Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience

SELECTED ABSTRACTS of CONFERENCE PRESENTATIONS at the 2013 INTERNATIONAL SOCIETY for NEUROFEEDBACK & RESEARCH (ISNR) 21ST ANNUAL CONFERENCE, DALLAS, TEXAS Published online: 04 Dec 2013.

To cite this article: (2013) SELECTED ABSTRACTS of CONFERENCE PRESENTATIONS at the 2013 INTERNATIONAL SOCIETY for NEUROFEEDBACK & RESEARCH (ISNR) 21ST ANNUAL CONFERENCE, DALLAS, TEXAS, Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience, 17:4, 272-288, DOI: 10.1080/10874208.2013.855484

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THIS OPEN-ACCESS CONTENT MADE POSSIBLE BY THESE GENEROUS SPONSORS Journal of Neurotherapy, 17:272–288, 2013 Copyright # 2013 ISNR. All rights reserved. ISSN: 1087-4208 print=1530-017X online DOI: 10.1080/10874208.2013.855484 PROCEEDINGS OF THE 2013 ISNR CONFERENCE

SELECTED ABSTRACTS OF CONFERENCE PRESENTATIONS AT THE 2013 INTERNATIONAL SOCIETY FOR NEUROFEEDBACK & RESEARCH (ISNR) 21ST ANNUAL CONFERENCE, DALLAS, TEXAS

Long-Term Follow-Up of Neurofeedback 21 male and 2 female clients. There were several Outcomes in Clients with Asperger’s criteria that had to be met for inclusion in this Syndrome study. First, all clients were assessed and trained at the ADD Centre. Second, all participants had Tanushree Bhandari symptoms of Asperger’s syndrome or had ADD Centre and Biofeedback Institute of received a diagnosis of Asperger’s syndrome. Toronto Third, all clients received neurofeedback and biofeedback training combined with metacogni- Introduction tive strategies at the ADD Centre between 1997 In 2010 a study was published indicating and 2011. Strategies selected aimed to assist improvement in symptoms of Asperger’s with academics and social skills. Fourth, all cli- syndrome as a result of a combination of ents completed a minimum of forty 50-min neurofeedback, biofeedback, and metacognitive training sessions. Last, all clients completed train- training (Thompson et al., 2010). This study ing at the centre between 2 and 14 years ago. represented the largest chart review to date Mean follow-up time was 6.5 years. All clients (N ¼ 150) investigating improvements in symp- were mailed a package that included (a) an invi- toms of Asperger’s syndrome following a course tation to participate in the study; (b) information of neurofeedback training. The aforementioned outlining the purpose, procedures, and possible study measured results immediately following benefits and risks of participating in the study, training. The question that remains is, How are as well an explanation of the confidentiality these clients doing today? The goal of the present agreement and withdrawal policy relating to study is to measure the long-term benefits of the study; (c) a consent form; (d) a set of four neurofeedback combined with biofeedback questionnaires (for adults—The ACQ, The Adult and metacognitive training by examining the cur- Self-Report Scale–VI Screener, DSM–IV Rating rent level of functioning of clients who completed Scale, and the Wender-Utah Rating Scale; for training more than 2 years ago. The hypothesis, children—Conner’s Global Index—Parent Ver- based on long-term follow-up of clients with sion, DSM-IV symptom list, ADD-Q for children, attention deficit=hyperactivity disorder (Gani and the Australian Scale for Asperger’s); and (e) a et al., 2009; Leung, 2012; Lubar, 1995) is that comment form. Participants were also invited to the improvements noted at posttesting will be comeinforfreeupdatetestingontheIntegrated maintained at follow-up, that is, after improve- Visual and Auditory Continuous Performance ment from pretraining to posttraining, scores will task and Test of Variables of Attention. be stable from posttraining to follow-up (results will not be significantly different). Results Data were compared across two data points: Method posttraining and at follow-up (i.e., current- The participant sample consisted of 23 clients level-of-functioning). Mean values were who had earlier been seen at the ADD Centre compared at each point for all questionnaire for neurofeedback training. The sample included data. Preliminary results demonstrate that

272 PROCEEDINGS OF THE 2013 ISNR CONFERENCE 273 scores on all questionnaires (ADD-Q, DSM–IV, training, for clients with symptoms of Conner’s and Australian Scale for Asperger’s Asperger’s syndrome, are maintained long Syndrome) at follow-up did not significantly term. differ from posttraining scores, indicating that clients had not experienced regression in func- Keep Them Coming Back: Interpersonal tioning. Comment forms filled out by parents Techniques and Their Relationship to Client contained anecdotal evidence of benefits Adherence, Engagement, and Satisfaction noticed by participants and parents. ‘‘We believe the Biofeedback supported him Jonathon Larson, Thomas Cothran, Christopher through a difficult time. It has only (had) posi- Haak, Lindsay Sheehan, Katherine Kereszturi, tive effects.’’ ‘‘In answering the questions Bethany Apa, Catherine Ryan, Robert Beedle, (questionnaires), I realized that many of the and Kelly O’Neill questions that related to behaviors my child Illinois Institute of Technology experienced before are not present today. I believe that the training he went through at Rigorous empirical research continues to the ADD Centre helped tremendously.’’ demonstrate the efficacy of neurofeedback ‘‘Removing him from school, taking him to therapy (NFT) in peak performance training his training (ADD Centre) gave Ramon (name and the treatment of psychiatric and neurologi- changed) a quality of life that before training cal disorders (Hammond, 2007; Yucha & was quite improbable and impossible.’’ Montgomery, 2008). However, according to ‘‘Katherine (name changed) has continued to NFT practitioners, one of the barriers to suc- advance since her treatments at the ADD cessful functional outcomes is client adherence Centre. The ADD Centre helped Katherine and ambivalence to ongoing treatment (Larson, wean herself off of medication and to this Ryan, & Baerentzen, 2010). NFT provides day she has not needed to return to the use an effective intervention for improving of meds.’’ self-regulation of brain activity, arousal, and reducing unwanted symptoms. However, the Limitations technology does not inherently contain com- ponents targeted at facilitating continued client Given the data collection method of a mail-out engagement. Human factors play a significant to previous clients, we were limited in the role in client adherence, engagement, and responses we received, as several clients did satisfaction with therapy. Research shows that not live at the same address anymore. This is patient engagement and support can be imp- expected with any long-term follow-up study. roved significantly using specific interpersonal There could well be a response bias in favor techniques (Beck, Daughtridge, & Sloane, of families who were happy with the outcomes 2002; Zolnierek & DiMatteo, 2009). Moving and therefore motivated to take the time to be beyond simple friendliness, this workshop will part of the study. However, the responses survey empirical literature related to profes- received from clients also reflected those who sional comportment and rapport, transtheoreti- were seeking support and therefore returned cal common factors of treatment outcomes, for an updated assessment. We recognize that motivational interviewing, and verbal and the sample for this pilot study is small, and nonverbal communication. This workshop will hence these results are only a preliminary fluidly combine dialectic and experiential reflection. We hope to continue to collect data teaching strategies to elucidate evidence-based and increase the sample for our study. strategies for guiding clients from first contact through successful termination of therapy. It is Conclusion intended to benefit practitioners from a wide These results support our hypothesis that the range of expertise, from the novice technician positive gains achieved through neurofeedback to the experienced clinician. 274 PROCEEDINGS OF THE 2013 ISNR CONFERENCE qEEG and Neurofeedback Diagnosis and brain activity triggered by sensory stimuli and Treatment for Sports Acquired Traumatic experiential images. It has the best test–retest Brain Injury reliability of all brainwaves, and it is an intraindi- vidual stable trait. It facilitates the organization of Michael Linden a brain-stem network that governs sympathetic Attention Learning Centers nervous system activity. The present study inves- Jay Gunkelman tigated the hypothesis that increasing alpha Brain Science International waveband amplitude through cranial electrother- Alan Strohmayer apy stimulation (CES) would lead to a reduction Brain Strength Training in the physiological and psychological symptoms of anxiety disorders. CES has been shown to The use of neurofeedback is gaining interest in inducethecortextoproduceanincreasein sport medicine and athletic organizations as alpha-wave activity. training for peak performance and, more recen- tly, for traumatic brain injury (TBI) and postcon- Methods cussive syndromes (PCS) rehabilitation. In this symposium we explore the use of qEEG to help Sixteen patients complaining of stress or anxiety identify the deficits resulting from sports acquired were recruited. They completed the Depre- TBI. We review and explore the use of the qEEG ssion, Anxiety and Stress Scale. Baseline CNS and other psychological performance tests to Measurement of Brainwave activity occurred describe the TBI and how they can be used to at the central SMS. Patients were put on a determinethecorrecttimetoreturntoplay 1-month waiting list and then reassessed with (RTP). RTP is currently a highly controversial topic the same measures as at baseline. They were in sports medicine. We show the role of qEEG provided with an Alpha-Stim CES device to Guided NF protocols in the recovery from TBI use for 2 months for 20 min per day. Posttreat- and other PCS, especially headache. The presen- ment trial reassessment then occurred. ters draw upon clinical case studies of TBI suc- cessfully treated using these techniques. Results and Discussion The measures at each assessment point were analyzed, providing means and significant differ- An Evaluation of the Psycho-Physiological ences. Key measures were for the AlphaWave Concomitants of Increasing Alpha-Wave amplitudes and the Depression, Anxiety and Amplitude in Anxiety and Stress Disorders Stress Scales Scores. Using CES led to a significant Lesley Parkinson and Alan Parkinson increase in alpha-wave activity and a significant BrainHealth reduction in self-report measures of anxiety and stress. The study demonstrated the importance Introduction of the alpha wave in reducing the physiological and psychological symptoms of anxiety and stress. Anxiety and anxiety disorders involve both psychological and physiological conditions. Anxi- ety covers uneasiness, apprehension, fear, and LORETA Phase Reset of the Human Default worry in circumstances that do not necessarily Network warrant it. Accompanying symptoms include those such as heart palpitations, muscle tension, Robert Thatcher fatigue, headaches, irritability, and sweating. Sufferers can also find themselves overwhelmed Objectives by accompanying stressful thoughts=cognitions. The purpose of this study was to compare Using brainwave oscillations is an important tool electroencephalogram (EEG) phase shift and for the understanding of cognitive processes. The lock durations between different Brodmann Alpha Waveband facilitates the integration of areas of the human default mode network. PROCEEDINGS OF THE 2013 ISNR CONFERENCE 275

Methods shown to be effective in reducing seizures (Tan The EEG was recorded from 19 scalp locations et al., 2009), the duration of treatment is often from 70 healthy normal subjects ranging in age long (6–12 months) with only an 80% success from 13 to 20 years. A time series of LORETA rate. Recently, the notion of epileptic neuronal current sources were computed from the center networks has been postulated (Stefan & Lopes voxel of 14 Brodmann areas (BA) comprising the de Silva, 2013). Utilizing such concepts, one default mode network. The Hilbert transform of can detect connectivity anomalies that trigger the LORETA time series was used to compute seizure events and measure their resolution as the instantaneous phase differences between all well. Data are presented to show how this app- pairs of BAs. Phase lock and shift durations were roach may be used to design potentially more computed for all combinations of BAs in the delta effective neurofeedback treatment plans with frequency band (1–4 Hz). Analyses of variance greater success rates than previously studied with Bonferroni corrections were computed with approaches. main effects of Brodmann areas, hemisphere, andeyesclosedversusopenconditions. Serial Norm-Referenced Quantitative EEG Results Evaluations During Subacute Recovery from Traumatic Brain Injury: A Validation Study Phase shift and lock duration exhibited discrete durations when comparing pairs of BAs. Phase Fred Ulam and Charity Shelton shift and lock durations, whereas discontinuous Missouri Rehabilitation Center, University of and unique for each BA, also exhibited expo- Missouri Health System nential changes with distance and were inver- sely related. Purpose Conclusions To assess the usefulness of quantitative EEG Each BA is a node in a network that phase locks (qEEG) in tracking recovery of attention=working with other nodes during discrete and specific memory among patients with traumatic brain intervals of time. The results indicate that ana- injuries (TBI) during subacute neurorehabilitation. tomical nodes behave like a shutter that opens and closes at specific durations giving rise to Subjects temporal packets of phase locked clusters of Twelve individuals with moderate to severe TBI neurons across networks. who were receiving inpatient neurorehabi- litation in a university-based hospital and who Neural Connectivity Theory of Epilepsy met inclusion criteria, participated. Twelve Robert Coben carefully matched healthy control subjects also Integrated Neuroscience Services participated.

The prevalence of epilepsy in the general Methods population has been estimated to be at least TBI subjects were administered a battery of 7 per 1,000 with rates rising over 4 decades neuropsychological tests and a quantitative (Hauser, Annegers, & Kurland, 1991). In addi- EEG evaluation every 2 weeks, from the time tion, there are subclinical seizure disorders that of enrollment to the time of discharge. Here, lead to unwanted symptoms to conditions such we focus on the Digit Span test from the as autism. If one considers all form of potential Wechsler Adult Intelligence Scale–IV, which seizures disorders and their manifestations, the includes measures of selective attention and prevalence and societal challenges that these auditory working memory. The neuropsycholo- issues cause are tremendous. Although basic gical tests and the EEGs were obtained within 2 neurofeedback (SMR augmentation) has been days of one another. Control subjects took the 276 PROCEEDINGS OF THE 2013 ISNR CONFERENCE same battery of tests and EEGs on two separate case series reviews eight cases in which an occasions, separated by 2 weeks. electroencephalographic normative database functional network symptom checklist match Analysis approach to treatment of veterans with both Linear regressions were performed for each TBI and PTSD was used. digit span subtest and relative power within each of the four traditional EEG frequency Method bands averaged from four cortical regions—left The 19-channel qEEG data were acquired frontal, right frontal, left posterior and right using Deymed Truscan and analyzed using posterior. NeuroGuide and the Thatcher Lifespan Nor- mative database. A symptom checklist match Results was constructed matching the individual’s Significant relationships between relative symptoms with their abnormal functional power and digit span were found for patients neural network metrics. Subjects were then and controls. For patients, decreases in delta trained with LORETA Z Score neurofeedback and theta, and increases in alpha accompanied with the goal of normalizing the EEG power, improved performance. Increases in alpha phase, and coherence metrics that were likely were associated with improvements for con- responsible for their symptoms based on the trols, while decreases in beta from the left pos- neuroimaging literature. Results were remark- terior region were associated with improved able in most cases with symptoms decreasing test scores. up to 10% per session even in cases when the symptoms had been persistent and stable Conclusions for years. However, in the cases where the QEEG measures of relative power were mean- most psychotropic medication was involved, ingfully associated with performance on tests of the results were still positive but slower. This attention=working memory for patients and functional network, symptom checklist appro- controls. Decreases in slow activity and increa- ach to training appears to offer the best avail- ses in alpha accompanied recovery of attention able approach to the treatment of complex following TBI. QEEG appears to be a valid mar- cases of TBI and PTSD. ker of recovery of attentional functions, and may be useful as dependent measure in studies The Relation Between Memory Improvement of novel interventions or in guiding neuromo- and QEEG Changes in Three Clinical dulation treatments. Groups as a Result of EEG Biofeedback Treatment Loreta Z Score Neurofeedback in the Kirtley Thornton Treatment of Veterans with PTSD and TBI The Neuroscience Center Dale Foster Memphis Integral Neurofeedback Institute It is important to understand the relationship Katherine Veazey-Morris between changes in the quantitative EEG Veterans Administration Medical Center (QEEG) variables and memory changes as a result of the EEG biofeedback treatment. With War exposes soldiers to multiple traumas, both this goal in mind the senior author reviewed his physiological and psychological. Many veterans clinical files from the last 5 years and examined return from their tours of duty suffering from the QEEG data addressing relative power and both traumatic brain injury (TBI) and post- coherence changes and memory (auditory traumatic stress disorder (PTSD). The complex and reading) improvements. The groups and idiosyncratic nature of such injuries often involved included (a) normal individuals want- results in treatment resistant symptoms. This ing to improve their cognitive functioning, (b) PROCEEDINGS OF THE 2013 ISNR CONFERENCE 277 traumatic brain injured (TBI) subjects, and (c) et al., 2009) for children with autism spectrum and (d) subjects who can best be classified as disorders (ASD). Of interest, in the work that having a specific learning disability (SLD). The has been done to date, it seems that the bene- SLD group was divided between those who fits of therapy are maintained and may even are older than 14 tears of age (adults) and those enhance over time. In this talk, I present data who are younger than age 14 (children) to refer- from children with ASD treated with neuro- ence the appropriate age-related normative feedback including a follow-up at 3 years and group values. The analysis revealed significant a single case study with follow-up period at 8 improvements in auditory and reading memory years. These findings further establish the acrossallgroupsaswellaschangesontheQEEG long-term benefits of neurofeedback. variables. All of the groups were performing above the normative reference group on mea- sures of auditory and reading memory in terms Efficacy of Cranial Electrotherapy Stimulation of percentage differences (24 to 97%)andstan- for Anxiety, PTSD, Insomnia and dard deviations (þ1.28 to 1.85). The average Depression: Military Service Members and auditory memory standard deviation improve- Veterans Self Report þ ment was 1.52, whereas the average percent- Jeff Marksberry % agechangewas82 . For the reading task, the Electromedical Products average memory standard deviation improve- ment was 1.38, whereas the percentage Cranial electrotherapy stimulation (CES) is improvement was 154%. The experimental prescribed for service members and veterans group was performing 1.66 SD (68%)above as a complementary or alternative medicine the control group on auditory memory and .90 modality for the treatment of anxiety, posttrau- SD (52%) above the control group on reading matic stress disorder (PTSD), insomnia and memory measures. For the QEEG variables, the depression. The purpose of this study was to average raw value of the Spectral Correlation examine service members’ and veterans’ per- Coefficient (SCC) change for alpha was 6.1 ceptions of the effectiveness and safety of CES points (2.09 SD), for SCC beta1 (13–32 Hz) treatment. service members and veterans 6.53 points (1.81 SD), and for beta2 (32– (N ¼ 1,514) who had obtained a CES device 64 Hz) 7.5 points (1.77 SD). The changes on through the Department of Defense or the relative power measures were less dramatic, Veterans Affairs Medical Center from 2006 to albeit significant. 2011 were invited to participate in the web- based survey via e-mail. One hundred fifty-two participants returned questionnaires. Data Coherence Training for ASD: Enduring were analyzed using descriptive statistics. The Effects Beyond 3 Years majority of participants reported substantial Robert Coben clinical improvement (>50%) from using CES: Integrated Neuroscience Services anxiety (66.7%), PTSD (62.5%), insomnia (65.3%), and depression (53.9%). Respondents Follow-up studies of neurofeedback outcome also perceived CES to be safe (99.0%). after the active phase of treatment has ended Those individuals who were not taking any are rare. While some studies have examined prescription medication rated CES as more outcome 3 to 6 months following treatment effective than the combined CES and prescrip- (i.e., Gevensleben et al., 2010; Leins et al., tion medication group. CES provides service 2007), follow-up periods that are longer than members and veterans with a safe, noninva- this are scant in the literature. Coben, Arns, sive, nondrug, easy-to-use treatment for anxi- and Kouijzer (2011) reported on follow-up ety, PTSD, insomnia, and depression that can periods up to 6 months in attention deficit= be used in the clinical setting or self-directed hyperactivity disorder and 1 year (Kouijzer at home. 278 PROCEEDINGS OF THE 2013 ISNR CONFERENCE

Neurofeedback for Early Psychosis: A underlies impairments in cognitive control. Theoretical Rationale for Cognitive This presentation will review neurofeedback Rehabilitation studies for schizophrenia and a neurodevelop- mental model of the disorder. Finally, a ration- Thomas Cothran, Jonathon Larson, Lindsay ale for the use of neurofeedback in treating Sheehan, Bethany Apa, and Christopher Haak cognitive impairments in early psychosis within Illinois Institute of Technology the context of a clinical staging model will be discussed. Cognitive impairments in schizophrenia are the strongest predictor of functional outcomes, are relatively unaffected by current pharmacologi- Neuromodulation of EEG LORETA cal interventions, and are present prior to the Connectivity Measures to Support first psychotic episode. Deficits in cognitive Abstinence From Alcohol and Drugs control appear to be a core characteristic of schizophrenia. Cognitive control refers to pro- Jack Johnstone cesses that allow information processing and Q-Metrx, Inc. behavior to vary adaptively in the moment. George Fein The construct encompasses a broad range of Neurobehavioral Research, Inc. mental operations including working memory, contextual processing, and attention allocation. Alcohol dependence is a disorder with an It appears related to a general-purpose, super- impulsive and compulsive drive toward alcohol ordinate network with critical nodes in the consumption and an inability to control or dorsolateral prefrontal cortex (DLPFC), anterior inhibit alcohol consumption. Neuroimaging cingulate cortex (ACC), and mediodorsal studies suggest that these behavioral compo- nucleus of the thalamus (MDN). Recent evi- nents correspond to an increased involvement dence suggests that impairments in cognitive of regions that mediate appetitive drive and control result from disruption in the coordi- reduced involvement of regions that mediate nation of activity across brain regions that executive inhibitory control. We have recently may stem from deficits in the development of shown using functional connectivity fMRI that, normal brain connectivity. Abnormalities in compared to nonsubstance abusing controls, neural synchrony are present in schizophrenia. long-term abstinent alcoholics evidence (a) Basic research suggests that deficits in neural decreased synchrony of limbic reward regions synchrony underlie the development of (e.g., caudate and thalamus) with both the deficient connectivity within and between dis- Anterior Cingulate Cortex (ACC) and the tributed neural networks. During adolescent Nucleus Acumbens (NAcc) and (b) increased brain maturation a shift occurs from local to synchrony of executive control regions (e.g., global coordination of brain states. In schizo- dorsolateral prefrontal cortex) with both the phrenia, nascent connectivity issues during NAcc and the subgenual ACC. These results childhood, that may be limited to small-world are graded with duration of abstinence and networks, are then unable to support the shift are present both in cross-sectional and longi- to higher order organization, resulting in dis- tudinal studies. These results are consistent ability. Precise neural synchronization between with a compensatory mechanism that develops neural assemblies appears to promote long- with abstinence such that at rest, decision- term potentiation and the development of making networks are primed to be less respon- cortical networks. The absence of such syn- sive to appetitive drive stimuli and ready to chronization may produce depression in the exhibit inhibitory control. Facilitation of these connection between neurons. Deficits in syn- adaptive changes may show promise as a treat- chrony could plausibly explain the specific dys- ment for individuals pursuing abstinence from function between DLPFC, ACC, and MDN that alcohol and drugs. Studies to be reported here PROCEEDINGS OF THE 2013 ISNR CONFERENCE 279 are extending these findings from fMRI to EEG reported in this paper is based on a 2-year using LORETA connectivity analysis with the progress report (2011 to 2012) with a total goal of developing a neurofeedback treatment sample size of 100 and (2012–2013) with a supporting long-term abstinence from alcohol total sample size of 100 addicted clients of and drugs. an addiction recovery program. Following neurotherapy, 100% of the 200 clients experi- enced profound relief from the symptoms of Continuous Performance Test Results addiction (depression, anxiety, insomnia, Following Neurofeedback and the Efficacy PTSD, and dual diagnosis) suffered prior to of Frequency Optimization Using Bipolar treatment. Training Montages John Putman Exercise for Attention: QEEG, ERP, The EEG Institute and Behavioral Evidence The existence of Infra low (or Very Slow) frequ- Lindsay Thornton encies in the brain has been known for many USOC years, but their relevance to the EEG has only Alex Thornton recently begun to be understood. (Very Slow frequencies are defined as those 0.1–0.01 or The link between exercise and cognition has lower). Although their origin is not completely been established (Chang et al., 2012; Smith clear, evidence suggests that they play a funda- et al., 2010). Effects tend to be small but signifi- mental role in the management of cortical cant, and tend to occur in executive function, dynamics. These low-frequency oscillations memory, and attention domains. Although also play a role in attention where lower ampli- there have been many studies that have exam- tudes of infralow activity are correlated with ined cognitive function in adults, purely cogni- attention deficits (Helps et al., 2007). In tive studies of exercise and cognition in addition, shifts in slow cortical potentials seem children are rare (Best, 2010). There are many to precede the onset of seizures (O’Leary & studies of children in the context of academic Goldring, 2007). performance. A review of school studies is con- tained in a recent CDC (2010) white paper; exercise in school generally has a positive effect Neurotherapy for Sustainable Addiction or no effect on academic and cognitive perfor- Recovery: An Integrated Model mance. Attention deficit=hyperactivity disorder Judith Ann Miller (ADHD) specific research on exercise is scarce. International Neural Renewal=Courage to Archer and Kostrzewa (2012) suggested that Change Ranch ADHD may be improved by exercise, noting that ADHD individuals tend to have deficits in Three decades of research and development many areas that are improved by exercise call for a state-of-the-science addiction recov- (Halperin & Healey, 2011). Preliminary evi- ery model. This paper introduces An Inte- dence suggests that ADHD children may dem- grated Solution for Addiction Recovery. The onstrate improved executive function after a purpose of this paper is threefold: (a) to long-term exercise program (Gapin et al., present a historical perspective on the advent 2011). A recent study (Pontifex et al., 2013) of neuroscience adapted for addiction treat- has demonstrated positive effects of a single ment, (b) to present an analytical case series bout of exercise on task switching and the P3 report that reveals neuro-therapy to be a component in ADHD, building on previous promising therapy for addiction solutions, work (Pontifex et al., 2011) showing differences and (c) to present an Integrated Model for in P3 latency and amplitude across high-fit and Sustainable Addiction Recovery. The research low-fit children. In the present study, students 280 PROCEEDINGS OF THE 2013 ISNR CONFERENCE

(N ¼ 55) were recruited to participate in a Operations, Program, and Medical. Clinically, month-long, before-school cycling program. neurofeedback proved effective in (a) rapidly Twenty-two unmedicated students had an relieving operational stress symptoms; (b) facil- ADHD diagnosis or had reported attentional itating personal management of Axis I and II difficulties and participated in QEEG and ERPs symptoms and behaviors, including easing sig- at pre- and postmeasure. Decreases in theta, nature mTBI symptoms; and (c) reducing mu, and alpha were observed at various sites recovery time from strenuous physical training. across the cortex. P3b latency and amplitude Operationally, neurofeedback delivered both improved. Although the sample size is small, unanticipated and unexpected benefits: Senior this study provides evidence of neuroeletric Officers used Alpha Theta (AT) sessions to changes toward the norm in unmedicated chil- facilitate visualization in mission planning, dren with attention deficits at baseline, and Intelligence Officers used AT to scaffold per- improved attentional behaviors. ceptual abilities, and patrol leaders used AT and Infralow neurofeedback sessions to facili- tate adjustment from long patrol hours noting The Impact of Audio Environment less distractibility, less irritation, and less fati- on Attention gue—overall, a rapid return to ‘‘baseline’’ after Charles Wasserman kinetic patrols. Programmatically, clinic utiliza- tion rates of neurofeedback by soldiers over This study examined the relationship between the course of the 12-month deployment sug- audio environment and attention. Although gests the neurofeedback ‘‘training the brain’’ background noise has generally been assumed paradigm to be congruent with Army values to be distracting, recent research has suggested in that sessions were viewed as a metric of per- that the opposite may be true. Attention was sonal responsibility, a training tool, rather than assessed in 27 participants using a continuous a behavioral health intervention. This percep- performance test under three different noise tion may have been key in reducing stigma conditions: exposure to ambient noise (the commonly associated with accessing beha- control), pink noise, and an audio track from vioral health services. Medically, the Battalion television. Attention was significantly improved Aid Station observed a decline in the number in pink noise as compared to the ambient of prescriptions issued for sleep and anxiety, noise, whereas no differences were found increased mood stabilization in soldiers, and between ambient and television conditions. increased cognitive efficiency in key infantry These findings suggest that not all noise is cre- units. Effectiveness of neurofeedback engen- ated equal when it comes to paying attention. dered a closer working relationships with army and navy doctors and psychiatrists who monitored psychiatric medications in person or Using Neurofeedback in a Forward vis-a`-vis telemedicine. Overall, anecdotal evi- Operating Base: Afghanistan dence from deployment suggests neurofeedback July 2011–July 2012 demonstrates cultural sensitivity to a special Michael Villanueva population’s operational and cultural needs. US Army Medical Service Corps 7214 Medical Support Unit Breathing, Blood Flow, and the Brain— Colin Rader An Evolutionary Understanding US Army 504th BFSB Stephen Elliott This presentation discusses lessons earned COHERENCE LLC from implementing neurofeedback within an Afghanistan Forward Operating Base. Four Resonant breathing generates a blood wave in perspectives are addressed: Clinical, Combat the circulatory system of significant magnitude. PROCEEDINGS OF THE 2013 ISNR CONFERENCE 281

This wave rises in the arterial tree during peak frequency, and when questioned, remem- exhalation and rises in the venous tree during bered having mTBI years before that was inhalation. During exhalation, oxygenated undiagnosed. Their symptoms were tracked blood exits the lungs, flows through the left across multiple brain functional sites by a rating heart and into both ascending and descending scale linked to fMRI findings to that site. Dif- aortas, the ascending aorta supplying the head fuse axonal injury was evident by involvement and brain. The physiological impetus for the of a majority dysfunctioning sites. As a result of wave is movement of the diaphragm. This pres- this finding, a neurofeedback protocol was entation asks, ‘‘What is the evolutionary developed to reward reduction of Delta peak necessity for the wave and for the diaphrag- frequency between 1.7 and 1.9 Hz. Patients matic action that produces it?’’ An argument is demonstrated within-session changes of 0.5 Hz presented that the diaphragm is necessary to or more in Delta peak frequency, demonstrat- move blood upward against gravity and evol- ing effective operant training to reduce this fre- ution of the diaphragm correlates with physical quency to enter the normal range. erectness of vertebrate life and of man. Immediate and Follow-Up Success Clinical Use of Delta Peak Frequency of Neurofeedback Treatment for 20 Severely Neurofeedback for Mild Head Trauma Depressed Clients: Quadrant Brain Theory and Application Frank Morganti Pittsburgh Hyperbaric Institute Angelo Bolea and Dennis Romig Richard Genardi Private practice Private practice The application of the quadrant brain theory was This talk presents assessment data and clinical previously demonstrated as successful in the results obtained by using the peak frequency neurofeedback treatment of chronic inpatient of Delta (1–4 Hz) as a key indicator and neuro- schizophrenia (Bolea, 2010). The quadrant brain feedback parameter. This approach made it theory and rationale was since applied with a possible to obtain improvements in clients cohort of 20 suicidal and severely depressed who did not respond to previous interventions. physician-referred patients. The initial treatment QEEGs were inspected of patients who had suf- success was 95% with only one client dropping fered one or more concussions and participated out of treatment. The 12-month follow-up had in a hospital based concussion program but 0% relapse in all clients that completed treat- failed to remit their symptoms back to normal, ment. These results compared to 50% relapse even after 20 or more hyperbaric oxygen treat- for prescription drug only treatment for ments were given after the concussion medical depression study groups. The quadrant brain treatment failed. QEEGs were given pre- and theory and methodology’s utility may extend posthyperbaric treatment and after medical beyond success in treating depression and failure, and further inspection of qEEGs results schizophrenia. The theory is presented as well revealed unchanged, significantly elevated as its application in the treatment of depression. Delta peak frequency in all or a majority of the 10=20 sites acquired during the pre and Two-Year Pilot Study of Neurotherapy and post qEEGs in the range of (2.0–2.8 Hz). These Audiovisual Entrainment in a Private, RuraL patients varied in age from 13 to 19 years old. K-12 School Several other older adults that had presenting symptoms of slow processing, depression, and Rebecca Ruefer, Shirley Dyk, and Paul Swingle short-term memory symptoms and were medi- ally treated specifically for those symptoms A 2-year study evaluating the feasibility of offer- underwent qEEG. They also had elevated Delta ing neurotherapy and audiovisual entrainment 282 PROCEEDINGS OF THE 2013 ISNR CONFERENCE in a private K-12 school in rural Montana began experiential work, this individual was able to in August 2011. Several groups of students were decrease psychotropic medication from six pre- included, comprising both mainstream neuroty- scriptions to zero, overcome numerous post- pical students and resource students and ran- traumatic stress symptoms, and improve ging in age from 6 to 18 years. All students cognitive function to the point of completing were evaluated using the Clinical Q assessment a graduate degree and becoming a licensed prior to treatment and again every 10 sessions. health service provider. The typical prognosis The Clinical Q reports were e-mailed to a of a patient with bipolar disorder treated with long-distance mentor, and the appropriate pro- conventional medicine is compared with the tocols were e-mailed back to the providers. The superior possibilities of an integral neurofeed- providers were a bioengineer and a special edu- back approach based on this case study. cation teacher, both of whom had undergone training but neither of whom was BCIA- Neurofeedback in a Public School Setting: certified. The logistics, feasibility and results, Efficacy as an Intervention for ADHD, both behavioral and academic, are presented. Inattentive Subtype to Improve Reading Achievement Integral Neurofeedback is Superior Jeffry La Marca to Conventional Medicine in a Case University of California, Riverside of Bipolar Disorder Dale Foster Neurofeedback has been used since the 1970s Memphis Integral Neurofeedback Institute as an intervention to address the symptoms of Bryan Butler attention deficit disorder=attention deficity Memphis Integral Neurofeedback Institute hyperactivity disorder (ADD=ADHD). Studies Wes Center consistently suggest that neurofeedback Focus for Living training enhances cognitive performance (Vernon et al., 2003), increases IQ scores Conventional medicine views bipolar disorder (Linden, Habib, & Radojevic, 1996), and as a biochemical disease with a psychopharma- improves attention (Leins et al., 2007). Further- cological treatment but no cure. Although this more, research indicates that neurofeedback is perspective offers some utility, recent advances most efficacious for ameliorating symptoms of in neuroscience offer alternative models that inattention, which are associated with learning are more effective in improving the function difficulties and academic problems. Addressing and quality of life of those who suffer from this the needs of students with ADD=ADHD is illness. This 20-year case study of a patient diag- especially critical in schools, as this is where nosed with bipolar disorder is viewed through most children are first identified and their the lens of the Integral AQAL model, including impairments become evident (USDE, OSERS, linear and nonlinear systems perspectives as & OSEP, 2008). Research consistently demon- well as subjective and intersubjective factors. strates that attention deficits have a deleterious The patient’s recovery and development is illu- effect on academic attainment (Barkley, 2002). strated through surface qEEG, LORETA, and Children with ADHD, inattentive subtype have SPECT neuroimaging, subjective report, and considerably more problems with processing neuropsychological assessment as he pro- speed than both typically developing peers gressed from physical disability to a highly func- and students with other subtypes (Ghelani, tioning adult via an integral neurofeedback Sidhu, Jain, & Tannock, 2004). Studies have approach. Using multiple modalities of neuro- also found that individuals with the inattentive feedback, biofeedback, neuro-modulation, subtype process visual information slowly and neuro-stimulation, lifestyle management, neu- exhibit impairments in allocating attention to rochemistry management, and intersubjective information within their visual field (Swanson, PROCEEDINGS OF THE 2013 ISNR CONFERENCE 283

Posner, Potkin, & Bonforte, 1991). Reading widespread changes in ERP=ERSP patterns for and math disorders, along with other learning reward stimuli during training. However, we disabilities, appear to be more prevalent in did not find significant conditioning of trained individuals with the inattentive subtype than bands within or across sessions. We also found in those with the predominately observed improved performance of a hemi- hyperactive-impulsive type (Willcutt & spheric attention task in the C3-Beta group after Pennington, 2000). Although medical and five sessions. To explain these and related results psychological interventions cannot be ignored, we are developing a four-part model: First, intro- especially because these are often implemen- spective tasks, such as mind wandering during ted with the specific goal of maximizing school rest or autobiographical memory, engage a success, the responsibility for accommodating Switching Network that activates an internally students with special needs in school ultimately directed Default Mode Network and deactivates falls to educators. Neurofeedback may have externally-directed problem-solving networks, the potential to be used by highly trained edu- Second, the DMN activates a ‘‘self-control’’ cators to improve school performance. This system that links rewards to internal states of presentation discusses the findings of the first arousal, motor activation, attentional focus, or study to directly examine the use of neurofeed- cognitive engagement. Third, the internal states back as an intervention to improve attention, covary with synchrony in fundamental EEG reading fluency, and reading comprehension ‘‘atoms.’’ We separately developed EEG atom in a public school setting. metrics, where each atom represents one oscil- latory EEG mode in the 1–40 Hz range, with a unique spectral envelope, topographical power Modeling EEG-Band Neurofeedback: distribution, and pattern of connectivity. Fourth, Modulating Internal States Without when the self-control system is engaged, neuro- Conditioning of EEG Sources feedback rewards condition internal state modu- Leonardo Trejo lations or ‘‘responses’’ that cause EEG atom Pacific Development and Technology, LLC synchrony levels to change accordingly. Thus Roman Rosipal, Nayson Fernandes, and Rasheed EEG-band training conditions the self-control Akbarut system, which can then manage internal states and global network connectivity. At least three neurofeedback techniques can produce measurable behavioral and neurophy- The Influence of Individual Alpha Peak siological changes. These involve modulating Frequency on Resting State EEG in Adults slow-cortical potentials (SCP), fMRI BOLD sig- With Attention-Deficit/Hyperactivity nals, or amplitude (or power) in narrow EEG Disorder bands. We think SCP neurofeedback may work indirectly by conditioning task-specific atten- Sarah Wyckoff tional focus, whereas fMRI neurofeedback University of Tuebingen=University of directly conditions regional brain activity during Pennsylvania task performance. However, the object of con- ditioning in EEG-band training is unclear Objectives because there is no overt task to perform, and Adult attention-deficit=hyperactivity disorder the electrophysiological and behavioral changes (ADHD) has been characterized by deviant pat- can occur rapidly. In a previous double-blind, terns of EEG activity during resting state, parti- placebo-controlled experiment, we trained part- cularly increased theta and decreased beta, to a icipants to increase EEG amplitude in narrow lesser degree. A recent investigation of childhood bands (C3-SMR, C4-SMR, C3-Beta, sham) using ADHD populations indicated that theta=beta auditory rewards and 30-min training sessions activity was mediated by individual differences over 5 consecutive days. We observed in alpha peak frequency (iAPF). The present 284 PROCEEDINGS OF THE 2013 ISNR CONFERENCE study seeks to investigate whether iAPF influence Currently, the field of neuroscience is driven EEG findings in adults with ADHD, as well as to mainly by genetics, neurochemistry, cell biology, explore the relation between resting-state brain and technology-enabled brain imaging. In an oscillations, iAPF, and core ADHD behaviors. earlier age, the field was more focused on neuro-physiology and system organization. This Methods presentation attempts to integrate these two Continuous 21-channel EEG was acquired from approaches in proposing a rational model for 46 adult participants with DSM-IV defined the processes that enable learning in general ADHD and 46 healthy controls. For each fre- and operant conditioning in particular. Specifi- quency band (delta, theta, alpha, beta, theta= cally it focuses on reward. What system organiza- alpha, and theta=beta power), power analysis tion produces changes in brain physiology and (absolute and relative power), and condition circuit dynamics as a result of reward? How do (eyes-closed and eyes-open), a mixed analysis these changes produce response reinforcement? of variance was used to examine the effects of What neurofeedback methodologies actually region and group using fixed frequency and promote and confirm these events? individualized iAPF bands. Partial correlation coefficients were calculated between ADHD Neurotherapy for the Treatment behavioral measures and QEEG data. of Noncombat Posttraumatic Stress Results Disorder: A Case Report Using fixed frequency bands, ADHD participants Corey Feinberg and Elsa Baehr presented with elevated theta, beta, theta=alpha, NeuroQuest and attenuated alpha activity. However, several interactions within the theta, beta, and theta= This is the case report of a female adult diag- alpha frequency bands were no longer significant nosed with posttraumatic stress disorder after using individualized frequency bands. No (PTSD) that was not induced by combat or consistent relation was found between resting- trauma experienced in the line of duty, but state brain oscillations and ADHD behaviors, rather the posttraumatic psychological distress with the exception of a weak positive correlation of having been reared by a mother who was between iAPF and inattention. The present a survivor of the Holocaust. The purpose of this results suggest that discrepant QEEG findings report is to examine the subject’s neurological within adult ADHD research may reflect differ- and behavioral response to neurofeedback ences in iAPF. In addition, EEG activity in adult training as a treatment intervention for her ADHD appears to be mediated by distinct neu- symptoms of PTSD. Pretreatment baseline rophysiological subgroups such as frontal theta measurements were taken that included an and high alpha peak frequencies. initial intake interview where the subject described the nature and severity of her Conclusion symptoms, a Quantitative EEG analysis was Future research should investigate the func- performed, and self-report inventories were tional role of resting-state brain oscillations by administered using Beck short forms for investigating neurophysiological subgroups depression (BDI) and anxiety (BAI). A customi- and controlling for iAPF. zed neurotherapy treatment strategy was applied using QEEG guided neurofeedback protocols involving posterior, eyes-closed The Pause That Reinforces: The Role combinations of Live Z-Score Training for of Arousal Modulation in EEG Operant power and coherence, as well as traditional Conditioning amplitude training protocols. Client observa- M. Barry Sterman tions were recorded at various significant David Geffen School of Medicine, UCLA points to reflect self-reported changes in PROCEEDINGS OF THE 2013 ISNR CONFERENCE 285 symptoms, and professional observations were improvement. Most of the patients completed at gathered about treatment progress from the least 10 sessions of NFB, and the degree of sub- patient’s therapist. In this case, the neurother- jective improvement (if any) was recorded. apy treatment strategy was able to produce sig- Twenty-four patients (77%) were found to have nificant changes in the subject’s EEG toward a subjective and=or objective improvement. pattern of normalization. These changes in These results are very promising, and indicate neurology mirrored positive patterns of reme- high potential effectiveness of LORETA Z-score diation in the subject’s symptoms of PTSD that NFB in the treatment of anxiety and depression. showed a significant reduction in both severity and frequency of occurrence. The improve- Coherence: Toward Multivariate Analyses ments in behavior were observed by the clin- and Training ician administering treatment, the subject’s therapist, and by the patient herself. Posttreat- Robert Coben ment assessment indicated decreases in anxi- Integrated Neuroscience Services ety as measured by the BAI and qualitative improvements in the post QEEG. Traditionally and historically, EEG coherence estimates have arisen from cross-correlations between pairs of electrodes (Bendat & Piersol, 1980; Otnes & Enochson, 1972). These con- LORETA Z-Score Neurofeedback as a Potential cepts have commonly been used and applied. Application in Depression and Anxiety In fact, a search in Google Scholar for ‘‘EEG J. Lucas Koberda, Andrew Bienkiewicz, Andrew coherence pairs’’ revealed more than 14,500 Moses, Laura Koberda, and Paula Koberda citations. Concerns in the literature have Tallahassee Neurobalance Center emerged about the accuracy of pairwise mea- sures (Barry, Clarke, McCarthy, & Selikowitz, Prior reports have already demonstrated that 2005), and research has demonstrated that standard 1–2 electrode neurofeedback (NFB) multivariate methods more accurately reflect is beneficial in the treatment of depression the true nature of connectivity (Blinowska, and anxiety (Dias, 2011; Hammond, 2005). 2011). These findings demonstrate the need Recent developments in computer technology for multivariate strategies for assessing coher- and the introduction of LORETA NFB enable ence. These various methods are presented more precisely targeted therapy. This report and discussed during this talk. Given that mul- contains analysis of 31 patients who were tivariate assessment strategies lead to more enrolled in LORETA Z-score NFB due to accurate coherence measures, it only makes depression and anxiety. Many of the patients sense that multivariate coherence training were referred for NFB by psychiatrists due to methods should be explored as well. One such resistance of the symptoms to medications. A initial approach is also presented. patient’s workup included EEG, QEEG=LORETA electrical imaging as well as brain imaging. Neurofeedback as an Alternative Treatment LORETA showed areas of frontal lobe or for Chronic Primary Insomnia Anterior Cingulate dysregulation as the most fre- quent finding. The design of this study was to Olivier Pallanca complete a QEEG before beginning NFB to con- Paris Hospital APHP-IMC duct QEEG-guided biofeedback treatment. A Yann Renard QEEG was also completed after 10 sessions of NFB therapy to see if any objective improve- The pathophysiology of Primary Insomnia (PI) ment in QEEG=LORETA abnormalities was remains mostly unclear, but cortical hyperarou- noted. Patients were also requested to give their sal may represent a final common pathway subjective feedback on the degree of symptoms in the development and maintenance of the 286 PROCEEDINGS OF THE 2013 ISNR CONFERENCE disorder, which might cause the experience of depression, and insomnia. The purpose of this sleep onset insomnia and non-restorative sleep presentation is to expose the practitioner to the (Perlis, 1997; Riemann, 2010). Several studies data behind neurotoxicity, nutrition, and brain have shown that patients with insomnia exhibit dysfunction. See how genetically modified foods elevated levels of Beta EEG activity (14–35 Hz) and herbicides cause physiologic disruption. at or around sleep onset and during NREM Many chemicals including heavy metals, solvents, sleep and EEG spectral power in the beta range and aspartame are causing damage to our neu- has been suggested to be an index of cortical rons. In addition, information about food allergies arousal (Buysse, 2008; Freedman, 1986; and Candida overgrowth and their link to symp- Merica, 1992; Perlis, 2001). Furthermore, cog- toms such as brain fog and irritability, and cogni- nitive behavioural therapy for insomnia, the tive dysfunction is discussed. Some nutritional first-line treatment for primary insomnia, pearls are given to the practitioner as well. reduces beta activity in insomnia patients (Cervena, 2004). A few studies involve neuro- Burnout, Interpersonal Commitment, Client feedback as a treatment for primary insomnia, Adherence, Continuing Education, and and most of the studies that use the SMR tech- Quality of Work Life Among Neurofeedback niques show improvement in sleep and day- Practitioners time functioning (Cortoos, 2006; Hammer, 2011). Methodology and preliminary results: Jonathon Larson, Thomas Cothran, Lindsay The aim of our study is to better characterize Sheehan, Katherine Kereszturi, Bethany Apa, the cortical hyperarousal that is exhibited by Catherine Ryan, Robert Beedle, Christopher patients with PI, especially during periods of Haak, and Kelly O’Neill wakefulness and during sleep onset, in com- Illinois Institute of Technology parison with a control group. The two groups (15 PI and 15 controls) were recruited after This presentation discusses a study of neuro- the validation of the PI diagnosis using the feedback (NFB) practitioner self-perceptions International Classification Sleep Disorders 2 related to quality of work life. Practitioner criteria. The EEG was recorded with a Nexus self-perceptions of common clinician factors 32 (Mindmedia) with a 21-electrode EEG cap, related to NFB were identified. To guide this with concomitant additional channels for heart current study, we utilized our previous concep- rate and skin conductance in order to correlate tual framework research on practitioner per- the emotional and EEG changes. The Openvibe spectives of NFB. One hundred forty-eight qEEG technique was used to analyze the signal. NFB practitioners completed online surveys In preliminary analyses, the Beta EEG activity gathering demographic information and ratings seems to be more elevated in some cortical areas of practice behaviors and characteristics. Our in the PI group. If the results are confirmed, results indicated that 74% of the variance in we want to develop a special neurofeedback quality of work life can be explained by a sig- technique to decrease the cortical hyperarousal nificant multiple correlation of burnout, inter- during wakefulness in patients with PI. personal skills commitment, and client adherence. We found monthly sessions corre- lated with financial gain or loss (FGL). We also Toxicity and Nutrition—Effects on Nervous found client adherence separately correlated System Function with monthly sessions, NFB knowledge, NFB Patricia Ryan learning commitment, and NFB mentorship. Alternatives—A Center For Conscious Health For NFB practitioner self-perceptions of com- mon clinician factors, the most frequently Practitioners are aware of the benefits of neuro- endorsed practitioner traits in rank order were feedback for a variety of disorders including (a) ethical, (b) attentive, (c) empathic, (d) calm, attention deficit=hyperactivity disorder, anxiety, (d) observant, (e) sense of humor, (f) analytical PROCEEDINGS OF THE 2013 ISNR CONFERENCE 287 and confident (tied), (g) friendly and realistic Methods expectations (tied), (h) optimistic, and (i) care- Anodal stimulation to the left dorsolateral pre- ful. NFB practitioner quality of work life frontal cortex (F3), with the cathode over the right appeared to be related to three straightforward supraorbital area (Fp2) was provided for 20 min components: reducing burnout, increasing at 1 mA over 10 daily sessions. Dependent mea- commitment to enhancing interpersonal skills, sures included relative power derived from six and increasing client adherence. Practitioners quantitative EEG studies obtained 2 days prior providing mentoring, practitioners improving to the first tDCS session, immediately before NFB knowledge and skills, and more monthly and after the first session, immediately before sessions are separately related to client adher- and after the 10th session, and 2 days following ence. Of interest, we found the number of the 10th session. A battery of neuropsychological monthly sessions positively correlated with tests assessing aspects of attention=working monthly FGL. We found a variety of perceived memory, inhibitory control and cognitive flexi- NFB common clinician factors adding to the bility were administered before the first and after complexity of understanding factors influen- the 10th tDCS treatment. cing NFB outcomes. Of interest, two (attentive and calm) of the top four practitioner Analysis self-perceptions of common clinician factors A repeated measures analysis of variance with are also important NFB client outcomes. post hoc t tests was used to examine EEG Finally, a post hoc analysis looking at groups and neuropsychological differences. with differing levels of monthly continuing education hours found significantly higher net Results income among practitioners with higher For the active tDCS group, theta decreased average hours. immediately following the first session at F3. Decreased delta was seen for the active group Cumulative Effects of Anodal tDCS on EEG between the first qEEG and the last, at Fp2. Oscillations and Attention Regulation Increases in alpha were seen for the active Among Individuals With Traumatic Brain group at both F3 and Fp2 between the first Injury qEEG and the final posttreatment qEEG. No sig- nificant EEG changes were seen for shams. The Fred Ulam active group with EEG slowing at the outset Missouri Rehabilitation Center, University of showed significant improvement in seven of Missouri Health System nine neuropsychological tests, whereas the Ben Hunter active group without slowing improved on only Forest Institute of Professional Psychology one test. Shams with slowing improved on three of nine tests, as did shams without slowing. Purpose The purpose of this study is to explore the Conclusions effects of transcranial direct current stimulation This preliminary, exploratory study suggests (tDCS) on EEG oscillations and attention regu- tDCS can safely modulate cortical excitability lation among individuals with traumatic brain among victims of TBI with beneficial effects injuries (TBI) undergoing inpatient neuroreh- on attention regulation. abilitation. Subjects Concussion Hits Hard: Recovery from the Multiple Effects of Concussion: Requires Twenty-six individuals with moderate to severe Interventions Be Based on an Appropriate TBIs participated in a randomized, placebo- Multimodal Assessment controlled, double-blind study of tDCS, with 13 in the active and 13 in the sham groups. Lynda Thompson and Michael Thompson 288 PROCEEDINGS OF THE 2013 ISNR CONFERENCE

ADD Centre and Biofeedback Institute of of response time. This should be combined Toronto with neuropsychological testing, in particular for short- and long-term memory, attention Assessment of the patient who has suffered a span, impulsivity and questionnaires regarding concussion should first be carried out by a medical health, depression, and anxiety. When knowledgeable medical specialist. However, available, balance assessment of vestibular MRI, PET, and CAT scans often show no abnor- function with a ‘‘force-plate’’ can be helpful. mality. In addition, traditional rehabilitation Extended biochemical assessment can be often meets the criteria of conservative ‘‘do added, and this can lead to appropriate dietary no harm’’ but may do little to remedy the and supplement interventions. This presen- deficiencies caused by minimal-to-moderate tation reviews some of the literature on TBI injury. This presentation suggests a method- and the connection to cardiac problems. It then ology for efficient and accurate assessment that outlines the neuroanatomical underpinnings can lead to effective intervention. The EEG and regarding why, how, and with what effect evoked potentials (ERP) can reveal the effects of LORETA–-score NFB can be used in conjunc- damage elicited by stretching and twisting of tion with some combination of HRV training, axons, called diffuse axonal injury (DAI). The transcranial direct current stimulation, passive evoked potentials are particularly important infrared feedback, and metacognitive strate- for reflecting brain speed. Concussion may gies, in addition to dietary interventions, to injure the right and=or left insula. This will bring a client back to high-level functioning. impair heart rate variability. Thus, concussion The theoretical aspects of this presentation will assessment should measure QEEG, ERPs, be supported by case examples: a PhD candi- HRV, and, using continuous performance tests, date in artificial intelligence, an author, a gradu- measure attention, impulsivity, and variability ate student in finance, and an athlete.