Neurofeedback Research Articles

30.1 EEG Learning Parameters in the ICAN Double-Blind RCT of Neurofeedback for ADHD

The objective is to explore which neurofeedback (NF) session parameters, such as EEG data, movement, and muscle artifact, identify NF learners vs nonlearners in the International Collaborative ADHD Neurofeedback (ICAN) randomized double-blind trial.

Infra-low frequency neurofeedback and insomnia as a model of CNS dysregulation.

This paper will review what is conventionally known of sleep homeostasis and focus on insomnia as a primary manifestation of brain dysregulation, whether as a solitary symptom or as part of a larger syndrome such as post-traumatic stress disorder, PTSD. It will discuss in brief behavioral/mindfulness treatments that have been used to treat neurologic diseases, as this is germane to the phenomenology of neurofeedback (NF). It will explore how neurofeedback may work at the subconscious level and cover the current clinical experience of the effectiveness of this technique in the treatment of insomnia. It will conclude with a case presentation.

Neurofeedback in patients with frontal brain lesions: A randomized, controlled double-blind trial.

BackgroundFrontal brain dysfunction is a major challenge in neurorehabilitation. Neurofeedback (NF), as an EEG-based brain training method, is currently applied in a wide spectrum of mental health conditions, including traumatic brain injury.ObjectiveThis study aimed to explore the capacity of Infra-Low Frequency Neurofeedback (ILF-NF) to promote the recovery of brain function in patients with frontal brain injury.Materials and methodsTwenty patients hospitalized at a neurorehabilitation clinic in Switzerland with recently acquired, frontal and optionally other brain lesions were randomized to either receive NF or sham-NF. Cognitive improvement was assessed using the Frontal Assessment Battery (FAB) and the Test of Attentional Performance (TAP) tasks regarding intrinsic alertness, phasic alertness and impulse control.ResultsWith respect to cognitive improvements, there was no significant difference between the two groups after 20 sessions of either NF or sham-NF. However, in a subgroup of patients with predominantly frontal brain lesions, the improvements measured by the FAB and intrinsic alertness were significantly higher in the NF-group.ConclusionThis is the first double-blind controlled study using NF in recovery from brain injury, and thus also the first such study of ILF NF. Although the result of the subgroup has limited significance because of the small number of participants, it accentuates the trend seen in the whole group regarding the FAB and intrinsic alertness (p = 0.068, p = 0.079, respectively). We therefore conclude that NF could be a promising candidate promoting the recoveryfrom frontal brain lesions. Further studies with larger numbers of patients and less lesion heterogeneity are needed to verify the usefulness of NF in the neurorehabilitation of patients with frontal brain injury (NCT02957695 ClinicalTrials.gov).

Neurofeedback for the Education of Children with ADHD and Specific Learning Disorders: A Review.

Neurofeedback (NF) is a type of biofeedback in which an individual’s brain activity is measured and presented to them to support self-regulation of ongoing brain oscillations and achieve specific behavioral and neurophysiological outcomes. NF training induces changes in neurophysiological circuits that are associated with behavioral changes. Recent evidence suggests that the NF technique can be used to train electrical brain activity and facilitate learning among children with learning disorders. Toward this aim, this review first presents a generalized model for NF systems, and then studies involving NF training for children with disorders such as dyslexia, attention-deficit/hyperactivity disorder (ADHD), and other specific learning disorders such as dyscalculia and dysgraphia are reviewed. The discussion elaborates on the potential for translational applications of NF in educational and learning settings with details. This review also addresses some issues concerning the role of NF in education, and it concludes with some solutions and future directions. In order to provide the best learning environment for children with ADHD and other learning disorders, it is critical to better understand the role of NF in educational settings. The review provides the potential challenges of the current systems to aid in highlighting the issues undermining the efficacy of current systems and identifying solutions to address them. The review focuses on the use of NF technology in education for the development of adaptive teaching methods and the best learning environment for children with learning disabilities.

SPECIAL ISSUE: Do Biofeedback, Neurofeedback, and Neuromeditation Have a Role in Psychedelic-Assisted Therapies?

SPECIAL ISSUE: Do Biofeedback, Neurofeedback, and Neuromeditation Have a Role in Psychedelic-Assisted Therapies?

Learning Curve of a Short-Time Neurofeedback Training: Reflection of Brain Network Dynamics Based on Phase-Locking Value

Neurofeedback (NF) training is a type of online biofeedback in which neural activity is measured and provided to the participant in real time to facilitate the top-down control of specific activation patterns. To improve the training efficiency, an investigation on the learning of EEG regulation and effect on neural activity during NF is critical. This article attempts to analyze the learning curve and the dynamics of the phase-locking value (PLV)-based brain network for a short-time EEG-based NF, in which 28 participants carried out alpha downregulating NF training in two consecutive days. The results reveal that participants could successfully construct the related learning network to achieve the training goals in the first day training and the beginning of the second day training. Moreover, the learning plateaus were discovered from the results of the relative amplitude and the functional brain network in the middle of the second day training. These findings could be helpful for better understanding of the learning process in NF from the functional connectivity viewpoint and would contribute to building a more efficient learning protocol for NF training.

Development of a brain wave model based on the quantitative analysis of EEG and EEG biofeedback therapy in patients with panic attacks during the COVID-19 pandemic

The current global crisis facing the world is the COVID-19 pandemic. Infection from the SARS-CoV-2 virus leads to serious health complications and even death. As it turns out, COVID-19 not only physically assails the health of those infected, but also leads to serious mental illness regardless of the presence of the disease. Social isolation, fear, concern for oneself and one's loved ones, all of this occurs when a pandemic overloads people. People exhibit numerous neurological disorders that have never happened to them before. Patients are diagnosed with frequent panic attacks, the result of which can be seen in their Quantitative Electroencephalogram results. This test may be one of the main diagnostic tools of the COVID-19 pandemic. From the results obtained, it is possible to compare and draw conclusions. This method of testing effectively allows EEG biofeedback training and observes its effect on brain activity. The feedback received in this way gives us the opportunity to properly tailor a protocol for the patient and their conditions. Numerous studies support the effectiveness of EEG biofeedback for panic attacks and other psychiatric disorders. The purpose of our study was to show the effectiveness of EEG biofeedback with a Quantitative Electroencephalogram of the brainwave pattern after having COVID-19 and what symptoms may result.

The effect of neurofeedback training combined with computer cognitive games on the time perception, attention, and working memory in children with ADHD

Objective The purpose of this study was to examine the effect of neurofeedback (NF) based on quantitative electroencephalography (QEEG) and SmartMind game on the time perception, attention, and working memory of children with Attention Deficit/Hyperactivity Disorder (ADHD) through an experimental design. Method Using a purposive sampling method, 32 male students diagnosed with ADHD were selected and then randomly assigned to an experimental group and a control group. The experimental group received the treatment (NF + SmartMind) for 30 weekly sessions. Children’s performances on a time perception test, a Continuous Performance Test (CPT), and a Wechsler working memory test (WISC) were examined before and after the intervention. Results A significant difference was observed between the mean scores of the pretest and post-test for the experimental group, implying that NF training improved short-time perception and long-time perception attention in CPT test: omission error component, Correct Response component, and working memory: Visual forward component. However, the treatment did not have a significant effect on the commission error component (CPT), working memory in terms of the visual reverse, auditory reverse, and auditory forward components. Conclusion NF combined with computer cognitive games (CCGs) can improve time perception, attention, and working memory in children with ADHD.

Frontal alpha asymmetry interaction with an experimental story EEG brain-computer interface.

Although interest in brain-computer interfaces (BCIs) from researchers and consumers continues to increase, many BCIs lack the complexity and imaginative properties thought to guide users toward successful brain activity modulation. We investigate the possibility of using a complex BCI by developing an experimental story environment with which users interact through cognitive thought strategies. In our system, the user's frontal alpha asymmetry (FAA) measured with electroencephalography (EEG) is linearly mapped to the color saturation of the main character in the story. We implemented a user-friendly experimental design using a comfortable EEG device and short neurofeedback (NF) training protocol. In our system, seven out of 19 participants successfully increased FAA during the course of the study, for a total of ten successful blocks out of 152. We detail our results concerning left and right prefrontal cortical activity contributions to FAA in both successful and unsuccessful story blocks. Additionally, we examine inter-subject correlations of EEG data, and self-reported questionnaire data to understand the user experience of BCI interaction. Results suggest the potential of imaginative story BCI environments for engaging users and allowing for FAA modulation. Our data suggests new research directions for BCIs investigating emotion and motivation through FAA.

A neurotherapy protocol to remediate cognitive deficits after adjuvant chemotherapy: a pilot study.

Adjuvant chemotherapy for breast cancer is undeniably effective in increasing survival rates but many breast cancer survivors (BCS) exhibit side effects including nausea, fatigue, stress, and neurocognitive deficits, known as "chemobrain." This pilot study explored how neurotherapy, or EEG biofeedback, a non-pharmacological approach, improved neurocognitive, behavioral, and neurophysiological deficits associated with BCS who underwent chemotherapy. Subjects underwent 18 sessions of EEG biofeedback training, in which audio and visual feedback occurred with successful shifting of EEG patterns. Quantitative EEG and assessment tests demonstrated neurophysiological, cognitive, and behavioral deficits in all nine subjects prior to training. EEG biofeedback resulted in significant improvements in neurophysiological, neurocognitive, and psychological functions in all nine subjects after training. We propose that this intervention and related forms of EEG biofeedback have the potential to significantly alleviate common side effects of chemotherapy in BCS and therefore merits additional research attention.

Toward an Adapted Neurofeedback for Post-stroke Motor Rehabilitation: State of the Art and Perspectives.

Stroke is a severe health issue, and motor recovery after stroke remains an important challenge in the rehabilitation field. Neurofeedback (NFB), as part of a brain–computer interface, is a technique for modulating brain activity using on-line feedback that has proved to be useful in motor rehabilitation for the chronic stroke population in addition to traditional therapies. Nevertheless, its use and applications in the field still leave unresolved questions. The brain pathophysiological mechanisms after stroke remain partly unknown, and the possibilities for intervention on these mechanisms to promote cerebral plasticity are limited in clinical practice. In NFB motor rehabilitation, the aim is to adapt the therapy to the patient’s clinical context using brain imaging, considering the time after stroke, the localization of brain lesions, and their clinical impact, while taking into account currently used biomarkers and technical limitations. These modern techniques also allow a better understanding of the physiopathology and neuroplasticity of the brain after stroke. We conducted a narrative literature review of studies using NFB for post-stroke motor rehabilitation. The main goal was to decompose all the elements that can be modified in NFB therapies, which can lead to their adaptation according to the patient’s context and according to the current technological limits. Adaptation and individualization of care could derive from this analysis to better meet the patients’ needs. We focused on and highlighted the various clinical and technological components considering the most recent experiments. The second goal was to propose general recommendations and enhance the limits and perspectives to improve our general knowledge in the field and allow clinical applications. We highlighted the multidisciplinary approach of this work by combining engineering abilities and medical experience. Engineering development is essential for the available technological tools and aims to increase neuroscience knowledge in the NFB topic. This technological development was born out of the real clinical need to provide complementary therapeutic solutions to a public health problem, considering the actual clinical context of the post-stroke patient and the practical limits resulting from it.

Novel EEG-Based Neurofeedback System Targeting Frontal Gamma Activity of Schizophrenia Patients to Improve Working Memory.

Patients with schizophrenia (SCZ) exhibit working memory (WM) deficits that are associated with deficient dorsal-lateral prefrontal cortical activity, including decreased frontal gamma power. We thus hypothesized that training SCZ patients to increase frontal gamma activity would improve their WM performance. We administered electroencephalographic (EEG) neurofeedback (NFB) to 31 participants with SCZ for 12 weeks (24 sessions), which provides real-time visual and auditory feedback related to frontal gamma activity. The EEG-NFB training significantly improved EEG markers of optimal working memory, e.g., frontal P3 amplitude and gamma power. Based on these promising results, we developed a novel, EEGLAB/MATLAB-based brain-computer interface (BCI) that delivers F3-F4 gamma coherence NFB with a dynamic threshold to SCZ patients randomized in a double-blind, placebo-controlled clinical trial. The BCI significantly increased F3-F4 gamma coherence after 12 weeks (24 sessions) of training, according to data from the first 12 subjects ( n=6 /group) who completed gamma- or placebo-NFB training.

One session of fMRI-Neurofeedback training on motor imagery modulates whole-brain effective connectivity and dynamical complexity

In the past decade, several studies have shown that Neurofeedback (NFB) by functional magnetic resonance imaging can alter the functional coupling of targeted and non-targeted areas. However, the causal mechanisms underlying these changes remain uncertain. Here, we applied a whole-brain dynamical model to estimate Effective Connectivity (EC) profiles of resting-state data acquired before and immediately after a single-session NFB training for 17 participants who underwent motor imagery NFB training and 16 healthy controls who received sham feedback. Within-group and between-group classification analyses revealed that only for the NFB group it was possible to accurately discriminate between the 2 resting-state sessions. NFB training-related signatures were reflected in a support network of direct connections between areas involved in reward processing and implicit learning, together with regions belonging to the somatomotor, control, attention, and default mode networks, identified through a recursive-feature elimination procedure. By applying a data-driven approach to explore NFB-induced changes in spatiotemporal dynamics, we demonstrated that these regions also showed decreased switching between different brain states (i.e. metastability) only following real NFB training. Overall, our findings contribute to the understanding of NFB impact on the whole brain’s structure and function by shedding light on the direct connections between brain areas affected by NFB training.

“Hyperfeedback” as a Tool to Assess and Induce Interpersonal Synchrony: The Role of Applied Social Neurosciences for Research, Training, and Clinical Practice

In the last 25 years, the field of neuroscience has seen exponential growth due to technological advances, which have not only allowed for collecting more accurate data, but also for addressing a variety of innovative studies for human development understanding. Neurofeedback (NF), and particularly Brain–Computer Interfaces (BCI) applications, are among the most promising methods, since they enable individuals to interact with a computer by using their brain activity to learn implicitly and train some specific cognitive and affective functions. These applications proved to be suitable for many different fields, from research to clinical practice. However, NF was used only in individual settings, with participants interacting with a computer, while more ecological and complex phenomena could be better explored in interactive contexts. In the present work, we propose that the future of BCI provided NF may lie in the development of interactive settings where two or more participants can be informed about their inter-brain synchrony to train and reinforce them towards enhanced joint interactions and promote learning and empowerment. We propose that BCI methods should move to brain-X-brain-computer interfaces (B2CI). In this new protocol, that we called “hyperfeedback,” brain signals coming from two people involved in a joint setting are processed so to provide a compound feedback. The possible applications of such a paradigm are discussed.

Biofeedback and Health Evidence-Based Biofeedback and Neurofeedback for People with Epilepsy and Seiz

Epilepsy is the fourth most common neurological disorder worldwide despite many anti-seizure medications. Biofeedback (BFB) and neurofeedback (NFB) have shown significant promise since the 1960s to improve seizure control, abnormalities in electroencephalography (EEG) and quantitative-EEG, and quality of life. Epilepsy is a disease of brain networks and BFB/NFB is a non-invasive, brain-centered, low-risk, low-cost, and reliable treatment for people with seizures/epilepsy and especially since standard seizure medications and epilepsy surgery often do not result in complete seizure control. Neuroscience healthcare clinician experience and a 60-year literature foundation show that BFB/NFB to improve brain dysregulation and abnormal network dynamics are known to be at the root of seizures/epilepsy. BFB/NFB trains individuals to self-regulate brain activity through real-time performance feedback. An exhaustive literature review for NFB/BFB and seizures/epilepsy (1960s–present) yielded 150 articles documenting improvements in seizures and EEG/QEEG abnormalities. Clinicians, insurers, and the public should support BFB/NFB as a first-line intervention for seizures/epilepsy.

A Single Session of SMR-Neurofeedback Training Improves Selective Attention Emerging from a Dynamic Structuring of Brain-Heart Interplay.

Research on sensorimotor rhythms (SMR) based on neurofeedback (NFb) emphasizes improvements in selective attention associated with SMR amplification. However, the long-term training proposed in most studies posed the question of acceptability, which led to the evaluation of the potential of a single NFb session. Based on cognitive and autonomic controls interfering with attention processes, we hypothesized changes in selective attention after a single SMR-NFb session, along with changes in brain–heart interplay, which are reflected in the multifractality of heartbeat dynamics. Here, young healthy participants (n = 35, 20 females, 21 ± 3 years) were randomly assigned either to a control group (Ctrl) watching a movie or to a neurofeedback (NFb) group performing a single session of SMR-NFb. A headset with EEG electrodes (positioned on C3 and C4) connected to a smartphone app served to guide and to evaluate NFb training efficacy. A Stroop task was performed for 8 min by each group before and after the intervention (movie vs. SMR-NFb) while collecting heart rate variability and C4-EEG for 20 min. When compared to Ctrl, the NFb group exhibited better Stroop performance, especially when facing incongruent trials. The multifractality and NFb training efficacy were identified as strong predictors of the gain in global Stroop performance, while multifractality was the only predictor regarding incongruent trials. We conclude that a single session of SMR-NFb improves selective attention in healthy individuals through the specific reorganization of brain–heart interplay, which is reflected in multifractal heartbeat dynamics.

Methodology and preliminary data on feasibility of a neurofeedback protocol to improve visual attention to letters in mild Alzheimer's disease

BackgroundBrain-computer interface (BCI) systems are controlled by users through neurophysiological input for a variety of applications, including communication, environmental control, and motor rehabilitation. Although individuals with severe speech and physical impairment are the primary users of this technology, BCIs have emerged as a potential tool for broader populations, including delivering cognitive training/interventions with neurofeedback (NFB). MethodsThis paper describes the development and preliminary testing of a protocol for use of a BCI system with NFB as an intervention for people with mild Alzheimer's disease (AD). The intervention focused on training visual attention and language skills, as AD is often associated with functional impairments in both. This funded pilot study called for enrolling five participants with mild AD in a six-week BCI EEG-based NFB intervention that followed a four-to-seven-week baseline phase. While two participants completed the study, the remaining three participants could not complete the intervention phase because of COVID-19 restrictions. ResultsPreliminary pilot results suggested: (1) participants with mild AD were able to participate in a study with multiple assessments per week and complete all outcome measures, (2) most outcome measures were reliable during the baseline phase, and (3) all participants with mild AD learned to operate a BCI spelling system with training. ConclusionsAlthough preliminary results demonstrate practical feasibility to deliver NFB intervention using a BCI to adults with AD, completion of the protocol in its entirety with more participants is needed to further assess whether implementing NFB-based cognitive intervention is justified by functional treatment outcomes. Trial registrationThis study was registered with ClinicalTrials.gov (NCT03790774).

Home-Based EEG Neurofeedback Intervention for the Management of Chronic Pain.

BackgroundChronic pain and associated symptoms often cause significant disability and reduced quality of life (QoL). Neurofeedback (NFB) as part of a Brain Computer Interface can help some patients manage chronic pain by normalising maladaptive brain activity measured with electroencephalography (EEG).ObjectivesThis study was designed to assess the efficacy and safety of a novel home-based NFB device for managing chronic pain by modifying specific EEG activity.MethodsA prospective, single-arm, proof-of-concept study was conducted between June 2020 and March 2021 among adults with chronic pain (registered with ClinicalTrials.gov NCT04418362). Axon EEG NFB systems for home use were provided to each, and 32–48 NFB training sessions were completed by the participants over 8-weeks. The primary outcome was self-reported pain. Assessment of central sensitisation, sleep quality, affective symptoms, change in QoL, adverse events during use and EEG correlations with symptoms were secondary outcomes.ResultsSixteen participants were enrolled. Eleven reported pain relief following NFB training, eight reporting clinically significant improvements. Central sensitisation symptoms improved by a third (p < 0.0001), sleep quality by almost 50% (p < 0.001), anxiety reduced by 40% (p = 0.015), and QoL improved at final follow-up for 13 participants. The majority (69%) of participants who upregulated relative alpha reported improved pain, and those who downregulated relative hi-beta reported improved pain, reduced anxiety and depression scores. There were no adverse events during the trial.ConclusionsHome-based NFB training is well-tolerated and may provide relief for sufferers of chronic pain and its associated symptoms.SummaryAxon, a home-based NFB training device, can positively influence pain and associated symptoms in a proportion of people with chronic pain.

Training the brain to time: the effect of neurofeedback of SMR–Beta1 rhythm on time perception in healthy adults

The timing ability plays an important role in everyday activities and is influenced by several factors such as the attention and arousal levels of the individuals. The effects of these factors on time perception have been interpreted through psychological models of time, including Attentional Gate Model (AGM). On the other hand, research has indicated that neurofeedback (NFB) training improves attention and increases arousal levels in the clinical and healthy population. Regarding the link between attentional processing and arousal levels and NFB and their relation to time perception, this study is a pilot demonstration of the influence of SMR-Beta1 (12-18Hz) NFB training on time production and reproduction performance in healthy adults. To this end, 12 (9 female and 3 males; M = 26.3, SD = 3.8) and 12 participants (7 female and 5 males; M = 26.9, SD = 3.1) were randomly assigned into the experimental (with SMR-Beta1 NFB) and control groups (without any NFB training), respectively. The experimental group underwent intensive 10 sessions (3days a week) of the 12-18Hz up-training. Time production and reproduction performance were assessed pre and post NFB training for all participants. Three-way mixed ANOVA was carried out on T-corrected scores of reproduction and production tasks. Correlation analysis was also performed between SMR-Beta1 and time perception. While NFB training significantly influenced time production (P < 0.01), no such effect was observed for the time reproduction task. The results of the study are finally discussed within the frameworks of AGM, dual-process and cognitive aspects of time perception. Overall, our results contribute to disentangling the underlying mechanisms of temporal performance in healthy individuals.

Assessing the mental state of attention using a neurofeedback system and serious game tool

Attention Deficit Hyperactivity Disorder (ADHD) is a neuropsychiatric disorder, which is predominantly treated with the administration of psychostimulants. A complementary alternative for ADHD treatment is the neurofeedback (NFB), a method in which patients are trained to perceive and control their physiology, regulate their own brainwaves. As the NFB has a repetitive aspect and can be long lasting, “serious games” may be used to maintain interest throughout the process. This paper presents the development of a NFB system to assess the mental state of attention and analyze the improvement of concentrated attention using the Neurofeedback Space, a Serious Game tool. We present a preliminary validation to choose the brain region and the signal processing algorithm to be used. Training accuracy of 98.12% and test accuracy of 93.88% were achieved. To test the complete NFB system, an experiment with 5 volunteers, and 5 sessions was carried out. Three evaluation metrics were used to analyze the performance of the proposed system: the game metrics, the ratios alpha/beta and theta/beta throughout the sessions, defined here as brain data, and the Concentrated Attention Test. Almost all volunteers improved their performance in the Concentrated Attention Test. Regarding the game metrics, it was possible to observe improvements in the Attention and Score between the most sessions. The brain data results were inconclusive, as there was no common behavior pattern for the volunteers, but it was possible to notice a similarity between the behavior of the game metrics and the brain data in some volunteers in T3 and C3 electrodes. The attention test and game metrics improvement show that the volunteers were able to perceive their own attention and control it to advance in the game.