1. Neurotherapy Iza Boesler, MD Betty Jarusiewicz, PhD EEG Spectrum 732-801-4505 E-mail: bjarus@comcast.net

2. Contents Background/Overview –What is Neurofeedback/Neurotherapy/EEG Biofeedback –How it Differs From Biofeedback –Types/Frequency Ranges/Uses/With Other Therapies – Why NT and Brain Regulation Works – Research Basis (Thumbnail sketch)

3. Contents (cont’d) Relationship to Genetics and Environment Immune System Important Current Research -QEEGs -Loretta - HBOT - Blood Flow Analysis

4. Background Other Names –EEG Biofeedback –Neurotherapy (NT) –Neurotraining (NT) How it Differs from Biofeedback

5. Contents (cont’d) Delivery of NT –What it looks like –Places of delivery –Types of measurement Our Research - Various Efficacy trials - Use of new measurement equipment - School use - Particular Protocols

6. Contents Cont’d Assistance to Families and/or Schools –Neurotherapy –Counseling during NT training –Group information sessions

7. Background: What is Neurofeedback and What does it do ? (Neuroregulation) the process of operant conditioning which changes one’s state (stabilizes CNS) and improves behavior using equipment that monitors and measures the electrical activity of the brain and TRAINS the brain to be more available to life’s requirements

8. Background: Types of Neurofeedback Beta/SMR –Eyes Open –Frequency Range 12-18 Hz Alpha/Theta –Eyes Closed –Frequency Range 0-11 Hz

9. Background - Terminology : Brainwave Frequencies (Brain States)

10. Some Documented Uses of Neurofeedback (See www.isnr.org for Comprehensive Bibliography)www.isnr.org Beta/SMR –ADD/ADHD –Learning Disabilities –Sleep –Anxiety, Impulsivity -Depression -Epilepsy -Autism

11. Alpha/Theta (after Beta/SMR) –Emotional and behavioral instability –Addiction (Note: NFB is approved by FDA for relaxation)

12. Integration with other Therapies/Approaches ADHD, Learning Disabilities, Autism, Epilepsy –Behavioral Therapies –Speech Therapies –Occupational Therapies –Counseling –Other (I.e. Assistive Learning)

13. Headaches (Migraines), Sleep, Anxiety, Impulsivity, Emotional and Behavioral Instability –Counseling –Medication Addictions, Peak Performance –Counseling

14. Research Basis 1974: Sterman, MacDonald, & Stone –Noted: seizures reduced by 66% on 4 individuals –Used SMR combined with inhibition of excessive slow wave activity (6-9 Hz) 1976 SMR: Lubar – Hyperactivity Effects noted: –subsided during training for epileptic seizure reduction –reduced even in absence of seizures –More effective than stimulant medication alone

15. Research Basis (cont’d) 1984: Lubar –SMR,with inhibits technique extended to attentional deficits and learning disabilities –Significant academic performance enhanced by use of Beta (12-15 Hz) 1989: Penniston & Kulkowsky –Addition of Alpha Theta Work –Operant conditioning with eyes closed –For use in meditation and mental imagery –Useful for Addiction, PTSD, and Peak Performance work

16. Research Basis (cont’d) 1989 – Othmer –Initial work with Epilepsy –Development of Software/Hardware for Operant Conditioning Process –Development of EEG Spectrum Inc. –Expansion to other conditions, setting up protocols, training practitioners

17. Research Basis (Cont’d) –Disregulated Brains Jarusiewicz – initial control pilot study Coben – use of supplemental devises –Blood flow, QEEGs –Mirror Neurons San Diego Jaime P

18. Why Neurofeedback Works (Operant Conditioning) –Brain can change with assistance directed by rewards: light, movement, and sound –Brain assists in finding best/better approach (New pathways? More dendrites?) –Brain will remain in new state as it “feels better” –Brain is continually used, maintaining “new skill”

19. Disregulated vs Regulated Brain

20. Example of Similar Exercise Model Cardio respiratory Exercise –Stronger heart and improved regulation –Sleep improved –Mood improved –Lower basal metabolism With thanks to Harold Burke, Ph.D.

21. In Summary, EEG Biofeedback: Enhances the ability of an individual to access and maintain different states of physiological arousal and to navigate from high-vigilance to rest. (trains the brain to regulate itself better) Hence, the treatment of disorders, such as ADHD, depression, and anxiety. With thanks to Harold Burke, Ph.D.

22. Summary (cont.) Enhances and supports the mechanisms by which the brain manages cortical hyper excitability and promotes stability. Hence, stabilization against “minor” problems, such as temper tantrums, vertigo, tics, OCD, bipolar disorder, panic attacks, and PMS; and against even lesser disruptions, such as attention problems, sequential and parallel processing, and normal sleep.

23. Summary (cont.) Reinforces equilibrium states. Hence, normalization of pain thresholds, appetite, and blood glucose levels.

24. What about the Placebo Effect? The effects of the training are highly specific to electrode placement and to training frequency band. Training protocols exist which can commonly elicit effects opposite to those desired. The effects of training with one protocol can be reversed with another. With thanks to Harold Burke, Ph.D.

25. What Brain Training Sessions Look Like: Client “Hookup”

26. Universal 10 20 Chart for Electrode Placement

27. Brain Training Session Screens Therapist (EEG) Client (Game)

29. Therapist’s Screen Measurement of total EEG signal at the scalp with electrode or two Amplification of microvolt-level signals for computer processing; Extraction of low, medium, and high frequencies

30. How is it done? (cont.) Progress is monitored every session; Initial sessions should be at a rate of 2- 3 per week until progress is seen (probably by 20 sessions). Research study: B. Jarusiewicz

31. Control by Right and Left Brain* The left brain “Style”: Analytic -Speech/language specialization -Processing -Focus The right brain “Style”: Holistic –Superior visuospatial performance –Emotions/tension –Anxiety And Left Brain/Right Brain 5 th Ed 1998, Springer, S & Deutsch, G

32. Brain Frequencies “Spectrals” (Note: Every person is different) Autistic * Typical * (note extensive delta, theta and alpha frequencies)

33. Measurement of Change By Client –Establish changes client wishes to make –Develop reporting mechanism

34. Measurement of Change By Therapist –Review behavior changes (checklists, drawings) –Review how client feels –Review brain activity (measured averages etc) –Review spectrals

35. Child’s Family Drawing at Beginning of NF - 8/3/94 (with thanks to L. Hirshberg)

36. Drawing after Twenty Sessions - 9/8/94

37. Drawing after forty sessions - 11/25/94

38. Hill and Castro ADD/HD Checklist

39. Measurement of Change For Research –Use of “standard” tests (ADI, ADOS, Checklists, IQ, memory and reading) –Corroborative Evidence (videos, interviews, school or other therapy reporting tests)

40. Autism Study Average Behavior Changes (ATEC) by Type Sociability 33% Speech/language/communication 30% Health 26% Sensory/cognitive awareness 16% p <. 010 for sociability p <.000 for speech p <.015 for health p <. 000 for sensory

41. Behavior Improvement Interview Results

42. Treatment Effectiveness Survey Results 1.Behavior Modification 2.Speech Therapy 3.Occupational Therapy Sensory Integration Neurofeedback *based on parents reports received to date, considering all types of therapies in their experience

43. What you can do for your child Be clear as to assessment of talents, skills, and issues to overcome (Full assessment with history, and videos) Determine a method of on-going measurement (per session, per time period) Choose one new approach at a time Measure, measure, measure

44. What you can do for your child Determine impact of and plan accordingly for –Family issues Diet Schedule/Rules –School issues Placement Simultaneous therapies –Social issues