) arousal, QEEG Phenotypes, and EEG vigilance models. Distinct and stable patterns of REFERENCES EEG activity have emerged using these models and various subtypes of ADHD ident- Angold, A., Costello, E. J., & Erkanli, A. (1999). ified. However, the assessment and profile Comorbidity. Journal of Child Psychology of peripheral physiological measures of Psychiatry and Allied Disciplines, 40, 57–87. arousal in ADHD has been less consistent Barkley, R. A. (1997). Behavioral inhibition, sustained and requires further investigation. Mangina attention, and executive functions: constructing a and Beuzeron-Mangina (1992) reported that unifying theory of ADHD. Psychological Bulletin, children and adolescents with learning 121(1), 65–94. disabilities=ADHD have an impaired regu- Barkley, R. A. (2006). Comorbid disorders, social and lation and asymmetries in electrodermal family adjustment, and subtyping. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: a response during cognitive tasks compared to handbook for diagnosis and treatment, (pp. 184– controls subjects. In a recent study Barry, 218). New York: Guilford. Clarke, Johnstone, McCarthy, and Selikowitz Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, (2009) reported no significant correlation K. (2004). Young adult follow-up of hyperactive between theta=beta ratios and skin conductance Proceedings of the 2010 ISNR Conference 331 level (SCL) in an adolescent ADHD popu- pretreatment physiological measure of lation. However, reduced SCL, alpha, and clinical and control participants will be pre- beta power was observed in the ADHD sented at the time of the presentation. group compared with control subjects. Finally, analysis of EEG Vigilance in a childhood ADHD population indicated that indi- Conclusion viduals with ADHD have more frequent vigilance state shifts and tend to spend more Specific findings will be discussed and time in lower vigilance stages (Sander, Arns, implication in the current treatment study Olbrich, & Hegerl, in press). EEG Vigilance and future research will be explored. and heart rate was accessed in a control population and the average heart rate decreased as participants entered the lower REFERENCES arousal=vigilance stages (Olbrich et al., 2009). Additional research is needed to Barry, R. J., Clarke, A. R., Johnstone, S. J., identify the baseline and task specific physio- McCarthy, R., & Selikowitz, M. (2009). Electroence- logical response in an adult ADHD popu- phalogram theta=beta ratio and arousal in attention lation. We hypothesize that adults ADHD deficit=hyperactivity disorder: Evidence of inde- will exhibit reduced physiological arousal pendent processes. Biological Psychiatry, 66, 398–401. (reduced heart rate and parasympathetic Mangina, C. A., & Beuzeron-Mangina, J. H. (1992). dominance of HRV and EDR variables) Psychophysiological treatment for learning disabilities: Controlled research and evidence. International compared to controls during resting state Journal of Psychophysiology, 12, 243–250. and cognitive=vigilance tasks. Olbrich, S., Mulert, C., Karch, S., Trenner, M., Leicht, G., Pogarell, O., et al. (2009). EEG-vigilance and Methods BOLD effect during simultaneous EEG=fMRI measurement. NeuroImage, 45, 319–332. Sander, C., Arns, M., Olbrich, S., & Hegerl, U. (in Heart rate, heart rate variability (HRV), press). EEG-vigilance and response to stimulants respiration rate, and electrodermal response in pediatric patients with attention deficit=hypera (EDR) activity was investigated as a function ctivity disorder. of CNS arousal=vigilance during resting state, CNV task, and auditory oddball task Theta=Beta and SCP Training in Children in two groups of adults (18þ years old), with with Attention-Deficit=Hyperactivity Dis- and without ADHD. Adult ADHD parti- order: Behavioral and Neurophysiological cipants met DSM–IV criteria for combined, Results from a Randomized Controlled Trial hyperactive, or attention type ADHD. Parti- cipants in both groups reported no additional Hartmut Heinrich, PhD serious physical, neurological, or psychiatric University of Erlangen disorders, had a Full-Scale IQ greater than 80, and were right hand dominant. Arousal was defined in terms sympathetic and para- Neurofeedback (NF) could help to improve sympathetic dominance in relation to heart attentional and self-management capabilities rate, respiration, HRV, and GSR. Analysis in children with ADHD. In a randomized of physiological measures was conducted for controlled trial, we evaluated the clinical effi- both groups and conditions. cacy of neurofeedback training using an attention skills training as control condition. Results We also compared slow cortical potential (SCP) training, which addresses phasic regu- This investigation is part of a long-term lation of cortical excitability, to theta=beta treatment study currently in progress. The training both at the behavioral and the most current results in relation to the neurophysiological level. 332 JOURNAL OF NEUROTHERAPY

Ninety-four children with ADHD, aged 8 The Brain That Changes Itself: The Neuro- to 12 years, either completed 36 sessions of plasticity Revolution & Film Clips of People NF training (n ¼ 59) or a computerized atten- Undergoing Plastic Change tion skills training (n ¼ 35). NF training consisted of one block of theta=beta training and Norman Doidge, MD one block of SCP training, each block com- Columbia University prising 18 units of 50 min (balanced order). At the behavioral level, NF was superior to the control training concerning core The discovery that the human brain can ADHD symptomatology as well as associa- change its own structure and function with ted domains. For the primary outcome mea- thought and experience, turning on its own sure (improvement in the FBB-HKS total genes to change its circuitry, reorganize itself, score, parent ratings), the effect size was and change its operation is the most impor- .60. For theta=beta and SCP training, com- tant change in our understanding of the brain parable improvements were observed. in 400 years. We explore how, given that the At the neurophysiological level (resting human brain has been plastic, we have missed EEG, event-related potentials during the this core feature, and how this misunder- attention network test), specific effects for standing led scientists to doubt the claims the two NF protocols could be demonstrated. made by the pioneers of neurofeed- For theta=beta training, for example, back. Many new cures for neurological and decrease of theta activity in the EEG was psychiatric conditions are described. Using associated with a reduction of ADHD symp- film clips of patients from his book The tomatology. SCP training was accompanied, Brain That Changes Itself, Dr. Doidge for example, by an increase of the contingent demonstrates some of the key principles of negative variation in the attention network neuroplasticity. test, that is, children were able to allocate more resources for preparation. EEG-and ERP-based predictors were found. Learning Objectives and Outline Future studies should address inter alia how to optimize (individualize) neurofeed- The participants will define neuroplasticity, back training, that is, which training proto- review the current understanding of it, col (or combination of protocols) should be and the history of the concept. used for a particular child. The participants will learn the ways in which the human brain is not ‘‘hardwired’’ and the clinical implications of this. Acknowledgments The participants will learn why, if the brain has always been plastic, it wasn’t This study was funded by the German detected and early manifestations of it Research Foundation (HE4536=2, MO were dismissed. 726=2, RO 698=4). Core innovations, using sensory substitution as an example, will be described, using film clips. REFERENCES Neuroplastic principles, and a new approach to treatment of neurological and psychi- Gevensleben, H., Holl, B., Albrecht, B., Vogel, C., atric problems that reorganizes the brain, Schlamp, D., Kratz, O., et al. (2009). Is neurofeed- will be described. back an efficacious treatment for ADHD? A rando- The concept of the plastic paradox will be mized controlled clinical trial. Journal of Child Psychology and Psychiatry, 50, 780–789. introduced and discussed to demonstrate Heinrich, H., Gevensleben, H., & Strehl, U. (2007). how neuroplasticity gives rise to both flex- Annotation: Neurofeedback—Train your brain to ible and rigid behaviors and outcomes. train behaviour. Journal of Child Psychology and Participants will be able to identify and Psychiatry, 48, 3–16. describe the plastic paradox. Proceedings of the 2010 ISNR Conference 333

REFERENCE Osteopathic Treatment of the Encephalon: A QEEG Study Doidge, N. (2007). The brain that changes itself. New York: Viking=Penguin. David Bergstein, DO Stillpoint Therapies, Inc. QEEG-Guided Neurofeedback for Anger Control Debora Elliott, MA Interactive Brain Analysis Jonathan Walker, MD Neurotherapy Center of Dallas The purpose of this study was to explore the objective changes in brainwave activity resulting from direct osteopathic treatment Recent changes in QEEG databases have of the encephalon. Quantitative electroence- revealed most anger control problems are phalography (QEEG) was employed to associated with excess high-frequency beta generate electrocortical ‘‘brainmaps’’ for activity in one or several brain areas. After analysis of these dependent variables: Absol- downtraining such activity, the anger is ute Power, Coherence, Phase Lag. usually decreased and anger control is A mixed gender group of 20 healthy part- improved. QEEG findings and the posttreat- icipants between 20 and 50 years of age were ment findings in 67 patients shows that this studied in a crossover experimental design. approach was significant in reducing anger Each participantt underwent a prestudy in all but 8% of patients. None were worse. treatment to clear nonphysiologic osteopathic lesions 30 days prior to the control phase of the experiment. First, individuals REFERENCES participated in a 60-min supine rest period with a QEEG measurement performed prior Walker, J. E. (2007). A neurologist’s clinical experience to and following the intervening rest period with QEEG neurofeedback in rehabilitation follow- (each with an eyes-open and eyes-closed ing brain injury. In J. R. Evans (Eds.), Contempor- component). This was the control condition. ary topics in neurofeedback. Handbook of The experimental condition was identical in neurofeedback, (pp. 353–361). Binghamton, NY: all aspects, except that the intervening rest Haworth. period was replaced with a single session of Walker, J. E., & Kozlowski, G. P. (2005). Neuro- osteopathic endocranial treatment, exactly feedback treatment of epilepsy. Child and 7 days following the control session, again Adolescent Psychiatric Clinics of North America, with QEEG measurement performed before 14, 163–176. Walker, J. E., Kozlowski, G., & Lawson, R. (2007). A and after the intervening treatment. A six modular activation=coherence approach to evaluat- technique protocol was designed and ing clinical=QEEG correlations and for guiding employed for the experimentation session, neurofeedback training: Modular insufficiencies, with techniques chosen to emphasize the modular excesses, disconnections, and hypercon- mobilization of the encephalon globally nections. Journal of Neurotherapy, 11, 25–44. and to reestablish the thalamus as its pri- Walker, J. E., Lawson, R., & Kozlowski, G. (2007). mary motion fulcrum. We hypothesize that Current status of QEEG and neurofeedback in such treatment of the endocranium should the treatment of clinical depression. In J. R. Evans lead to systematic and quantifiable changes (Ed.), The Handbook of neurofeedback. Dynamics in the brain’s electrocortical activity. The and clinical applications (pp. 341–352). Binghamton, results of all four QEEG measurements were NY: Haworth. Walker, J. E., & Norman, C. (2006). The neurophy- recorded for each participant; the signals siology of dyslexia: A selective review with implica- were processed and analyzed statistically. tions for neurofeedback remediation and results of Significant changes in group electrocorti- treatment in 12 consecutive patients. Journal of cal activity resulted from the endocranial Neurotherapy, 10, 45–55. treatment protocol. A large increase in 334 JOURNAL OF NEUROTHERAPY

Absolute Power in the Alpha frequency band neural substrates of reading readiness in (p ¼ .028), increased Coherence in the Beta young dyslexic readers. frequency band (p ¼ .02), decreased Coher- ence in the Theta frequency band (p ¼ .016), and decreased Phase Lag in the Beta fre- Participants and Methods quency band (p ¼ .012) were found in the eyes-closed condition for the Treatment As a component of a larger pilot study, we group. A small decrease in Absolute Power analyzed surface qEEG and low resolution across the Delta (p ¼ .017) and Theta brain electromagnetic tomography (LOR- (p ¼ .034) frequency bands, substantially ETA) activation patterns during reading in increased Coherence in the Beta frequency 2 children (ages 6 and 8 years old) with docu- band (p ¼ .018), and increased Phase Lag mented reading disability. The children across the Theta (p ¼ .025) and Alpha received 60 hr of training, consisting of (p ¼ .024) frequency bands were found in exposure to gated and filtered sound, tail- the eyes-open condition for the Treatment ored to each child’s specific auditory proces- group. In addition to the significant changes sing pattern, embedded in a classical musical in magnitude for these dependent variables, a recording (EnListen method). We identified consistent pattern of nonrandom, centra- pre–post training changes in qEEG and lized, and orderly activity was found in most voxel-level neuro-electric source localization of the Pre=Post results for the treatment (LORETA) patterns during reading, and group. In contrast, although several depen- measured the impact of training on psycho- dent variables did change as a result of the metric indices of reading readiness. Rest period, all control measures lacked either statistical significance (Absolute Power) or central organization (Coherence and Phase Lag). Results In all, these findings provide strong evidence that electrocortical activity was We observed increased activation during directly affected by the endocranial treat- reading in left temporo-parietal cortex and ment protocol. The results of this osteo- left inferior frontal regions, similar to pat- pathic study provide justification for terns observed in normal readers. We noted further osteopathic research in the endocra- a shift from right frontal to bilateral frontal nial field. activation consistent with patterns reported for well-compensated dyslexic readers. Increased regional activation in the anterior EnListen and Learn: Auditory Processing cingulate gyrus was interpreted to reflect Training Impacts Neural Substrates of Read- enhanced activation of an attention circuit ing Readiness in Dyslexic Readers during task. Although overall reading gains were modest, gains of up to 1 SD on mea- Roger Riss, PhD, and Paula Ray, PsyD sures of phoneme discrimination, working Madonna Rehabilitation Hospital memory and reading fluency, suggested enhanced reading readiness.

Objective Conclusions

Convergent neuropsychological, neuroima- Preliminary findings suggest that auditory- ging, and electrophysiological evidence has processing training may have potential to implicated a central role for phonological- positively impact neural correlates of reading processing dysfunction in dyslexia. In the readiness in dyslexic readers, providing an present pilot study, we examine the impact of enhanced foundation for subsequent remedial an auditory processing intervention on the educational interventions. Proceedings of the 2010 ISNR Conference 335

REFERENCES Temple, E., Deutsch, G. K., et al. (2003). Neural deficits in children with dyslexia ameliorated by beha- Aylward, E. H., Richards, J., Beringer, V. W., Nagy, vioral remediation: Evidence from functional W. E., Field, B. A., et al. (2003). Instructional treat- MRI. Proceedings of the National Academy of ment associated with changes in brain activation in Sciences USA, 100, 2860–2865. children with dyslexia. Neurology, 61, 212–219. Thornton, K. E., & Carmody, D. P. (2005). Electroen- Breteler, M. H., Arns, M., Peters, S., Giepmans, I., & cephalogram biofeedback for reading disability and Verhoeven, L. (2010). Erratum to ‘‘Improvements traumatic brain injury. Child and Adolescent Psychi- in Spelling after QEEG-based Neurofeedback in atric Clinics of North America, 14, 137–162, vii. Dyslexia: A Randomized Controlled Treatment Study. Applied Psychophysiology and Biofeedback, 35, 182. Marketing the Neurofeedback Practice Breteler, M. H., Arns, M., Peters, S., Giepmans, I., & Verhoeven, L. (2010). Improvements in spelling Jeffrey Hunter, DBA after QEEG-based neurofeedback in dyslexia: A Assumption College randomized controlled treatment study. Applied Psychophysiology and Biofeedback, 35, 5–11. Eden, G. F., & Moats, L. (2002). The role of neu- The presentation involves a brief introduc- roscience in the remediation of students with tion to a strategic marketing assessment dyslexia. Nature Neuroscience, 5(Suppl.), 1080–1084. and planning tool that can be used to Gaab, N., Gabrieli, J. D., et al. (2007). Neural correlates of rapid auditory processing are disrupted in develop a comprehensive marketing plan children with developmental dyslexia and amelio- for the neurofeedback practice (please see rated with training: An fMRI study. Restorative below). The concept of USP, development Neurology and Neuroscience, 25, 295–310. of a Unique Selling Point for the neurofeed- Gabrieli, J. D. (2009). Dyslexia: A new synergy back practice, is discussed. between education and cognitive neuroscience. USP, or unique selling point (and some- Science, 325, 280–283. times referred to as unique selling prop- Horwitz, B., Rumsey, J. M., et al. (1998). Functional osition or unique selling position), is a connectivity of the angular gyrus in normal reading fundamental concept in marketing. It refers and dyslexia. Proceedings of the National Academy to some element of the marketer’s offering of Sciences USA, 95, 8939–8344. which makes it more attractive to potential Kohler, S., Paus, T., et al. (2004). Effects of left inferior prefrontal stimulation on episodic memory clients or customers than the offering of formation: A two-stage fMRI-rTMS study. Journal competitors who are vying for the same cli- of Cognitive Neuroscience, 16, 178–188. ents or customers. To be effective, a USP Liddle, E., Jackson, G., et al. (2005). An evaluation of should provide some type of differentiation a visual biofeedback intervention in dyslexic adults. that is of value to customers. An example Dyslexia, 11, 61–77. from the automotive world would be an Rumsey, J. M., Horwitz, B., et al. (1999). A functional automobile which is unusually efficient and lesion in developmental dyslexia: left angular gyral environment friendly, much more so than blood flow predicts severity. Brain and Language, other competing automobiles. Furthermore, 70, 187–204. a good USP should be one that is not easily Shaywitz, S. E., & Shaywitz, B. A. (2008). Paying imitated. It should be long-lasting and attention to reading: The neurobiology of reading and dyslexia. Developmental Psychopathology, 20, should also be able to be communicated 1329–1349. effectively to potential clients or customers. Shaywitz, S. E., Shaywitz, B. A., et al. (2003). Neural The ‘‘U’’ of USP equals that which makes systems for compensation and persistence: Young the product or service different. The ‘‘S’’ is adult outcome of childhood reading disability. Bio- that which makes it attractive. The ‘‘P’’ logical Psychiatry, 54, 25–33. represents its ability to make an impression Tansey, M. A., & Bruner, R. L. (1983). EMG and on the mind of a consumer. EEG biofeedback training in the treatment of a In the domain of neurofeedback practice, 10-year-old hyperactive boy with a developmental a potential USP might be ‘‘specialization.’’ reading disorder. Biofeedback & Self-Regulation, A practice is the only one in the state of 8, 25–37. Rhode Island that provides comprehensive 336 JOURNAL OF NEUROTHERAPY therapeutic approaches to ADD=ADHD, implications. This pilot study describes the including qEEG diagnosis, Z-score neuro- development and implementation of treat- feedback training, whole-family counseling, ment protocols that includes pre- and postin- behavior therapy for the patient, and tervention QEEG, neurofeedback training, nutritional analysis with dietary recommen- consultation for behavioral modification, dations for the child. (This example is and parental education on FAS. It also intended simply to illustrate the point, not discusses the variations and complexities of serve as a recommendation.) using various neurofeedback treatment proto- The neurofeedback practice that develops, cols and the overall scope of treatment for chil- maintains, and promotes an effective USP dren diagnosed on the spectrum of FASD. when compared to its competitors will gain and retain market share. The oral presentation also makes brief REFERENCE reference to the following material, which forms the basis of the proposed workshop This is a pilot study, and on literature review no other presentation on marketing the neurofeed- research studies were found in which neurofeedback back practice. has been used as an intervention for individuals diagnosed with FAS.

REFERENCES Gamma Induction=Beta Attunement (GI=BA) Intervention Protocol & Neurodegenerative Blakeman, R. (2007). Integrated marketing communication. Lanham, MD: Rowman & Littlefield. Jaclyn Gisburne, PhD, and Jana Harr, BA Fortenberry, J. L. (2009). Health care marketing: Rocky Mountain NeuroAdvantage Tools and techniques. Sudbury, MA: Jones & Bartlett. Levinson, J. C. (2007). Guerilla marketing, 4th ed. The GI=BA protocol is an intervention New York, NY: Mariner. protocol developed over the past 4 years. Formerly known as ‘‘beta-reset,’’ the Neurofeedback: A Critical Treatment Compo- GI=BA protocol has shown promise with nent to Behavioral Modification and Parent cognitive, affective, and physical patholo- Education for Individuals Diagnosed with gies. Its full potential, limitations, and the Fetal Alcohol Syndrome (FAS) understanding of its neurological potentials are still being explored. However, the pur- James Kowal, PhD pose of this presentation is to look at this Center for Traumatic Stress and other protocols and their utility as interventions that interrupt and=or reverse the systemic activities associated with Ajeet Charate chronic and neurodegenerative disorders. Trinity Services, Inc. We discuss how evoking gamma wave potentials, which naturally emanate from Fetal alcohol syndrome (FAS) is a condition the occipital and parietal regions, can facili- that is very prevalent and extremely difficult tate restoration of more normal frequency to treat. It is on the spectrum of the Fetal distribution throughout the brain. We Alcohol Spectrum Disorders (FASD). Preva- surmise that the gamma-wave potentials lence of FASD is estimated to be at least 10 are instrumental in the ‘‘resetting’’ of the per 1,000, or 1% of all births. FASD is an frequency distributions at these areas and umbrella term used to describe the range of that they have global implications in the effects that occur in an individual who is remission of symptoms. We discuss several exposed to alcohol prenatally. These effects case studies that reflect the resetting activi- may include physical, mental, behavioral, ties as evidenced by the often-instantaneous and=or learning disabilities with lifelong recovery of the clients. We also discuss Proceedings of the 2010 ISNR Conference 337 briefly the role of stress=trauma in the components can be used for discrimination development of pathologies and several of ADHD adults from healthy participants. adjunct modalities that help the clients resolve these entrenched and often encapsu- Methods lated experiences. Two groups of age- and sex-matched adults (74 ADHD, 74 controls) performed REFERENCES a visual two stimulus GO=NOGO task. ERP responses were decomposed into inde- Bauer, M., Oostenveld, R., Peeters, M., & Fries, P. pendent components by means of ICA. A (2006). Tactile spacial attention enhances gamma-band activity in somatosensory cortex and feature selection algorithm defined a set of reduces low-frequency activity in parieto-occipital independent component features, which areas. Journal of Neuroscience, 26, 490–501. was entered into a support vector machine. Canolty, R. T., Edwards, E., Dalal, S. S., Soltani, M., Nagarajan, S. S., Kirsch, H. E., et al. (2006, Septem- ber 15). High gamma power is phase-locked to theta Results oscillation in human neocortex. Science, 1626–1628. Fields, R. D. (2009, November). New culprits in The feature set consisted of five latency chronic pain. Scientific American, 50–57. measures in specific time windows, which Levy, R., Hutchinson, W. D., Lozano, A. M., & were collected from four different inde- Dostrovsky, J. O. (2000). High-frequency synchro- pendent components. The independent com- nization of neuronal activity in the subthalamic ponents involved were a novelty component, nucleus of Parkinsonian patients with limb tremor. a sensory related and two executive function Journal of Neuroscience, 20, 7766–7775. related components. Using a 10-fold Porreca, F., & Price, T. (2009, November). When pain cross-validation approach, classification lingers. Scientific American, 34–41. Schiller, D., Levy, I., Niv, Y., LeDoux, J. E., & Phelps, accuracy was 92%. E. A. (2008). From fear to safety and back: Rever- sal of fear in the human brain. Journal of Neu- Conclusions roscience, 28, 11517–11525. A crossvalidation study by means of sup- Classification of ADHD Patients on the Basis port vector machine with new data of Nor- of Independent ERP Components Using a wegian research group to classify ADHD Machine Learning System—Crossvalidation adults which indicates that classification by With New Data means of linear and nonlinear methods is Andreas Mueller, PhD feasible in the context of clinical groups. Brain and Trauma Foundation Further, independent ERP components have been shown to provide features that can be used for characterizing clinical populations. The transformation from research into Background clinical praxis will be shown. In the context of sensory and cognitive- processing deficits in ADHD patients, there is considerable evidence of altered event REFERENCES related potentials (ERP). Most of the studies, however, were done on ADHD children. Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults. What the science says Using the independent component analysis . New York: Guilford. (ICA) method, ERPs can be decomposed Barry, R. J., Clarke, A. R., Johnstone, S. J. (2003). A into functionally different components. review of electrophysiology in attention deficit= Using the classification method of support hyperactivity disorder: I. Qualitative and quantitat- vector machine, this study investigated ive electroencephalography. Clinical Neurophysiol- whether features of independent ERP ogy, 114, 171–183. 338 JOURNAL OF NEUROTHERAPY

Brown, T. E. (2009). ADHD comorbidities. Handbook activity of the brain regions that have been for ADHD complications in children and adults. shown to play an important role in PTSD Washington, DC: American Psychiatric Publishing. (Lanius et al., 2006). Of the various available Fallgatter, A. J., Ehlis, A. C., Rosler, M., Strik, W. K., methodologies for differentiating between Blocher, D., & Herrmann, M. J. (2005). Diminished PTSD and non-PTSD subjects, we have cho- prefrontal brain function in adults with psychopathology in childhood related to attention deficit sen to focus on analysis of EEG data, using hyperactivity disorder. Psychiatry Research, 138, an array of theoretical and algorithmic 157–169. approaches drawn from the recent literature. Kropotov,J.D.(2008).Executivesystem.InJ.D. Kropotov (Ed.), Quantitative EEG, event-related potentials and neurotherapy, (pp. 253–291). Amsterdam: Materials and Methods Academic Press. Data were obtained from a sample of 10 Using EEG to Predict Neurotherapy Treat- individuals with comorbid PTSD and ment Outcome in PTSD cocaine addiction and 9 control participants from a larger study on attentional bias to Estate Sokhadze, PhD, Eric Toolson, PhD, pictorial cues (Sokhadze et al., 2008). The Beth Perry, PhD, and Michael Hollifield, MD 10 participants underwent 12 sessions of neu- University of Louisville rofeedback as a therapeutic intervention, with the goal of increasing the sensorimotor rhythm with either a decrease or no change in theta waves at C3 (motor strip) referenced Introduction to the left mastoid. After preprocessing (60 Hz filtering removal of artifacts), data Posttraumatic stress disorder (PTSD) is a were characterized by FFT, and the largest debilitating disease characterized by hyperar- Lyapunov exponents (L1), correlation ousal, avoidance, and numbing, and=or reex- dimensions (D2), and autocorrelation func- periencing aspects of the original trauma. tions (ACF) were computed using pro- Lifetime prevalence of PTSD in community prietary Matlab1-based software, based on samples is around 6.8% and as high as 30% a windowed variant (Toolson & Perry, among specific populations such as Vietnam 2010, in preparation) of the Rosenstein veterans and female victims of rape. Treat- et al. (1993) algorithm. ment efficacy in PTSD ranges from 50% to 75% but is highly variable among sufferers, which results in high treatment costs, signifi- Results cant drop-out rates, and low treatment efficiency. Published efforts to quantify bio- Two measures of the complexity of the logical differences between PTSD and EEG tracings—L1 and the rate of decay of non-PTSD subjects have failed to yield con- the ACF—were significantly lower in sistent findings (Costa et al., 2002). More PTSD-cocaine addicted patients than in con- important for predicting treatment out- trols. After neurofeedback, the EEG com- comes, there is a paucity of research to ident- plexity as measured by both L1 and ACF ify biomarkers early in treatment that signal rate of decay were significantly increased, an eventual therapeutic response to an inter- and this correlated with clinical improve- vention. Our long-term goal is to produce an ment. However, in contrast with results algorithm that allows discrimination of reported by Chae and colleagues (2004), responders from nonresponders in the early among others, we did not find a statistically stages of a therapeutic intervention. To that significant difference in the correlation end, we believe that the best predictors= dimension (D2) of EEG recordings compar- monitors of response to therapy will be ing PTSD-cocaine addicted patients with based on appropriate analysis of data from controls, nor did neurofeedback result in physiological measures that directly reflect any change in the value of D2. Proceedings of the 2010 ISNR Conference 339

Conclusions At almost all stages of development and aging, provision of specific lipid molecules L1 and ACF rate of decay complexity in specific ratios shapes neural architecture in EEG tracings may be markers of impr- and function. These molecular demands are ovement with neurofeedback in PTSD amplified in an array of clinical conditions cocaine-addicted participants. Further res- as well as being vital in efforts to develop earch is needed to determine if these biomar- elite performers. Although lipids shape kers will distinguish between responders and neural architecture and are at the foundation nonresponders early in treatment, if this bio- of neuroplasticity, a range of essential nutri- marker effect is similar in ‘‘pure PTSD’’ part- ent inputs drive the metabolic networks that icipants versus comorbid participants, and if define the efficiency of neuron communi- this biomarker effect is similar or different cation. This session explores the role of spe- across types of therapeutic interventions. cific lipids in shaping neural architecture, function, and neuroplasticity, along with selected essential nutrient inputs that are fundamental to nervous system function REFERENCES and performance. It also briefly introduces methodologies with the potential for charac- Chae, J.-H., Jeong, J., Peterson, B. S., Kim, D.-J., terizing the impact of subtle variance in Bahk, W.-M., Jun, T.-Y., et al. (2004). Dimensional metabolic networks by using conventional complexity of the EEG in patients with posttrau- QEEG assessment metrics, such as coher- matic stress disorder. Psychiatry Res-Neuroimaging, ence, as well as some novel techniques char- 131, 79–89. acterizing directional information flow. Costa, M., Goldberger, A. L., & Peng, C. K. (2002). Multiscale entropy analysis of complex physiologic time series. Physical Review Letters, 89, 68–102. REFERENCES Lanius, R. A., Bluhm, R., Lanius, U., & Pain, C. (2006). A review of neuroimaging studies in PTSD: Amara, C. E., et al. (2007). Mild mitochondrial uncou- Heterogeneity of response to symptom provo- pling impacts cellular aging in human muscles cation. Journal of Psychiatric Research, 40, 709– in vivo. PNAS, 104, 1057–1062. 729. Bouwens, M., et al. (2009). Fish-oil supplementation Rosenstein, M. T., Collins, J. J., & De Luca, C. J. induces anti-inflammatory gene expression profiles (1993). A practical method for calculating Lyapu- in human blood mononuclear cells. American Jour- nov exponents from small data sets. Physica D, nal of Clinical Nutrition, 90, 415–424. 65, 117–134. C¸akir, T., et al. (2007). Reconstruction and flux analysis Sokhadze, E., Singh, S., Stewart, C., Hollifield, M., of coupling between metabolic pathways of astro- El-Baz, A., & Tasman, A. (2008). Attentional bias cytes and neurons: Application to cerebral hypoxia. to drug-and stress-related pictorial cues in cocaine Theoretical Biology and Medical Modeling, 4, 48. addiction comorbid with PTSD. Journal of Lukiw, W. J., et al. Docosahexaenoic acid and the Neurotherapy, 12, 205–225. aging brain. Journal of Nutrition, 138, 2510–2514. Secher, N. H., et al. (2008). Cerebral blood flow and metabolism during exercise: Implications for fatigue. Nutrient Modifiers of Neuroplasticity and Journal of Applied Physiology, 104, 306–314. Performance, and the Exploration of Novel QEEG Assessment Metrics Beyond Neurotherapy: The Ethics of National Security Neuroscience Michael Schmidt, PhD NASA Ames Research Center Jonathan Marks, MA, BCL Harvard University The human brain is nearly 60% lipid and it is structurally dependent upon specific molecu- Neuroscience and associated neuro-tech- lar lipid forms. nologies have transformed diagnosis and 340 JOURNAL OF NEUROTHERAPY treatment for thousands of patients—from of NeuroFieldelectromagnetic stimulation on those with severe depression that is not the brain. Seven-min QEEG recordings were responsive to drugs to those with severely obtained in an eyes open and eyes closed con- impaired consciousness. Some ethicists and dition. The NeuroField cap was placed over science studies scholars have expressed the QEEG cap and a brief electromagnetic concerns about the manner in which therapies stimulation was administered. Immediately have changed as a result of recent neuroscience following the NeuroField stimulation the developments. This lecture focuses on ethical QEEG eyes open and eyes closed condition concerns raised by various nontherapeutic was repeated. The data were analyzed via applications involving both drugs and medical the NeuroGuide statistics program using a devices—among them, fMRI, EEG, transcu- multivariate analysis of variance and descrip- taneous magnetic stimulation, and oxytocin— tive methods. Significant differences were in the national security context. How are such observed from pre- to posttest conditions drugs and devices transforming the national for each test subject. NeuroField appears to security mission? How and why have these lift cortical suppression as evidenced by sig- drugs and devices been developed? And how nificant absolute power, asymmetry, coher- have they been received and implemented ence, and phase changes in the brain. The in the national security world? What are the clinical relevance of NeuroField appears to ethical implications of these translations? Are be in its ability to lift suppression so that the implications different depending upon other methods of EEG neurofeedback can whether the technologies live up to the claims be used more effectively. made by their proponents? This lecture addresses these questions and explores the complex interactions between the national REFERENCES security and neuroscience communities—as well as the implications of recent research on Berman, R. M., Narasimhan, M., Sanacora, G., et al. public understanding of brain images and neu- (2000). A randomized clinical trial of repetitive tran- roscientific explanations. scranial magnetic stimulation in the treatment of major depression. Biological Psychiatry, 47, 332–337. Grunhaus, L., Dannon, P. N., Schreiber, S., et al. REFERENCES (2000). Repetitive transcranial magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder: An Marks, J. H. (2007). Interrogational neuroimaging in open study. Biological Psychiatry, 47, 314–324. counterterrorism: A ‘‘no-brainer’’ or a human McTaggart, L. (2008). The field. New York: Harper. rights hazard? American Journal of Law & Medi- Martis, B., & Janicak, P. G. (2000, July). Transcranial cine, 33, 483–500. magnetic stimulation for major depression: Thera- Marks, J. H. (2010a). Neuroconcerns: Some responses peutic possibilities. International Drug Therapy to my critics. American Journal of Bioethics: Neu- Newsletter, 1–10. roscience, 1(2), W1–W3. Oschman, J. L. (2000). Energy medicine. New York: Marks, J. H. (2010b). A neuroskeptic’s guide to neu- Churchill Livingstone. roethics and national security. American Journal Post, R. M., Kimbrell, T. A., McCann, U. D., et al. of Bioethics: Neuroscience, 1(2), 4–12. (1999). Repetitive transcranial magnetic stimulation as a neuropsychiatric tool: Present status and future The Immediate Effect of NeuroField as potential. The Journal of ECT, 15, 39–59. Measured by Pre–Post QEEG Pridmore, S., Bruno, R., Turnier-Shea, Y., et al. (2000). Comparison of unlimited numbers of rapid Nicholas Dogris, PhD transcranial magnetic stimulation (rTMS) and ECT treatment sessions in major depressive episode. NeuroField, Inc. International Journal of Neuropsychopharmacology, 3, 129–134. Pridmore, S., & Belmaker, R. (1999). Transcranial mag- Twenty research subjects participated in an netic stimulation in the treatment of psychiatric disor- experiment to measure the immediate impact ders. Psychiatry and Clinical Neuroscience, 53, 541–548. Proceedings of the 2010 ISNR Conference 341

An International Study of the BAUD Applica- self-induce high-amplitude gamma synchrony dur- tions for Emotional and Chronic Pain Issues ing mental practice. Proceedings of the Nationall Academy of Sciences USA, 101, 16369–16373. G. Frank Lawlis, PhD Lawlis Peavey PNP Center Pilot Investigation: QEEG Phenotypes and EEG Vigilance of Adult ADHD

The purpose of this study was to determine Sarah Wyckoff, MA whether the Bioaccoustical Utilization University of Tu¨bingen Device (BAUD) could be effective in allevi- [email protected] ating symptoms related to emotional issues, Martijn Arns, MSc impulsive behavioral issues, and=or chronic Brainclinics Diagnostics pain. Eighty-six patients treated by 19 Christian Sander and Ute Strehl therapists in the United States, Switzerland, University of Tu¨bingen Portugal, and Denmark underwent treatment with the BAUD for one or more sessions. A Likert rating of symptomatology Objective was recorded before and after treatment for all patients and 3 weeks after treatment EEG=QEEG analysis of adults with in a subset of patients. Analysis of immedi- ADHD compared to healthy controls and= ate posttreatment data using McNemar’s or normative database populations have test demonstrated clinically and statistically produced a variety of patterns of activity. significant improvement in all three symp- Adults with ADHD show the typical increase tom groupings. Data recorded 3 weeks in Theta=Beta ratios, with varying Theta ele- posttreatment demonstrated stability of vations and Beta reductions (Bresnahan, posttreatment results in most patients in Anderson, & Barry, 1999; Bresnahan & the emotional issues and chronic pain cate- Barry, 2002; Clarke et al., 2008a). Some exhi- gories (insufficient 3-week posttreatment bit increased absolute Theta and Alpha power data were available in the impulsive beha- without differences in Beta activity (Koehler vioral issues category for analysis). These et al., 2009). Others exhibit increased data suggest that the BAUD is effective in low-Alpha (8–10 Hz) and=or high-Alpha alleviating symptoms from a variety of (10–12 Hz) activity, depending on task con- psychological sources. dition (Loo et al., 2009; White, 2001, 2003), whereas coherence data indicates a reduction in hemispheric differences of Delta and Alpha REFERENCES bands (Clarke et al., 2008b) and increased right-hemisphere alpha dominance is corre- Bittman, B., Berk, L., Shannon, M., Sharaf, M., lated with a greater number of ADHD symp- Westerngard, J., Guegler, K. J., et al. (2005). Rec- toms (Hale et al., 2009). Distinct EEG and reational music-making modulates the human stress behavior patterns or subtypes in an adult response. Medical Science Monitor, 11, BR31–40. ADHD population have also been observed. Doidge, N. (2007). The brain that changes itself. New Thompson and Thompson (2005) reported York: Penguin. elevated Theta=Beta ratios, low Alpha, elev- Labbe, E., Schmidt, Babun, J., & Pharr, M. (2007). ated Hi Beta=SMR, and combined elevated Coping with stress: The effectiveness of different Theta=Beta and Hi Beta=SMR ratios corre- types of music. Applied Psychophysiology and Bio- spond to specific symptom presentation in a feedback, 32, 163–168. clinical adult population. In an attempt to Lawlis, F. (2004). The ADD answer. New York: Viking. develop theory-driven models for QEEG Lawlis, F. (2009). Retraining the brain. New York: interpretation, neurofeedback protocol selec- Plume. tion, and medication response prediction the Lutz, A., Greischar, L., Rawlings, N. B., Ricard, M., EEG Phenotype (Johnstone, Gunkelman, & & Davidson, R. J. (2004). Long-term mediators Lunt, 2005) and EEG Vigilance (Bente, 342 JOURNAL OF NEUROTHERAPY

1964; Hegerl, 2008) models have emerged to Conclusion explain state and trait differences in clinical populations. These models have been Specific findings are discussed and impli- utilized in the evaluation of childhood ADHD cations for protocol selection in the current and control populations and stimulant treatment study and future research projects medication response in childhood ADHD are explored. (Arns, Gunkelman, Breteler, & Spronk, 2008; Sander, Arns, Olbrich, & Hegerl, in press). Limited research is available on the application of these models in an REFERENCES adult ADHD population for assessment or determination of neurofeedback treatment Arns, M., Gunkelman, J., Breteler, M., & Spronk, D. protocols. (2008). EEG phenotypes predict treatment outcome to stimulants in children with ADHD. Journal of Integrative Neuroscience, 7(3), 421–438. Bente, D. (1964). Vigilanz, dissoziative Vigilanz- Methods verschiebung und Insuffizienz des Vigilita¨tstonus [Vigilance, dissociative vigilance shifting and insuf- Continuous 19-channel EEG was recorded ficiency of vigilance stages]. In H. Kranz & K. during eye closed and eyes open resting state, Heinrich (Eds.), Begleitwirkung und Mißerfolge der CNV task, and auditory oddball task in two psychiatrischen Pharmakotherapie [Accompanying groups of adults (18þ years old), with and effects and failures of psychiatric pharmacotherapy]. without ADHD. Adult ADHD participants Stuttgart, Germany: Thieme. met DSM–IV criteria for combined, hyperac- Bresnahan, S. M., Anderson, J. W., & Barry, R. J. tive, or attention type ADHD. Participants in (1999). Age-related changes in quantitative EEG both groups reported no additional serious in attention-deficit=hyperactivity disorder. Biologi- cal Psychiatry, 46, 1690–1697. physical, neurological, or psychiatric disor- Bresnahan, S. M., & Barry, R. J. (2002). Specificity of ders; had a full scale IQ greater than 80; and Quantitative EEG analysis in adults with attention were right hand dominant. For each partici- deficit hyperactivity disorder. Psychiatry Research, pant, the EOG corrected raw EEG for the 112, 133–144. EO and EC condition was obtained and a com- Clarke, A. R., Barry, R. J., Heaven, P. C., McCarthy, parison of the individual data to a matched R., Selikowitz, M., & Bryne, M. K. (2008a). EEG normative database controls was conducted. coherence in adults with attention-deficit= Participant data were then rated to possess hyperactivity disorder. International Journal of one or more of the following EEG phenotypes Psychophysiology, 76, 35–40. outlined by Johnstone et al. (2005): (a) Frontal Clarke, A. R., Barry, R. J., Heaven, P. C., McCarthy, Slow, (b) Slowed Alpha Peak Frequency, (c) R., Seilkowitz, M., & Bryne, M. K. (2008b). EEG in adults with attention-deficit=hyperactivity Frontal Beta Spindles, or (d) Paroxysmal disorder. International Journal of Psychophysiology, EEG. EEG Vigilance clusters and state 70, 176–183. changes will also be assessed in accordance Hale, T. S., Smalley, S. L., Hanada, G., Macion, J., with the Vigilance Classification Algorithm McCracken, J. T., McGough, J. J., et al. (2009). presented by Hegerl and colleagues (2008). Atypical alpha asymmetry in adults with ADHD. Neuropsychologia, 47, 2082–2088. Hegerl, U., Stein, M., Mulert, C., Mergl, R., Olbrich, Results S., Dichgans, E., et al. (2008). EEG-vigilance differences between patients with borderline person- This investigation is part of a long-term ality disorder, patients with obsessive-compulsive European Archives treatment study currently in progress. The disorder and healthy controls. of Psychiatry and Clinical Neuroscience, 258, most current results related to the distri- 137–143. bution of EEG Phenotypes and EEG Vigil- Johnstone, J., Gunkelman, J., & Lunt, J. (2005). Clini- ance states in the ADHD and control cal database development: Characterization of populations will be presented at the time of EEG phenotypes. Clinical EEG and Neuroscience, the presentation. 36, 99–107. Proceedings of the 2010 ISNR Conference 343

Koehler, S., Lauer, P., Schreppel, T., Jacob, C., Heine, impairment, there are disruptions in proces- M., Boreatti-Hummer, A., et al. (2009). Increased sing emotion in individuals with substance EEG power density in alpha and theta bands in dependence and in those predisposed to drug adult ADHD patients. Journal of Neural Trans- abuse. According to the ‘‘allostasis’’ theory mission, 116, 97–104. (Koob et al., 2004; Koob & Le Moal, 2001) Loo, S. K., Hale, T. S., Macion, J., Hanada, G., McGough, J. J., McCracken, J. T., et al. (2009). sensitization to drugs and counteradaptation Cortical activity patterns in ADHD during arousal, are hypothesized to contribute to dysregula- activation, and sustained attention. Neuropsycholo- tion of hedonic homeostasis and to observed gia, 47, 2114–2119. brain reward system abnormalities in Sander, C., Arns, M., Olbrich, S., & Hegerl, U. (in already-addicted individuals. However, in press). EEG-vigilance and response to stimulants in some cases hedonic dysfunctions and lower pediatric patients with attention deficit=hyperactivity sensitivity to positive affect might be an disorder. Journal of Clinical Neurophysiology. inherited trait predisposing afflicted indivi- Thompson, L., & Thompson, M. (2005). Neurofeed- duals to drug-seeking and drug-taking beha- back intervention for adults with ADHD. Journal viors that may result in substance abuse and of Adult Development, 12, 123–130. ultimately in drug dependence. White, J. N., Jr. (2001). Neuropsychological and electrophysiological assessment of adults with atten- Neurofeedback training-based neurother- tion deficit hyperactivity disorder. Unpublished doc- apy is one of the potentially efficacious toral dissertation, The University of Tennessee, nonpharmacological treatment options for Knoxville. substance use disorders (Sokhadze et al., White, J. N., Jr. (2003). Comparison of QEEG reference 2007, 2008, 2009). There have been an databases in basic signal analysis and in the evalu- increasing number of neurofeedback proto- ation of adult ADHD. Journal of Neurotherapy, 7. cols that report success in treating a variety of addictive behaviors. There are practically Effects of Gamma Neurofeedback Training no studies on the use of neurofeedback in on Perceived PositiveEmotional State and adolescents and young adults with occasional Cognitive Functions drug use when individuals have drug use history but did not yet developed substance Estate Sokhadze, PhD dependence (Trudeau, 2005). One of the University of Louisville most promising direction of neurofeedback research is development of protocols that might be used to prevent drug abuse through Jonathan Cowan, PhD, Timothy Horrell, BS, self-regulation training aimed to enhance of Allan Tasman, MD, Guela Sokhadze, and EEG measures of positive emotional states. Christopher Stewart, MD In a previous study it was show an association of prefrontal gamma oscillations with positive emotional states (Cowan & Rubik, Introduction 2009). One of the specific aims of this pilot study was to determine the dynamics of It has been shown that emotional abnor- self-reported perceived positive emotional malities are typical for addicts. Alexithymia state rating before, during and after twelve (i.e., state of deficiency in understanding, 25-min-long neurofeedback training course processing, or describing emotions; in 2 groups of participants. One group had Fukunishi, 1996) and dysphoria (i.e., state documented drug use history (N ¼ 6; most of inability to experience positive emotions, of them referred from Louisville Adolescent mood lability; Cowan et al., 1980), and Network for Substance Abuse Treatment— decreased emotional reactivity to natural a community mental health system of care positive reinforcers (Gerra et al., 2003) are for adolescents with substance use=abuse highly prevalent among substance abusers issues), and the other was a group of drug- and in those at risk for development of sub- naı¨ve participants (N ¼ 6; recruited mostly stance use disorders. Therefore, in addition from students and residents). Our hypothesis to well-known attentional and cognitive was that the prefrontal high-frequency power 344 JOURNAL OF NEUROTHERAPY increase over 12 neurofeedback training improved performance on IVA þ Plus and sessions is possible and will be accompanied MicroCog tests at the post-12-session neuro- by increased rating scores of positive feedback course. Posttraining evaluations emotional states. Our prediction was that showed a decrease in depression scores and successful completers of the neurofeedback increased happiness and self-satisfaction training in the groups of adolescents and rating in both participant groups in this young adults both with and without drug= study. We discuss potential utility of the Focus alcohol abuse history will improve sub- and Neureka! protocol for self-regulation of sequent performance on cognitive tests and attention and emotional state in individuals will increase positive affect. predisposed for substance abuse.

Method REFERENCES As a preferred neurofeedback protocol, we used enhancement of gamma range (centered Beck, A. T., Steer, R. A., & Brown, G. K. (1996). around 40 Hz) activity (so-called Neureka! Manual for the Beck Depression Inventory-II. San parameter; Peak Achievement Trainer Antonio, TX: Psychological Corporation. [PAT]) and inhibition=suppression of other Cowan, J. D., Kay, D. C., Neidert, G. L., Ross, F. E., frequencies (i.e., ‘‘Focus’’ parameter) at the & Belmore, S. M. (1980). Defeated and joyless: Potential measures of change in drug abuser char- prefrontal site (FPz). Training of high- acteristics. Journal of Nervous and Mental Disease, frequency activity in 40 Hz centered gamma 168, 391–399. band at the midline prefrontal site after 12 ses- Cowan, J. D. (2008). The Neureka! protocols manual. sions resulted, as it was predicted in better per- Goshen, KY: Peak Achievement Training. formance on neurocognitive (MicroCog) and Fukunishi, I. (1996). Alexithymia in substance abuse: attention (IVA þ Plus) tasks and improved Relationship to depression. Psychological Reports, scores on emotional self-reports (happiness 78, 641–642. and self-satisfaction, Siahpush et al., 2008) Geringer, J. M., Madsen, C. K., & Gregory, D. (2004). and clinical (Beck Depression Inventory–II; A fifteen-year history of the Continuous Response Beck et al., 1996) status. This protocol used Digital Interface: Issues relating to validity and in the study is based on the PAT application reliability. Bulletin of the Council for Research in Music Education, 160, 1–15. ‘‘Brain Happiness and Focus’’ and is intended Gerra, G., Baldaro, B., Zaimovic, A., Moi, G., to train focus, concentration and emotional Bussandri, M., et al. (2003). Neuroendocrine state (Cowan, 2008). Individual reports of responses to experimentally-induced emotions self-received happiness scores were assessed among abstinent opioid-dependent subjects. Drug during each neurofeedback session using the & Alcohol Dependence, 71, 25–35. Continuous Response Digital Interface dial Koob, G. F., & Le Moal, M. (2001). Drug addiction, (CRDI; Geringer et al., 2004) and recorded dysregulation of reward, and allostasis. Neuropsy- on a per-minute basis. The CRDI reading chopharmacology, 24, 97–129. showed significant positive correlation with Koob, G. F., Ahmed, S. H., Boutrel, B., Chen, S., et al. relative gamma power during individual train- (2004). Neurobiological mechanisms in the tran- ing sessions and exhibited the tendency to sition from drug use to drug dependence. Neuroscience and Biobehavioral Reviews, 27, increase with the number of conducted neuro- 739–749. feedback sessions. Siahpush, M., Spittal, M., & Singh, G. K. (2008). Happiness and life satisfaction prospectively predict Conclusion self-rated health, physical health, and the presence of limiting, long-term health conditions. American Journal of Health Promotion, 23(1), 18–26. Neurofeedback training aimed at enhance- Sokhadze, E., Stewart, C., & Hollifield, M. (2007). ment of focus and Neureka! measures was Integrating cognitive neuroscience methods with accompanied by positively correlated subjec- neurofeedback therapy in treatment of substance tive self-reports of positive emotional feelings use disorder comorbid with PTSD. Journal of during self-regulation sessions and resulted in Neurotherapy, 11(2), 13–44. Proceedings of the 2010 ISNR Conference 345

Sokhadze, E., Stewart, C., Sokhadze, G., Hollifield, Method M., & Tasman, A. (2009, April 3). EEG biofeedback and reactivity to pictorial and verbal drug-and stress- Training sites were chosen based on related cues in cocaine addiction comorbid with QEEG information and symptoms. Using PTSD. Paper presented at the AAPB annual meet- Neurocybernetics EEGer software, the initial ing, Albuquerque, NM. Sokhadze, T. M., Cannon, R. & Trudeau, D. L. sites trained were CZ-A1 and F4-A2. CZ was (2008). EEG biofeedback as a treatment for sub- chosen to impact neural activity associated stance use disorders: Review, rating of efficacy with OCD. F4 was selected to impact execu- and recommendations for future research. Applied tive functions. During the initial training ses- Psychophysiology & Biofeedback, 33, 1–28. sion, 0–7 Hz activity at both sites was two to Trudeau, D. L. (2005). Applicability of brain wave bio- three times higher in amplitude than SMR. feedback to substance use disorder in adolescents. Therefore, it was decided to inhibit 0–7 Hz Child and Adolescent Clinics of North America, 14, amplitudes and increase SMR (12–15 Hz) 125–136. amplitudes. Additional training sites included C4-A2, FZ-A1, T3-F7 and T3-P3. Using Neurofeedback to Treat OCD Symp- Every training session consisted of training toms in a Low Functioning Down’s Syndrome each of two sites for 15 min, respectively. Client The client was seen for a total of 51 sessions.

Kay Sheehan, EdD, and Rodney Mers, MA ADD Center of Colorado Results Due to the client’s low-functioning condition, he was unable to do any pre- and post- Introduction testing, such as the TOVA. His parents’ finances precluded a posttraining QEEG. The unique aspects of this case are the Therefore, the positive change assessment was extent of the client’s low functioning and based on reports from the parents of the client’s the severity of his OCD symptoms. This behaviors at home, check lists, and in-session 24-year-old young adult man’s OCD symp- observations of the client’s behaviors and inter- toms significantly improved by Session 12. actions by the neurofeedback therapist. In Neurofeedback training was continued to addition, the training data were recorded in a see how further training could improve his file on the EEGer software enabling within overall functioning. and between session comparisons. The goal of training was to reduce the At 12 sessions the parents had seen very severity of the OCD (compulsive type) symp- positive changes in the client’s ability to stop toms to improve his daily life and to see if an activity and move on to another activity. medications for OCD (Zoloft and supple- He was making eye contact more often and ments) could be reduced or eliminated. The delaying less when asked to do something. primary OCD symptoms his parents found Neurofeedback was continued to see if hampering his daily life were his focus on further improvement could be made in these one thing (e.g., turning the light switch on behaviors, to address language issues, and to and off until he was redirected and con- eliminate medications for OCD. stantly sorting mail until redirected), his The parents continued to note improvement inability to shift from one task to another, in the client’s ability to move from task to task and his inability to do things in a timely as well as to complete tasks more quickly. In manner consistent with his overall function- addition, the client’s Zoloft and all supplements ing (e.g., taking 2 hr to fold a stack of were discontinued, and the improvements towels). The client’s compulsive behavior made during the training were maintained. resulted in his inability to move from task The therapist who did the neurofeedback to task in a sheltered workshop and conse- training noted increasing eye contact as train- quent removal from the workshop. ing progressed to the point of consistent 346 JOURNAL OF NEUROTHERAPY appropriate eye contact toward the end of the Single Cell Memory: How Individual Neurons neurofeedback training. At the 45th session, Route and Store Temporary Information to for the first time, the client picked a neuro- Maintain Attention feedback game, which he had not done pre- viously. His language also improved—for Donald Cooper, PhD example, at the 47th session, the client began University of Colorado, Boulder using phrases as opposed to making one-word responses as he had been doing. When asked to pay attention to the screen Our brain’s short-term memory system has so he could get more beeps, he always had just been likened to the rewritable RAM memory said, ‘‘Sorry.’’ At this session he said, ‘‘Sorry of a computer. To perform normal func- about that’’ while making eye contact. In the tions, we need the ability to transiently store, remaining neurofeedback sessions, he pro- quickly and reliably, large amounts of data, gressed from using a one-word response, but only a small amount of this needs to be ‘‘Sorry,’’ when asked a question to using a retained in the longer term. Scientists have simple sentence: ‘‘I don’t know.’’ spent decades working out which parts of the brain are responsible for this memory buffer system and how neural networks man- Conclusion age this feat. Original theories suggested the memories were retained by multiple cells This case suggests that neurofeedback forming ‘‘circuits’’ around which electrical training can be helpful in treating OCD symp- impulses were fired for the necessary period. toms in a low-functioning Down’s Syndrome More recent ideas have centered around the client. The positive changes in his behavior concept that even an individual neurons in helped the client and his parents have a more the cortex could somehow hold information. positive daily routine and may lead to shel- To test this we probed individual prefrontal tered workshop employment. The client’s par- neurons from mice using tiny electrodes to ents were so pleased with his progress they measure their function. We found that a decided to continue neurofeedback training particular component of the cells in question but opted for home training due to finances. tells the cell to start an internal signaling system that holds the ‘‘memory’’ in place. Gene deletion of a protein that initiates this signal- REFERENCES ing cascade eliminated the single-cell memory buffer. Details and updates can be Brownback, T., & Mason, L. (2003). The Brownback, obtained from the Cooper Laboratory web- Mason and Associates Neurofeedback System: Man- site at http://www.Neurocloud.org ual 3. Allentown, PA. Cheng, Z., Liu, S., & Gong, Y. (1993). Stability of intellectual structure of learning disabled and normal children. Psychological Science (China), 16, 158–161. REFERENCES Fleischman, M. J., & Othmer, S. (2006). Case study: Improvements in IQ score and maintenance of (Available at http://www.Neurocloud.org) gains following EEG biofeedback with mildly Fowler, M. A., Sidiropoulou, K., Phillips, C., Ozkan, developmentally delayed twins. Journal of Neu- E., & Cooper, D. C. (2007). Corticolimbic rotherapy, 9, 35–46. expression of TRPC4 and TRPC5 channels in the Hammond, D. C. (2003). QEEG guided neurofeed- rodent brain. PloS One, 2(6), e57. back in the treatment of obsessive compulsive Sidiropoulou, K., Lu, F. M., Fowler, M., Xiao, R., disorder. Journal of Neurotherapy, 7, 25–52. Ozkan, E., Phillips, C., et al. (2009). Dopamine Thompson, M., & Thompson, L. (2003). The neuromodulation of prefrontal cortical mGluR5- feedback book: An introduction to basic concepts in mediated intrinsic regenerative activity. Nature applied psychophysiology. Wheat Ridge, CO: The Neuroscience, 12, 287–300. Association for Applied Psychophysiology and Switching signals in the brain. PLoS Biology, 3(6), Biofeedback. e210. Proceedings of the 2010 ISNR Conference 347

Could Neurofeedback Reconstruct Synchron- Wang, F. Gu, & E. Shen (eds.), Advances in ous Networks Lost Following Traumatic cognitive neurodynamics–Proceedings of the Inter- Brain Injury? national Conference on Cognitive Neurodynamics. New York: Springer Verlag. Paul Rapp, PhD Department of Military and Emergency A Pilot Study: Positive Emotion Monitoring Medicine Uniformed Services, University of with Hemoencephalography Among a Group the Health Sciences of Taiwanese Elders Huey-Tzy Justina Chen, PhD In some instances, individuals receiving Fu Jen Catholic University mild closed skull head injuries are asympto- <[email protected]> matic in the immediate postinjury period but subsequently present significant impair- Paul Kwong, DSc ment in cognitive and affective processing. Hong Kong University The objective of our research program is to Meng-Twin Wu identify individuals at risk of delayed-onset Catholic University Sai-Hung Tang, Cardinal dysfunction and to provide preemptive treat- Tien Hospital ment. The analysis begins with a physiological model of progressive diffuse axonal The objective of the intervention is to injury. This model predicts alterations in improve the positive emotion by eliciting transient, stimulus-dependent synchronous joy from a protocol of ‘‘story-telling.’’ In this behavior. Preliminary results are consistent 2009 pilot study, 7 participants in Taipei ran- with this prediction. The model suggests that ging from 60 to 85 years of age were selected procedures which facilitate the reconstruc- in a snowball sample. Each participant tion of synchronous networks may prevent chatted with the principle investigator for a postinjury deterioration in asymptomatic couple of minutes, with Toomim’s hemoen- patients and may provide an effective treat- cephalography (HEG) headband attached, ment for patients who present postinjury before and after the participant told his or neuropsychiatric disorders. It is hypothe- her stories. The single sessions of about sized that neurofeedback protocols using 20 min per person were conducted on site. recently developed time-dependent measures Each participant’s oxygen levels as measured of multivariate central nervous system by HEG signals at fp1 and fp2 were mea- synchronous behavior may accomplish this. sured before intervention as baseline and during the storytelling episode. The new modality of ‘‘neurofeedback’’ REFERENCES intervention consists of (a) letting the participant learn to observe his or her colorful HEG Allefeld, C., Frisch, S., & Schlesewsky, M. (2005). signals online, (b) encouraging with the Detection of early cognitive processing by activity facilitators to elicit life stories with event-related phase synchronization analysis. uplifting episodes, (c) telling the participants NeuroReport, 16, 13–16. to relate their immanent positive feelings Allefeld, C., & Kurths, J. (2004). An approach to mul- and ‘‘somatic markers’’ to HEG signal as dis- tivariate phase synchronization analysis and its played dynamically on a portable screen, and application to event related potentials. International (d) intentionally reproducing joyful feelings. Journal of Bifurcation and Chaos, 14, 417–426. It was found that the signals during the ordi- Delorme, A., & Makeig, S. (2004). EEGLAB: An nary conversational period, ‘‘before’’ and open source toolbox for analysis of single trial EEG dynamics including independent component analysis. ‘‘after’’ the storytelling, are lower. There are Journal of Neuroscience Methods, 134,9–21. clear ‘‘net gains’’ of HEG signals in the Hernandez, R. S., & Rapp, P. E. (2007). Network story-telling period. The results show that synchronization=desynchronization defects in the when the participants exhibit joyful and posi- pathogenesis of neuropsychiatric disorders. In R. tive narrations, emotional expressions or 348 JOURNAL OF NEUROTHERAPY linguistic affects of the HEG signals are training=treatment can evolve beyond techni- obviously strong and sustained longer. A pilot ques to neurofeedback psychology and study resulting from the new method of using psychotherapy for those seeking more and HEG to augment an intervention of an activity professionals wanting to take the field further. program for elderly persons is presented. In addition to case vignettes and pilot Storytelling as augmented by HEG neuro- study research results, discussion, musings, feedback might be an effective modality of idealizing, and a critical eye will be employed intervention to improve the positive emotion to assess the potential of synthesizing the of elderly people. This dynamically facili- best of the past with the brightest of the tated approach is probably more efficient present toward a creative neuropsychologi- than a passive approach whereby an elderly cal hybrid for the future. participant plays neurofeedback games by himself or herself. Further studies are called for with a sufficient sample size and video REFERENCES recording in order to design an evidence- based intervention protocol. Buzsaki, G. (2006). Rhythms of the brain. New York: Oxford University Press. Horstman, J. (2009). The scientific American: Day in Neuroscience and Depth Psychology: A First the life of your brain. New York: Wiley. Step in Connecting Neurofeedback with Jung, C. G. (1960). The structure and dynamics of Jung’s Theory of Complexes the psyche. Princeton, NJ: Princeton University Press. David Drapes, PhD Lindorff, D. (2004). Jung and Pauli. Wheaton, IL: Private practice Quest Books. Schwartz, J. (2002). The mind and the brain. New York: Regan Books. This will be a sharing, seminarlike offering to Stein, M. (1998). Jung’s map of the soul. Chicago: Open Court. examine the effects of brain wave modulation and control beyond symptom reduction toward personality change. Clini- Effectiveness of an Advanced Form of Tran- cal case material will be presented that sup- scranial Electrical Stimulation in Cases of port the work of C. G. Jung, one of the Persistent Anxiety and Depression first clinical professionals to use biofeedback 100 years ago. The question of neurofeed- Nancy White, PhD back as a treatment for personality com- The Enhancement Institute plexes will be addressed from theoretical, neurological, and clinical perspectives. Empirical research based on a patient’s In an average year in the United States some subjective reports appears to indicate a 40 million people suffer from anxiety and greater and more pervasive change in out- another 20 million become clinically look toward self and life with neurofeed- depressed. The symptoms of these disorders back-assisted depth psychotherapy. This cause substantial distress for the sufferers exposes the neurological underpinnings of and their families and cost society dearly each Jung’s ideas about complexes, psychic year in lost time and suboptimal job perform- energy, and archetypal patterns, perhaps ance. Moreover, the number of people exhibit- rhythmic patterns within the collective uni- ing symptoms of depression and anxiety verse of the patient’s mind=brain or neuro- continues to grow and is projected to continue oscillation gone awry. growing until 2020. Research continues to Happiness, benevolence, resilience, and an demonstrate that the available pharmaceutical open embrace of life have been outcomes treatments are not much more effective than observed with patients in neurofeedback- placebo; in fact, recent articles point out that assisted depth psychotherapy. Neurofeedback placebo appears to be as effective as most of Proceedings of the 2010 ISNR Conference 349 the currently popular psychotropics. Persons Kirsch, D. L., & Smith, D. B. (2004). Cranial electro- who cannot find an effective solution to their therapy stimulation for anxiety, depression, insom- depression or anxiety tend to get worse and nia, cognitive dysfunction, and pain: A review and develop bad habits as they seek to compensate, meta-analysis. In P. J. Rosch & M. S. Markov making treatment even more complex. (Eds.), Bioelectromagnetic medicine (pp. 687–699). New York: Dekker. Although certain neurofeedback protocols Palkin, J. R., Bushkova, N. V., Demjanenko, A. M., have proven effective for depression and anxi- Sderzhikova, E. I., Janushko, G. L., Bushov, K. ety, they still take months to mediate the G., et al. Evaluation of effectiveness of use of nonin- symptoms of these disorders. This presen- vasive transcranial electrostimulation for treatment tation reviews the results of a pilot study of border line depression. SPB Psychiatric Hospital, involving anxious and=or depressed patients S. Petersburg Centre of Neuroses, Leningrad who were treated in a clinical setting using Regional Addiction Center, Psycho-neurological an advanced Transcranial Electrical Stimu- Research Institute, and Kalaco Scientific, Inc. lation (TES) system approved by the Food Pizinger, R., Katsnelson, Y., Krupitsky, E. M., & and Drug Administration for the treatment Woody, G. (2009) Presentation of the Efficacy of of anxiety, depression, and insomnia. In clini- Transcranial Electrostimulation to the Under- Secretary of Health for the Department of Veterans cal trials this system mediated the symptoms Affairs. Personal communication. of anxiety, depression, and insomnia in a last- The World Health Organization. (2004a). The global ing way in most patients within 2 to 4 weeks by burden of disease: 2004 update. Geneva, Switzer- providing stimulation that appears to affect land: Author. the hypothalamus and associated brain struc- The World Health Organization. (2004b). The world tures to adapt and alter the levels of neuro- health report 2004: Changing history, Annex chemicals critical to maintaining normal Table 3: Burden of disease in DALYS by cause, mood. The purpose of the pilot study was sex, and mortality stratum in WHO regions, esti- to confirm the effectiveness of advanced mates for 2002. Geneva, Switzerland: Author. TES in the everyday clinical setting using as measurement standards the quantitative Practitioner Perspectives of Neurofeedback EEG and a multifaceted battery of pre- and Therapy posttests and scans common to the clinical setting. Case studies demonstrate the nature Jonathon Larson, EdD, Catherine Ryan, and and progress of treatment and the specific Mogens Baerentzen, MS outcomes achieved. Illinois Institute of Technology

REFERENCES Introduction Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., Erbaugh, J. (1961). An inventory for measuring Research continues to increase empirical depression. Archives of General Psychiatry, 4, support for neurofeedback therapy (NFT) 53–63. efficacy and effectiveness. Hammond (2007) Demotes-Mainard, P., Bourgeois, M., & Vincent, J. D. compiled an extensive bibliography of neuro- (2004). Efficiency of transcranial electrostimulation feedback research, and Yucha and Gilbert on anxiety and insomnia symptoms during a wash- (2008) published Evidence-Based Practice out period in depressed patients: A double blind in Biofeedback and Neurofeedback. Kaiser study. Biological Psychiatry, 29, 451–456. (2010) reported 5,565 biofeedback and neu- Krupitsky, E., Woody, G., Katsnelson, Y., Rice, D., rofeedback papers indexed within PubMed, Bushkova, N., Palkin, Y., et al. (2002). Transcranial 1 and Arns (2010) summarized 31 applied neu- Electronic Stimulation (TES) using Nexalin for mild=moderate major depression in adults: A Russian roscience papers published between August randomized trial. Unpublished manuscript. and December of 2009. Despite advances in Kirsch, D. L. (2002). The science behind cranial electro- the quantity and quality of NFT research, a therapy stimulation. Edmonton, Canada: Medical comprehensive literature review found a Scope. handful of investigations into practitioner 350 JOURNAL OF NEUROTHERAPY variables related to NFT process and out- Conclusions come variables. Hammond and Kirk (2008) emphasized the importance of establishing Our results provided 237 themes sorted formal NFT practice standards. An investi- into 23 categories within 5 conceptual frame- gation reported demographic variables for works for future research on NFT prac- practitioners from around the world (Rubi, titioner process and outcome variables. The 2006). A staff training program highlighted disadvantage framework highlighted utiliza- age as a potential practitioner variable for tion and dissemination problems while the specific client types (Thompson & Thomp- advantage framework identified variables son, 2008). Research reported the importance possibly impacting NFT. The skill, knowl- of exploring client and practitioner relation- edge, and trait conceptual frameworks ships (Aguilar-Prinsloo & Lyle, 2010). With offered direction for exploring practitioner limited investigation on NFT practitioner variables influencing NFT outcomes. Future variables and recommendations from current factor analysis research may include develop- research, we proposed to explore practitioner ing and testing a measurement tool for prac- variables through qualitative methods. The titioner variables. We do not offer these goal and research significance of this study findings as a comprehensive list of NFT were to identify a wide range of NFT themes issues or practitioner factors; rather, we offer for utilization in future research on prac- this as a potential starting point for investi- titioner process and outcome variables. gating practitioner variables related to NFT. In addition, we may have missed additional themes due to our sample size Methods and method of data collection. Overall, we utilized CBPR and systematic filling methods We utilized Community Based Participa- to categorize practitioner perspectives to tory Research (CBPR) to engage practi- guide components of future NFT research. tioners in the process of identifying NFT factors. Through online surveys, we collected demographic variables and perspectives about NFT from 70 consented participants. REFERENCES We utilized SPSS descriptive statistics for our demographic and NFT experience infor- Aguilar, S., & Lyle, R. (2010). Client perception of the mation. We utilized Loftland and Loftland’s neurofeedback experience: The untold perspective. (1984) systematic filing system and Berg’s Journal of Neurotherapy, 14, 55–60. (2004) themes to concepts to analyze our Arns, M. (2010). News from other journals and web- data set, which allowed us to categorize simi- sites. Journal of Neurotherapy, 14, 61–64. lar themes into conceptual frameworks. Barrett-Lennard, G. T. (1962). Dimensions of therapist response as causal factors in therapeutic change. Psychological Monographs: General and Results Applied, 76, 1–33. Berg, B. L. (2004). Qualitative research methods, 5th ed. Our sample demonstrated various levels of New York: Pearson Education. age, education, licensures, certifications, and Cattell, H. E. P., & Mead, A. D. (2008). The sixteen experience; however, we found an equal gen- personality factor questionnaire (16PF). The Sage der distribution. For the advantage concep- Handbook of Personality Theory and Assessment, tual framework, we found 84 concepts fitting 2, 135–159. into 6 categories. The disadvantage frame- Gaston, L., & Marmar, C. R. (1991). Manual for the work included 53 concepts within 5 categories. California Psychotherapy Alliance Scales –CALPAS. Unpublished manuscript, Department of Psychiatry Practitioner characteristics were divided into McGill University, Montreal, Canada. three separate conceptual frameworks: skills Goldberg, L. R. (1993). The structure of phenotypic (35 concepts in 3 categories), knowledge (29 personality traits. American Psychologist, 48, 26–34. concepts in 4 categories), and traits (36 con- Hammond, D. C. (2007). Comprehensive neurofeedback cepts in 5 categories). bibliography. Journal of Neurotherapy, 11, 45–60. Proceedings of the 2010 ISNR Conference 351

Hammond, D. C., & Kirk, L. (2008). First, do no harm: opportunity to just capture the stories of Adverse effects and the need for practice standards in their experience. In the meantime, ISNR neurofeedback. Journal of Neurotherapy, 12, 79–88. has hosted a special panel that has quickly Horvath, A. O., & Greenberg, L. (1986). The develop- become a favorite for bringing this same idea ment of the Working Alliance Inventory: A into a room for all to enjoy. research handbook. In L. Greenberg & W. Pinsoff (Eds.), The psychotherapeutic process. A research Our first special panel took place in 2008 handbook (pp. 529–556). New York: Guilford. with contributions from Tom Budzynski, Israel, B. A., Eng, E., Schultz, A. J., & Parker, E. A. Joel Lubar, and Barry Sterman. It was truly (Eds.). (2005). Methods in community-based partici- one of the most entertaining and educational patory research in health. San Francisco, CA: Wiley. events of the conference as we all came Kaiser, D. (2010, Spring). Letter from AAPB presi- together to share experiences and speculate dent: Neurocosmology and the law. NeuroConnec- about our common future. The panel parti- tions, pp. 4 & 6. cipants are given a very loose goal of making Loftland, J. A., & Loftland, L. H. (1984). Analyzing a 30-min presentation each sharing their social settings: A guide to qualitative observation perspective of neurofeedback’s past, present, and analysis. Belmont, CA: Wadsworth. and future. It ranged from a photo slideshow McGuire-Snieckus, R., McCabe, R, Catty, J., Hansson, L., & Priebe, S. (2007). A new scale to assess the of other pioneers and colleagues highlighting therapeutic relationship in community mental health landmark achievements, presentation of data care: STAR. Psychological Medicine, 37, 85–95. and studies, to simple storytelling about our Rubi, M. C. M. (2006). Neurofeedback around the field and accomplishments. In 2009 we were world. Journal of Neurotherapy, 10, 63–73. very honored to hear from Joe Kamiya, Juri Yucha, C., & Montgomery, D. (2008). Evidence-based Kropotov, and Nancy White. This year I practice in biofeedback and neurofeedback. Wheat have decided to turn our focus to a few Ridge, CO: Association for Psychophysiology and of the pioneering women of our field. The Biofeedback. invited speakers will be Eugenia Bodenhamer- Davis, Judith Lubar, and Lynda Thompson. PANEL ABSTRACTS Be sure to arrive early on Wednesday to par- ticipate in the welcome reception and the spe- Neurofeedback: The Past, Present and Future cial panel where we hear these pioneering women give us their perceptions on ‘‘Neuro- Eugenia Bodenhamer-Davis feedback: the Past, Present and Future.’’ University of North Texas Neurofeedback for Epilepsy: A Review and Judith Lubar, LCSW Update Southeastern Biofeedback Institute Lynda Thompson, PhD Gabriel Tan, PhD ADD Centre VA Medical Center Abstract by Leslie Sherlin, PhD

As any previous ISNR attendee will tell you D. Corydon Hammond, PhD much of the learning experience occurs in the University of Utah Medical Center hallways and around dinner tables with Jonathan Walker, MD experienced providers. In my early career Neurotherapy Center of Dallas and still today I find catching conversation Robert Coben, PhD with the brightest minds of our field to be Neurorehabilitation & Neuropsychological the most satisfying and educational experi- Services ences and the one that I always remember most from the conferences. If you’re lucky This symposium is intended to provide both a enough to find an empty seat at a table with review and an update on the use of neuro- one of our elder pioneers or an up–and-coming feedback (NF) to treat individuals suffering innovator you should take advantage of this from epilepsy, particularly those who appear 352 JOURNAL OF NEUROTHERAPY to be resistant to traditional pharmacother- John, E. R., et al. (1987). Normative databanks and apy. The prevalence and types of epilepsy neurometrics: Basic concepts, methods and results along with the respective treatment outcome of norm construction. In A. Remond (Ed.), Hand- data are briefly described. The symposium book of electroencephalography and clinical neurophy- then describes NF approaches and protocols siology (Vol. 3, pp. 449–495). Amsterdam: Elsevier. Kraak, B., & Nord-Ru¨diger, D. (1989). Fragebogen zu for the treatment of epilepsy (including SMR Lebenszielen und zur Lebenszufriedenheit.Go¨ttin- and SCP training). The discussion includes a gen, Germany: Hogrefe. presentation of a recently published meta- Krampen, G. (1991). Fragebogen zu Kompetenz-und analysis on NF and epilepsy (Tan et al., Kontrollu¨berzeugungen.Go¨ttingen, Germany: Hogrefe. 2009). In addition, the low energy NF system Larsen, S. (2006). The healing power of neurofeedback: is also briefly presented (Hammond, 2007; The revolutionary LENS technique for restoring opti- Larsen, 2006; Ochs, 2006). The symposium mal brain function. Rochester, VT: Healing Arts Press. also discusses an approach that focuses on Nelson, H. E. (1976). A modified card sorting test sensi- individualizing clinical protocol based on tive to frontal lobe defects. Cortex, 12, 313–324. QEEG findings (Walker, 2008; Walker & Nuwer, M. R. (1988). Frequency analysis and topo- Kozlowski, 2005) to improve on the out- graphic mapping of EEG and evoked potentials in epilepsy. EEG, 69, 18–126. come. Last but not least, data supporting Ochs, L. (2006). The Low Energy Neurofeedback Sys- the use of genotype=EEG connectivity analy- tem (LENS): Theory, background, and introduc- ses in the treatment of epilepsy in autistic tion. Journal of Neurotherapy, 10(2–3), 5–39. children are presented. Q & A session at Reicherts, M., & Perrez, M. (1993). Fragebogen zum the end will hopefully solicit input from the Umgang mit Belastung im Verlauf-UBV. Bern, audience for further discussion. Switzerland: Hans Huber. Sterman, M. B. (2000). Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clinical Electroencepha- REFERENCES lography, 32, 45–55. Tan, G., Thornby, J., Hammond, D. C., Strehl, U., Ayers, M. E. (1988). Long-term clinical treatment Canady, B., Amemann, K., et al. (2009). Meta- follow-up of EEG neurofeedback for epilepsy. Epi- analysis of EEG biofeedback in treating epilepsy. lepsy Support Program Newsletter, 3(2), 8–9. Clinical EEG & Neuroscience, 40, 173–179. Ayers, M. E. (1995). Long-term follow-up of EEG Walker, J. E. (2008). Power spectral frequency and neurofeedback with absence seizures. Biofeedback coherence abnormalities in patients with intractable & Self-Regulation, 20, 309–310. epilepsy and their usefulness in long-term remedia- Collura, T. F. (2010). Advanced BrainMaster EEG tion of seizures using neurofeedback. Clinical EEG Neurofeedback Practicum. Future Health. & Neuroscience, 39, 203–204. Collura, T. F., Guan, J., Tarrant, J., Bailey, J., & Walker, J. E., & Kozlowski, G. P. (2005). Neuro- Starr, F. (2010). EEG biofeedback case studies feedback treatment of epilepsy. Child & Adolescent using live Z-scores and a normative database. Jour- Psychiatric Clinics of North America, 14, 163–176. nal of Neurotherapy, 14, 22–46. Gehring, A., & Blaser, A. (1993). MMPI – Minnesota Multiphasic Personality Inventory. Deutsche Applications of QEEG and Neurofeedback in Kurzform fu¨r Handauswertung. 2. Aufl. Bern, Sport Psychology Switzerland: Huber. Hammond, D. C. (2007). LENS: The Low Energy Neu- Michael Linden, PhD rofeedback System. New York: Haworth. ADD Treatment Centers Hammond, D. C., & Kirk, L. (2008). First, do no harm: Adverse effects and the need for practice standards in neurofeedback. Journal of Neurother- Jeffrey Fannin, PhD apy 12 , , 79–88. Center for Cognitive Enhancement Hammond, D. C. (2010). The need for individualiza- tion in neurofeedback. Applied Psychophysiology Wes Sime, PhD & Biofeedback, 35, 31–36. First Step Recovery & Wellness Center Hautzinger, M., Bailer, M., Worall, H., & Keller, F. (1994). Beck-Depressions-Inventar (Bearbeitung der The science of sport psychophysiology has deutschen Ausgabe). Bern, Switzerland: Hans Huber. been developing gradually over the past 20 Proceedings of the 2010 ISNR Conference 353 to 30 years. Initially most theoretical models Fannin, J. (2009a). Is brain mapping the future of lead- and intervention techniques were cognitive ership? BNet Insight. and behaviorally based. In recent years the Fannin, J. (2009b). Mapping the complex mind. Tempe: principles of the Zone of Optimal Perform- Arizona State University Research. ance were developed, which features statisti- Sime,W.E.(2000,October).The use of biofeedback and neurofeedback in applied psychophysiology to obtain cal models to calculate the ideal range of objective assessment of progress in reducing stress and arousal and confidence associated with best tension in performance and increasing attentional focus. outcomes. More recently, brain wave pat- Paper presented at the meeting of the American Associ- terns and ratios of various frequencies and ation for Applied Sport Psychology, Nashville, TN. states of consciousness have been assessed Sime, W., & Silverman, S. (2008, January). Many during performance in preparation to con- roads to Rome: Becoming fully engaged in the per- duct training protocols designed to enhance formance. NeuroConnections. the qualities of focus, concentration, and Strack, L., & Wilison (Eds.). (in press). Athletes with more relevant terms such as ‘‘being fully Asperger’s and Attention Deficit Disorder in Appli- engaged or absorbed in the task at hand.’’ cations of Biofeedback and Neurofeedback in Sport The panel brings together the expertise of Psychology. AAPB Publishing. three professionals approaching sport performance from different perspectives. These POSTER ABSTRACTS perspectives include (a) QEEG profiles of successful athletes and QEEG based Neuro- A Study Comparing the Brain Function of feedback, (b) QEEG Assessment and Neuro- Healthy and ADHD Adults During Rest and feedback with athletes with ADD and Go=NoGo Task in EEG=ERP and fMRI Asperger’s, and (c) General Neurofeedback combined with other physiological techni- Cynthia Kerson, PhD ques with athletes. ISNR The outcome of this panel session should be to advance the science of sport psycho- Leslie Sherlin, PhD physiology to utilize more accurate neuro- NovaTech EEG logical (QEEG) assessment and training Estate Sokhadze, PhD (Neurofeedback) strategies with athletes. University of Louisville Rex Cannon, PhD University of Tennessee REFERENCES David Hubbard, MD Hubbard Foundation Blumenstein, B. (2002). Biofeedback applications in sport and exercise: Research findings. In B. Blumenstein, M. Bar-Eli, & G. Tenenbaum (Eds.), Brain and body Discussion in sport and exercise: Biofeedback applications in performance enhancement (pp. 37–54). New York: Wiley The prevalence of Attention Deficit Hyper- & Sons. activity Disorder (ADHD) is an estimated Blumenstein, B., Bar-Eli, N., & Tenenbaum, G. (2002). 4.1% in adults, second only to depression. Biofeedback applications in performance enhance- Recently, several quantitative electroencepha- ment: Brain and body in sport and exercise. New lographic (QEEG), event-related potential York: Wiley & Sons. (ERP), and functional magnetic resonance Hatfield, B. D., Haufler, A. J., Hung, T. M., & imaging (fMRI) studies have been completed Spalding, T. W. (2004). Electroencephalographic to examine electrophysiological and blood Jour- studies of skilled psychomotor performance. flow behaviors in adults with Attention Deficit nal of Clinical Neurophysiology, 21, 144–156. Hatfield, B. D., Haufler, A. J., & Spalding, T. W. Hyperactive Disorder (ADHD). This study (2006). A cognitive neuroscience perspective on utilizes concomitant neuroimaging methodol- sport performance. In E. Acevedo & Ekkekakis ogies to examine the default mode network (Eds.), Psychobiology of physical activity (pp. 221– (DMN) in healthy and ADHD adults to ascer- 240). Champaign, IL: Human Kinetics Press. tain differences during rest and Go=NoGo 354 JOURNAL OF NEUROTHERAPY task. The DMN consists of 12 functionally Connors Rating Scale and the Mini Inter- related regions that are consistently shown national Neuropsychiatric Interview to deter- increased in activity in an eyes-closed resting mine accuracy of symptom reporting and to condition as compared to functionally specific rule out psychological comorbidities. Exclusion cognitive tasks or eyes-opened resting con- criteria consist of previous head trauma, recent dition. Recent data indicate dysfunction in drug or alcohol abuse (14 days), or neurological right parietal areas in ADHD as compared syndromes. We record sequential 19-channel to control. However, the strength of the tem- EEG, ERP, and fMRI during the eyes open poral connections in EEG frequency domains and closed states and while performing the has not been investigated in this population. TOVA Go=NoGo continuous attention test. Eyes open and eyes closed states are recorded for approximately 5 min. The TOVA test Objectives takes approximately 20 min to administer. The QEEG results are evaluated with com- This EEG=ERP=fMRI study proposes to parison to a normative database and with the correlate brain behavior from each neuro- standardized low-resolution electromagnetic imaging method and elucidate functional con- tomography (eLORETA) analysis. Functional nectivity patterns in the ADHD group during connectivity is assessed using the seed-based resting state (eyes open and eyes closed) and approach in eLORETA. The fMRI results will an active cognitive task. Recruitment of neural be evaluated using Brain VoyagerTM and other resources involving temporal correlations may neuroimaging software packages. provide important information about both attentional and self-regulatory processes in ADHD individuals as compared to healthy controls. These data may provide important REFERENCES information relating to potential biomarkers for ADHD as well as to increase the specificity Beauregard, M., & Levesque, J. (2006). Functional of methods for neurotherapy treatment of magnetic resonance imaging investigation of the ADHD. The data may also confirm that effects of neurofeedback training on the neural bases EEG is an adequate methodology to evaluate of selective attention and response inhibition in chil- ADHD. Given the regional deficits shown in dren with attention-deficit=hyperactivity disorder. Applied Psychophysiology & Biofeedback, 31, 3–20. ADHD research we examine the default net- Bregadze, N., & Lavric, A. (2006). ERP differences work regions and their specific relationship with vs. without concurrent fMRI. International with the bilateral anterior insular cortices. Journal of Psychophysiology, 62, 54–59. Numerous regions within the default network, Karakas, H. M., Karakas, S., O¨ zkan Ceylan, A., & especially left medial prefrontal and anterior Tali, E. T. (2009). Recording event-related activity medial regions are shown (assuming sources under hostile magnetic resonance environment: Is at or near the surface electrode F3, Fz, F7 con- multimodal EEG=ERP-MRI recording possible? tribute to the ERP average) to contribute International Journal of Psychophysiology, 3,6. many of the putative mechanisms found in Matsuda, T., Matsuura, M., Ohkubo, T., Ohkubo, H., ERP research (e.g., frontal NoGo-N2 and Takahashi, K., Tamaki, M., et al. (2002). Simul- P3, Error-related Negativity, etc.). taneous recording of EEG and functional MRI. International Congress Series, 1232, 351–355. Otswald, D., Porcara, C., & Bagshaw, A. P. (2010). An Methods informative theoretic approach to EEG-fMRI integration of visually evoked responses. NeuroImage, In this study, we recruit 16 participants (8 49, 498–516. healthy and 8 ADHD adults). We attempt to Uddin, L. Q., Kelly, A. M., Bharat, B., Margulies, D. S., Shehzad, Z., Shaw, D., et al. (2008). Network recruit an equal number of age-similar male homogeneity reveals decreased integrity of and female individuals. The ADHD adults default-mode network in ADHD. Journal of Neu- are recruited through local clinicians and roscience Methods, 169, 249–254. CHADD chapters. They have been initially Verkhlyutov, V. M., Gapienko, G. V., Ushakov, V. L., interviewed by phone and administered the Portnova, G. V., Verkhlyutova, I. A., Anisimov, Proceedings of the 2010 ISNR Conference 355

N. V., et al. (2010). MRI morphometry of the cer- Introduction to Clinical Medicine depart- ebral ventricles in patients with attention deficit ments. Anonymity and confidentiality was hyperactivity disorder. Neuroscience and Behavioral maintained because names and identification Physiology, 40, 295–303. were not requested and responses were not directly linked to addresses. Data were ana- Factors Influencing Neuroscience Grades of lyzed using correlation where p < .05 was Medical Students determined as significant.

Liris Benjamin, MBBS, MPH, PhD, Phillip Results Cooles, MD, Alexander Martin, PhD, Laura Welke, PhD, and Griffin Benjamin, MD The study indicated that students entering Ross University School of Medicine with higher MCAT scores were more likely to have higher Neuroscience grades (p ¼ .03). It also showed that students who Introduction spent more hours reviewing lectures on media site were more likely to have higher Neuroscience has rapidly become an inte- grades (p ¼ .04). There was no relationship gral part of living and society. This growth between attitude and grade (p ¼ .29). necessitates a greater understanding and sim- plification of subject. New approaches to medi- Discussion and Conclusion cal education need to be incorporated into the curriculum to enable students to meet its evolv- Media site is an effective learning resource ing dimensions. These approaches must target for Neuroscience students. This method of not only the physical constructs of the material delivery of the curriculum is apt for medical but also the bio-psychosocial components of students who normally have arduous sche- both the learner and the educator. dules. Furthermore, MCAT score is a pre- As described earlier by Bloom, but still dictor of Neuroscience grades. fundamental to education today, learning should involve knowledge (cognition), attitude (affective), and skills (psychomotor). REFERENCES In other words, not only the head but also the heart and hand of our students need to Bloom, B. S. (Ed.). (1956). Taxonomy of educational objectives. The classification of educational goals be considered. The aim of this study was (pp. 201–207). Susan Fauer Company. therefore to determine whether students’ Howe, A., Campion, P., Searle, J., & Smith, H. (2004). prior knowledge, attitude or study practice Learning in practice. New perspectives—approaches influenced their Neuroscience grades. to medical education at four new UK medical schools. British Medical Journal, 329, 327–331. Methods EEG Correlates of Improved Outcomes from A cross-sectional survey was conducted SDOC Using a Novel Treatment Protocol using an electronic self-administered questionnaire via Survey Monkey. The instrument Philip DeFina, PhD was designed to gain information from International Brain Research Foundation third-semester medical students that had pre- viously done the Neuroscience course. Self-reported information on students’ prior James Thompson, PhD knowledge (MCAT scores), attitude, and Comprehensive Neuroscience Center study practices toward Neuroscience and their final grades was collected. The study was conducted in collaboration Jonathan Fellus, MD, Rosemarie Moser, with members from the Anatomy and PhD, Philip Schatz, PhD, Monika Eller, 356 JOURNAL OF NEUROTHERAPY

OTR, Maria McNish, MS, Pasquale Frisina, regions. No significant changes were noted PhD, and Charles Prestigiacomo, MD on EEG measures for patients in the ‘‘clinical improvement’’ or ‘‘no change’’ groups. Objective Conclusions The purpose of this research is to validate clinical progression and emergence in Results provide objective validation of the patients with Severe Disorders of Conscious- efficacy of the MCP in improving patient ness (SDOC), following a novel Multi-modal outcomes, and the validity of EEG measures Care Protocol (MCP), using electroencepha- in quantifying patient recovery status. logram (EEG) data.

Methods REFERENCES

Participants were 21 SDOC patients from American Academy of Neurology. (1995). Practice the following etiologies: Vegetative State parameter: Assessment and management of persons (VS) traumatic (VS-TBI; n ¼ 6), VS nontrau- in the persistent vegetative state. Neurology, 45, matic (VS-NTBI; n ¼ 10), Minimally Con- 1015–1018. scious State (MCS-TBI; n ¼ 3), MCS American Medical Association. (2009). Current pro- nontraumatic (MCS-NTBI; n 2). Patients cedural terminology. Washington, DC: Author. ¼ Andrews, K., et al. (1996). Misdiagnosis of the vegetat- in the study received the MCP protocol, a ive state: Retrospective study in a rehabilitation 12-week innovative coma recovery protocol unit. British Medical Journal, 313, 13–16. involving polypharmacy, nutraceuticals, Childs, N. L., Mercer, W. N., & Childs, H. W. (1993). median nerve stimulation, and traditional Accuracy of diagnosis of persistent vegetative state. therapies. The MCP is designed to maxi- Neurology, 43, 1465–1467. mally normalize electrochemical balance, Coleman, M. R., et al. (2009). A multimodal approach to through multimodal neuromodulation, opti- the assessment of patients with disorders of con- mizing the brain’s ability to heal and repair sciousness. Progress in Brain Research, 177, 231–248. the injured cells and networks. Patients were Finnigan, S. P., et al. (2007). Quantitative EEG indices assigned to independent groups based on of sub-acute ischaemic stroke correlate with clinical emergence from VS=MCS (n 13), clinical outcomes. Clinical Neurophysiology, 118, 2525– ¼ 2532. improvement (n ¼ 4), or no change (n ¼ 4). Giacino, J., & Kalmar, K. (1997). The vegetative and Design was a within-subjects retrospective minimally conscious states: A comparison of clini- case series measuring pre–post MCP inter- cal features and functional outcome. Journal of vention EEG data. Main Outcome Measures Head Trauma Rehabilitation, 12(4), 36–51. were: Coma Recovery Scale–Revised (CRS– Giacino, J. T., et al. (2002). The minimally conscious R), Disability Rating Scale (DRS), Delta- state: Definition and diagnostic criteria. Neurology, Alpha Ratio (DAR), Theta-Beta ratio 58, 349–353. (TBR), Power Ratio Index (PRI), Total Leon-Carrion, J., et al. (2009). Delta-alpha ratio corre- Asymmetry (TotAsym), and Peak Frequency lates with level of recovery after neurorehabilitation (Peak Hz). in patients with acquired brain injury. Clinical Neu- rophysiology, 120, 1039–1045. Mohonk Report. (2006). A report to congress improv- Results ing outcomes for individuals with disorders of consciousness, assessment, treatment, and research needs Outcome groups showed no significant . Mohonk, NY. The Multi-Society Task Force on PVS. (1994). Medi- differences on EEG measures at baseline. cal aspects of the persistent vegetative state. New Patients emerging from SDOC showed sig- England Journal of Medicine, 330, 1499–1508. nificant changes from baseline on CRS–R Shepperd, S., et al. (2009). Can we systematically and DRS scores, as well as DAR, TBR, review studies that evaluate complex interventions? PRI, and changes in Peak Hz in posterior PLoS Medicine, 6(8), e1000086. Proceedings of the 2010 ISNR Conference 357

Whyte, J., Laborde, A., & DiPasquale, M. (1999). behaviorally examine attention processes as Assessment and treatment of the vegetative and they occur in each hemisphere separately. minimally conscious patient. In M. Rosenthal, E. This approach will allow clinical selection R. Griffith, J. S. Kreutzer, & B. Pentland (Eds.), of training protocols to be informed by mod- Rehabilitation of the adult and child with traumatic els of lateralized attention as well as possibly brain injury (3rd ed., pp. 435–452). Philadelphia: FA Davis. elucidating the methods of action of EEGBF Zumsteg, D., Hungerbuhle, H., & Wieser, H. (2004). that are related to electrode placement. Atlas of adult electroencephalography. Bad Honnef, Germany: Hippocampus Verlag. REFERENCES

Whole-Head EEG Effects of Lateralized Fallgatter, A. J., & Herrmann, M. J. (2001). Electro- EEG Biofeedback Training physiological assessment of impulsive behavior in healthy subjects. Neuropsychologia, 39, 328–333. Andrew Hill, MA, Cphil, and Eran Zaidel, Gruzelier, J. G., & Egner, T. (2005). Critical validation PhD studies of neurofeedback. Child and Adolescent Psy- UCLA chiatric Clinics of North America, 14, 83–104. Hill, A., Barnea, A., Herzberg, K., Rassis-Ariel, A., Rotem, S., Meltzer, Y., et al. (2008). Measuring and modulating hemispheric attention. In F. Aboitiz Clinical EG Biofeedback is typically per- & D. Cosmelli (Eds.), From attention to goal- formed with one or two electrode channels. directed behavior (pp. 125–144). New York, NY: Selection of training sites is based on clinical Springer. education and experience and rationalization Raz, A. (2004). Attentional mechanisms and networks. of scalp location related to underlying neu- In C. Spielbereger (Ed.), Encyclopedia of applied roanatomical structures. For example, left psychology (pp. 203–208). San Diego, CA: Elsevier anterior sites may be trained for language, Science. temporal sites for emotion regulation, par- Riccio, C. A., Reynolds, C. R., Low, P., & Moore, J. J. ietal sites for sensory integration, and so (2002). The continuous performance test: A win- on. It is unclear however to what extent the dow on the neural substrates for attention? Archives choice of training site affects the underlying of Clinical Neuropsychology, 17(3), 235–272. Zaidel, E., Clarke, J. M., & Suyenobu, B. (1990). EEG produced at that training site com- Hemispheric independence: A paradigm case for pared to EEG at other sites throughout the cognitive neuroscience. In A. B. Scheibel & A. F. scalp. Wechsler (Eds.), Neurobiology of higher cognitive We are performing a short but intense function, (pp. 297–355). New York: Guilford. course of EEG Biofeedback, with concomitant lateralized behavioral testing. Dense Neurofeedback, Cranial Electrotherapy array (64-channel) EEG is recorded during Stimulation, and Microcurrent Electrical eyes open and eyes closed non-task baselines, Therapy to Treat Tinnitus: A Case Series under lateralized continuous and transient attention tasks, and in response to Mark Lawrence Johnson, MS, and Eugenia single-channel EEG feedback conditions. Bodenhamer-Davis, PhD Four groups (double-blind, random assign- University of North Texas ment) with different EEG Biofeedback protocols are being trained with contrasting EEGBF protocols including C4-A2 SMR, C3-A1 SMR, C3-A1 Beta, and a Sham Background EEGBF condition. With this data we will be able to correlate Tinnitus is a vexing disorder characterized changes in whole-head EEG with EEGBF by phantom sound perceptions that have no training on discrete channels, contrast differ- external source. Individuals with tinnitus ent EEGBF protocols to determine if who seek treatment are often told they must they produce different EEG effects, and learn to live with it. There has been some 358 JOURNAL OF NEUROTHERAPY initial evidence that neurofeedback and elec- Vernon, J. (1987). Use of electricity to suppress tin- trical stimulation therapy modalities may nitus. Seminars in Hearing, 8(1), 29–48. suppress tinnitus in some individuals. The Weiler, E. W. J., Brill, K., Tachiki, K., & Schneider, D. purpose of this study was to retroactively (2002). Neurofeedback and quantitative electroen- examine a case series of clients who were cephalography. International Tinnitus Journal, 8, 87–93. treated for tinnitus with varied neuromodu- Weisz, N., Moratti, S., Meinzer, M., Dohrmann, K., & latory interventions to extend the current Elbert, T. (2005). Tinnitus perception and distress is literature featuring these modalities and also related to abnormal spontaneous brain activity as to more closely consider etiological and measured by magnetoencephalography. PLoS other clinical considerations. Medicine, 2(6), 0546-0553.

Measures EEG Predictors of Treatment Response to Cognitive-Behavioral Therapy in Patients Five client records were obtained from a with Obsessive-Compulsive Disorder university-based neurotherapy clinic. These records were used to examine the efficacy Jana Koprivova, MA, Michal Raszka, MD, of several different treatment modalities used Jan Prasko, MD, PhD, Martin Brunovsky, to treat tinnitus, which included neurofeed- MD, PhD, and Jiri Horacek, MD, PhD back, cranial electrotherapy stimulation, Prague Psychiatric Center, and Charles Uni- and microcurrent electrical therapy. These versity, Prague records were then assessed for pre- and post- changes on assessment measures related to treatment outcomes. Background

Results Despite medical progress, a high percent- age of obsessive-compulsive patients are still Statistical analyses are in progress. It is not responding at all or not responding suffi- expected that independent t-test results will ciently to current treatment. There is a need reveal significant improvements in tinnitus to seek predictors of treatment outcome that severity in some participants. would help in the choice of the best treatment option in particular cases. EEG studies pre- Conclusions viously reported that patients not responding to selective serotonin reuptake inhibitors Depending on the etiology of the tinnitus, (SSRIs) show abnormalities in the theta pre- and post-test measures (EMG baseline, (Prichep et al., 1993) or beta (Fontenelle BAI, BDI, BHS, PSQI, and MCMI) are also et al., 2006) frequency band. The aim of our expected to yield some etiological considera- study was to look for EEG predictors of tions that might inform treatment strategies. treatment response to cognitive behavioral therapy. Based on previous findings on EEG abnormalities in anterior cingulate cortex (ACC; Koprivova et al., submitted; REFERENCES Sherlin & Congedo, 2005) and its predictive value for treatment response to SSRIs Dohrmann, K., Weisz, N., Schlee, W., Hartmann, T., & Elbert, T. (2007). Neurofeedback for treating tin- (Fontenele et al., 2006) we focused on ACC nitus. Progress in Brain Research, 166, 473–485. and its ventral and dorsal subdivision. Engelberg, M., & Bauer, W. (1985). Transcutaneous electrical stimulation for tinnitus. Laryngoscope, 95, 1167–1172. Methods Saunders, J. C. (2007). The role of central nervous system plasticity in tinnitus. Journal of Communication We analyzed EEG of 15 OCD patients Disorders, 40, 313–334. (age ¼ 31.4 8.05; 6 men and 9 women; 5 Proceedings of the 2010 ISNR Conference 359 drug-free and 10 medicated with SSRIs) who Discussion were suffering from marked obsessive- compulsive symptoms (the mean score at Our results are consistent with previous the Yale–Brown Obsessive-Compulsive Scale findings of higher theta in SSRIs nonrespon- [Y-BOCS] was 22,9 7.61) and took part in ders (Prichep et al., 2003). Theta in OCD a 6-week intensive cognitive behavioral ther- generated in medial frontal cortex has been apy program. Clinical obsessive-compulsive linked with an enhanced performance moni- symptoms as well as symptoms of general toring and obsessive thoughts (Fitzgerald anxiety (according to the Beck Anxiety et al., 2005; Maltby et al., 2005). It is possible Inventory [BAI]) were assessed twice, before that elevated theta activity may be a general and after the therapy. EEG was recorded predictor of worse treatment outcome in pretreatment. EEG data were analyzed in 8 OCD. This is a challenge for neurofeedback frequency bands (delta 2–6 Hz, theta aimed at reducing the theta activity that 6.5–8 Hz, alpha1 8.5–10 Hz, alpha2 10.5– might help to overcome the resistance. 12 Hz, beta1 12.5–18 Hz, beta2 18.5–21 Hz, beta3 21.5–30 Hz, gamma 30.5–40 Hz). Based on the priori hypothesis, absolute Acknowledgments and relative current density power was computed in ACC and its ventral and dorsal This work was supported by the grant subdivision using the standardized Low- IGA NS9751-3=2008 provided by the Minis- Resolution Electromagnetic Tomography try of Health of the Czech Republic and software (Pascual-Marqui, 2002). Spearman CNS MSMT CR 1M0517 provided by the correlations were computed between absolute Ministry of Education, Youth and Sports and relative current density power and of the Czech Republic. relative change in psychopathology (Y-BOCS score, obsession and compulsion subscore, Beck Depression Inventory and REFERENCES BAI scores). Fitzgerald, K. D., Welsh, R. C, Gehring, W. J., Abelson, J. L., Himle, J. A., Liberzon, I., et al. Results (2005). Error-related hyperactivity of the anterior cingulate cortex in obsessive-compulsive disorder. The improvement of clinical symptoms Biological Psychiatry, 57, 287–294. after cognitive behavioral therapy was nega- Fontenelle, L. F., Mendlowicz, M. V., Ribeiro, P., tively related to the amount of absolute and Piedade, R. A., & Versiani, M. (2006). Low-resolution relative theta pretreatment (p .05). Higher electromagnetic tomography and treatment response ¼ in obsessive-compulsive disorder. International Jour- absolute and relative theta in ventral ACC nal of Neuropsychopharmacology, 9(1), 89–94. and total ACC before treatment was related Koprivova, J., Congedo, M., Horacek, J., Prasko, J., with smaller relative improvement of Raszka, M., Brunovsky, M., et al. (submitted). Y-BOCS score and obsession subscore. The EEG source analysis in obsessive-compulsive disorder improvement of obsession subscore was also using standardized low-resolution electromagnetic negatively related with relative theta in dor- tomography and independent component analysis. sal ACC. Subjectively rated improvement Manuscript submitted for publication. of general anxiety as measured with BAI Maltby, N., Tolin, D. F., Worhunsky, P., O’Keefe, T. was negatively related with relative theta in M., & Kiehl, K. A. (2005). Dysfunctional action total ACC as well as in its both subdivisions monitoring hyperactivates frontal-striatal circuits and with relative alpha1 current density in obsessive-compulsive disorder: an event-related fMRI study. Neuroimage, 24, 495–503. power in dorsal ACC. There was no corre- Pascual-Marqui, R. D. (2002). Standardized lation between subjectively rated improve- low-resolution brain electromagnetic tomography ment of depressive symptoms (Beck (sLORETA): Technical details. Methods & Findings Depression Inventory score) and EEG in Experimental & Clinical Pharmacology, 24(Suppl. before treatment. D), 5–12. 360 JOURNAL OF NEUROTHERAPY

Prichep, L. S., Mas, F., Hollander, E., Liebowitz, M., In our previous studies the biggest P900 John, E. R., Almas, M., et al. (1993). Quantitative amplitude for the relevant stimulus (P) was electroencephalographic subtyping of obsessive- found in the group with 2 (of 4) countered I compulsive disorder. Psychiatry Research, 50, stimuli. Based on that it was decided to include 25– 32. the following groups in the present study: Sherlin, L., & Congedo, M. (2005). Obsessive- compulsive dimension localized using low- resolution brain electromagnetic tomography 1. 2CM—one of the stimuli was a parti- (LORETA). Neuroscience Letters, 387, 72–74. cipant’s birth date (P) and 2 (of 4) I stimuli were countered. Investigating the P900 Component with 2. 2CMPrC—one of the stimuli was a part- 5-Button CTP Protocol for Assessing icipant’s birth date (P) and 2 (of 5) stimuli Memory Deficit and Malingering were countered. One countered stimulus was the P and another was one of the 4 Is. Elena Labkovsky, PhD, and J. Peter Rosen- 3. 2CM IN PrC—there was no P (all 5 stim- feld, PhD uli in the protocol were irrelevant to the Northwestern University subject). Two (of 5) stimuli were countered. 4. NoCM IN—there was no P (all 5 stimuli Introduction in the protocol were irrelevant to the participant). There were no countermeasures For our studies on investigation of decep- involved. tion, memory deficit and malingering we developed an ERP-based Complex Trial The total number of participants was 49. Protocol (CTP; Rosenfeld et al., 2004). The modified version of the original CTP was Results later developed and 5-button random response was introduced to the protocol for The group amplitudes for P900 increasing the CTP accuracy. To demon- (peak-peak), uV (SD in parentheses), were strate that the modified CTP is resistant to as follows: countermeasure use, we taught our participants to implement mental ‘‘countermea- 1. 2CM group (n ¼ 13)—P: 4.130 (3.004), sures’’ (CMs). Adding the 5-button random Iall (all 4 Is combined): 3.320 (2.441). response seems to cause emergence of a 2. 2CM IN PrC group (n ¼ 11)—P: 1.337 novel long latency ERP component -P900. (0.739), Iall: 0.860 (0.694). The current study is an attempt to further 3. 2CM PrC group (n ¼ 12)—P: 2.727 investigate the P900 component. (2.308), Iall: 1.643 (1.076). 4. NoCM IN group (n ¼ 13)—P: 1.448 Methods (1.861), Iall: 0.595 (0.703).

In the CTP with random button responses A mixed analysis of variance (ANOVA; 4 (Rosenfeld et al., 2008) a rare Probe (P) or group 2 stimulus type) yielded F(3, frequent Irrelevant (I) stimulus appears on 45) ¼ 7.007, p < .001 for groups and F(1, screen first and is followed by either a target 45) ¼ 14.172, p < .001 for stimulus type (P (T) or nontarget (NT) stimulus in the second vs. Iall). There was no interaction found, part of the same trial. There were 4 different F(3, 45) ¼ 0.319, p ¼ .812. Irrelevants and 1 Probe included. A partici- The follow-up ANOVAs (4 groups) separ- pant was instructed to randomly press 1 of ately for P and Iall (peak-to-peak ampli- 5 buttons on one response box to the first tudes, uV) with a post hoc Bonferroni stimulus (P or I). Then the participant adjustment showed no difference between pressed 1 of 2 buttons on another response the two ‘‘innocent’’ groups (NoCM IN and box for T or NT. 2CM IN), p ¼ .111 (P) and p ¼ 1.0 (Iall). Proceedings of the 2010 ISNR Conference 361

There was a significant difference between an indicator of countermeasure use in a modified 2CM group and each of the two innocent complex trial protocol. Psychophysiology, 46, s1– groups for both P and Iall: p ¼ .19 (P, 2CM s142. IN PrC), p ¼ .001 (Iall, 2CM IN PrC); and Luck, S. J. (2005). An introduction to the event-related p ¼ .18 (P, NoCM IN), p ¼ .036 (Iall, NoCM potential technique. Cambridge, MA: MIT Press. Rosenfeld, J. P., Labkovsky, E., Winograd, M., Lui, IN). In the group with Probe and 2 counter- M., Vandenboom, C., & Chedid, E. (2008). The measures (one of the countered stimuli was Complex Trial Protocol (CTP): A new, the P), no significant difference was found for countermeasure-resistant, accurate P300-based the P when comparing with either 2CM group method for detection of concealed information. (p ¼ .689) or each of the innocent groups Psychophysiology, 45, 906–919. (p ¼ .803 2CM In PrC; p ¼ .9–NoCMIN). Rosenfeld, J. P., Soskins, M., Bosh, G., & Ryan, A. Iall in 2CM group significantly differed (2004). Simple effective countermeasures to from each of the 3 other groups (p ¼ .001 P300-based tests of detection of concealed infor- 2CM IN PrC; p ¼ .036 2CM PrC; and mation. Psychophysiology, 41, 205–219. p ¼ .000 – NoCM IN). There was no difference in Iall between the 3 later groups. A Novel ‘‘Double-Probe Complex Trial Pro- tocol’’ for Assessment of Memory Deficit and Malingering Conclusions Elena Labkovsky, PhD, and J. Peter Rosen- The results demonstrate that the presence feld, PhD of a relevant to the subject item (P) is crucial Northwestern University in eliciting the P900 component with the 5-button CTP protocol and countermeasures to 2 (of 4) irrelevants. When P and an I share the same characteristic (as it is in 2CM PrC Introduction where one I and the P are countered, thus making the P similar to the I) the P900 The Complex Trial Protocol (CTP) is a amplitude to the P becomes smaller. P300-based memory deficit and malingering P900 may represent an ‘‘action monitor- test. It proved effective and accurate with ing’’ component. It appears in the self-referred (autobiographical) information frontal-central areas of the scalp and emerges experiments (hit rate: 92–100%; Rosenfeld in a potentially conflict situation where a pre- et al., 2008). pared action might need to be withheld or if In the CTP protocol, each trial contains an action was executed but mismatch between two parts. There is a Probe (P; a relevant the outcome and the task requirements was to the participant item [his=her birthday]) detected after that. Further investigation of or Irrelevant (I; any date, not relevant to the P900 component is required. the participant) in the first part of a trial, and a Target (T; an item with ‘‘assigned significance’’) or Non-Target (NT; item with- REFERENCES out any specific meaning) in the second part of each trial. The two stimuli are sepa- Andreassi, J. L. (2000). Psychophysiology: Human rated by about 1 s. behavior and physiological response (4th ed.). In the present study we examine a novel Mahwah, NJ: Erlbaum. ‘‘Double-Probe’’ CTP. It differs from the orig- Kropotov, J. (2009). Quantitative EEG, event-related inal CTP in that we replace NT stimuli in the potentials and neurotherapy . New York: Elsevier. second part of a trial with a new set of a P Labkovsky, E., & Rosenfeld, J. P. (2008). Detecting simulated amnesia for self-referred information (P2) and three Is (NT1, NT2, and NT3). All with enhanced ERP(P300)-based protocol. Archives the stimuli in the second part are from a differ- of Clinical Neuropsychology, 23, 664. ent category compared to the first part. Thus, Labkovsky, E. B., Rosenfeld, J. P., & Sokolovsky, A. there were dates in the first part and city (2009). Putative novel ERP component (P900) as names—in the second part of a trial. 362 JOURNAL OF NEUROTHERAPY

We hypothesize that introducing the ‘‘P1-Iall1’’ difference was significant, again second set of a P and Is will increase accu- making a combined result a ‘‘hit.’’ Eventu- racy of the protocol. ally, the ‘‘Double-Probe’’ approach leads to 100% detection. Group analysis: The averaged P300 ampli- Methods tudes (peak-to-peak, uV) were (a) first part of a trial: 9.108 (P1), 3.477 (Iall1); and 2) Participants (N ¼ 13) were undergraduate second part of a trial: 11.835 (P2), 7.173 students recruited from a student pool at (Iall2). The t test for the first part of a trial Northwestern University. showed significant difference between P1 In the first part of a trial there were 4 dif- and Iall1 amplitudes, t(12) ¼ 5.472, p < .001. ferent I stimuli (I1, I2, I3, and I4) and 1 P In the second part of a trial, a difference (P1). All stimuli in the first part were dates. between P2 and Iall2 amplitudes was also The P was a participant’s birth date. significant, t(12) ¼ 5.378, p < .001. In the second part the stimuli were city names. There were 3 Is (NT1, NT2, and NT3), 1 P (P2), and one T. The Is were irrel- Conclusions evant to the participant city names. The P was a participant’s hometown name, and The results demonstrate that our novel the T was a city with an assigned significance ‘‘Double-Probe Complex Trial Protocol’’ (‘‘Chicago’’ was used as the T). can be effectively used for assessment of For ERP calculations we use a composite memory deficit, malingering, and detection of all 4 Is combined in the first part of a trial of deception. In situations when the differ- (Iall1) and 3 Is combined (Iall2) in the ence between P300 probe and combined second part of a trial. irrelevant amplitude is nonsignificant or There were 2 response boxes for recording marginal in one part of a trial, data from behavioral data. A participant was instructed the second part can provide extra infor- to randomly press 1 of 5 buttons on one mation for making a clinical or forensic response box to the first stimulus (P1 or I1, decision. As a next step, further investigation I2, I3, and I4). Then the participant pressed of the new protocol is required, including 1 of 2 buttons on another response box for running a control group. the stimuli in the second part of a trial: the left button for P2 or any I from the second part and the right button for Ts. REFERENCES

Results Andreassi, J. L. (2000). Psychophysiology: Human behavior and physiological response (4th ed). Mahwah, NJ: Erlbaum. Individual analysis: Bootstrapped based Kropotov, J. (2009). Quantitative EEG, event-related hit rates at .9 confidence level was 12=13 potentials and neurotherapy. New York: Elsevier. (92%; for both (a) first part of a trial (dates) Labkovsky, E., & Rosenfeld, J. P. (2008). Detecting based on P1 versus Iall1 (all 4 Is from Part 1 simulated amnesia for self-referred information combined) and (b) second part of a trial (city with enhanced ERP(P300)-based protocol. Archives names), based on P2 versus Iall2 (all 3 Is from of Clinical Neuropsychology, 23, 664. Part 2 combined). One of the participants did Labkovsky, E. B., & Rosenfeld, J. P. (2009). not show significantly bigger probe ampli- P300-based protocol (with acoustic stimuli) for tude compared to Iall in the first part (dates), assessing memory deficit, malingering, and decep- but the difference between P2 and Iall2 ampli- tion in clinical and forensic settings. Journal of Neurotherapy, 13, 274–275. tudes was significant. Thus, a combined result Luck, S. J. (2005). An introduction to the from both parts of the trial is a ‘‘hit.’’ A differ- event-related potential technique. Cambridge, ent participant showed nonsignificant differ- MA: MIT Press. ence between P2 and Iall2 amplitude Polich, J. (1986). Normal variation of P300 from audi- (second part of a trial) but in the first part tory stimuli. Electroencephalography and Clinical Proceedings of the 2010 ISNR Conference 363

Neurophysiology=Evoked Potentials Section, 65, Rationale for Pilot Study 236–240. Polich, J., & Kokb, A. (1995). Cognitive and biological The qEEG is very useful in revealing the determinants of P300: An integrative review. Bio- underlying abnormal brainwave patterns logical Psychology, 41, 103–146. associated with Attention Deficit Hyperac- Rosenfeld, J. P., Labkovsky, E., Winograd, M., Lui, M., Vandenboom, C., & Chedid, E. (2008). The tivity Disorder (ADHD) and many other dis- Complex Trial Protocol (CTP): A new, orders. The system can discriminate with countermeasure-resistant, accurate P300-based more than 90% accuracy ADHD from learn- method for detection of concealed information. ing difficulties and from normal. Many psy- Psychophysiology, 45, 906–919. chiatrists, pediatricians, and psychologists Rosenfeld, J. P., Soskins, M., Bosh, G., & Ryan, A. involved in the diagnosis of learning disor- (2004). Simple effective countermeasures to ders and ADHD are unaware of a significant P300-based tests of detection of concealed infor- body of research that supports the use of mation. Psychophysiology, 41, 205–219. topometric (visual) qEEG analysis as a Soskins, M., Rosenfeld, J. P., & Niendam, T. (2001). diagnostic tool for differentiating between The case for peak-to-peak measurement of P300 organic and functional brain disorders recorded at .3 Hz high pass filter settings in detection of deception. International Journal of Psycho- including learning difficulties, ADHD, physiology, 40, 173–180. schizophrenia, epilepsy, and cerebral atro- phy associated with alcohol abuse, depression, and anxiety. Psychophysiologists Does Sexual Reassignment Surgery Rewire have established normative qEEG databases. the Brain: A Comparison of Pre=Post qEEG The differences in brain wave patterns Results revealed in these comparisons point to subtypes of ADHD that are not documented J J Miles, PhD, and Stuart Donaldson, PhD in the Diagnostic and Statistical Manual of University of Calgary Mental Disorders (4th ed.). Studies of qEEG patterns of ADHD children and adults are consistent with findings revealed by Positron As identified by the quantitative electroence- Emission Topography, functional Magnetic phalogram (qEEG), statistically important Resonance Imaging, Single Photon Emission brain wave patterns related to gender ident- Computed Tomography (SPECT), and other ity might be observed when a transgendered neuroimaging studies. More recently, person has undergone sexual reassignment research from SPECT brain studies by surgery (SRS). The observed differences in Daniel Amen and his colleagues have ident- brain wave patterns may prove useful in ified six subtypes of ADHD that correlate treatment, and or assessment for readiness to qEEG patterns found in individuals with for postsurgery success for a transsexual per- Attention Deficit Disorder (ADD). son. Reassessment of brain wave patterns Although various psychometric measure- immediately after diagnosis, treatment, and ments are available to clinicians, presently surgery will perhaps reveal that the previous there are no data available that document pattern was not altered and no longer stat- the qEEG for use in assessments. Thus, istically important. This pilot study might topometric (or Visual) QEEG analysis is a support the concept that brain wave patterns powerful adjunct to psychometric assessment related to gender identity do have a corre- in this area (Duff, 2002). lated and measurable energetic effect. In addition, this study may objectively identify an immediate energetic change after HRT= qEEG surgeries in the direction of normalcy and health. Results of the study, including seren- A qEEG is a topographic=visual enhance- dipitous findings, will be available for dis- ment of a traditional EEG. During the pro- cussion regarding these questions and many cedure, electrical activity of the brain, at others. rest and during stimulation, is recorded for 364 JOURNAL OF NEUROTHERAPY analysis. Each area of the brain normally REFERENCES spends a characteristic amount of time in alpha, beta, theta, and delta activity. By Cairns, S., Crozier, S., VanderWerf, J., Mottosky, R., comparing a patient’s brain mapping to a & Miles, J. J. (2005, May 18). Outcome measure: control population, it may be possible to One year later. Paper presented at the Alberta localize areas of focal slowing and enhanced Services for Students Conference, Mount Royal areas of electrical activity. qEEG is not an College, Calgary, Alberta, Canada. invasive procedure; it can be used on all Miles, J. J. (2004). ‘‘The New Sexual Performance Drugs’’, Alberta Services for Students Conference, age groups but requires the interpretation Red Deer, Alberta, 12=05=2004, Refereed. of a specialist trained in quantitative Miles, J. J. (2005, June 1). Time management for work encephalographic analysis. Interpretation of and life balance. Law Clerks’ Forum: Advanced the qEEG involves an assessment of the stat- Litigation and Corporate Commercial Issues, istical degree of congruence or lack of Insight Information conference, Calgary, Alberta, congruence between a patient and the Canada. normal population, or the degree of simi- Miles, J. J. (2006a, September). Alcohol use amongst larity between a given patient and a qEEG the transgendered community. Paper presented at profile that may be characteristic of some the BACCHUS Western Regional Conference, defined clinical group. The quantitative Olds College, Alberta, Canada. approach can display not only variations in Miles, J. J. (2006b, May). Working with clients with stuttering disorder. Paper presented at the Alberta the qEEG profiles but also progressive Services for Students Conference, Northern Lakes changes in neurophysiological function over College, Alberta, Canada. time. qEEGs are presently utilized in the Miles, J. J. (2008). Therapy for sleep issues and the evaluation of (a) attention deficit disorder, integration of a comprehensive holistic treatment (b) anxiety, (c) depression, (d) substance abuse model. Paper presented at the International Con- disorders, (e) psychiatric disorders, and (f) ference on Integrative, Complimentary Alternative closed head injuries (Donaldson, 2009). Medicine and Mental Health, Toronto, Ontario, The most common and well-documented Canada. use of neurofeedback is in the treatment of Miles, J. J., & Donaldson, S. (2009). The use of the ADHD with multiple studies showing neuro- qEEG in assessment of gender identity. Paper pre- feedback to be useful in the treatment of sented at the World Professional Association for Transsexual Health, Oslo, Norway. ADD. Other areas where neurofeedback Miles, J. J., & Shaw, M. (2009). The use of a journal in has been researched include treatment of a comprehensive treatment paradigm. Paper pre- substance abuse, anxiety, depression, epi- sented at the World Professional Association for lepsy, obsessive compulsive disorder, learn- Transsexual Health, Oslo, Norway. ing disabilities, bipolar disorder, conduct disorder, anger and rage, cognitive impairment, migraines, headaches, chronic pain, Tracking Emotion Dysregulation in Cocaine autism spectrum disorders, sleep, posttrau- Addiction Using Event Related Theta and matic stress disorder, and mild traumatic Alpha Oscillations brain injury (Donaldson, 2009). Hence, the effort to discover the usefulness of the qEEG Muhammad Adeel Parvaz, MS, Thomas as a tool for providing empirical data for Maloney, PhD, Greg Hajcak, PhD, and Rita assessment, treatment, and prediction of suc- Z Goldstein, PhD cess for postsexual reassignment surgery in Stony Brook University transsexuals would seem appropriate. Does sexual reassignment surgery create or cause new neural networks that literally change the brain and allow it to operate with greater Introduction efficiency, productivity, and functionality in the postsurgery transsexual compared to Event related oscillations (EROs) are the genetic men and women? brain rhythms evoked at the onset of an Proceedings of the 2010 ISNR Conference 365 external stimulus. They are isolated by when viewing the drug-related as compared decomposition of electroencephalogram to neutral images (C3 electrode, 480– (EEG) time series into weighted combinations 5203 msec, Z ¼ 4.54, p ¼ .02). Alpha rhythm of simultaneous sinusoidal functions that showed the highest desynchronization in could be superimposed to reconstitute a response to these drug cues, less so to the given complex waveform. Of these oscilla- other emotional pictures (pleasant and tions, increase in poststimulus theta (3– unpleasant images) and the least to the neu- 7 Hz) band is associated with orientation, tral stimuli (cocaine > pleasant=unpleasant > concentration of attention, and the proces- neutral; PZ=P4, 875–1150 msec, Z > 4.2, sing of emotional information (e.g., Inter- p < .001). national Affective Picture System [IAPS] pictures], whereas desynchronization in lower alpha band (7–10 Hz) is associated Discussion with external attention encompassing vigilance and expectancy. In the current study, In healthy controls, we successfully repli- our goal was to use EROs to study emotion- cated earlier studies by showing that the al processing in individuals with current theta band indexes valence (separating cocaine use disorder (CUD), a psychopath- pleasant from unpleasant pictures), whereas ology that has only recently been targeted the alpha band tracks arousal (distinguishing for this purpose. neutral from all other emotionally valenced pictures). In CUD, however, both bands dif- ferentiated between the drug and the other Methods pictures (theta: drug vs. neutral pictures; alpha: drug vs. the other emotionally Evoked EEG synchronization and desyn- valenced images). Therefore, both bands chronization in the lower and upper theta may be used to assess emotional dysregula- and alpha bands were quantified in 37 tion in drug addiction, quantifying individuals with CUD, and 31 demographi- attention-bias toward drug-related stimuli cally matched healthy control participants as postulated by the incentive-sensitization while they passively viewed pleasant, theory. The potential significance of results unpleasant, neutral (IAPS), and cocaine- (especially the arousal=valence differences related pictures. compared to healthy controls and practical clinical uses to enhance emotion regulation and decrease craving in CUD) remains to Results be explored. Replicating previous results in controls, upper theta band showed increased synchronization when viewing pleasant as compared REFERENCES to unpleasant images (F3 electrode, 600–640 msec, Z ¼ 4.46, p ¼ .014), with a Aftanas, L. I., Reva, N. V., Varlamov, A. A., trend in the same direction in the lower theta Pavlov, S. V., & Makhnev, V. P. (2004). Analysis band (F3 electrode, 780–880 msec, Z ¼ 3.81, of evoked EEG synchronization and desynchroni- p ¼ .053), whereas alpha rhythm showed zation in conditions of emotional activation in higher desynchronization in response to all humans: Temporal and topographic characteris- emotionally valenced versus neutral stimuli tics. Neuroscience and Behavioral Physiology, 34, 859–867. (CP3 electrode, 760–794 msec, Z ¼ 4.86, Moeller, S. J., Maloney, T., Parvaz, M. A., Dunning, p < .001). In CUD, however, theta band did J. P., Alia-Klein, N., Woicik, P. A., et al. (2009). not differentiate between the pleasant and Enhanced choice for viewing cocaine pictures in unpleasant pictures (p > .1); instead it cocaine addiction. Biological Psychiatry, 66, showed significantly higher synchronization 169–176. 366 JOURNAL OF NEUROTHERAPY

Efficacy of Neurofeedback Training in Chil- through pre and post-Quantitative Electro- dren with High Functioning Autism Spectrum encephalography for each participant. Disorders at the Level of Overt and Covert Behavior Results Marjan Saeb, MA, and Reza Rostami, MD At the level of overt behavior, NF training University of Social Welfare and Rehabili- resulted in symptom reduction in 75% of the tation recruited children suffering from ASD. Com- paring the three core symptoms, NF was more efficacious in alleviating the symptoms related to communication. Besides, improve- Aim ment was also recorded in the performance of 75% of the subjects following treatment. The aim of the present study was to inves- At the level of covert behavior, analysis of tigate the efficacy of Neurofeedback (NF) posttraining results revealed changes in brain training for alleviating the symptoms and functioning of 87% (7 of 8) of participants; improving the performance in children with the noticed changes were mostly (62%) in high functioning Autism Spectrum Disorders form of reduction within the range of Delta (ASD) at two levels: overt behavior, and cov- and High Beta. ert behavior.

Conclusions Method Considering the following reasons, we can The study was conducted in a ‘‘single- claim that the reduction of symptoms is subject’’ design with multiple baselines and resulted from the NF training: First, follow-ups. Eight children with high- reduction of symptoms have taken place in functioning ASD and ranging in age from 8 the treatment phase not in the baseline; to 13 (M age ¼ 10.12) participated in the second, because 3 groups of participants study. Participants were divided into 3 entered the training phase at different times, groups differing with each other in time of groups that were still in the baseline could onset of the training and thus the number be regarded as a control for the participants of baseline records (3 records for the first in the treatment phase (the control group in group, 5 for the second, and 7 for the third baseline had no variance in severity of symp- one). All participants went through 30 ses- toms, whereas reduction trend of the group in sions of Neurotherapy. Assessments were the training phase was taking place); third, done at two levels of overt behavior (symp- reduction in the severity of symptoms in toms and performance) and covert behavior ASD after NF was shown in the previous stu- (brain functioning) during the baseline, dies too. The same argument applies for the training course, and follow-up. The acquired improvement in performance. At the covert data at the level of overt behavior were ana- behavior level, Reduction in the absolute lyzed using two main methods: visual analy- powers of Delta and High Beta frequency sis and effect size. At the level of covert bands is concordant with the treatment goals behavior, the data were analyzed via visual in other researches such as Jarusiewicz analysis and paired t test. At the overt beha- (2002). Considering all the acquired infor- vior level, repeated measurements were used mation, we claim that the use of NF training during baseline, training course, and can lead to partial improvements at the level follow-up via two researcher-made scales of overt and covert behavior in children with called Symptom Assessment Scale and ASD. But this does not apply to every child Performance Assessment Scale. Assessment with Autism, and in some cases it may cause at the level of covert behavior was done some serious adverse effects. Proceedings of the 2010 ISNR Conference 367

REFERENCES performance in IVA þ Plus test in 8 patients with ADD=ADHD. One of the aims was to Coben, R., & Padolsky, I. (2007). Assessment-guided investigate whether using EEG measures to neurofeedback for autistic spectrum disorder. Jour- control size and brightness of a DVD is nal of Neurotherapy, 11, 5–23. effective for maintaining motivational Jarusiewicz, B. (2002). Efficacy of neurofeedback for engagement of children with ADHD during children in the autistic spectrum. Journal of Neu- training. rotherapy, 6, 39–49. Koujzer, M., Moor, J., Gerrits, B., Congedo, M., & Schie, H. (2008). Neurofeedback improves execu- Method tive functioning in children with Autism Spectrum Disorders. Research in Autism Spectrum Disorders, All 8 patients with ADHD diagnosis were 3, 145–162. evaluated and referred to the lab from the Paoletti, J. L., & Kaiser, D. A. (2006, July). Neurother- Weisskopf Child Evaluation Center. Neuro- apeutic assessment and training of an autistic individual. What’s New in Neurofeedback, 9. Retrieved feedback training was conducted on weekly from http://start.eegspectrum.com/Newsletter/ basis with 30-min-long sessions using 12 dif- jul2006.htm ferent fragments of documentary films Sichel, A., Fehmi, L., & Goldestein, D. (1995). Positive depicting nature scenes (BBC Planet Earth outcome with neurofeedback treatment in a case of series). EEG was recorded from the pre- mild autism. Journal of Neurotherapy, 1, 60–64. frontal site (FPz) referenced to the left ear- lobe. To enhance focus, participants were trained to suppress wide band spectrum, Neurofeedback Training to Improve Attention whereas alertness parameter was a wideband and Control Alertness in ADHD measure of the upward shift of the frequencies in the EEG. Visual feedback was Estato Sokhadze, PhD, Guela Sokhadze, and arranged in a form of control of brightness, Lonnie Sears, PhD size, and continuation of the documentary University of Louisville by the ‘‘focus and alertness’’ measures. Audi- tory feedback was used to inform the participant when these two measures were under the threshold level. The IVAþPlus test was Introduction administered before and after neurofeedback course in each participant. Another clinical Neurofeedback-base treatment of ADHD behavioral outcome included measures from has received substantial empirical support the Aberrant Behavior Checklist (ABC). The in recent years (Arns et al., 2009). Neuro- ABC (Aman & Singh, 1994) is a clinician- feedback effects were manifested not only administered rating scale assessing five in clinical improvements but also in normal- problem areas: Irritability, Lethargy=Social izations of qEEG patterns (Gevensleben Withdrawal, Stereotypy, Hyperactivity, and et al., 2009) and ERP (Kropotov et al., Inappropriate Speech, and is based on care- 2005). Positive effects of neurofeedback in giver reports. ADHD were achieved with several different protocols (e.g., SMR=theta=beta, slow beta=theta, slow cortical potential, etc.); Results and Conclusion however, in most studies it was outlined that number and lengths of neurofeedback ses- Neurofeedback training aimed at sions, location of EEG electrodes, and enhancement of focus and alertness mea- motivation of participants are important fac- sures was accompanied by improved in per- tors determining success of treatment in chil- formance on IVAþPlus test and lowered dren with ADHD. In this exploratory study Hyperactivity and Irritability scores of the we investigated effects of 12 sessions of ABC. Self-regulation of prefrontal EEG prefrontal neurofeedback on behavioral measures of focus and alertness using 368 JOURNAL OF NEUROTHERAPY protocol with DVD-control as a visual feed- training can affect both the SCP and long back was effective in maintaining interest wavelength cortical activity. and motivational engagement of children with ADHD. Twelve 30-min-long sessions of neurofeedback were sufficient to achieve REFERENCES ability to control EEG parameters of interest in most of ADHD participants. Collura, T. F. (1995). Basic electronics and physics. In K. Levin & H. Luders (Eds.), Comprehensive clinical neurophysiology, (pp. 1–10). New York: Elsevier. REFERENCES Collura, T. F. (2009, January). Practicing with multi-channel EEG, DC, and slow cortical poten- Aman, M. G., & Singh, N. N. (1994). Aberrant Beha- tials. NeuroConnections, 34. vior Checklist–Community. Supplementary manual. Othmer, S., & Othmer, S. (2010, spring). Introduction East Aurora, NY: Slosson Educational. to infra-low frequency training. NeuroConnections, Arns, M., de Ridder, S., Strehl, U., Breteler, M., & 14. Coenen, A. (2009). Efficacy of neurofeedback treat- Strehl, U. (2009). Slow cortical potentials neurofeed- ment in ADHD: The effects on inattention, impul- back. Journal of Neurotherapy, 13, 117. sivity and hyperactivity: A meta-analysis. Clinical EEG Neuroscience, 40, 180–189. The Effect of Different Photic Entrainment Gevensleben, H., Holl, B., Albrecht, B., et al. (2009). Frequencies used During Live Z Score Neuro- Distinct EEG effects related to neurofeedback training in children with ADHD. International feedback: A Preliminary Examination Journal of Psychophysiology, 74, 149–157. Kropotov, J. D., Grin-Yatsenko, V. A., Ponomarev, Jeff Tarrant, PhD V. A., et al. (2005). ERPs correlates of EEG relative Spring Grove Counseling beta training in ADHD children. International Journal of Psychophysiology, 55(1), 23–34. Introduction Understanding Infra-Low Frequency Neuro- feedback Many neurofeedback practitioners utilize a range of technology-based therapies in Lincoln Stoller, PhD their practice. One technique commonly used Tenger Research, LLC is audiovisual entrainment. This strategy utilizes light and=or sound stimulation at specific frequencies to impact brain wave Infra-low Frequency (ILF) neurofeedback functioning. Demos (2005) reviewed the use training is loosely defined as training EEG of Audio Visual Entrainment for relaxation, signals below 0.5 Hz. This is generally well pain management, and ‘‘brain brightening’’ understood in the context of slow cortical as well as specific applications including potentials (SCP) but poorly understood in ADHD and depression. AVE is also used cases where trainees claim to discriminate to help a client learn what it ‘‘feels like’’ to between harmonics differing by hundredths produce a desired brainwave state (Siever, of a Hertz in the 0.1 Hz EEG range (Othmer, 2009). It can be used as a stand-alone treat- 2010). I provide a theoretical analysis of sig- ment or in conjunction with neurofeedback nals of this frequency to explain what is training. Clinicians have used the visual feed- happening when we train these EEG compo- back with view holes in the eyeset during a nents. The short-time averaging used for neurofeedback session to encourage a spe- training does not violate the calculation of cific response and facilitate the neurofeed- the EEG components over a longer time back process. Although most people will epoch. The electrical responses provided by entrain between 5 and 15 Hz, it has been the trainee to low frequencies and the noted that some people have differing DC signal are qualitatively different. ILF responses to the stimulation (Siever, 2000). Proceedings of the 2010 ISNR Conference 369

The immediate impact of AVE and photic electrode for each client was considered a stimulation has become even more notice- separate ‘‘subject’’ resulting in 60 ‘‘subjects’’ able with the recent advent of live z score (15 clients 4 electrodes each). neurofeedback training, which allows the Within-subjects analyses of variance therapist to observe client brainwave activity (ANOVAs) are conducted for each of the 8 in comparison to a normative database in NeuroGuide bands. The Dependent Variable ‘‘real time’’ while neurofeedback is occur- is the treatment condition, and the Inde- ring. The current study explores trends and pendent Variable is the change scores for response patterns when using specific fre- each frequency band. These analyses deter- quencies or immersive photic stimulation mine if any of the experimental conditions during live z score neurofeedback training. (10 hz, 14 hz, 18 hz, immersive) demonstrate significantly more change in EEG bands than a standard live z score neurofeedback Method treatment. Positive ANOVA findings are followed by post hoc analysis to determine Fifteen child and adolescent clients in the which independent variables are responsible author’s neurofeedback practice participated for the significance. in the study. Each client received 4 channel live z score training at placements specific to their symptoms and pretreatment QEEG. Conclusions During 5 consecutive sessions, the first 5 min of the session was recorded with neurofeed- The results are considered and discussed back only. The second 5 min included the in relation to the possible mechanisms of same neurofeedback protocol along with audiovisual entrainment. For example, if one of five visual stimulation conditions different patterns of response are discovered, (no AVE, 10 hz, 14 hz, 18 hz, immersive) can this be attributed to different mechan- using eyesets with view holes. The order of isms of action based on individual differ- exposure was counterbalanced between ences of the clients. Is there a way to clients. The data from each of the 5-min determine what types of photic stimulation segments was analyzed through the Neuro- may be most beneficial for specific brain- Guide Normative Database (Thatcher, wave patterns? What are the implications 1987). The BrainMaster Atlantis 4 4 was for using audio visual entrainment simul- used along with the Applied Neuroscience, taneously with neurofeedback? What direc- Inc. Z DLL software for all neurofeedback tions does this provide for future research sessions. The DAVID Paradise XLþwith in this area? white light True-Vu Omniscreen Eyesets was used to administer all AVE sessions. Immersive photic stimulation utilized the BrainMaster Atlantis immersive glasses. REFERENCES

Demos, J. (2005). Getting started with neurofeedback. Results New York: Norton & Co. Siever, D. (2000). The rediscovery of audio-visual Absolute and Relative Power z scores entrainment technology. Edmonton, Canada: were obtained for each of the 5-min segments Comptronic Devices Limited. for all 4 channels of each participant using Siever, D. (2009). Audio-visual entrainment: History, the 8 standard bands in NeuroGuide Deluxe physiology, and clinical studies. In J. R. Evans 2.5.7 (delta, theta, alpha, beta, high beta, (Ed.), Handbook of neurofeedback: Dynamics and clinical applications (pp. 155–183). New York: beta1 beta2, beta3). These data were trans- Informa Healthcare. formed into change scores by subtracting Thatcher, R. W. (1987). Federal copyright the z score obtained from the first 5-min (TXu-347-139) of the ‘‘Life span EEG Normative segment (control) of each session from Database’’ and all of its derivatives, transforma- the second (experimental) segment. Each tions, and revisions. 370 JOURNAL OF NEUROTHERAPY

Post Hoc Analysis of the QEEG Reveals the sensory motor strip, or (b) single channel Most Desirable Treatment Protocols and increase or decrease training at any indicated Identifies Clients Vulnerable to Overtraining ‘‘10–20 system’’ location, or (c) 4-channel simultaneous z score neurofeedback. Sessions Thomas Matthews, PhD were 1 hr, one or two per week (occasionally Optimum Performance Solutions less often), and the total number of sessions was determined by consideration of the resources available and attaining client goals. Introduction The multimodal approach required occasional counseling sessions devoted to This neurofeedback case series demon- progress review and to functional issues strates an approach to post hoc scoring of raised by the client, family or the case- the qEEG to develop neurofeedback treatment management team. Many of the clients had plans. The findings illustrate that otherwise serious brain-based disabilities and adequate nonobvious treatment protocols are empiri- financial resources, so treatment was rather cally identified and lead to substantial clinical extensive in those cases. Several clients improvement in targeted issues. The further started neurofeedback before the case series evidence that clients can be vulnerable to over- began and were included in the study when training offers support of previous findings. their treatment planning included the post hoc qEEG scoring procedure. Not all clients Method completed treatment during the study time frame. Most had exhausted other treatment Participants: All 30þ neurofeedback cases options before seeking neurofeedback, but in a private practice clinic since initiation of some were referred relatively soon after ser- the assessment procedure were asked to par- ious head trauma and consequently had con- ticipate, representing more than 1,000 treat- current conventional treatments such as OT, ment sessions. Those who provided PT, or speech therapy; many had psychotro- informed consent were included in a retro- pic and other medications. spective review of assessment and treatment Data sample procedure: Data were com- outcome. Most clients were adults with his- piled from the treatment charts by an under- tory of brain injury, who function across a graduate intern supervised by biology faculty range from disabled to high-functioning proof a local university, scored, and summary fessionals. Age range was 9 to 68. statistics conducted. Treatment success was Clinical Records Data Pool: The Clinical measured by scoring client and third-party Records comprised assessment and treat- reports of progress that had been written ment records. Assessment records consisted by the clinician in the chart notes during of (a) screening review of function, medical the course of treatment, and in a few history, and prior assessments to develop instances where available by repeat quanti- localization hypotheses in a formal report; tative assessment. Particular attention was (b) quantitative assessment including qEEG; given to examples where the planning tool and (c) post hoc scoring of qEEG output. indicated otherwise unexpected protocols Treatment records consisted of the for 4-site simultaneous z score training. Vul- detailed protocol sheet and chart note for nerability to overtraining was measured by every session. Treatment itself was EEG scoring the chart record for (a) shifts in treat- operant conditioning using any protocol that ment protocol toward reduced training time appeared to be desirable for that client based in each session, or (b) shifts toward on assessment and treatment response, in the less-fatiguing protocols, as opposed to com- context of a multimodal approach. The clin- pleting the expected number of sessions with ician provided (a) conventional ‘‘beta’’= a protocol and moving on, or (c) frank over- ‘‘SMR’’ neurofeedback training along the training episodes. Proceedings of the 2010 ISNR Conference 371

The post hoc qEEG scoring procedure The further evidence that clients can be evolved over the period of the study. Conse- vulnerable to overtraining offers support of quently some refinements were available only previous findings. in the final version of the treatment planning tool. To conduct the study, the qEEG Conclusion data for all participants was reevaluated employing the final version of the planning Otherwise nonobvious treatment proto- tool. It was hypothesized that high SD(D) cols can be empirically identified, which lead scores for a given protocol (i.e., standard to substantial clinical improvement in tar- deviation of the deviance scores computed geted issues. The clients vulnerable to over- by the planning tool) would predict vulner- training can be identified and treatment ability to overtraining for that client if using tailored to their needs, offering support of thatprotocol. Furthermore it was expected previous findings. Neurofeedback is a spe- that vulnerability would be modulated by cific and potent intervention to which there (a) severity of TBI, (b) hypoglycemia or can be adverse response (Hammond et al., hyperglycemia, and possibly by exceptionally 2001; Hammond & Kirk, 2008; Lubar et al., high general intelligence (see Matthews, 1981; Ochs, 2007; Whitsett et al.,1982). 2007). The clinician also evolved in his Matthews (2007) offered the hypothesis that capacity to use the information. For clients clients vulnerable to overtraining may be later in the case series, the clinician reserved identified and the training tailored to their such very high-SD(D) protocols until the cli- needs. Supporting examples are discussed ent demonstrated adequate stabilization in to clarify this relationship. response to other neurofeedback. The author=clinician is Clinical Director of Optimum Performance Solutions LLC in Topeka, Kansas, which in addition to the Results clinic does business as AcuityZ. AcuityZ makes available the post hoc qEEG scoring The findings illustrate that otherwise non- procedure used in this study. Alternative obvious treatment protocols are empirically treatment-planning procedures include the identified by the post hoc scoring of the symptom-to-location tool included in the qEEG, and lead to substantial clinical training module of NeuroGuide1 offered improvement in targeted issues. Examples by Applied Neurosciences Inc., the BMANS are reviewed to provide a clinical appreci- Manual Series by Brownback Mason Associ- ation of how the procedure incrementally ates, the CN 1020 from EEG Professionals, improved planning, treatment, and outcome. and the Mini-Q by NewMind Apps.