Neurofeedback Therapy Research Articles

Electroencephalographic neurofeedback: Level of evidence in mental and brain disorders and suggestions for good clinical practice

The technique of electroencephalographic neurofeedback (EEG NF) emerged in the 1970s and is a technique that measures a subject's EEG signal, processes it in real time, extracts a parameter of interest and presents this information in visual or auditory form. The goal is to effectuate a behavioural modification by modulating brain activity. The EEG NF opens new therapeutic possibilities in the fields of psychiatry and neurology. However, the development of EEG NF in clinical practice requires (i) a good level of evidence of therapeutic efficacy of this technique, (ii) a good practice guide for this technique. Firstly, this article investigates selected trials with the following criteria: study design with controlled, randomized, and open or blind protocol, primary endpoint related to the mental and brain disorders treated and assessed with standardized measurement tools, identifiable EEG neurophysiological targets, underpinned by pathophysiological relevance. Trials were found for: epilepsies, migraine, stroke, chronic insomnia, attentional-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, major depressive disorder, anxiety disorders, addictive disorders, psychotic disorders. Secondly, this article investigates the principles of neurofeedback therapy in line with learning theory. Different underlying therapeutic models are presented didactically between two continua: a continuum between implicit and explicit learning and a continuum between the biomedical model (centred on "the disease") and integrative biopsychosocial model of health (centred on "the illness"). The main relevant learning model is to link neurofeedback therapy with the field of cognitive remediation techniques. The methodological specificity of neurofeedback is to be guided by biologically relevant neurophysiological parameters. Guidelines for good clinical practice of EEG NF concerning technical issues of electrophysiology and of learning are suggested. These require validation by institutional structures for the clinical practice of EEG NF.

The mechanism of neurofeedback training for treatment of central neuropathic pain in paraplegia: a pilot study.

BackgroundCentral neuropathic pain has a prevalence of 40 % in patients with spinal cord injury. Electroencephalography (EEG) studies showed that this type of pain has identifiable signatures, that could potentially be targeted by a neuromodulation therapy. The aim of the study was to investigate the putative mechanism of neurofeedback training on central neuropathic pain and its underlying brain signatures in patients with chronic paraplegia.MethodsPatients’ EEG activity was modulated from the sensory-motor cortex, electrode location C3/Cz/C4/P4 in up to 40 training sessions Results. Six out of seven patients reported immediate reduction of pain during neurofeedback training. Best results were achieved with suppressing Ɵ and higher β (20–30 Hz) power and reinforcing α power at C4. Four patients reported clinically significant long-term reduction of pain (>30 %) which lasted at least a month beyond the therapy. EEG during neurofeedback revealed a wide spread modulation of power in all three frequency bands accompanied with changes in the coherence most notable in the beta band. The standardized low resolution electromagnetic tomography analysis of EEG before and after neurofeedback therapy showed the statistically significant reduction of power in beta frequency band in all tested patients. Areas with reduced power included the Dorsolateral Prefrontal Cortex, the Anterior Cingulate Cortex and the Insular Cortex.ConclusionsNeurofeedback training produces both immediate and longer term reduction of central neuropathic pain that is accompanied with a measurable short and long term modulation of cortical activity. Controlled trials are required to confirm the efficacy of this neurofeedback protocol on treatment of pain. The study is a registered UKCRN clinical trial Nr 9824.

Effectiveness of Neurofeedback Associated with Cognitive Rehabilitation Therapy on Children with Attention Defect Hyperactivity Disorder (ADHD)

Objectives: Neurofeedback is known as a modern therapy for hyperactive children, nevertheless it is not a complete therapy for these patients. The goal of this therapy is to create a complete therapy for ADHD children, so neurofeedback is used with cognitive rehabilitation therapy to make more integrated therapy. Method: this is an experimental study. 30 subjects were selected through random selection from women who referred to 5 clinics of Tehran city, and they were placed into 2 experimental groups and 1 control group. Groups are matched in age, sexuality and economic situation. One group just received neurofeedback into 10 sessions, another group received neurofeedback plus cognitive rehabilitation therapy at the same during, and control group received no therapy or they leaved the therapy at the first steps. Integrated visual and auditory test (IVA) was used as pretest and posttest, to measure two factors (attention and impulsivity) in ADHD children. Cognitive rehabilitation therapy protocol is based on work of Nejati (1391). Data evaluated by dependent T test and analysis of covariance. Results: according to findings, there is meaningful difference between all groups in attention and impulsivity factors. The group who received neurofeedback plus cognitive rehabilitation therapy showed more improvement in attention and impulsivity factors. Also there was a meaningful difference between neurofeedback group and control group in attention factor. Conclusion: neurofeedback is supposed as a facilitator therapy to improve attention factor in ADHD children, but not as a complete therapy, especially about performance factors. Also, it is better to use a complementary therapy such as cognitive rehabilitation therapy that focuses more on performance factors. It leads to more positive effects on impulsivity or even hyperactivity.

Evaluation of the effectiveness of neurofeedback in the reduction of Posttraumatic stress disorder (PTSD) in a patient following high-voltage electric shock with the use of ERPs

The aim of our research was an evaluation of the effectiveness of neurofeedback in reducing the symptoms of Post-trauma stress disorder (PTSD), which had developed as a result of a high-voltage electric burn to the head. Quantitative EEG (QEEG) and Event related potentials (ERPs) were utilised in the evaluation. A 21-year-old patient, experienced 4(th) degree burns to his head as a result of a high-voltage electric burn. The patient was repeatedly operated on and despite the severity of the injuries was to recover. However the patient complained of flashbacks, difficulties with sleeping as well as an inability to continue work in his given profession. Specialist tests were to show the presence within him of PTSD. As a result of which the patient was provided with neurofeedback therapy. The effectiveness of this therapy in the reduction (eradication) of the symptoms of PTSD were evaluated through the utilisation of qantitative eeg (Qeeg) and event related potentials (ERPs). It was found that in the first examination that ERPs display the most significant deviations from the reference in the two components: (1) the one component is generated within the cingulate cortex. The pattern of its deviation from the norms is similar to that found in a group of OCD patients. In contrast to healthy subjects the component repeats itself twice; (2) the second component is generated in the medial prefrontal cortex. Its pattern (neuromarker) is similar to that found in PTSD patients. There is a delay in the late part of the component, which probably reflects the flashbacks. In the second examination, after neurofeedback training, the ERPs were similar to the norm. The patient returned to work. Chronic PTSD developed within the patient as a result of a high-voltage electric burn. The application of a method of therapy (neurofeedback) resulted in the withdrawal of the syndrome symptoms. ERPs in a GO/NOGO task can be used to plan neurofeedback and in the assessment of functional brain changes induced by neurotherapeutic programmes. Funds Collection: Private sources.

The Effectiveness of Neurofeedback Therapy in Craving of Methamphetamine Use

Introduction: Relapse in methamphetamine dependency is one of the most difficult parts to treat. Therefore treatment of craving for usage is one of the essential sections of treatment in methamphetamine dependency (addiction). This study evaluates the effect of neurofeedback therapy on craving for use. Methods: In this study 20 male patient with methamphetamine dependency who diagnosed on the basis of DSM-V were selected. None of the patients had any psychiatric and neurologic disorder except addiction of methamphetamine. Patients were divided into 2 groups of 10. The first group has taken real neurofeedback therapy sessions while the second has undergone non-real neurofeedback (sham) therapy. Then the two groups have been compared with t-test. Result: The result shows that in the first group (real neurofeedback), craving for methamphetamine use has been decreased significantly whereas in the second group (non-real or sham), the decrease was not significant. Conclusion: Neurofeedback therapy is effective in treatment of craving for methamphetamine use.

Evaluation of Neurofeedback Therapy in Adolescents with Major Depressive Disorder Who Take Fluoxetine

Introduction: Major depression is one of the most common psychiatric disorders that is with depressed mood and characterized by feelings of sadness, low self esteem and lack of interest or pleasure in daily activities. Objective: The main aim of this article is comparison of efficacy of real neurofeedback therapy versus sham (unreal or placebo) in adolescents with major depressive disorder in Iran, Mashhad. Material & Method: This study included 28 adolescents with major depression that were diagnosed by psychiatric interview according to DSM -V and Hamilton scale. They were randomly divided into two groups. All patients were treated with 20 mg of fluoxetine. Half received neurofeedback treatment on F3 region and the other half received unreal neurofeedback treatment or sham (placebo). Immediately after the 20th session Hamilton test was conducted. Results: The efficacy of treatment with real and unreal neurofeedback on adolescents' depression shows difference in scores. The differences between pre-test and post-test scores within each group and finally between the two groups were compared using independent t-test. According to the results, the index calculated t (-0.9) is not significant. So there is no significant difference between real and unreal neurofeedback effects. Conclusion: This study shows that real neurofeedback therapy was effective; but this efficacy was not significantly different from unreal neurofeedback therapy in adolescent depression. This means that in F3 region, the effect of real neurofeedback therapy was not any different from unreal neurofeedback on adolescents' depression. Experiments on other regions are suggested.

Effectiveness of Neuro-feedback on Mathematics Disorder

Background and Purpose: Because of the importance of treatment of learning disorders, this study was conducted to evaluate the treatment of mathematics disorder as one of the learning disabilities by using neurofeedback. Method: In this study, 28 third grade-primary school children were selected by psychiatric interview, academic records and third grade mathematic test result. One group (N=14) received neurofeedback treatment and on the other group (N=14) non-real neurofeedback treatment (sham or placebo) was conducted. Neurofeedback treatment was performed based on enhancement of beta/theta ratio in CZ region. Each child received 20 sessions of neurofeedback therapy for 10-12 weeks. Each session lasted 30 minutes. The mathematics test was done three times: before neurofeedback treatment, after the 20th session, and after a year as a follow up. Results: The two groups were matched for age, education, sex and degree of intelligence and severity of mathematics disorder. The comparison between real and sham groups showed that the effect of real neurofeedback therapy was significant versus sham group (P<0.05). A significant increase was seen in consecutive math results in experimental group compared with sham group (P<0.01). The difference trend was linear (P<0.05). The difference between pre-test and post-test was significant only in males and not significant in females. Conclusion: In group with real neurofeedback therapy, mathematics performance was improved significantly. This neurofeedback effect was also seen after a one-year follow up (P<0.01). In separate evaluation between boys and girls, the significant effect was only seen in boys.

The Effect of Neurofeedback Therapy in Primary Enuretic Children

Introduction: Enuresis is one of the most common psychiatric disorders in children. Classical treatments for primary enuretic children are conditioning (Bell and Pad method, and drug therapy). Neurofeedback is a kind of conditioning by changing amplitudes of brain waves. Method: Three groups of 10 enuretic children were selected randomly. All three groups took imipramine. The first group also took neurofeedback sessions with protocol of enhancement of β/θ wave ratio in occipital zone. The second group took non-real neurofeedback sessions beside the drug. The third group just took the drug. Result: All three groups showed significant remission (P Neurofeedback by this protocol was not any more efficient than imipramine therapy by itself.

EEG Neurofeedback therapy: Can it attenuate brain changes in TBI?

Electroencephalogram Neurofeedback therapy (EEG-NFT) has several potential beneficial effects in terms of improving cognition and electrophysiological regulation among patients with brain injury. However, in vivo structural and functional changes remain less explored. The aim of the present study is to explore EEG-NFT induced in vivo changes in traumatic brain injury (TBI) patients. Two patients with mean age of 15 years with moderate head injury who had more than seven post concussion symptoms and poor cognitive performances (<5 percentile) were subjected to 20 sessions of EEG-NFT. The neuropsychological test scores, post concussion symptoms and MRI scan of the brain were recorded pre-post to EEG-NFT. During EEG-NFT the cognitive scores and concussion symptoms improved significantly (p < 0.05). The EEG-NFT has shown significant increase in cortical grey matter (GM) volumes (p < 0.0001) and fractional anisotropy (FA) of cortical white matter (WM) tracts (p < 0.0001, voxel max 60 and above). There was a significant decrease in global, local efficiency, cost and clustering coefficient of functional connectivity (Wilcoxon Sign Rank Test p < 0.05). Interestingly there was a significant increase in thalamo-cortical connection (increase FA value) after EEG-NFT. The EEG-NFT therapy has shown significant changes in structural and functional connectivity among young moderately injured TBI patients.

Neurofeedback as supportive therapy after stroke. Case report

Abstract Background New developments and trends in neurophysiology are presented from the point of view of diagnostics and the new technology available. Based on their own experiences and the literature available, the authors have analyzed neurofeedback, a new rehabilitation method which combines elements of psycho- and neurophysiotherapy. Objective To explore the usefulness of neurofeedback therapy for stroke patients. The progress of a female patient with Broca's aphasia receiving therapy is analyzed, in which neurofeedback was used alongside more traditional rehabilitation methods. Methods The report describes the case of a 53-year-old woman following a hemorrhagic stroke in the left hemisphere, with a past myocardial infarction, hypertension and 40-year-long history of cigarette smoking. A number of tests were used to assess the patient's neurological and neuropsychological functioning. Results An increase in the proportion of β waves in the left hemisphere of the brain and an increase in the amplitude of the SMR in the right hemisphere. Δ and τ waves decreased in both amplitude and percentage in the two hemispheres. Also, a reduction in the τ/β to τ/SMR ration was observed. In comparative tests positive results obtained in terms of: concentration, visual perception, categorizing, as well as the regulation of affect and reduction in the aphasia symptoms. Conclusions Previous studies suggest that neurofeedback leads to lasting symptom reduction. This needs to be confirmed with tests on larger samples using standardized assessment procedures.

Z-score LORETA Neurofeedback as a Potential Rehabilitation Modality in Patients with CVA

This is multi-case presentation describing promising rehabilitation results of Z-score LORETA neurofeedback therapy of patients suffering from prior stroke. Potential benefits include improved cognitive function and motor performance.

Z-Score LORETA Neurofeedback as a Potential Therapy for ADHD

Attention deficit hyperactivity disorder (ADHD) is a disorder of relatively high prevalence and frequently contributes to poor school and work performance. Neurofeedback (NFB) has proven to be an effective therapeutic modality in the treatment of ADHD. Recently introduced z-score LORETA neurofeedback offers promise as a tool, and appears to provide a more efficient therapy than standard two-channel neurofeedback. This advantage is based on the ability to train 19 channels simultaneously, and the ability to directly target an electrically dysregulated area of the brain, which may be more difficult to access with standard neurofeedback therapy (areas addressed with LORETA neurofeedback include the cingulate gyrus and hippocampal structures). This paper presents our experience with Z-score LORETA neurofeedback in the treatment of ADHD.

Improvement of Neurofeedback Therapy for Improved Attention Through Facilitation of Brain Activity Using Local Sinusoidal Extremely Low Frequency Magnetic Field Exposure

Traditional neurofeedback (NF) is a training approach aimed at altering brain activity using electroencephalography (EEG) rhythms as feedback. In NF training, external factors such as the subjects' intelligence can have an effect. In contrast, a low-energy NF system (LENS) does not require conscious effort from the subject, which results in fewer attendance sessions. However, eliminating the subject role seems to eliminate an important part of the NF system. This study investigated the facilitating effect on the theta-to-beta ratio from NF training, using a local sinusoidal extremely low frequency magnetic field (LSELF-MF) versus traditional NF. Twenty-four healthy, intelligent subjects underwent 10 training sessions to enhance beta (15-18 Hz), and simultaneously inhibit theta (4-7 Hz) and high beta (22-30 Hz) activity, at the Cz point in a 3-boat-race video game. Each session consisted of 3 statuses, PRE, DURING, and POST. In the DURING status, the NF training procedure lasted 10 minutes. Subjects were led to believe that they would be exposed to a magnetic field during NF training; however, 16 of the subjects who were assigned to the experimental group were really exposed to 45 Hz-360 µT LSELF-MF at Cz. For the 8 other subjects, only the coil was located at the Cz point with no exposure. The duty cycle of exposure was 40% (2-second exposure and 3-second pause). The results show that the theta-to-beta ratio in the DURING status of each group differs significantly from the PRE and POST statuses. Between-group analysis shows that the theta-to-beta ratio in the DURING status of the experimental group is significantly (P < .001) lower than in the sham group. The result shows the effect of LSELF-MF on NF training.

Combined use of conventional medicine with traditional Korean medicine to treat children with epilepsy.

Few studies have been conducted among pediatric patients to examine clinical outcomes associated with the combined use of Oriental medicine and other therapies to treat epilepsy. The purpose of this study was to examine the clinical and laboratory characteristics of children with epilepsy being treated with traditional Korean medicine (TKM) in addition to their conventional antiepileptic drugs (AEDs), and to survey whether other nonpharmacologic combination treatments were also being used. The study included 398 pediatric patients with epilepsy being treated at the Pediatric Neurology Clinic of Pusan National University Children's Hospital. A questionnaire-based survey was carried out to determine the extent to which combination treatments were being used from March 1 to July 31, 2011. Of the 398 epileptic patients, 75 (18.8%) were receiving treatment based on TKM in addition to their AED treatment. The number of AEDs used was significantly greater in this group (mean ± standard deviation, 2.3 ± 1.5) than in the group not receiving TKM (2.0 ± 1.2; p=.028). The number of seizure-free patients in the TKM group (44 patients [59%]) was significantly reduced (p=.037) compared with the group not receiving such treatment (236 patients [73%]). Of the 398 patients, 237 (59.5%) were receiving other combination treatments. Fifty-six of the 75 patients (74.7%) in the TKM group were receiving other combination treatments (p<.001 compared with nonusers), which included language therapy, education therapy (music therapy, art therapy), Chuna therapy, and health food supplements (p=.004, p<.001, p=.011, and p=.004, respectively). The use of other combination treatments, such as rehabilitation therapy, counseling, cognitive behavioral therapy, and neurofeedback therapy, did not differ between the two groups. The TKM group took more AEDs and had fewer seizure-free patients and more patients receiving other combination treatments, such as language, music, and art therapies.

Effect of Neurofeedback and Electromyographic-Biofeedback Therapy on Improving Hand Function in Stroke Patients

Purpose: The aim of the present study was to evaluate the effect of applying electroencephalogram (EEG) biofeedback (neurobiofeedback) or electromyographic (EMG) biofeedback to conventional occupational therapy (OT) on improving hand function in stroke patients. Methods: This study was designed as a preliminary clinical trial. Thirty patients with stroke were entered the study. Hand function was evaluated by Jebsen Hand Function Test pre and post intervention. Patients were allocated to 3 intervention cohorts: (1) OT, (2) OT plus EMG-biofeedback therapy, and (3) OT plus neurofeedback therapy. All patients received 10 sessions of conventional OT. Patients in cohorts 2 and 3 also received EMG-biofeedback and neurofeedback therapy, respectively. EMG-biofeedback therapy was performed to strengthen the abductor pollicis brevis (APB) muscle. Neurofeedback training was aimed at enhancing sensorimotor rhythm after mental motor imagery. Results: Hand function was improved significantly in the 3 groups. The spectral power density of the sensorimotor rhythm band in the neurofeedback group increased after mental motor imagery. Maximum and mean contraction values of electrical activities of the APB muscle during voluntary contraction increased significantly after EMG-biofeedback training. Conclusion: Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT. Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy.

Effectiveness of Neurofeedback Therapy in Children with Separation Anxiety Disorder

Background: Anxiety disorders are one of the most common psychiatric disorders in children. Its incidence is 2-5% of children and adolescents under age 18. Anxiety disorders are more common in girls than boys. It may start in pre-school, but mostly are in age of 7 to 8 years old. Method: The main objective of this article was to find out the effect of neurofeedback therapy in children with separation-anxiety disorder. Study population was Children from 7 to 12 years old with separation anxiety disorder who were referred to the child psychiatric clinic and they were divided randomly into two groups of 12. One group (N=12) received neurofeedback therapy and the other group (N=12) received sham neurofeedback therapy (placebo). Data was analyzed with t- test by 21th version SPSS software.

An exploration of EEG features during recovery following stroke - implications for BCI-mediated neurorehabilitation therapy

BackgroundBrain-Computer Interfaces (BCI) can potentially be used to aid in the recovery of lost motor control in a limb following stroke. BCIs are typically used by subjects with no damage to the brain therefore relatively little is known about the technical requirements for the design of a rehabilitative BCI for stroke.Methods32-channel electroencephalogram (EEG) was recorded during a finger-tapping task from 10 healthy subjects for one session and 5 stroke patients for two sessions approximately 6 months apart. An off-line BCI design based on Filter Bank Common Spatial Patterns (FBCSP) was implemented to test and compare the efficacy and accuracy of training a rehabilitative BCI with both stroke-affected and healthy data.ResultsStroke-affected EEG datasets have lower 10-fold cross validation results than healthy EEG datasets. When training a BCI with healthy EEG, average classification accuracy of stroke-affected EEG is lower than the average for healthy EEG. Classification accuracy of the late session stroke EEG is improved by training the BCI on the corresponding early stroke EEG dataset.ConclusionsThis exploratory study illustrates that stroke and the accompanying neuroplastic changes associated with the recovery process can cause significant inter-subject changes in the EEG features suitable for mapping as part of a neurofeedback therapy, even when individuals have scored largely similar with conventional behavioural measures. It appears such measures can mask this individual variability in cortical reorganization. Consequently we believe motor retraining BCI should initially be tailored to individual patients.

Effectiveness of Neurofeedback Therapy in Children with Separation Anxiety Disorder

Effectiveness of Neurofeedback Therapy in Children with Separation Anxiety Disorder

Determination of the Effects of Neurofeedback Training in the Neuropsychological Rehabilitation in Inattentive and Combined Subtypes of Attention Deficit/Hyperactivity Disorder

Introduction: The aim of the present study was to compare the effect of neurofeedback in neuropsychological rehabilitation of attention in children with combined (C) and predominantly inattentive (IA) subtypes of ADHD. Method: This research is a quasi-experimental study by which, from among 7–12 year old children referred to the Atiyeh Psychiatric Center, 30 children diagnosed with either Combined or predominantly Inattentive subtypes of ADHD (15 children in each subtype) underwent 30 sessions (3 sessions per week) of neurofeedback therapy. For assessing children's cognitive performance, the children in both treatment groups were administered before and after treatment with a time interval of 10 weeks, both the visual and auditory continuous performance tests (IVA). Patient diagnosis for assignment to either of two ADHD subtypes was carried out with the Conner’s rating scale, a Clinical Interview Checklist, and Psychiatrist evaluation. Results: Neurofeedback training significantly increased all IVA subscales scores, with the exception of the Balance scale, in all subjects, regardless of treatment group (subtype). Results of MANOVA analysis indicated that the two subtypes did not differ in terms of effectiveness of neurofeedback training with the exception of the Readiness scale. Conclusion: The present findings supported the efficacy of Neurofeedback training in increasing children’s scores on the IVA-CPS battery of tests, regardless of subtype classification. These findings are interpreted within recent theoretical and developments regarding the validity of subtypes and the usefulness of a dimensional approach.

Brain Inconspicuous Effect by Local Sinusoidal Extremely Low Frequency Magnetic Exposure Based on Wavelet Packet Analysis: Innovation in Online Passive Neurofeedback Therapy by the Neuro-LSELF System

Neurofeedback (NF) is a training approach that aims to reinforce brain activity by using the information of human electroencephalogram (EEG) rhythms as a feedback. In addition, some studies have reported Extremely Low Frequency (0–300 Hz, intensity < 500 µT) Magnetic Field (ELF MF) effects upon the EEG and its rhythms. The purpose of this study is to determine if an approach that combines the effects of Local Sinusoidal Extremely Low Frequency Magnetic Fields (LSELF MF) with NF yields higher performance on desired NF goals. The NF protocol used in this study consisted of enhancement of the beta rhythm and inhibition of theta and high beta rhythms in exposed and sham groups for the purpose of improving attention. Twenty-four healthy subjects of at least average intelligence attended 10 sessions of NF training. Sixteen of them were exposed to 45 Hz sinusoidal ELF (360 µT) at F3 to lead to the desired LSELF MF effects on Cz. Wavelet packet analysis was used for the detection of changes in EEG rhythms. Result...