Neurofeedback abstracts presented by
A Matter of Mind - Self-Regulation & Mindfulness Training
Neurofeedback and QEEG
growing.com/mind - (408) 984-3333 - mind@growing.com

[ updated January 2008 ]

Hum Brain Mapp. 2008 Feb;29(2):157-66.

Atlas-based multichannel monitoring of functional MRI signals in real-time: Automated approach.

Lee JH, O'Leary HM, Park H, Jolesz FA, Yoo SS.

Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Massachusetts.

We report an automated method to simultaneously monitor blood-oxygenation-level-dependent (BOLD) MR signals from multiple cortical areas in real-time. Individual brain anatomy was normalized and registered to a pre-segmented atlas in standardized anatomical space. Subsequently, using real-time fMRI (rtfMRI) data acquisition, localized BOLD signals were measured and displayed from user-selected areas labeled with anatomical and Brodmann's Area (BA) nomenclature. The method was tested on healthy volunteers during the performance of hand motor and internal speech generation tasks employing a trial-based design. Our data normalization and registration algorithm, along with image reconstruction, movement correction and a data display routine were executed with enough processing and communication bandwidth necessary for real-time operation. Task-specific BOLD signals were observed from the hand motor and language areas. One of the study participants was allowed to freely engage in hand clenching tasks, and associated brain activities were detected from the motor-related neural substrates without prior knowledge of the task onset time. The proposed method may be applied to various applications such as neurofeedback, brain-computer-interface, and functional mapping for surgical planning where real-time monitoring of region-specific brain activity is needed. Hum Brain Mapp 2008. (c) 2007 Wiley-Liss, Inc.

PMID: 17370340 [PubMed - in process]

Appl Psychophysiol Biofeedback. 2008 Jan 24 [Epub ahead of print]

EEG Biofeedback as a Treatment for Substance Use Disorders: Review, Rating of Efficacy, and Recommendations for Further Research.

Sokhadze TM, Cannon RL, Trudeau DL.

Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA, tato.sokhadze@louisville.edu.

Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training-either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given.

PMID: 18214670 [PubMed - as supplied by publisher]

BMC Biol. 2008 Jan 16;6(1):4 [Epub ahead of print]

Transient reduction of tinnitus intensity is marked by concomitant reductions of delta band power.

Kahlbrock N, Weisz N.

ABSTRACT: BACKGROUND: Tinnitus is an auditory phantom phenomenon, characterized by the sensation of sounds without objectively identifiable sound sources. So far its causes are not well understood. Previous research found altered patterns of spontaneous brain activity in chronic tinnitus sufferers compared to healthy controls, yet it is unknown whether these abnormal oscillatory patterns are causally related to the tinnitus sensation. Partial support for this notion comes from a neurofeedback approach developed by our group in which significant reductions in tinnitus loudness could be achieved in patients who successfully normalized their patterns of spontaneous brain activity. The current work attempts to complement these studies by scrutinizing how modulations of tinnitus intensity alter ongoing oscillatory activity. RESULTS: In the present study the relation between tinnitus sensation and spontaneous brain activity was investigated using residual inhibition (RI) to reduce tinnitus intensity and source-space projected magnetencephalographic (MEG) data to index brain activity. RI is the sustained reduction (criteria here: 50% for at least 30 seconds) in tinnitus loudness after cessation of a tonal tinnitus masker. A pilot study (n = 38) identified ten patients who showed RI. A significant reduction of power in the delta (1.3 - 4.0 Hz) frequency band was observed in temporal regions during RI (p [less than or equal to] 0.001). CONCLUSIONS: The current results suggest that changes of tinnitus intensity induced by RI are mediated by alterations in the pathological patterns of spontaneous brain activity, specifically a reduction of delta activity. Delta activity is a characteristic oscillatory activity generated by deafferented/deprived neuronal networks. This implies that RI effects might reflect the transient reestablishment of balance between excitatory and inhibitory neuronal assemblies via reafferentation, that has been perturbed (in most tinnitus individuals) by a hearing damage. Since enhancements have been reported in the delta frequency band for tinnitus at rest, this result conforms to our assumption that a normalization of oscillatory properties of cortical networks is a prerequisite for attenuating the tinnitus sensation. For RI to have therapeutic significance however, this normalization would have to be stabilized.

PMID: 18199318 [PubMed - as supplied by publisher]

J Pers Soc Psychol. 2008 Jan;94(1):1-15.

Left frontal cortical activation and spreading of alternatives: Tests of the action-based model of dissonance.

Harmon-Jones E, Harmon-Jones C, Fearn M, Sigelman JD, Johnson P.

Department of Psychology, Texas A&M University.

The action-based model of dissonance predicts that following decisional commitment, approach-oriented motivational processes occur to assist in translating the decision into effective and unconflicted behavior. Therefore, the modulation of these approach-oriented processes should affect the degree to which individuals change their attitudes to be more consistent with the decisional commitment (spreading of alternatives). Experiment 1 demonstrated that a neurofeedback-induced decrease in relative left frontal cortical activation, which has been implicated in approach motivational processes, caused a reduction in spreading of alternatives. Experiment 2 manipulated an action-oriented mindset following a decision and demonstrated that the action-oriented mindset caused increased activation in the left frontal cortical region as well as increased spreading of alternatives. Discussion focuses on how this integration of neuroscience and dissonance theory benefits both parent literatures. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

PMID: 18179314 [PubMed - in process]

J Pain. 2007 Dec 18 [Epub ahead of print]

New Insights Into Neuromodulatory Approaches for the Treatment of Pain.

Jensen MP, Hakimian S, Sherlin LH, Fregni F.

Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington.

Two lines of evidence about the association between the experience of pain and brain state (measured via electroencephalogram or EEG) have recently come to light. First, research from a number of sources suggests a link between brain EEG activity and the experience of pain. Specifically, this research suggests that the subjective experience of pain is associated with relatively lower amplitudes of slower wave (delta, theta, and alpha) activity and relatively higher amplitudes of faster wave (beta) activity. Second, there has been a recent increase in interest in interventions that impact the cortical neuromodulation of pain, including behavioral treatments (such as self-hypnosis training and neurofeedback) and both invasive and noninvasive brain stimulation. Although a direct causal link between experience of pain and brain activity as measured by EEG has not been established, the targeting of pain treatment at a cortical level by trying to affect EEG rhythms directly is an intriguing possibility. PERSPECTIVE: Preliminary evidence suggests the possibility, which has not yet adequately tested or proven, that the experience of chronic pain is linked to cortical activity as assessed via an electroencephalogram. Support for this hypothesis would have important implications for understanding the mechanisms that underlie a number of pain treatments, and for developing new innovative treatments for chronic pain management.

PMID: 18096437 [PubMed - as supplied by publisher]

Appl Psychophysiol Biofeedback. 2007 Dec;32(3-4):169-83. Epub 2007 Nov 3.

Changes in EEG current sources induced by neurofeedback in learning disabled children. An exploratory study.

Fernández T, Harmony T, Fernández-Bouzas A, Díaz-Comas L, Prado-Alcalá RA, Valdés-Sosa P, Otero G, Bosch J, Galán L, Santiago-Rodríguez E, Aubert E, García-Martínez F.

Departamento de Neurobiología Conductual y Cognitiva, Instituto de Neurobiología, Campus UNAM-UAQ, Universidad Nacional Autónoma de México, Boulevard Juriquilla # 3001, Juriquilla, Querétaro, 76230, Mexico. thalia@servidor.unam.mx

The objective of this work was to explore Neurofeedback (NFB) effects on EEG current sources in Learning Disabled (LD) children, and to corroborate its beneficial consequences on behavioral and cognitive performance. NFB was given in twenty 30-min sessions to 11 LD children to reduce their abnormally high theta/alpha ratios (Experimental Group). Another five LD children with the same characteristics received a placebo treatment (Control Group). In the Control Group no changes in behavior or EEG current source were observed. In the Experimental Group, immediately after treatment children showed behavioral and cognitive improvements, but current source analysis showed few modifications; however, 2 months after treatment many changes occurred: a decrease in current of frequencies within the theta band, mainly in left frontal and cingulate regions, and enhancement in current of frequencies within the alpha band, principally in the right temporal lobe and right frontal regions, and of frequencies within the beta band, mainly in left temporal, right frontal and cingulate cortex regions. In conclusion, NFB is a possibly efficacious treatment for LD children with an abnormally high theta/alpha ratio in any lead. The changes observed in EEG current sources may reflect the neurophysiological bases of the improvement that children experienced in their behavioral and cognitive activities.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 17978869 [PubMed - in process]

PLoS ONE. 2007 Oct 31;2(10):e1094.

A Blueprint for Real-Time Functional Mapping via Human Intracranial Recordings.

Lachaux JP, Jerbi K, Bertrand O, Minotti L, Hoffmann D, Schoendorff B, Kahane P.

INSERM, U821, Lyon, F-69500, France.

BACKGROUND: The surgical treatment of patients with intractable epilepsy is preceded by a pre-surgical evaluation period during which intracranial EEG recordings are performed to identify the epileptogenic network and provide a functional map of eloquent cerebral areas that need to be spared to minimize the risk of post-operative deficits. A growing body of research based on such invasive recordings indicates that cortical oscillations at various frequencies, especially in the gamma range (40 to 150 Hz), can provide efficient markers of task-related neural network activity. PRINCIPAL FINDINGS: Here we introduce a novel real-time investigation framework for mapping human brain functions based on online visualization of the spectral power of the ongoing intracranial activity. The results obtained with the first two implanted epilepsy patients who used the proposed online system illustrate its feasibility and utility both for clinical applications, as a complementary tool to electrical stimulation for presurgical mapping purposes, and for basic research, as an exploratory tool used to detect correlations between behavior and oscillatory power modulations. Furthermore, our findings suggest a putative role for high gamma oscillations in higher-order auditory processing involved in speech and music perception. CONCLUSION/SIGNIFICANCE: The proposed real-time setup is a promising tool for presurgical mapping, the investigation of functional brain dynamics, and possibly for neurofeedback training and brain computer interfaces.

PMID: 17971857 [PubMed - in process]

Behav Brain Funct. 2007 Jul 26;3:35.

Controlled evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD).

Drechsler R, Straub M, Doehnert M, Heinrich H, Steinhausen HC, Brandeis D.

Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland. renate.drechsler@kjpd.uzh.ch.

ABSTRACT: BACKGROUND: Although several promising studies on neurofeedback training in Attention Deficit/Hyperactivity Disorder (ADHD) have been performed in recent years, the specificity of positive treatment effects continues to be challenged. METHODS: To evaluate the specificity of a neurofeedback training of slow cortical potentials, a twofold strategy was pursued: First, the efficacy of neurofeedback training was compared to a group training program for children with ADHD. Secondly, the extent of improvements observed in the neurofeedback group in relation to successful regulation of cortical activation was examined. Parents and teachers rated children's behaviour and executive functions before and after treatment. In addition, children underwent neuropsychological testing before and after training. RESULTS: According to parents' and teachers' ratings, children of the neurofeedback training group improved more than children who had participated in a group therapy program, particularly in attention and cognition related domains. On neuropsychological measures children of both groups showed similar improvements. However, only about half of the neurofeedback group learned to regulate cortical activation during a transfer condition without direct feedback. Behavioural improvements of this subgroup were moderately related to neurofeedback training performance, whereas effective parental support accounted better for some advantages of neurofeedback training compared to group therapy according to parents' and teachers' ratings. CONCLUSION: There is a specific training effect of neurofeedback of slow cortical potentials due to enhanced cortical control. However, non-specific factors, such as parental support, may also contribute to the positive behavioural effects induced by the neurofeedback training.

PMID: 17655749 [PubMed - in process]

Agri. 2007 Jul;19(3):47-53.

Neurofeedback in fibromyalgia syndrome.

Kayıran S, Dursun E, Ermutlu N, Dursun N, Karamürsel S.

Kocaeli University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kocaeli, Turkey.

EEG Biofeedback (Neurofeedback-NFB) is a learning strategy that enables people to alter their brainwaves. In the present case study, we applied a NFB protocol on three patients with Fibromyalgia Syndrome (FMS). The existing symptoms and clinical conditions of the patients attributed to FMS, Visual Analog Scale for pain and fatigue, Hamilton Depression and Anxiety Inventory Scales, Beck Depression and Anxiety Inventory Scales, and SF-36 were recorded before and after NFB training. Most of the symptoms were decreased after ten sessions. There was also improvement in all of the scales after the treatment. The results of the present study may suggest NFB training as a novel treatment method in FMS.

PMID: 18095199 [PubMed - as supplied by publisher]

Neuroimage. 2007 Apr 15;35(3):1238-46. Epub 2007 Jan 31.

Regulation of anterior insular cortex activity using real-time fMRI.

Caria A, Veit R, Sitaram R, Lotze M, Weiskopf N, Grodd W, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, Eberhard-Karls-University of Tübingen, Tübingen, Germany. andrea.caria@uni-tuebingen.de <andrea.caria@uni-tuebingen.de>

Recent advances in functional magnetic resonance imaging (fMRI) data acquisition and processing techniques have made real-time fMRI (rtfMRI) of localized brain areas feasible, reliable and less susceptible to artefacts. Previous studies have shown that healthy subjects learn to control local brain activity with operant training by using rtfMRI-based neurofeedback. In the present study, we investigated whether healthy subjects could voluntarily gain control over right anterior insular activity. Subjects were provided with continuously updated information of the target ROI's level of activation by visual feedback. All participants were able to successfully regulate BOLD-magnitude in the right anterior insular cortex within three sessions of 4 min each. Training resulted in a significantly increased activation cluster in the anterior portion of the right insula across sessions. An increased activity was also found in the left anterior insula but the percent signal change was lower than in the target ROI. Two different control conditions intended to assess the effects of non-specific feedback and mental imagery demonstrated that the training effect was not due to unspecific activations or non feedback-related cognitive strategies. Both control groups showed no enhanced activation across the sessions, which confirmed our main hypothesis that rtfMRI feedback is area-specific. The increased activity in the right anterior insula during training demonstrates that the effects observed are anatomically specific and self-regulation of right anterior insula only is achievable. This is the first group study investigating the volitional control of emotionally relevant brain region by using rtfMRI training and confirms that self-regulation of local brain activity with rtfMRI is possible.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 17336094 [PubMed - indexed for MEDLINE]

Conf Proc IEEE Eng Med Biol Soc. 2007;1:2485-8.

The role of attention in the tinnitus decompensation: reinforcement of a large-scale neural decompensation measure.

Low YF, Trenado C, Delb W, Corona-Strauss FI, Strauss DJ.

Computational Diagnostics and Biocybernetics Unit, Saarland University; Saarland University of Applied Sciences, Homburg/Saarbruecken, Germany. yinfen@cdb-unit.de.

Large-scale neural correlates of the tinnitus decompensation have been identified by using wavelet phase stability criteria of single sweep sequences of auditory late responses (ALRs). The suggested measure provided an objective quantification of the tinnitus decompensation and allowed for a reliable discrimination between a group of compensated and decompensated tinnitus patients. By interpreting our results with an oscillatory tinnitus model, our synchronization stability measure of ALRs can be linked to the focus of attention on the tinnitus signal. In the following study, we examined in detail the correlates of this attentional mechanism in healthy subjects. The results support our previous findings of the phase synchronization stability measure that reflected neural correlates of the fixation of attention to the tinnitus signal. In this case, enabling the differentiation between the attended and unattended conditions. It is concluded that the wavelet phase synchronization stability of ALRs single sweeps can be used as objective tinnitus decompensation measure and can be interpreted in the framework of the Jastreboff tinnitus model and adaptive resonance theory. Our studies confirm that the synchronization stability in ALR sequences is linked to attention. This measure is not only able to serve as objective quantification of the tinnitus decompensation, but also can be applied in all online and real time neurofeedback therapeutic approach where a direct stimulus locked attention monitoring is compulsory as if it based on a single sweeps processing.

PMID: 18002498 [PubMed - in process]

Prog Brain Res. 2007;166:473-85.

Neurofeedback for treating tinnitus.

Dohrmann K, Weisz N, Schlee W, Hartmann T, Elbert T.

University of Konstanz, Department of Psychology, Konstanz, Germany. katalin.dohrmann@uni-konstanz.de

Many individuals with tinnitus have abnormal oscillatory brain activity. Led by this finding, we have developed a way to normalize such pathological activity by neurofeedback techniques (Weisz et al. (2005). PLoS Med., 2: e153). This is achieved mainly through enhancement of tau activity, i.e., oscillatory activity produced in perisylvian regions within the alpha frequency range (8-12 Hz) and concomitant reduction in delta power range (0.5-4 Hz). This activity is recorded from electrodes placed on the frontal scalp. We have found that modification of the tau-to-delta ratio significantly reduces tinnitus intensity. Participants who successfully modified their oscillatory pattern profited from the treatment to the extent that the tinnitus sensation became completely abolished. Overall, this neurofeedback training was significantly superiorin reducing tinnitus-related distress than frequency discrimination training.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 17956812 [PubMed - indexed for MEDLINE]

Restor Neurol Neurosci. 2007;25(3-4):371-8.

Tuning the tinnitus percept by modification of synchronous brain activity.

Dohrmann K, Elbert T, Schlee W, Weisz N.

University of Konstanz, Department of Psychology, Box D 25, 78457 Konstanz, Germany. Katalin.Dohrmann@uni-konstanz.de

PURPOSE: Tinnitus, the perception of sound without the presence of a physical stimulus, provides the opportunity to study neural codes of percepts without simultaneous processing of stimuli. Previously, we have found that tinnitus is associated with enhanced delta- and reduced tau-power in temporal brain regions. By operantly modifying corresponding aspects of spontaneous EEG activity, the aim of the present study was to corroborate the assumption that tinnitus should be reduced if patterns of ongoing synchronous brain activity are normalised. METHODS: In response to different variants of neurofeedback, a total of twenty-one patients produced significant changes in EEG frequency bands. RESULTS: Simultaneous alteration of both frequency bands was strongly related to changes in tinnitus intensity matched before and after the intervention (r=-0.74). In those two patients with the greatest modulatory success, the tinnitus sensation resided completely in response to the treatment. Comparing the neurofeedback-treated patients with a group of patients trained with a frequency discrimination task (n=27), the tinnitus relief in the neurofeedback group was significantly stronger. CONCLUSIONS: This study supports the notion that altered patterns of intrinsic ongoing brain activity lead to phantom percepts and offer new routes to the treatment of tinnitus.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 17943012 [PubMed - in process]

J Neuroengineering Rehabil. 2007 Oct 17;4(1):40

A brain-computer interface with vibrotactile biofeedback for haptic information.

Chatterjee A, Aggarwal V, Ramos A, Acharya S, Thakor NV.

ABSTRACT: BACKGROUND: It has been suggested that Brain-Computer Interfaces (BCI) may one day be suitable for controlling a neuroprosthesis. For closed-loop operation of BCI, a tactile feedback channel that is compatible with neuroprosthetic applications is desired. Operation of an EEG-based BCI using only vibrotactile feedback, a commonly used method to convey haptic senses of contact and pressure, is demonstrated with a high level of accuracy. METHODS: A Mu-rhythm based BCI using a motor imagery paradigm was used to control the position of a virtual cursor. The cursor position was shown visually as well as transmitted haptically by modulating the intensity of a vibrotactile stimulus to the upper limb. A total of six subjects operated the BCI in a two-stage targeting task, receiving only vibrotactile biofeedback of performance. The location of the vibration was also systematically varied between the left and right arms to investigate location-dependent effects on performance. RESULTS AND CONCLUSIONS: Subjects are able to control the BCI using only vibrotactile feedback with an average accuracy of 56% and as high as 72%. These accuracies are significantly higher than the 15% predicted by random chance if the subject had no voluntary control of their Mu-rhythm. The results of this study demonstrate that vibrotactile feedback is an effective biofeedback modality to operate a BCI using motor imagery. In addition, the study shows that placement of the vibrotactile stimulation on the biceps ipsilateral or contralateral to the motor imagery introduces a significant bias in the BCI accuracy. This bias is consistent with a drop in performance generated by stimulation of the contralateral limb. Users demonstrated the capability to overcome this bias with training.

PMID: 17941986 [PubMed - as supplied by publisher]

Fiziol Cheloveka. 2007 Jul-Aug;33(4):24-32.

[Biofeedback for the optimization of psychomotor reactivity: Communication I. Comparative analysis of biofeedback and common performance practice]

[Article in Russian]

Bazanova OM, Shtark MB.

Publication Types: Comparative Study Research Support, Non-U.S. Gov't

PMID: 17853818 [PubMed - indexed for MEDLINE]

Top Stroke Rehabil. 2007 Jul-Aug;14(4):59-66.

The role of biofeedback in stroke rehabilitation: past and future directions.

Nelson LA.

Department of Psychiatry, University of Washington, School of Medicine, Seattle, Washington, USA.

Biofeedback has been applied to many aspects of stroke rehabilitation, with mixed results. This is largely due to the varying modalities, differences between study designs, and methods of measuring success and progress. How well biofeedback works appears to be inversely related to the direct observability of the function about which information is being provided. The more covert the function (e.g., swallowing muscle activity, attention, cortical functioning, etc.), the more helpful biofeedback is likely to be. However, biofeedback in general can have a very positive impact, even through indirect means. Improvements in self confidence, shifting of locus of control, and instantly being provided information regarding changes in one's physical functioning as a result of mental activity can be helpful in setting the tone for success in rehabilitation more generally.

Publication Types: Review

PMID: 17698458 [PubMed - indexed for MEDLINE]

Acta Neurochir Suppl. 2007;97(Pt 2):555-9.

Brain-computer interface: a reciprocal self-regulated neuromodulation.

Angelakis E, Hatzis A, Panourias IG, Sakas DE.

P.S. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece. angelakis@acgmail.gr

Brain-computer interface (BCI) is a system that records brain activity and process it through a computer, allowing the individual whose activity is recorded to monitor this activity at the same time. Applications of BCIs include assistive modules for severely paralyzed patients to help them control external devices or to communicate, as well as brain biofeedback to self regulate brain activity for treating epilepsy, attention-deficit hyperactivity disorder (ADHD), anxiety, and other psychiatric conditions, or to enhance cognitive performance in healthy individuals. The vast majority of BCIs utilizes non-invasive scalp recorded electroencephalographic (EEG) signals, but other techniques like invasive intracortical EEG, or near-infrared spectroscopy measuring brain blood oxygenation are tried experimentally.

Publication Types: Review

PMID: 17691347 [PubMed - indexed for MEDLINE]

Altern Med Rev. 2007 Jun;12(2):146-51.

EEG biofeedback in the treatment of attention deficit hyperactivity disorder.

Friel PN.

Washington State Toxicology Laboratory, Forensic Laboratory Services Bureau Suit 360, 2203 Airport Way South, Seattle, WA 98134, USA. Pat.Friel@wsp.wa.gov

Electroencephalogram (EEG) biofeedback, also known as neurofeedback, is a promising alternative treatment for patients with attention deficit/hyperactivity disorder (AD/HD). EEG biofeedback therapy rewards scalp EEG frequencies that are associated with relaxed attention, and suppresses frequencies associated with under- or over-arousal. In large-scale clinical trials, the efficacy of EEG biofeedback for AD/HD is comparable to that of stimulant medications. Many different EEG biofeedback protocols for AD/HD are available. Single-channel protocols developed by Lubar and interhemispheric protocols developed by the Othmers are widely practiced and supported by large-scale clinical studies.

Publication Types: Review

PMID: 17604459 [PubMed - indexed for MEDLINE]

J Hum Hypertens. 2007 Dec;21(12):973-975. Epub 2007 May 31.

Biofeedback treatment of prehypertension: analyses of efficacy, heart rate variability and EEG approximate entropy.

Xu XY, Gao J, Ling D, Wang TH.

1Laboratory of Biofeedback, Department of Physiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, PR China.

PMID: 17541386 [PubMed - as supplied by publisher]

Expert Rev Neurother. 2007 Apr;7(4):315-9.

Place of electroencephalograpic biofeedback for attention-deficit/hyperactivity disorder.

Hirshberg LM.

Publication Types: Editorial Review

PMID: 17425483 [PubMed - indexed for MEDLINE]

Hippocampus. 2007;17(6):413-9.

Human neocortical and hippocampal near-DC shifts are interconnected.

Fell J, Fritz NE, Burr W, Ludowig E, Axmacher N, Elger CE, Helmstaedter C.

Department of Epileptology, University of Bonn, D-53105 Bonn, Germany. juergen.fell@ukb.uni-bonn.de

Hippocampal DC shifts have been observed under various physiological and pathological conditions. Here, we studied the interconnection of slow shifts (0.01 Hz high-pass) in surface EEG and hippocampal shifts as emerging in an event-related EEG biofeedback paradigm. Hippocampal EEG activity was monitored by depth electrodes implanted in four epilepsy patients for presurgical evaluation. Trials were sorted according to the near-DC shifts occurring at the surface position Cz, which was the feedback electrode, into positive, indistinct (i.e., small or biphasic) and negative shifts. We found significant hippocampal near-DC shifts being positively or negatively correlated to the shifts in surface EEG in all four patients. The amplitudes of the hippocampal near-DC shifts were several times larger than the surface shifts. The polarity of the shifts appears to depend on the location of the electrode contacts with respect to the hippocampal subfields. The finding that neocortical and hippocampal near-DC shifts are interconnected may open new perspectives for the prediction and control of mediotemporal lobe seizures. (c) 2007 Wiley-Liss, Inc.

PMID: 17372976 [PubMed - indexed for MEDLINE]

Clin Neuropsychol. 2007 Jan;21(1):110-29.

EEG neurofeedback: a brief overview and an example of peak alpha frequency training for cognitive enhancement in the elderly.

Angelakis E, Stathopoulou S, Frymiare JL, Green DL, Lubar JF, Kounios J.

Department of Psychology, Drexel University, Philadelphia, PA 19102-1192, USA.

Neurofeedback (NF) is an electroencephalographic (EEG) biofeedback technique for training individuals to alter their brain activity via operant conditioning. Research has shown that NF helps reduce symptoms of several neurological and psychiatric disorders, with ongoing research currently investigating applications to other disorders and to the enhancement of non-disordered cognition. The present article briefly reviews the fundamentals and current status of NF therapy and research and illustrates the basic approach with an interim report on a pilot study aimed at developing a new NF protocol for improving cognitive function in the elderly. EEG peak alpha frequency (PAF) has been shown to correlate positively with cognitive performance and to correlate negatively with age after childhood. The present pilot study used a double-blind controlled design to investigate whether training older individuals to increase PAF would result in improved cognitive performance. The results suggested that PAF NF improved cognitive processing speed and executive function, but that it had no clear effect on memory. In sum, the results suggest that the PAF NF protocol is a promising technique for improving selected cognitive functions.

Publication Types: Randomized Controlled Trial Research Support, N.I.H., Extramural Review

PMID: 17366280 [PubMed - indexed for MEDLINE]

Int J Neurosci. 2007 Mar;117(3):337-57.

The effects of neurofeedback training in the cognitive division of the anterior cingulate gyrus.

Cannon R, Lubar J, Congedo M, Thornton K, Towler K, Hutchens T.

Psychology Program, University of Tennessee, Brain Research and Neuropsychology Lab, Knoxville, Tennessee 37996, USA. rcannon2@utk.edu

This study examines the efficacy of neurofeedback training in the cognitive division of the anterior cingulate gyrus and describes its relationship with cortical regions known to be involved in executive functions. This study was conducted with eight non-clinical students, four male and four female, with a mean age of twenty-two. Learning occurred in the ACcd at significant levels over sessions and in the anterior regions that receive projections from the AC. There appears to be a multidimensional executive circuit that increases in the same frequency in apparent synchrony with the AC and it may be possible to train this sub-cortical region using LNFB.

Publication Types: Clinical Trial

PMID: 17365119 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2007 Jun;32(2):73-88. Epub 2007 Mar 14.

Neurofeedback for children with ADHD: a comparison of SCP and Theta/Beta protocols.

Leins U, Goth G, Hinterberger T, Klinger C, Rumpf N, Strehl U.

Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Osianderstrasse 24, 72076, Tübingen, Germany. Ulrike.leins@med.uni-tuebingen.de

Behavioral and cognitive improvements in children with ADHD have been consistently reported after neurofeedback-treatment. However, neurofeedback has not been commonly accepted as a treatment for ADHD. This study addresses previous methodological shortcomings while comparing a neurofeedback-training of Theta-Beta frequencies and training of slow cortical potentials (SCPs). The study aimed at answering (a) whether patients were able to demonstrate learning of cortical self-regulation, (b) if treatment leads to an improvement in cognition and behavior and (c) if the two experimental groups differ in cognitive and behavioral outcome variables. SCP participants were trained to produce positive and negative SCP-shifts while the Theta/Beta participants were trained to suppress Theta (4-8 Hz) while increasing Beta (12-20 Hz). Participants were blind to group assignment. Assessment included potentially confounding variables. Each group was comprised of 19 children with ADHD (aged 8-13 years). The treatment procedure consisted of three phases of 10 sessions each. Both groups were able to intentionally regulate cortical activity and improved in attention and IQ. Parents and teachers reported significant behavioral and cognitive improvements. Clinical effects for both groups remained stable six months after treatment. Groups did not differ in behavioural or cognitive outcome.

Publication Types: Comparative Study Research Support, Non-U.S. Gov't

PMID: 17356905 [PubMed - indexed for MEDLINE]

Neuroreport. 2007 Jan 8;18(1):39-43.

Processing speed in recurrent visual networks correlates with general intelligence.

Jolij J, Huisman D, Scholte S, Hamel R, Kemner C, Lamme VA.

Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands. j.jolij@exeter.ac.uk

Studies on the neural basis of general fluid intelligence strongly suggest that a smarter brain processes information faster. Different brain areas, however, are interconnected by both feedforward and feedback projections. Whether both types of connections or only one of the two types are faster in smarter brains remains unclear. Here we show, by measuring visual evoked potentials during a texture discrimination task, that general fluid intelligence shows a strong correlation with processing speed in recurrent visual networks, while there is no correlation with speed of feedforward connections. The hypothesis that a smarter brain runs faster may need to be refined: a smarter brain's feedback connections run faster.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 17259858 [PubMed - indexed for MEDLINE]

Neuroimage. 2007 Apr 1;35(2):968-78. Epub 2007 Jan 25.

Reward expectation modulates feedback-related negativity and EEG spectra.

Cohen MX, Elger CE, Ranganath C.

Department of Epilepsy and Center for Life and Brain, Sigmund-Freud-Str. 25, Bonn 53105, Germany. mcohen@ucdavis.edu

The ability to evaluate outcomes of previous decisions is critical to adaptive decision-making. The feedback-related negativity (FRN) is an event-related potential (ERP) modulation that distinguishes losses from wins, but little is known about the effects of outcome probability on these ERP responses. Further, little is known about the frequency characteristics of feedback processing, for example, event-related oscillations and phase synchronizations. Here, we report an EEG experiment designed to address these issues. Subjects engaged in a probabilistic reinforcement learning task in which we manipulated, across blocks, the probability of winning and losing to each of two possible decision options. Behaviorally, all subjects quickly adapted their decision-making to maximize rewards. ERP analyses revealed that the probability of reward modulated neural responses to wins, but not to losses. This was seen both across blocks as well as within blocks, as learning progressed. Frequency decomposition via complex wavelets revealed that EEG responses to losses, compared to wins, were associated with enhanced power and phase coherence in the theta frequency band. As in the ERP analyses, power and phase coherence values following wins but not losses were modulated by reward probability. Some findings between ERP and frequency analyses diverged, suggesting that these analytic approaches provide complementary insights into neural processing. These findings suggest that the neural mechanisms of feedback processing may differ between wins and losses.

Publication Types: Research Support, N.I.H., Extramural Research Support, U.S. Gov't, P.H.S.

PMID: 17257860 [PubMed - indexed for MEDLINE]

J Child Psychol Psychiatry. 2007 Jan;48(1):3-16.

Annotation: neurofeedback - train your brain to train behaviour.

Heinrich H, Gevensleben H, Strehl U.

Child & Adolescent Psychiatry, University of Erlangen-Nürnberg, Germany. hheinri@arcor.de

BACKGROUND: Neurofeedback (NF) is a form of behavioural training aimed at developing skills for self-regulation of brain activity. Within the past decade, several NF studies have been published that tend to overcome the methodological shortcomings of earlier studies. This annotation describes the methodical basis of NF and reviews the evidence base for its clinical efficacy and effectiveness in neuropsychiatric disorders. METHODS: In NF training, self-regulation of specific aspects of electrical brain activity is acquired by means of immediate feedback and positive reinforcement. In frequency training, activity in different EEG frequency bands has to be decreased or increased. Training of slow cortical potentials (SCPs) addresses the regulation of cortical excitability. RESULTS: NF studies revealed paradigm-specific effects on, e.g., attention and memory processes and performance improvements in real-life conditions, in healthy subjects as well as in patients. In several studies it was shown that children with attention-deficit hyperactivity disorder (ADHD) improved behavioural and cognitive variables after frequency (e.g., theta/beta) training or SCP training. Neurophysiological effects could also be measured. However, specific and unspecific training effects could not be disentangled in these studies. For drug-resistant patients with epilepsy, significant and long-lasting decreases of seizure frequency and intensity through SCP training were documented in a series of studies. For other child psychiatric disorders (e.g., tic disorders, anxiety, and autism) only preliminary investigations are available. CONCLUSIONS: There is growing evidence for NF as a valuable treatment module in neuropsychiatric disorders. Further, controlled studies are necessary to establish clinical efficacy and effectiveness and to learn more about the mechanisms underlying successful training.

PMID: 17244266 [PubMed - indexed for MEDLINE]

J Physiol. 2007 Mar 15;579(Pt 3):571-9. Epub 2007 Jan 18.

Volitional control of neural activity: implications for brain-computer interfaces.

Fetz EE.

Department of Physiology and Biophysics, Washington National Primate Research Center, University of Washington, Seattle, WA 98195-7290, USA. fetz@u.washington.edu

Successful operation of brain-computer interfaces (BCI) and brain-machine interfaces (BMI) depends significantly on the degree to which neural activity can be volitionally controlled. This paper reviews evidence for such volitional control in a variety of neural signals, with particular emphasis on the activity of cortical neurons. Some evidence comes from conventional experiments that reveal volitional modulation in neural activity related to behaviours, including real and imagined movements, cognitive imagery and shifts of attention. More direct evidence comes from studies on operant conditioning of neural activity using biofeedback, and from BCI/BMI studies in which neural activity controls cursors or peripheral devices. Limits in the degree of accuracy of control in the latter studies can be attributed to several possible factors. Some of these factors, particularly limited practice time, can be addressed with long-term implanted BCIs. Preliminary observations with implanted circuits implementing recurrent BCIs are summarized.

Publication Types: Research Support, N.I.H., Extramural Review

PMID: 17234689 [PubMed - indexed for MEDLINE]

IEEE Trans Neural Syst Rehabil Eng. 2006 Dec;14(4):401-9.

Suitability of the cingulate cortex for neural control.

Marzullo TC, Miller CR, Kipke DR.

Neuroscience Program, University of Michigan, Ann Arbor, MI 48109, USA. tmarzull@umich.edu

Recent neuroprosthetic work has focused on the motor cortex as a source of voluntary control signals. However, the motor cortex can be damaged in upper motor neuron degenerative diseases such as primary lateral sclerosis and amyotrophic lateral sclerosis. The possibility exists that prefrontal areas may also be used in neuroprosthetic devices. Here, we report the use of the cingulate cortex in a neuroprosthetic model. Seven rats were able to significantly modulate spiking activity in the cingulate cortex in order to receive reward. Furthermore, experiments with single neurons provide evidence that the cingulate cortex neuronal modulation is highly flexible and thus useful for a neuroprosthetic device.

Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17190032 [PubMed - indexed for MEDLINE]

Fiziol Cheloveka. 2006 Nov-Dec;32(6):28-32.

[Correction of psychoemotional disturbances during pregnancy by the method of adaptive bioregulation with feedback according to EEG]

[Article in Russian]

Fedotchev AI, Kim EV.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 17180887 [PubMed - indexed for MEDLINE]

Usp Fiziol Nauk. 2006 Oct-Dec;37(4):82-92.

[Utilization of feedback signals from patient's own endogenous rhythms for non-drug correction of human functional disturbances]

[Article in Russian]

Fedotchev AI, Bondar' AT, Matrusov SG, Semenov VS, Soin AG.

The most advanced approach to non-drug correction of human functional disturbances via utilization of feedback signals from patient's own endogenous rhythms, i.e., EEG rhythms, respiratory and heart rate is presented and substantiated. The advantages of its application to biofeedback training procedures are reviewed. Alternative way to utilize the feedback signals through automatic modulation of stimulation parameters by patient's endogenous rhythms is analyzed. The author's own contributions to the field are presented and the most promising ways of further approach development are delineated.

Publication Types: English Abstract Review

PMID: 17140002 [PubMed - indexed for MEDLINE]

Hum Brain Mapp. 2007 Oct;28(10):1033-44.

Real-time fMRI using brain-state classification.

LaConte SM, Peltier SJ, Hu XP.

Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA 30322, USA. slaconte@bme.emory.edu

We have implemented a real-time functional magnetic resonance imaging system based on multivariate classification. This approach is distinctly different from spatially localized real-time implementations, since it does not require prior assumptions about functional localization and individual performance strategies, and has the ability to provide feedback based on intuitive translations of brain state rather than localized fluctuations. Thus this approach provides the capability for a new class of experimental designs in which real-time feedback control of the stimulus is possible-rather than using a fixed paradigm, experiments can adaptively evolve as subjects receive brain-state feedback. In this report, we describe our implementation and characterize its performance capabilities. We observed approximately 80% classification accuracy using whole brain, block-design, motor data. Within both left and right motor task conditions, important differences exist between the initial transient period produced by task switching (changing between rapid left or right index finger button presses) and the subsequent stable period during sustained activity. Further analysis revealed that very high accuracy is achievable during stable task periods, and that the responsiveness of the classifier to changes in task condition can be much faster than signal time-to-peak rates. Finally, we demonstrate the versatility of this implementation with respect to behavioral task, suggesting that our results are applicable across a spectrum of cognitive domains. Beyond basic research, this technology can complement electroencephalography-based brain computer interface research, and has potential applications in the areas of biofeedback rehabilitation, lie detection, learning studies, virtual reality-based training, and enhanced conscious awareness. Wiley-Liss, Inc.

Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

PMID: 17133383 [PubMed - in process]

Brain Res Bull. 2006 Dec 11;71(1-3):83-90. Epub 2006 Sep 1.

Relaxation strategies and enhancement of hypnotic susceptibility: EEG neurofeedback, progressive muscle relaxation and self-hypnosis.

Batty MJ, Bonnington S, Tang BK, Hawken MB, Gruzelier JH.

Imperial College, London W6 8RP, UK.

Hypnosis has been shown to be efficacious in a range of clinical conditions, including the management of chronic pain. However, not all individuals are able to enter a hypnotic state, thereby limiting the clinical utility of this technique. We sought to determine whether hypnotic susceptibility could be increased using three methods thought to facilitate relaxation, with particular interest in an EEG neurofeedback protocol which elevated the theta to alpha ratio. This was compared with progressive muscle relaxation and self-hypnosis. Ten subjects with moderate levels of susceptibility (2-7/12) were randomly assigned to each condition and assessed for hypnotic susceptibility prior to and upon completion of 10 sessions of training. Hypnotic susceptibility increased post-training in all groups, providing further evidence that operant control over the theta/alpha ratio is possible, but contrary to our predictions, elevation of the theta/alpha ratio proved no more successful than the other interventions. Nonetheless, all three techniques successfully enhanced hypnotic susceptibility in over half of the participants (17/30), a similar incidence to that reported using other methods. As previously reported, the majority who were not susceptible to modification were at the lower levels of susceptibility, and the greater increases tended to occur in the more susceptible subjects. However, here enhancement was disclosed in some at low levels, and capability was found of reaching high levels, both features not typically reported. Further research is warranted.

Publication Types: Randomized Controlled Trial

PMID: 17113932 [PubMed - indexed for MEDLINE]

Prog Brain Res. 2006;159:421-31.

Validating the efficacy of neurofeedback for optimising performance.

Gruzelier J, Egner T, Vernon D.

Department of Psychology, Goldsmiths College, University of London, Lewisham Way, New Cross, London SE14 6NW, UK. j.gruzelier@gold.ac.uk

The field of neurofeedback training has largely proceeded without validation. Here we review our studies directed at validating SMR, beta and alpha-theta protocols for improving attention, memory, mood and music and dance performance in healthy participants. Important benefits were demonstrable with cognitive and neurophysiological measures which were predicted on the basis of regression models of learning. These are initial steps in providing a much needed scientific basis to neurofeedback, but much remains to be done.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 17071246 [PubMed - indexed for MEDLINE]

Neuroreport. 2006 Oct 23;17(15):1649-53.

Brain potentials associated with outcome expectation and outcome evaluation.

Yu R, Zhou X.

Department of Psychology, Peking University, Beijing, China.

Feedback-related negativity is a negative deflection in brain potentials associated with feedback indicating monetary losses or response errors. Feedback-related negativity is studied primarily in paradigms in which participants experience negative outcomes that appear to be contingent upon their previous choices. This study investigated whether feedback-related negativity can be elicited by a randomly assigned cue indicating potential monetary loss. The expected loss or win can be materialized or averted depending on participants' performance in a subsequent game. Compared with the win cue, the loss cue elicited a weak but significant feedback-related negativity-like effect. It is suggested that the anterior cingulate cortex, which generates feedback-related negativity, may function as a pre-warning system that alerts the brain to get ready for future events.

Publication Types: Evaluation Studies Research Support, Non-U.S. Gov't

PMID: 17001286 [PubMed - indexed for MEDLINE]

Clin EEG Neurosci. 2006 Jul;37(3):198-203.

Follow-up study of learning-disabled children treated with neurofeedback or placebo.

Becerra J, Fernández T, Harmony T, Caballero MI, García F, Fernández-Bouzas A, Santiago-Rodríguez E, Prado-Alcalá RA.

Universidad Autónoma de Querétaro, Mexico.

This report is a 2-year follow-up to a previous study describing positive behavioral changes and a spurt of EEG maturation with theta/alpha neurofeedback (NFB) training in a group of Learning Disabled (LD) children. In a control paired group, treated with placebo, behavioral changes were not observed and the smaller maturational EEG changes observed were easily explained by increased age. Two years later, the EEG maturational lag in Control Group children increased, reaching abnormally high theta Relative Power values; the absence of positive behavioral changes continued and the neurological diagnosis remained LD. In contrast, after 2 years EEG maturation did continue in children who belonged to the Experimental Group with previous neurofeedback training; this was accompanied by positive behavioral changes, which were reflected in remission of LD symptoms.

Publication Types: Controlled Clinical Trial Research Support, Non-U.S. Gov't

PMID: 16929704 [PubMed - indexed for MEDLINE]

Cereb Cortex. 2007 Jun;17(6):1314-22. Epub 2006 Aug 2.

Time-frequency intracranial source localization of feedback-related EEG activity in hypothesis testing.

Papo D, Douiri A, Bouchet F, Bourzeix JC, Caverni JP, Baudonnière PM.

Laboratoire de Psychologie Cognitive, CNRS UMR 6146, Université de Provence, Marseille, France. david.papo@jussieu.fr

The neural correlates of the response to performance feedback have been the object of numerous neuroimaging studies. However, the precise timing and functional meaning of the resulting activations are poorly understood. We studied the electroencephalographic response time locked to positive and negative performance feedback in a hypothesis testing paradigm. The signal was convoluted with a family of complex wavelets. Intracranial sources of activity at various narrow-band frequencies were estimated in the 100- to 400-ms time window following feedback onset. Positive and negative feedback were associated to 1) early parahippocampo-cingular sources of alpha oscillations, more posteriorly located and long lasting for negative feedback and to 2) late partially overlapping neural circuits comprising regions in prefrontal, cingular, and temporal cortices but operating at feedback-specific latencies and frequencies. The results were interpreted in the light of neurophysiological models of feedback and were used to discuss methodological issues in the study of high-level cognitive functions, including reasoning and decision making.

PMID: 16885204 [PubMed - indexed for MEDLINE]

Prax Kinderpsychol Kinderpsychiatr. 2006;55(5):384-407.

[Neurofeedback for children with ADHD: a comparison of SCP- and theta/beta-protocols]

[Article in German]

Leins U, Hinterberger T, Kaller S, Schober F, Weber C, Strehl U.

Universitätsklinik für Psychiatrie und Psychotherapie, Universität Tübingen. ulrike.leins@med.uni-tuebingen.de

Research groups have consistently reported on behavioral and cognitive improvements of children with ADHD after neurofeedback. However, neurofeedback has not been commonly accepted as a treatment for ADHD. This is due, in part, to several methodological limitations. The neurofeedback literature is further complicated by having several different training protocols. Differences between the clinical efficacy of such protocols have not been examined. This study addresses previous methodological shortcomings while comparing the training of theta-beta-frequencies (theta-beta-group) with the training of slow cortical potentials (SCP-group). Each group comprised of 19 children with ADHD that were blind to group assignment. The training procedure consisted of 30 sessions and a six months follow-up training. Pre-/post measures at pretest, the end of the training and the follow-up included tests of attention, intelligence and behavioral variables. After having already reported intermediate data (Strehl et al. 2004), this paper gives account on final results: Both groups are able to voluntarily regulate cortical activity, with the extent of learned self-regulation depending on task and condition. Both groups improve in attention and IQ. Parents and teachers report significant behavioral and cognitive improvements. Clinical effects for both groups remain stable six months after training. Groups do not differ in behavioral or cognitive outcome variables.

Publication Types: Comparative Study English Abstract Randomized Controlled Trial

PMID: 16869483 [PubMed - indexed for MEDLINE]

Trends Neurosci. 2006 Sep;29(9):536-46. Epub 2006 Jul 21.

Brain-machine interfaces: past, present and future.

Lebedev MA, Nicolelis MA.

Department of Neurobiology and Center for Neuroengineering, Duke University, Durham, NC 27710, USA.

Since the original demonstration that electrical activity generated by ensembles of cortical neurons can be employed directly to control a robotic manipulator, research on brain-machine interfaces (BMIs) has experienced an impressive growth. Today BMIs designed for both experimental and clinical studies can translate raw neuronal signals into motor commands that reproduce arm reaching and hand grasping movements in artificial actuators. Clearly, these developments hold promise for the restoration of limb mobility in paralyzed subjects. However, as we review here, before this goal can be reached several bottlenecks have to be passed. These include designing a fully implantable biocompatible recording device, further developing real-time computational algorithms, introducing a method for providing the brain with sensory feedback from the actuators, and designing and building artificial prostheses that can be controlled directly by brain-derived signals. By reaching these milestones, future BMIs will be able to drive and control revolutionary prostheses that feel and act like the human arm.

Publication Types: Review

PMID: 16859758 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2006 Jun;31(2):97-114. Epub 2006 Jul 15.

The significance of sigma neurofeedback training on sleep spindles and aspects of declarative memory.

Berner I, Schabus M, Wienerroither T, Klimesch W.

University of Salzburg, Division of Physiological Psychology, Hellbrunnerstrasse 34, 5020 Salzburg, Austria. iris.berner@gmx.net

The functional significance of sleep spindles for overnight memory consolidation and general learning aptitude as well as the effect of four 10-minute sessions of spindle frequency (11.6-16 Hz, sigma) neurofeedback-training on subsequent sleep spindle activity and overnight performance change was investigated. Before sleep, subjects were trained on a paired-associate word list task after having received either neurofeedback training (NFT) or pseudofeedback training (PFT).Although NFT had no significant impact on subsequent spindle activity and behavioral outcomes, there was a trend for enhanced sigma band-power during NREM (stage 2 to 4) sleep after NFT as compared to PFT. Furthermore, a significant positive correlation between spindle activity during slow wave sleep (in the first night half) and overall memory performance was revealed. The results support the view that the considerable inter-individual variance in sleep spindle activity can at least be partly explained by differences in the ability to acquire new declarative information.We conclude that the short NFT before sleep was not sufficient to efficiently enhance phasic spindle activity and/or to influence memory processing. NFT was, however, successful in increasing sigma power, presumably because sigma NFT effects become more easily evident in actually trained frequency bands than in associated phasic spindle activity.

Publication Types: Clinical Trial

PMID: 16845599 [PubMed - indexed for MEDLINE]

Sleep Med Rev. 2006 Aug;10(4):255-66. Epub 2006 Jun 27.

Neurophysiological aspects of primary insomnia: implications for its treatment.

Cortoos A, Verstraeten E, Cluydts R.

Department of Cognitive and Biological Psychology, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium. acortoos@vub.ac.be

Insomnia has usually been studied from a behavioral perspective. Somatic and/or cognitive conditioned arousal was shown to play a central role in sleep complaints becoming chronic, and was used as a starting point for the development of treatment modalities. The introduction of the neurocognitive perspective, with its focus on cortical or CNS arousal, has given rise to a renewed interest in the neurophysiological characteristics of insomnia. Recent research, using quantitative EEG, neuroimaging techniques and the study of the microstructure of sleep, suggests a state of hyperarousal with a biological basis. Furthermore, insomnia might not be restricted to sleep complaints alone because it appears to be a 24-h disorder, affecting several aspects of daytime functioning as well. These new findings have implications for the treatments used and indicate that a focus on cortical or CNS arousal should be pursued. As such, the use of EEG neurofeedback, a self-regulation method based on the paradigm of operant conditioning, might be a promising treatment modality. Preliminary results for insomnia and successful applications for other disorders suggest that this treatment can have the necessary stabilizing effects on the EEG activity, possibly resulting in a normalizing effect on daytime as well as nighttime functioning.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 16807007 [PubMed - indexed for MEDLINE]

IEEE Trans Neural Syst Rehabil Eng. 2006 Jun;14(2):225-9.

Brain-computer interfaces for 1-D and 2-D cursor control: designs using volitional control of the EEG spectrum or steady-state visual evoked potentials.

Trejo LJ, Rosipal R, Matthews B.

NASA Ames Research Center, Moffett Field, CA 94035, USA. ltrejo@quasarusa.com

We have developed and tested two electroencephalogram (EEG)-based brain-computer interfaces (BCI) for users to control a cursor on a computer display. Our system uses an adaptive algorithm, based on kernel partial least squares classification (KPLS), to associate patterns in multichannel EEG frequency spectra with cursor controls. Our first BCI, Target Practice, is a system for one-dimensional device control, in which participants use biofeedback to learn voluntary control of their EEG spectra. Target Practice uses a KPLS classifier to map power spectra of 62-electrode EEG signals to rightward or leftward position of a moving cursor on a computer display. Three subjects learned to control motion of a cursor on a video display in multiple blocks of 60 trials over periods of up to six weeks. The best subject's average skill in correct selection of the cursor direction grew from 58% to 88% after 13 training sessions. Target Practice also implements online control of two artifact sources: 1) removal of ocular artifact by linear subtraction of wavelet-smoothed vertical and horizontal electrooculograms (EOG) signals, 2) control of muscle artifact by inhibition of BCI training during periods of relatively high power in the 40-64 Hz band. The second BCI, Think Pointer, is a system for two-dimensional cursor control. Steady-state visual evoked potentials (SSVEP) are triggered by four flickering checkerboard stimuli located in narrow strips at each edge of the display. The user attends to one of the four beacons to initiate motion in the desired direction. The SSVEP signals are recorded from 12 electrodes located over the occipital region. A KPLS classifier is individually calibrated to map multichannel frequency bands of the SSVEP signals to right-left or up-down motion of a cursor on a computer display. The display stops moving when the user attends to a central fixation point. As for Target Practice, Think Pointer also implements wavelet-based online removal of ocular artifact; however, in Think Pointer muscle artifact is controlled via adaptive normalization of the SSVEP. Training of the classifier requires about 3 min. We have tested our system in real-time operation in three human subjects. Across subjects and sessions, control accuracy ranged from 80% to 100% correct with lags of 1-5 s for movement initiation and turning. We have also developed a realistic demonstration of our system for control of a moving map display (http://ti.arc.nasa.gov/).

Publication Types: Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16792300 [PubMed - indexed for MEDLINE]

Pediatrics. 2006 Nov;118(5):e1530-40. Epub 2006 Oct 23.

Self-regulation of slow cortical potentials: a new treatment for children with attention-deficit/hyperactivity disorder.

Strehl U, Leins U, Goth G, Klinger C, Hinterberger T, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Gartenstrasse 29, 72074 Tübingen, Germany. ute.strehl@uni-tuebingen.de

OBJECTIVE: We investigated the effects of self-regulation of slow cortical potentials for children with attention-deficit/hyperactivity disorder. Slow cortical potentials are slow event-related direct-current shifts of the electroencephalogram. Slow cortical potential shifts in the electrical negative direction reflect the depolarization of large cortical cell assemblies, reducing their excitation threshold. This training aims at regulation of cortical excitation thresholds considered to be impaired in children with attention-deficit/hyperactivity disorder. Electroencephalographic data from the training and the 6-month follow-up are reported, as are changes in behavior and cognition. METHOD: Twenty-three children with attention-deficit/hyperactivity disorder aged between 8 and 13 years received 30 sessions of self-regulation training of slow cortical potentials in 3 phases of 10 sessions each. Increasing and decreasing slow cortical potentials at central brain regions was fed back visually and auditorily. Transfer trials without feedback were intermixed with feedback trials to allow generalization to everyday-life situations. In addition to the neurofeedback sessions, children exercised during the third training phase to apply the self-regulation strategy while doing their homework. RESULTS: For the first time, electroencephalographic data during the course of slow cortical potential neurofeedback are reported. Measurement before and after the trials showed that children with attention-deficit/hyperactivity disorder learn to regulate negative slow cortical potentials. After training, significant improvement in behavior, attention, and IQ score was observed. The behavior ratings included Diagnostic and Statistical Manual of Mental Disorders criteria, number of problems, and social behavior at school and were conducted by parents and teachers. The cognitive variables were assessed with the Wechsler Intelligence Scale for Children and with a computerized test battery that measures several components of attention. All changes proved to be stable at 6 months' follow-up after the end of training. Clinical outcome was predicted by the ability to produce negative potential shifts in transfer sessions without feedback. CONCLUSIONS: According to the guidelines of the efficacy of treatments, the evidence of the efficacy of slow cortical potential feedback found in this study reaches level 2: "possibly efficacious." In the absence of a control group, no causal relationship between observed improvements and the ability to regulate brain activity can be made. However, it could be shown for the first time that good performance in self-regulation predicts clinical outcome. "Good performance" was defined as the ability to produce negative potential shifts in trials without feedback, because it is known that the ability to self-regulate without feedback is impaired in children and adults with attention problems. Additional research should focus on the control of unspecific effects, medication, and subtypes to confirm the assumption that slow cortical potential feedback is a viable treatment option for attention-deficit/hyperactivity disorder. Regulation of slow cortical potentials may involve similar neurobiological pathways as medical treatment. It is suggested that regulation of frontocentral negative slow cortical potentials affects the cholinergic-dopaminergic balance and allows children to adapt to task requirements more flexibly.

Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

PMID: 17060480 [PubMed - indexed for MEDLINE]

Magn Reson Med Sci. 2006 Oct;5(3):157-65.

Real-time functional MRI: development and emerging applications.

Bagarinao E, Nakai T, Tanaka Y.

Grid Technology Research Center, National Institute of Advanced Industrial Science and Technology, Ibaraki, Japan. baggy@ni.aist.go.jp

Real-time functional magnetic resonance imaging (fMRI) is an emerging technique for assessing the dynamic and robust changes in brain activation during an ongoing experiment. Real-time fMRI allows measurement of several processes within the brain as they occur. The extracted information can be used to monitor the quality of acquired data sets, serve as the basis for neurofeedback training, and manipulate scans for interactive paradigm designs. Although more work is needed, recent results have demonstrated a variety of potential applications for real-time fMRI for research and clinical use. We discuss these developments and focus on methods enabling real-time analysis of fMRI data sets, novel research applications arising from these approaches, and potential use of real-time fMRI in clinical settings.

Publication Types: Review

PMID: 17139142 [PubMed - indexed for MEDLINE]

Neuroreport. 2006 Aug 21;17(12):1273-8.

Increasing cortical activity in auditory areas through neurofeedback functional magnetic resonance imaging.

Yoo SS, O'Leary HM, Fairneny T, Chen NK, Panych LP, Park H, Jolesz FA.

Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. yoo@bwh.harvard.edu

We report a functional magnetic resonance imaging method to deliver task-specific brain activities as biofeedback signals to guide individuals to increase cortical activity in auditory areas during sound stimulation. A total of 11 study participants underwent multiple functional magnetic resonance imaging scan sessions, while the changes in the activated cortical volume within the primary and secondary auditory areas were fed back to them between scan sessions. On the basis of the feedback information, participants attempted to increase the number of significant voxels during the subsequent trial sessions by adjusting their level of attention to the auditory stimuli. Results showed that the group of individuals who received the feedback were able to increase the activation volume and blood oxygenation level-dependent signal to a greater degree than the control group.

Publication Types: Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

PMID: 16951568 [PubMed - indexed for MEDLINE]

Mol Psychiatry. 2006 Jun;11(6):528-38.

How psychotherapy changes the brain--the contribution of functional neuroimaging.

Linden DE.

School of Psychology, University of Wales Bangor, Bangor, UK. d.linden@bangor.ac.uk

A thorough investigation of the neural effects of psychotherapy is needed in order to provide a neurobiological foundation for widely used treatment protocols. This paper reviews functional neuroimaging studies on psychotherapy effects and their methodological background, including the development of symptom provocation techniques. Studies of cognitive behavioural therapy (CBT) effects in obsessive-compulsive disorder (OCD) were consistent in showing decreased metabolism in the right caudate nucleus. Cognitive behavioural therapy in phobia resulted in decreased activity in limbic and paralimbic areas. Interestingly, similar effects were observed after successful intervention with selective serotonin reuptake inhibitors (SSRI) in both diseases, indicating commonalities in the biological mechanisms of psycho- and pharmacotherapy. These findings are discussed in the context of current neurobiological models of anxiety disorders. Findings in depression, where both decreases and increases in prefrontal metabolism after treatment and considerable differences between pharmacological and psychological interventions were reported, seem still too heterogeneous to allow for an integrative account, but point to important differences between the mechanisms through which these interventions attain their clinical effects. Further studies with larger patient numbers, use of standardised imaging protocols across studies, and ideally integration with molecular imaging are needed to clarify the remaining contradictions. This effort is worthwhile because functional imaging can then be potentially used to monitor treatment effects and aid in the choice of the optimal therapy. Finally, recent advances in the functional imaging of hypnosis and the application of neurofeedback are evaluated for their potential use in the development of psychotherapy protocols that use the direct modulation of brain activity as a way of improving symptoms.

Publication Types: Review

PMID: 16520823 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2006 Mar;31(1):85-94.

Deactivation of brain areas during self-regulation of slow cortical potentials in seizure patients.

Strehl U, Trevorrow T, Veit R, Hinterberger T, Kotchoubey B, Erb M, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany. ute.strehl@uni-tuebingen.de

This study investigates the neurophysiological basis of EEG feedback for patients with epilepsy. Brain areas are identified that become hemodynamically deactivated when epilepsy patients, trained in EEG self-regulation, generate positive slow cortical potentials (SCPs). Five patients were trained in producing positive SCPs, using a training protocol previously established to reduce seizure frequency in patients with drug refractory epilepsy. Patients attempted to produce positive SCP shifts in a functional magnetic resonance imaging (fMRI) scanner. Two patients were able to reliably produce positive SCP shifts. When these successful regulators were prompted to produce positive SCPs, blood oxygen level-dependent (BOLD) response indicated deactivation, in comparison to a control state, around the recording electrode, frontal lobe, and thalamus. Unsuccessful regulators' BOLD response indicated no deactivation in cortical areas proximal to the active electrode. No thalamic deactivation was found in poor regulators. Decreased seizure frequency from SCP training may be the result of positively reinforced inhibition in cortical areas proximal to active electrode placement, the frontal cortex, and the thalamus.

Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

PMID: 16752105 [PubMed - indexed for MEDLINE]

Expert Rev Neurother. 2006 Apr;6(4):533-40.

Electroencephalographic biofeedback for the treatment of attention-deficit hyperactivity disorder in childhood and adolescence.

Holtmann M, Stadler C.

Department of Child and Adolescent Psychiatry and Psychotherapy, J.W. Goethe-University, Frankfurt/Main, Deutschordenstrasse 50, D-60528 Frankfurt am Main, Germany. holtmann@em.uni-frankfurt.de

Considerable scientific effort has been directed at developing effective treatments for attention-deficit hyperactivity disorder (ADHD). Among alternative treatment approaches, electroencephalographic (EEG) biofeedback has gained promising empirical support in recent years. Short-term effects were shown to be comparable to those of stimulant medication at the behavioral and neuropsychological level, leading to significant decreases of inattention, hyperactivity and impulsivity. In addition, EEG biofeedback results in concomitant improvement of neurophysiological patterns. EEG biofeedback may already be used within a multimodal setting, providing affected children and adolescents with a means of learning to counterbalance their ADHD symptoms without side effects. However, there is still a strong need for more empirically and methodologically sound evaluation studies.

Publication Types: Review

PMID: 16623652 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2006 Mar;31(1):21-35.

Foundation and practice of neurofeedback for the treatment of epilepsy.

Sterman MB, Egner T.

Department of Neurobiology, School of Medicine, UCLA, USA. msterman@ucla.edu

This review provides an updated overview of the neurophysiological rationale, basic and clinical research literature, and current methods of practice pertaining to clinical neurofeedback. It is based on documented findings, rational theory, and the research and clinical experience of the authors. While considering general issues of physiology, learning principles, and methodology, it focuses on the treatment of epilepsy with sensorimotor rhythm (SMR) training, arguably the best established clinical application of EEG operant conditioning. The basic research literature provides ample data to support a very detailed model of the neural generation of SMR, as well as the most likely candidate mechanism underlying its efficacy in clinical treatment. Further, while more controlled clinical trials would be desirable, a respectable literature supports the clinical utility of this alternative treatment for epilepsy. However, the skilled practice of clinical neurofeedback requires a solid understanding of the neurophysiology underlying EEG oscillation, operant learning principles and mechanisms, as well as an in-depth appreciation of the ins and outs of the various hardware/software equipment options open to the practitioner. It is suggested that the best clinical practice includes the systematic mapping of quantitative multi-electrode EEG measures against a normative database before and after treatment to guide the choice of treatment strategy and document progress towards EEG normalization. We conclude that the research literature reviewed in this article justifies the assertion that neurofeedback treatment of epilepsy/seizure disorders constitutes a well-founded and viable alternative to anticonvulsant pharmacotherapy.

Publication Types: Review

PMID: 16614940 [PubMed - indexed for MEDLINE]

IEEE Trans Neural Syst Rehabil Eng. 2006 Mar;14(1):30-7.

Steady-state somatosensory evoked potentials: suitable brain signals for brain-computer interfaces?

Müller-Putz GR, Scherer R, Neuper C, Pfurtscheller G.

Laboratory of Brain-Computer Interfaces, Institute for Computer Graphics and Vision, Graz University of Technology, 8010 Graz, Austria. gernot.mueller@ieee.org

One of the main issues in designing a brain-computer interface (BCI) is to find brain patterns, which could easily be detected. One of these pattern is the steady-state evoked potential (SSEP). SSEPs induced through the visual sense have already been used for brain-computer communication. In this work, a BCI system is introduced based on steady-state somatosensory evoked potentials (SSSEPs). Transducers have been used for the stimulation of both index fingers using tactile stimulation in the "resonance"-like frequency range of the somatosensory system. Four subjects participated in the experiments and were trained to modulate induced SSSEPs. Two of them learned to modify the patterns in order to set up a BCI with an accuracy of between 70% and 80%. Results presented in this work give evidence that it is possible to set up a BCI which is based on SSSEPs.

Publication Types: Clinical Trial

PMID: 16562629 [PubMed - indexed for MEDLINE]

Zh Nevrol Psikhiatr Im S S Korsakova. 2006;106(2):31-6.

[The use of individual EEG peculiarities for increase of neurofeedback efficiency]

[Article in Russian]

Bazanova OM, Aftanas LI.

An aim of the study was to demonstrate efficiency of neurofeedback in using individual frequency ranges of electroencephalogram (EEG). The sessions of theta/beta decreasing and alpha simulating trainings were carried out in 2 outpatients: one of them with attention deficit disorder (a schoolboy) and another one with functional pain contraction (a professional musician). The neurofeedback with standard frequency did not result in any improvement of psychometric and EEG characteristics of both patients. The neurofeedback training with individual frequency of maximal peak and alpha band width improved these characteristics that suggest efficiency of the approach used.

Publication Types: English Abstract

PMID: 16548372 [PubMed - indexed for MEDLINE]

Expert Rev Neurother. 2006 Feb;6(2):247-57.

Neurofeedback treatment of epilepsy: from basic rationale to practical application.

Egner T, Sterman MB.

Functional MRI Research Center, Columbia University, Neurological Institute, Box 108, New York, NY 10032, USA. te2111@columbia.edu

The treatment of epilepsy through operant conditioning of the sensorimotor rhythm electroencephalogram has a 35-year history. Neurophysiological studies have shown that this phasic oscillation reflects an inhibitory state of the sensorimotor system. Operant learning of sensory motor rhythm production results in an upregulation of excitation thresholds within the thalamocortical sensory and motor circuitry, which in turn is associated with reduced susceptibility to seizures. The clinical benefits derived from this neurofeedback training protocol, particularly in patients that are nonresponsive to pharmacotherapy, have been documented in many independent laboratories. Recent advances in computer technology have resulted in the availability of relatively inexpensive high-quality equipment for the application of neurofeedback therapy, thus presenting a viable and promising treatment alternative to the interested clinician.

PMID: 16466304 [PubMed - indexed for MEDLINE]

Clin Neurophysiol. 2006 Mar;117(3):531-7. Epub 2006 Feb 2.

Comment in: Clin Neurophysiol. 2006 Mar;117(3):479-83.

P300-based brain computer interface: reliability and performance in healthy and paralysed participants.

Piccione F, Giorgi F, Tonin P, Priftis K, Giove S, Silvoni S, Palmas G, Beverina F.

IRCCS, S. Camillo Hospital, Alberoni, 70, 30126 Venice, Italy. piccioneparrinello@aliceposta.it

OBJECTIVE: This study aimed to describe the use of the P300 event-related potential as a control signal in a brain computer interface (BCI) for healthy and paralysed participants. METHODS: The experimental device used the P300 wave to control the movement of an object on a graphical interface. Visual stimuli, consisting of four arrows (up, right, down, left) were randomly presented in peripheral positions on the screen. Participants were instructed to recognize only the arrow indicating a specific direction for an object to move. P300 epochs, synchronized with the stimulus, were analyzed on-line via Independent Component Analysis (ICA) with subsequent feature extraction and classification by using a neural network. RESULTS: We tested the reliability and the performance of the system in real-time. The system needed a short training period to allow task completion and reached good performance. Nonetheless, severely impaired patients had lower performance than healthy participants. CONCLUSIONS: The proposed system is effective for use with healthy participants, whereas further research is needed before it can be used with locked-in syndrome patients. SIGNIFICANCE: The P300-based BCI described can reliably control, in 'real time', the motion of a cursor on a graphical interface, and no time-consuming training is needed in order to test possible applications for motor-impaired patients.

Publication Types: Comparative Study

PMID: 16458069 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2006 Mar;31(1):3-20.

Functional magnetic resonance imaging investigation of the effects of neurofeedback training on the neural bases of selective attention and response inhibition in children with attention-deficit/hyperactivity disorder.

Beauregard M, Lévesque J.

Centre de Recherche en Neuropsychologie et Cognition, Département de Psychologie, Université de Montréal, Montréal, Canada. mario.beauregard@umontreal.ca

Two functional magnetic resonance imaging (fMRI) experiments were undertaken to measure the effect of neurofeedback training (NFT), in AD/HD children, on the neural substrates of selective attention and response inhibition. Twenty unmedicated AD/HD children participated to these experiments. Fifteen children were randomly assigned to the Experimental (EXP) group whereas the other five children were randomly assigned to the Control (CON) group. Only subjects in the EXP group underwent NFT. EXP subjects were trained to enhance the amplitude of the SMR (12-15 Hz) and beta 1 activity (15-18 Hz), and decrease the amplitude of theta activity (4-7 Hz). Subjects from both groups were scanned one week before the beginning of NFT (Time 1) and 1 week after the end of NFT (Time 2), while they performed a "Counting Stroop" task (Experiment 1) and a Go/No-Go task (Experiment 2). At Time 1, in both groups, the Counting Stroop task was associated with significant activation in the left superior parietal lobule. For the Go/No-Go task, no significant activity was detected in the EXP and CON groups. At Time 2, in both groups, the Counting Stroop task was associated with significant activation of the left superior parietal lobule. This time, however, there were significant loci of activation, in the EXP group, in the right ACC, left caudate nucleus, and left substantia nigra. No such activation loci were seen in CON subjects. For the Go/No-Go task, significant loci of activation were noted, in the EXP group, in the right ventrolateral prefrontal cortex, right ACcd, left thalamus, left caudate nucleus, and left substantia nigra. No significant activation of these brain regions was measured in CON subjects. These results suggest that NFT has the capacity to functionally normalize the brain systems mediating selective attention and response inhibition in AD/HD children.

Publication Types: Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 16552626 [PubMed - indexed for MEDLINE]

Neurosci Lett. 2006 Feb 20;394(3):216-21. Epub 2005 Dec 15.

Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: a functional magnetic resonance imaging study.

Lévesque J, Beauregard M, Mensour B.

Centre de Recherche en Neuropsychologie Expérimentale et Cognition (CERNEC), Département de psychologie, Université de Montréal, Canada.

Attention Deficit Hyperactivity Disorder (AD/HD) is a neurodevelopmental disorder mainly characterized by impairments in cognitive functions. Functional neuroimaging studies carried out in individuals with AD/HD have shown abnormal functioning of the anterior cingulate cortex (ACC) during tasks involving selective attention. In other respects, there is mounting evidence that neurofeedback training (NFT) can significantly improve cognitive functioning in AD/HD children. In this context, the present functional magnetic resonance imaging (fMRI) study was conducted to measure the effect of NFT on the neural substrates of selective attention in children with AD/HD. Twenty AD/HD children--not taking any psychostimulant and without co-morbidity-participated to the study. Fifteen children were randomly assigned to the Experimental (EXP) group (NFT), whereas the other five children were assigned to the Control (CON) group (no NFT). Subjects from both groups were scanned 1 week before the beginning of the NFT (Time 1) and 1 week after the end of this training (Time 2), while they performed a Counting Stroop task. At Time 1, for both groups, the Counting Stroop task was associated with significant loci of activation in the left superior parietal lobule. No activation was noted in the ACC. At Time 2, for both groups, the Counting Stroop task was still associated with significant activation of the left superior parietal lobule. This time, however, for the EXP group only there was a significant activation of the right ACC. These results suggest that in AD/HD children, NFT has the capacity to normalize the functioning of the ACC, the key neural substrate of selective attention.

Publication Types: Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 16343769 [PubMed - indexed for MEDLINE]

Prog Brain Res. 2006;159:151-65.

Upper alpha ERD and absolute power: their meaning for memory performance.

Klimesch W, Doppelmayr M, Hanslmayr S.

Department of Physiological Psychology, Institute of Psychology, University of Salzburg, A-5020 Salzburg, Austria. wolfgang.klimesch@sbg.ac.at

A variety of studies have shown that EEG alpha activity in the upper frequency range is associated with different types of cognitive processes, memory performance, perceptual performance and intelligence, but in strikingly different ways. For semantic memory performance we have found that resting or reference power is positively associated with performance, whereas during actual processing of the task, small power--reflected by a large extent of event-related desynchronization (ERD)--is related to good performance. We also have shown that the induction of large alpha reference power by neurofeedback training or repetitive transcranial magnetic stimulation (rTMS) at individual alpha frequency mimicked exactly the situation which is typical for good memory performance under normal situations: increased alpha reference power is associated with large ERD and good performance. Recent studies have demonstrated that this relationship holds true only for memory and not perceptual tasks that require the identification of simple visual stimuli under difficult conditions. In contrast to good memory performance, good perceptual performance is related to small pre-stimulus alpha power and a small ERD. We interpret this finding in terms of cortical inhibition vs. activation preceding task performance by assuming that large rhythmic alpha activity reflects inhibition. We assume that small reference alpha enhances perceptual performance because the cortex is activated and prepared to process the stimulus, whereas memory performance is enhanced if the cortex is deactivated before a task is performed because in typical memory tasks selective processing can start only after the to-be-remembered item or cue is presented. We also suggest that conflicting results about alpha ERD and the neural efficiency hypothesis (which assumes that highly intelligent exhibit a small ERD) can also be interpreted in terms of inhibition. Only if an intelligence test actually requires the activation of (semantic) memory, a large (because task specific) ERD can be observed. If other processing systems are required, the semantic memory system may even become suppressed, which is reflected by alpha event-related synchronization (ERS) or at least a largely decreased ERD.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 17071229 [PubMed - indexed for MEDLINE]

Brain Cogn. 2005 Dec;59(3):314-21.

Effect of neurofeedback on hemispheric word recognition.

Barnea A, Rassis A, Zaidel E.

Bio-Keshev Center, Kibutz Givat Chaim Ichud, Israel.

We applied SMR/theta neurofeedback (NF) training at central sites of 20 Israeli children aged 10-12 years, half boys and half girls. Half of the subjects received C3 training and the other half C4 training, consisting of 20 half-hour sessions. We assessed the effects of training on lateralized lexical decision in Hebrew. The lateralized lexical decision test reveals an independent contribution of each hemisphere to word recognition (Barnea, Mooshagian, & Zaidel, 2003). Training increased accuracy and sensitivity. It increased left hemisphere (LH) specialization under some conditions but it did not affect interhemispheric transfer. Training did affect psycholinguistic processing in the two hemispheres, differentially at C3 and C4. Training also increased hemispheric independence. There were surprising sex differences in the effects of training. In boys, C4 training improved LH accuracy, whereas in girls C3 training improved LH accuracy. The results suggest that the lateralized NF protocol activates asymmetric hemispheric control circuits which modify distant hemispheric networks and are organized differently in boys and girls.

Publication Types: Clinical Trial Research Support, N.I.H., Extramural

PMID: 16337872 [PubMed - indexed for MEDLINE]

Int J Neurosci. 2005 Jun;115(6):781-802.

Unconscious operant conditioning in the paradigm of brain-computer interface based on color perception.

Kaplan AY, Lim JJ, Jin KS, Park BW, Byeon JG, Tarasova SU.

Department of Human Physiology, Biological Faculty, Moscow State University, Moscow, Russian Federation. akaplan@mail.ru

This study investigate the mutual fine-tuning of ongoing EEG rhythmic features with RGB values controlling color shades of computer screen during neuro-feedback training. Fifteen participants had not been informed about the existence of neurofeedback loop (NF), but were guided only to look at the computer screen. It was found that during such unconscious NF training, a variety of color shades on the screen gradually changed from rather various types to the main one within the framework of color palette specified for each individual. This phenomenon was not observed in control experiments with simulated neuro-feedback. Individual color patterns induced on the screen during NF did not depend on the schema of connection between of EEG rhythms and RGB controller. It is suggested that the basic neurophysiological mechanism of described NF training consists of the directed selection of EEG patterns reinforced by comfortable color shades without conscious control.

PMID: 16019574 [PubMed - indexed for MEDLINE]

PLoS Med. 2005 Jun;2(6):e153. Epub 2005 Jun 28.

Tinnitus perception and distress is related to abnormal spontaneous brain activity as measured by magnetoencephalography.

Weisz N, Moratti S, Meinzer M, Dohrmann K, Elbert T.

Department of Psychology, University of Konstanz, Germany. Nathan.Weisz@uni-konstantz.de

BACKGROUND: The neurophysiological mechanisms underlying tinnitus perception are not well understood. Surprisingly, there have been no group studies comparing abnormalities in ongoing, spontaneous neuronal activity in individuals with and without tinnitus perception. METHODS AND FINDINGS: Here, we show that the spontaneous neuronal activity of a group of individuals with tinnitus (n = 17) is characterised by a marked reduction in alpha (8-12 Hz) power together with an enhancement in delta (1.5-4 Hz) as compared to a normal hearing control group (n = 16). This pattern was especially pronounced for temporal regions. Moreover, correlations with tinnitus-related distress revealed strong associations with this abnormal spontaneous activity pattern, particularly in right temporal and left frontal areas. Overall, effects were stronger for the alpha than for the delta frequency band. A data stream of 5 min, recorded with a whole-head neuromagnetometer under a resting condition, was sufficient to extract the marked differences. CONCLUSIONS: Despite some limitations, there are arguments that the regional pattern of abnormal spontaneous activity we found could reflect a tinnitus-related cortical network. This finding, which suggests that a neurofeedback approach could reduce the adverse effects of this disturbing condition, could have important implications for the treatment of tinnitus.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 15971936 [PubMed - indexed for MEDLINE]

Clin EEG Neurosci. 2005 Apr;36(2):99-107.

Clinical database development: characterization of EEG phenotypes.

Johnstone J, Gunkelman J, Lunt J.

Q-Metrx, Inc., Burbank, California 91506, USA. Jack@q-metrx.com

We propose development of evidence-based methods to guide clinical intervention in neurobehavioral syndromes based on categorization of individuals using both behavioral measures and quantification of the EEG (qEEG). Review of a large number of clinical EEG and qEEG studies suggests that it is plausible to identify a limited set of individual profiles that characterize the majority of the population. Statistical analysis has already been used to document "clusters" of qEEG features seen in populations of psychiatric patients. These clusters are considered here as intermediate phenotypes, based on genetics, and are reliable indices of brain function, not isomorphic with DSM categories, and carry implications for therapeutic intervention. We call for statistical analysis methods to be applied to a broad clinical database of individuals diagnosed with neurobehavioral disorders in order to empirically define clusters of individuals who may be responsive to specific neurophysiologically based treatment interventions, namely administration of psychoactive medication and/or EEG neurofeedback. A tentative set of qEEG profiles is proposed based on clinical observation and experience. Implication for intervention with medication and neurofeedback for individuals with these neurophysiological profiles and specific qEEG patterns is presented.

PMID: 15999905 [PubMed - indexed for MEDLINE]

Prilozi. 2005 Dec;26(2):35-42.

Spectrum-weighted EEG frequency ("brain-rate") as a quantitative indicator of mental arousal.

Pop-Jordanova N, Pop-Jordanov J.

Pediatric Clinic, Faculty of Medicine, University of Skopje, R. Macedonia.

A concept of brain-rate is introduced, defining it as the weighted mean frequency of the EEG spectrum. In analogue to the blood pressure, heart-rate and temperature, used as standard preliminary indicators of corresponding general bodily activations, it is proposed to use the brain-rate as a preliminary indicator of general mental activation (mental arousal) level. In addition, along with the more specific few-band biofeedback parameters (theta-beta ratio, relative beta ratio, etc.), the brain-rate could be effectively used as a general multiband biofeedback parameter.

PMID: 16400227 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2005 Dec;30(4):365-73.

Neurofeedback: an alternative and efficacious treatment for Attention Deficit Hyperactivity Disorder.

Fox DJ, Tharp DF, Fox LC.

Advanced Neurotherapy Solutions, College Station, Texas 77840, USA. drfox@advancedntsolutions.com

Current research has shown that neurofeedback, or EEG biofeedback as it is sometimes called, is a viable alternative treatment for Attention Deficit Hyperactivity Disorder (ADHD). The aim of this article is to illustrate current treatment modalities(s), compare them to neurofeedback, and present the benefits of utilizing this method of treatment to control and potentially alleviate the symptoms of ADHD. In addition, this article examines the prevalence rates and possible etiology of ADHD, the factors associated with ADHD and brain dysfunction, the current pharmacological treatments of ADHD, Ritalin, and the potential risks and side effects. Behavior modification and cognitive behavioral treatment for ADHD is discussed as well. Lastly, a brief history of the study of neurofeedback, treatment successes and clinical benefits, comparisons to medication, and limitations are presented.

Publication Types: Review

PMID: 16385424 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2005 Dec;30(4):347-64.

Can neurofeedback training enhance performance? An evaluation of the evidence with implications for future research.

Vernon DJ.

Department of Applied Social Sciences, Canterbury Christ Church University, Augustine House, Canterbury, Kent, United Kingdom. d.j.vernon@canterbury.ac.uk

There have been many claims regarding the possibilities of performance enhancement training. The aim of such training is for an individual to complete a specific function or task with fewer errors and greater efficiency, resulting in a more positive outcome. The present review examined evidence from neurofeedback training studies to enhance performance in a particular area. Previous research has documented associations between specific cortical states and optimum levels of performance in a range of tasks. This information provides a plausible rationale for the use of neurofeedback to train individuals to enhance their performance. An examination of the literature revealed that neurofeedback training has been utilised to enhance performance from three main areas; sport, cognitive and artistic performance. The review examined evidence from neurofeedback training studies within each of these three areas. Some suggestive findings have been reported with regard to the use of neurofeedback training to enhance performance. However, due to a range of methodological limitations and a general failure to elicit unambiguous changes in baseline EEG activity, a clear association between neurofeedback training and enhanced performance has yet to be established. Throughout, the review highlights a number of recommendations to aid and stimulate future research.

Publication Types: Review

PMID: 16385423 [PubMed - indexed for MEDLINE]

Cochrane Database Syst Rev. 2005 Oct 19;(4):CD002029.

Update of: Cochrane Database Syst Rev. 2003;(4):CD002029.

Psychological treatments for epilepsy.

Ramaratnam S, Baker GA, Goldstein LH.

Apollo Hospitals, Department of Neurology, 21 Greams Lane, Off Greams Road, Madras, Tamil Nadu, India 60006. rsridharan@vsnl.com

BACKGROUND: Psychological interventions such as relaxation therapy, cognitive behaviour therapy, bio-feedback and educational interventions have been used alone or in combination in the treatment of epilepsy, to reduce the seizure frequency and improve the quality of life. OBJECTIVES: To assess whether the treatment of epilepsy with psychological methods is effective in reducing seizure frequency and/or leads to a better quality of life. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group's Specialized Register (July 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), and MEDLINE (1966 to March 2005). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies. SELECTION CRITERIA: Randomized or quasi-randomized studies assessing one or more types of psychological or behaviour modification techniques for people with epilepsy. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the trials for inclusion and extracted data. Primary analyses were by intention to treat. Outcomes included reduction in seizure frequency and quality of life. MAIN RESULTS: We found three small trials (50 participants) of relaxation therapy. They were of poor methodological quality and a meta-analysis was therefore not undertaken. No study found a significant effect of relaxation therapy on seizure frequency. One trial found cognitive behavioural therapy to be effective in reducing depression, among people with epilepsy with a depressed affect, whilst another did not.One trial of group cognitive therapy found no significant effect on seizure frequency. Two trials of combined relaxation and behaviour therapy and one of EEG bio-feedback and four of educational interventions did not provide sufficient information to assess their effect on seizure frequency. One small study of galvanic skin response biofeedback reported significant reduction in seizure frequency. Combined use of relaxation and behaviour modification was found beneficial for anxiety and adjustment in one study. In one study EEG bio-feedback was found to improve the cognitive and motor functions in individuals with greatest seizure reduction. Educational interventions were found to be beneficial in improving the knowledge and understanding of epilepsy, coping with epilepsy, compliance to medication and social competencies. AUTHORS' CONCLUSIONS: In view of methodological deficiencies and limited number of individuals studied, we have found no reliable evidence to support the use of these treatments and further trials are needed.

Publication Types: Review

PMID: 16235293 [PubMed - indexed for MEDLINE]

J Huazhong Univ Sci Technolog Med Sci. 2005;25(3):368-70.

A controlled study of the effectiveness of EEG biofeedback training on-children with attention deficit hyperactivity disorder.

Xiong Z, Shi S, Xu H.

Department of Child Health, Hubei Maternal and Child Hospital, Wuhan 430070, China.

In order to study the treatment of the children with attention deficit hyperactivity disorder (ADHD), the integrated visual and auditory continuous performance test (IVA-CPT) was clinically applied to evaluate the effectiveness of electroencephalogram (EEG) biofeedback training. Of all the 60 children with ADHD aged more than 6 years, the effective rate of EEG biofeedback training was 91.6% after 40 sessions of EEG biofeedback training. Before and after treatment by EEG biofeedback training, the overall indexes of IVA were significantly improved among predominately inattentive, hyperactive, and combined subtype of children with ADHD (P<0.001). It was suggested that EEG biofeedback training was an effective and vital treatment on children with ADHD.

PMID: 16201300 [PubMed - indexed for MEDLINE]

IEEE Trans Biomed Eng. 2005 Sep;52(9):1588-96.

Visual spatial attention control in an independent brain-computer interface.

Kelly SP, Lalor EC, Finucane C, McDarby G, Reilly RB.

Department of Electronic & Electrical Engineering, University College Dublin, Belfield Dublin 4, Ireland. simon.kelly@ee.ucd.ie

This paper presents a novel brain computer interface (BCI) design employing visual evoked potential (VEP) modulations in a paradigm involving no dependency on peripheral muscles or nerves. The system utilizes electrophysiological correlates of visual spatial attention mechanisms, the self-regulation of which is naturally developed through continuous application in everyday life. An interface involving real-time biofeedback is described, demonstrating reduced training time in comparison to existing BCIs based on self-regulation paradigms. Subjects were cued to covertly attend to a sequence of letters superimposed on a flicker stimulus in one visual field while ignoring a similar stimulus of a different flicker frequency in the opposite visual field. Classification of left/right spatial attention is achieved by extracting steady-state visual evoked potentials (SSVEPs) elicited by the stimuli. Six out of eleven physically and neurologically healthy subjects demonstrate reliable control in binary decision-making, achieving at least 75% correct selections in at least one of only five sessions, each of approximately 12-min duration. The highest-performing subject achieved over 90% correct selections in each of four sessions. This independent BCI may provide a new method of real-time interaction for those with little or no peripheral control, with the added advantage of requiring only brief training.

Publication Types: Clinical Trial

PMID: 16189972 [PubMed - indexed for MEDLINE]

Am J Drug Alcohol Abuse. 2005;31(3):455-69.

Effects of an EEG biofeedback protocol on a mixed substance abusing population.

Scott WC, Kaiser D, Othmer S, Sideroff SI.

Neuropsychiatric Institute, University of California, Los Angeles, California, USA.

This study examined whether an EEG biofeedback protocol could improve outcome measures for a mixed substance abusing inpatient population. METHOD: One hundred twenty-one volunteers undergoing an inpatient substance abuse program were randomly assigned to the EEG biofeedback or control group. EEG biofeedback included training in Beta and SMR to address attentional variables, followed by an alpha-theta protocol. Subjects received a total of 40 to 50 biofeedback sessions. The control group received additional time in treatment equivalent to experimental procedure time. The Test of Variables of Attention (TOVA), and MMPI, were administered with both tester and subject blind as to group placement to obtain unbiased baseline data. Treatment retention and abstinence rates as well as psychometric and cognitive measures were compared. RESULTS: Experimental subjects remained in treatment significantly longer than the control group (p <0.005). Of the experimental subjects completing the protocol, 77% were abstinent at 12 months, compared to 44% for the controls. Experimental subjects demonstrated significant improvement on the TOVA (p<.005) after an average of 13 beta-SMR sessions. Following alpha-theta training, significant differences were noted on 5 of the 10 MMPI-2 scales at the p<.005 level. CONCLUSIONS: This protocol enhanced treatment retention, variables of attention, and abstinence rates one year following treatment.

Publication Types: Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 16161729 [PubMed - indexed for MEDLINE]

Prilozi. 2005 Aug;26(1):71-80.

Neurofeedback treatment of children with attention deficit hyperactivity disorder.

Pop-Jordanova N, Markovska-Simoska S, Zorcec T.

Department of Pediatrics, Faculty of Medicine, University of Skopje, R. Macedonia.

BACKGROUND: Biofeedback is a modern computer-related technique used for assessment and therapy of many psychophysiological disorders, especially stress-related ones. After a short overview of the basic concepts of biofeedback, in this study the application of EEG biofeedback (neurofeedback) in the assessment of and therapy for attention deficit hyperactivity disorders (ADHD) is presented and discussed. METHODS: The study comprised 12 children diagnosed as ADHD, selected according to ICD-10, and assessed by WISC-R, Q-EEG, neurofeedback and Conner's questionnaire for parents and teachers. The mean age was 9.5 years (7 to 13), both sexes. Each of them participated in a five-month programme of neurofeedback training, performed two times weekly with Biograph/ProComp 2.0 protocols. RESULTS: Post-treatment results showed an improved EEG pattern expressed in increased 16-20 Hz (beta) activity and decreased 4-8 Hz (theta) activity. In parallel, higher scores on WISC-R, better school notes and improved social adaptability and self-esteem were obtained. CONCLUSIONS: EEG biofeedback operant conditioning is a good choice for treatment of ADHD children. The method is non-invasive and has high cost-benefit. Optimal results are obtained in children of higher age. Cooperation with family members and teachers is crucial.

PMID: 16118616 [PubMed - indexed for MEDLINE]

Semin Pediatr Neurol. 2005 Jun;12(2):106-13.

Nonpharmacological treatment options for epilepsy.

Sheth RD, Stafstrom CE, Hsu D.

Department of Neurology, University of Wisconsin, Madison, Madison, WI 53792-5132, USA. sheth@neurology.wisc.edu

Approximately one third of children with epilepsy have persistent seizures despite trials of multiple antiepileptic medications. For some of these patients, epilepsy surgery may provide freedom from seizures. However, in many cases, epilepsy surgery is not a viable treatment option. Nonpharmacological approaches are a useful adjunct to help manage seizures in these children. This review examines the role of vagus nerve stimulation, the ketogenic diet, and various forms of EEG biofeedback therapy in children with intractable epilepsy. Although the mechanism of action is not known precisely for any of these adjunctive therapies, they add an important and evolving dimension to the management of difficult to control epilepsy in children. In addition, pyridoxine-dependent seizures are discussed as an example of an etiology of refractory seizures that responds well to replacement therapy.

Publication Types: Review

PMID: 16114176 [PubMed - indexed for MEDLINE]

Appl Neuropsychol. 2005;12(2):64-76.

Clinical utility of EEG in attention deficit hyperactivity disorder.

Loo SK, Barkley RA.

UCLA Neuropsychiatric Institute, Los Angeles, California 90024, USA. sloo@mednet.ucla.edu

Electrophysiological measures were among the first to be used to study brain processes in children with attention deficit hyperactivity disorder (ADHD; Diagnostic and Statistical Manual of Mental Disorders [4th ed.], American Psychiatric Association, 1994) and have been used as such for over 30 years (see Hastings & Barkley, 1978, for an early review). More recently, electroencephalography (EEG) has been used both in research to describe and quantify the underlying neurophysiology of ADHD, but also clinically in the assessment, diagnosis, and treatment of ADHD. This review will first provide a brief overview of EEG and then present some of the research findings of EEG correlates in ADHD. Then, the utility of EEG in making an ADHD diagnosis and predicting stimulant response will be examined. Finally, and more controversially, we will review the results of the most recent studies on EEG biofeedback (neurofeedback) as a treatment for ADHD and the issues that remain to be addressed in the research examining the efficacy this therapeutic approach.

Publication Types: Review

PMID: 16083395 [PubMed - indexed for MEDLINE]

Patol Fiziol Eksp Ter. 2005 Apr-Jun;(2):15-9.

[Changes in brain function in patients with boderline neuropsychic disorders after therapy with electroencephalographic BFB-training]

[Article in Russian]

Zvereva ZF, Torybarov FS, Khvorostina AV.

PMID: 16078650 [PubMed - indexed for MEDLINE]

Int J Neurosci. 2005 Jun;115(6):781-802.

Unconscious operant conditioning in the paradigm of brain-computer interface based on color perception.

Kaplan AY, Lim JJ, Jin KS, Park BW, Byeon JG, Tarasova SU.

Department of Human Physiology, Biological Faculty, Moscow State University, Moscow, Russian Federation. akaplan@mail.ru

This study investigate the mutual fine-tuning of ongoing EEG rhythmic features with RGB values controlling color shades of computer screen during neuro-feedback training. Fifteen participants had not been informed about the existence of neurofeedback loop (NF), but were guided only to look at the computer screen. It was found that during such unconscious NF training, a variety of color shades on the screen gradually changed from rather various types to the main one within the framework of color palette specified for each individual. This phenomenon was not observed in control experiments with simulated neuro-feedback. Individual color patterns induced on the screen during NF did not depend on the schema of connection between of EEG rhythms and RGB controller. It is suggested that the basic neurophysiological mechanism of described NF training consists of the directed selection of EEG patterns reinforced by comfortable color shades without conscious control.

PMID: 16019574 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2005 Jun;30(2):95-114.

Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder.

Monastra VJ, Lynn S, Linden M, Lubar JF, Gruzelier J, LaVaque TJ.

FPI Attention Disorders Clinic, Endicott, New York 13760, USA. drmonastra@stny.rr.com

Historically, pharmacological treatments for attention-deficit/hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of case and controlled group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment. This review paper critically examines the empirical evidence, applying the efficacy guidelines jointly established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). On the basis of these scientific principles, EEG biofeedback was determined to be "probably efficacious" for the treatment of ADHD. Although significant clinical improvement was reported in approximately 75% of the patients in each of the published research studies, additional randomized, controlled group studies are needed in order to provide a better estimate of the percentage of patients with ADHD who will demonstrate such gains in clinical practice.

Publication Types: Meta-Analysis Review

PMID: 16013783 [PubMed - indexed for MEDLINE]

Biol Psychol. 2006 Feb;71(2):148-54. Epub 2005 Jul 7.

The feedback-related negativity reflects the binary evaluation of good versus bad outcomes.

Hajcak G, Moser JS, Holroyd CB, Simons RF.

Department of Psychology, University of Delaware, Newark, DE, USA. hajcak@psych.udel.edu

Electrophysiological studies have utilized event-related brain potentials to study neural processes related to the evaluation of environmental feedback. In particular, the feedback-related negativity (FRN) has been shown to reflect the evaluation of monetary losses and negative performance feedback. Two experiments were conducted to examine whether or not the FRN is sensitive to the magnitude of negative feedback. In both experiments, participants performed simple gambling tasks in which they could receive a range of potential outcomes on each trial. Relative to feedback indicating monetary gain, feedback indicating non-rewards was associated with a FRN in both experiments; however, the magnitude of the FRN did not demonstrate sensitivity to the magnitude of non-reward in either experiment. These data suggest that the FRN reflects the early appraisal of feedback based on a binary classification of good versus bad outcomes. These data are discussed in terms of contemporary theories of the FRN, as well as appraisal processes implicated in emotional processing.

Publication Types: Research Support, N.I.H., Extramural

PMID: 16005561 [PubMed - indexed for MEDLINE]

Fiziol Cheloveka. 2005 May-Jun;31(3):93-9.

[Increase in athletes' functional capacities via biological feedback]

[Article in Russian]

Vysochin IuV, Denicenko IuP, Gordeev IuV.

PMID: 16004406 [PubMed - indexed for MEDLINE]

Eur J Neurosci. 2005 Jun;21(11):3169-81.

Neuronal mechanisms underlying control of a brain-computer interface.

Hinterberger T, Veit R, Wilhelm B, Weiskopf N, Vatine JJ, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Gartenstrasse 29, D-72074 Tübingen, Germany. thilo.hinterberger@uni-tuebingen.de

Brain-computer interfaces (BCIs) enable humans or animals to communicate or control external devices without muscle activity using electric brain signals. The BCI used here is based on self-regulation of slow cortical potentials (SCPs), a skill that most people and paralyzed patients can acquire with training periods of several hours up to months. The neurophysiological mechanisms and anatomical sources of SCPs and other event-related brain potentials have been described but the neural mechanisms underlying the self-regulation skill for the use of a BCI are unknown. To uncover the relevant areas of brain activation during regulation of SCPs, the BCI was combined with functional magnetic resonance imaging. The electroencephalogram was recorded inside the magnetic resonance imaging scanner in 12 healthy participants who learned to regulate their SCP with feedback and reinforcement. The results demonstrate activation of specific brain areas during execution of the brain regulation skill allowing a person to activate an external device; a successful positive SCP shift compared with a negative shift was closely related to an increase of the blood oxygen level-dependent response in the basal ganglia. Successful negativity was related to an increased blood oxygen level-dependent response in the thalamus compared with successful positivity. These results may indicate learned regulation of a cortico-striatal-thalamic loop modulating local excitation thresholds of cortical assemblies. The data support the assumption that human subjects learn the regulation of cortical excitation thresholds of large neuronal assemblies as a prerequisite for direct brain communication using an SCP-driven BCI. This skill depends critically on an intact and flexible interaction between the cortico-basal ganglia-thalamic circuits.

Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

PMID: 15978025 [PubMed - indexed for MEDLINE]

Eur J Neurosci. 2005 Jun;21(11):3161-8.

Knowing good from bad: differential activation of human cortical areas by positive and negative outcomes.

Nieuwenhuis S, Slagter HA, von Geusau NJ, Heslenfeld DJ, Holroyd CB.

Department of Cognitive Psychology, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands. stn20@dds.nl

Previous research has identified a component of the event-related brain potential (ERP), the feedback-related negativity, that is elicited by feedback stimuli associated with unfavourable outcomes. In the present research we used event-related functional magnetic resonance imaging (fMRI) and electroencephalographic (EEG) recordings to test the common hypothesis that this component is generated in the caudal anterior cingulate cortex. The EEG results indicated that our paradigm, a time estimation task with trial-to-trial performance feedback, elicited a large feedback-related negativity (FRN). Nevertheless, the fMRI results did not reveal any area in the caudal anterior cingulate cortex that was differentially activated by positive and negative performance feedback, casting doubt on the notion that the FRN is generated in this brain region. In contrast, we found a number of brain areas outside the posterior medial frontal cortex that were activated more strongly by positive feedback than by negative feedback. These included areas in the rostral anterior cingulate cortex, posterior cingulate cortex, right superior frontal gyrus, and striatum. An anatomically constrained source model assuming equivalent dipole generators in the rostral anterior cingulate, posterior cingulate, and right superior frontal gyrus produced a simulated scalp distribution that corresponded closely to the observed scalp distribution of the FRN. These results support a new hypothesis regarding the neural generators of the FRN, and have important implications for the use of this component as an electrophysiological index of performance monitoring and reward processing.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 15978024 [PubMed - indexed for MEDLINE]

Ment Retard Dev Disabil Res Rev. 2005;11(2):116-30.

Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder.

Rojas NL, Chan E.

Division of General Pediatrics, Children's Hospital Boston, Boston, MA 02115, USA.

Use of complementary and alternative medicine (CAM) for treatment of attention-deficit hyperactivity disorder (ADHD) has become widespread in both referral and primary care populations. We review the purported mechanism of action and available evidence for selected CAM therapies for ADHD. Enduring controversies, such as elimination of artificial food additives, colors, and/or preservatives; the effect of sugar on behavior in children; and the use of EEG biofeedback, have been well studied but lack support as effective sole treatments for ADHD. The initial evidence for some emerging CAM therapies, such as essential fatty acid supplementation, yoga, massage, homeopathy, and green outdoor spaces, suggests potential benefits as part of an overall ADHD treatment plan. More rigorously designed studies are needed to evaluate their effectiveness as single therapy for ADHD. Copyright 2005 Wiley-Liss, Inc.

Publication Types: Review

PMID: 15977318 [PubMed - indexed for MEDLINE]

Int J Rehabil Res. 2005 Jun;28(2):159-63.

Effects of electroencephalogram biofeedback with Asperger's syndrome.

Scolnick B.

Center for Psychiatric Rehabilitation and Recovery, Sargent College, Boston University, 940 Commonwealth Avenue, Boston, MA 02215, USA. scolnick@bu.edu

This article reports the pilot study of electroencephalogram (EEG) biofeedback to improve focusing and decrease anxiety in 10 adolescent boys diagnosed with Asperger's syndrome attending a therapeutic day school. Five of the boys dropped out of the study before 12 sessions were completed. The analysis of pre- and post-intervention quantitative EEGs for the five students who completed the study showed a trend to "normalization", but did not reach statistical significance. All five boys who completed 24 sessions showed improved behavior as rated by parents and teachers, but other factors, such as maturation could not be ruled out as causes of the improvement. The challenges facing this research and proposals for further exploration are outlined.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 15900187 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2005 Mar;30(1):64-73.

Biofeedback and dance performance: a preliminary investigation.

Raymond J, Sajid I, Parkinson LA, Gruzelier JH.

Imperial College London, St Dunstan's Road, London W6 8RF, UK.

Alpha-theta neurofeedback has been shown to produce professionally significant performance improvements in music students. The present study aimed to extend this work to a different performing art and compare alpha-theta neurofeedback with another form of biofeedback: heart rate variability (HRV) biofeedback. Twenty-four ballroom and Latin dancers were randomly allocated to three groups, one receiving neurofeedback, one HRV biofeedback and one no intervention. Dance was assessed before and after training. Performance improvements were found in the biofeedback groups but not in the control group. Neurofeedback and HRV biofeedback benefited performance in different ways. A replication with larger sample sizes is required.

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 15889586 [PubMed - indexed for MEDLINE]

Behav Healthc Tomorrow. 2005 Apr;14(2):10.

Bio-electric approaches for youths; treating post-stroke depression.

[No authors listed]

PMID: 15887601 [PubMed - indexed for MEDLINE]

Fertil Steril. 2005 Apr;83(4):857-64.

Stress reactivity and family relationships in the development and treatment of endometriosis.

Harrison V, Rowan K, Mathias J.

Family Health Services and Center for the Study of Natural Systems and the Family, Woman's Hospital of Texas, 7580 Fannin, Houston, TX 77054, USA. vichar@worldnet.att.net

OBJECTIVE: To examine stress physiology and facts of family functioning associated with development and course of endometriosis symptoms. DESIGN: Clinical case data and literature review. SETTING: Private practice in hospital-affiliated medical office. PATIENT(S): One woman with endometriosis, her parents, and a nonsymptomatic volunteer. INTERVENTION(S): Measures of physiologic and neural reactivity with biofeedback and neurofeedback equipment during family history interview and while sitting quietly. MAIN OUTCOME MEASURE(S): Electroencephalography (EEG), digital skin temperature (DST), electrodermal response (EDR), and electromyography (EMG); facts of family history; contact with family. RESULT(S): Endometriosis symptoms were associated with DST, EDR, EMG, and EEG measures indicating prolonged stress reactions for the symptomatic woman and her parents. Facts of family history and relationships for three generations set the stage for stress reactions. Striking differences are evident in the physiology, family history, and contact with family of the nonsymptomatic woman. CONCLUSION(S): Differences warrant further study, a larger sample, and additional measures using hormone assay to establish connections between stress reactions in the family, endometriosis symptoms, and response to treatment. Further research will document changes in physiology and in symptoms that accompany interruption of stress reactions with self-regulation training and family systems psychotherapy.

Publication Types: Case Reports Review

PMID: 15820791 [PubMed - indexed for MEDLINE]

Brain Res Cogn Brain Res. 2005 May;23(2-3):287-92.

The effects of alpha/theta neurofeedback on personality and mood.

Raymond J, Varney C, Parkinson LA, Gruzelier JH.

Division of Neuroscience and Psychological Medicine, Imperial College London, St Dunstan's Road, London, W6 8RF, England.

Alpha/theta neurofeedback has been shown to be successful both in treating addictions and in enhancing artistry in music students. How its effects are mediated are not yet clear. The present study aimed to test the hypothesis that alpha/theta neurofeedback works inter alia by normalising extreme personality and raising feelings of well being. 12 participants with high scores for Withdrawal (as measured by the PSQ) were given either alpha/theta neurofeedback or mock feedback and their personality and mood were assessed. Withdrawal scores on the PSQ-80 were not found to change in either group but significant effects were found for the Profile Of Mood States (POMS), with real feedback producing higher overall scores than mock feedback (P = 0.056). Real feedback caused participants to feel significantly more energetic (P < 0.01) than did mock feedback. Sessions of real feedback made participants feel more composed (P < 0.01), agreeable (P < 0.01), elevated (P < 0.01) and confident (P < 0.05), whilst sessions of mock feedback made participants feel more tired (P < 0.05), yet composed (P < 0.01). These findings suggest that, whilst 9 sessions of alpha/theta neurofeedback was insufficient to change personality, improvements in mood may provide a partial explanation for the efficacy of alpha/theta neurofeedback.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 15820636 [PubMed - indexed for MEDLINE]

Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):163-76, viii.

Neurofeedback treatment of epilepsy.

Walker JE, Kozlowski GP.

Neurotherapy Center of Dallas, 12870 Hillcrest Road, Suite 201, Dallas, TX 75230, USA. neurotherapycenter@sbcglobal.net

With electroencephalographic (EEG) biofeedback (or neurofeedback), it is possible to train the brain to de-emphasize rhythms that lead to generation and propagation of seizure and emphasize rhythms that make seizures less likely to occur. With recent improvements in quantitative EEG measurement and improved neurofeedback protocols, it has become possible in clinical practice to eliminate seizures or reduce the amount of medication required to control them. In this article, the history of neurofeedback for epilepsy is presented followed by discussions of the relevant neurophysiology of epilepsy. A model of how neurofeedback might raise the seizure threshold is then presented. Clinical experience using a quantitative EEG-guided approach is described, including a representative case study.

Publication Types: Review

PMID: 15564057 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2005 Mar;30(1):1-10.

Increasing individual upper alpha power by neurofeedback improves cognitive performance in human subjects.

Hanslmayr S, Sauseng P, Doppelmayr M, Schabus M, Klimesch W.

Department of Physiological Psychology, University of Salzburg, Salzburg, Austria.

The hypothesis was tested of whether neurofeedback training (NFT)--applied in order to increase upper alpha but decrease theta power--is capable of increasing cognitive performance. A mental rotation task was performed before and after upper alpha and theta NFT. Only those subjects who were able to increase their upper alpha power (responders) performed better on mental rotations after NFT. Training success (extent of NFT-induced increase in upper alpha power) was positively correlated with the improvement in cognitive performance. Furthermore, the EEG of NFT responders showed a significant increase in reference upper alpha power (i.e. in a time interval preceding mental rotation). This is in line with studies showing that increased upper alpha power in a prestimulus (reference) interval is related to good cognitive performance.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 15889581 [PubMed - indexed for MEDLINE]

Conf Proc IEEE Eng Med Biol Soc. 2005;5:5362-4.

Development of EEG biofeedback system based on virtual reality environment.

Mingyu L, Jue W, Nan Y, Qin Y.

Key Lab. of Biomed. Inf. Eng. of Ministry of Educ., Xi'an Jiaotong Univ.

A noninvasive EEG biofeedback system based on virtual reality (VR) environment is developed. The system translates EEG signals into movement and interaction. VR environment provides an ideal medium to represent the spatial and temporal nature of electrical activity emanating from the brain. The VR environment is developed based on MS DirectX technique. SMR-component based biofeedback training in three normal male subjects and two female subjects are reported. The difficulties in biofeedback research and our future research interests are discussed.

PMID: 17281463 [PubMed - in process]

Conf Proc IEEE Eng Med Biol Soc. 2005;5:4568-71.

Nonlinear analysis in treatment of intractable epilepsy with EEG biofeedback.

Zhao L, Liang Z, Hu G, Wu W.

Department of Biomedical Engineering, Tsinghua University, Beijing 100084, China.

About 25% epilepsy patients are suffering from medically intractable epileptic seizure. Many studies have shown that electroencephalogram (EEG) biofeedback therapy has the exciting potential for seizure control. In this paper, five patients with intractable epilepsy were trained to increase the production of sensorimotor (12~15Hz) activity and decrease the production of slow theta (4~7Hz) activity. Nonlinear analysis are proposed to evaluate the effect of biofeedback training. In all the five patients, the complexity and approximate entropy of EEG increased significantly (P<0.05) after (about 1-month) the biofeedback treatment.

PMID: 17281256 [PubMed - in process]

Int J Psychophysiol. 2005 May;56(2):143-55. Epub 2005 Jan 8.

Alpha-contingent EEG feedback reduces SPECT rCBF variability.

McLaughlin T, Steinberg B, Mulholland T, Friberg L.

Lawrence General Hospital, 1 General Street, Lawrence, MA 01841, USA.

EEG feedback methods, which link the occurrence of alpha to the presentation of repeated visual stimuli, reduce the relative variability of subsequent, alpha-blocking event durations. The temporal association between electro-cortical field activation and regional cerebral blood flow (rCBF) led us to investigate whether the reduced variability of alpha-blocking durations with feedback is associated with a reduction in rCBF variability. Reduced variability in the rCBF response domain under EEG feedback control might have methodological implications for future brain-imaging studies. Visual stimuli were randomly presented to seven subjects, contingent upon the occurrence of alpha (alpha-contingent stimulation (ACS)) or alpha-blocking (not-alpha-blocking-contingent stimulation (NACS)) events. We employed a within-subjects design. rCBF was measured from multiple, cortical and sub-cortical regions. The primary dependent variables were the Mean, Standard Deviation and the ratio of Mean/Standard Deviation of: 1) the alpha-blocking response durations and 2) the temporally summated rCBF responses within the Visual Associative regions of interest (ROIs). Additional within-subjects rCBF measures were derived to quantify the variance-reducing effects of ACS across multiple, distributed areas of the brain. Both EEG and rCBF measures demonstrated decreased variability under ACS. This improved control was seen for localized as well as anatomically distributed rCBF measures.

PMID: 15804449 [PubMed - indexed for MEDLINE]

Psychophysiology. 2005 Mar;42(2):180-90.

Fine-tuning of auditory cortex during speech production.

Heinks-Maldonado TH, Mathalon DH, Gray M, Ford JM.

Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.

The cortex suppresses sensory information when it is the result of a self-produced motor act, including the motor act of speaking. The specificity of the auditory cortical suppression to self-produced speech, a prediction derived from the posited operation of a precise forward model system, has not been established. We examined the auditory N100 component of the event-related brain potential elicited during speech production. While subjects uttered a vowel, they heard real-time feedback of their unaltered voice, their pitch-shifted voice, or an alien voice substituted for their own. The subjects' own unaltered voice feedback elicited a dampened auditory N100 response relative to the N100 elicited by altered or alien auditory feedback. This is consistent with the operation of a precise forward model modulating the auditory cortical response to self-generated speech and allowing immediate distinction of self and externally generated auditory stimuli.

Publication Types: Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. Research Support, U.S. Gov't, P.H.S.

PMID: 15787855 [PubMed - indexed for MEDLINE]

Psychophysiology. 2005 Mar;42(2):161-70.

Brain potentials associated with expected and unexpected good and bad outcomes.

Hajcak G, Holroyd CB, Moser JS, Simons RF.

Department of Psychology, University of Delaware, Newark, Delaware 19716, USA. hajcak@psych.udel.edu

The error-related negativity (ERN) is an event-related brain potential observed when subjects receive feedback indicating errors or monetary losses. Evidence suggests that the ERN is larger for unexpected negative feedback. The P300 has also been shown to be enhanced for unexpected feedback, but does not appear to be sensitive to feedback valence. The present study evaluated the role of expectations on the ERN and P300 in two experiments that manipulated the probability of negative feedback (25%, 50%, or 75%) on a trial-by-trial basis in experiment 1, and by varying the frequency of positive and negative feedback across blocks of trials in experiment 2. In both experiments, P300 amplitude was larger for unexpected feedback; however, the ERN was equally large for expected and unexpected negative feedback. These results are discussed in terms of the potential role of expectations in processing errors and negative feedback.

Publication Types: Research Support, N.I.H., Extramural Research Support, U.S. Gov't, P.H.S.

PMID: 15787853 [PubMed - indexed for MEDLINE]

J Clin Psychol. 2005 May;61(5):621-5.

Neurofeedback in adolescents and adults with attention deficit hyperactivity disorder.

Butnik SM.

ADDVANTAGE, PLLC, Richmond, VA 23226, USA. sbutnik@gmail.com

Neurofeedback is being utilized more commonly today in treating individuals who have attention deficit hyperactivity disorder (ADHD). Neurofeedback, which is based on theories that recognize the organic basis of ADHD, utilizes biofeedback to guide individuals to regulate their brain activity. Neurofeedback relies on research that has demonstrated that most individuals who have ADHD, as compared to matched peers, have excess slow wave activity and reduced fast wave activity. It provides immediate feedback to the individual about his or her brain wave activity in the form of a video game, whose action is influenced by the individual's meeting predetermined thresholds of brain activity. Over several sessions of using the video and auditory feedback, individuals reduce their slow wave activity and/or increase their fast wave activity. Individuals who complete a course of training sessions often show reduced primary ADHD symptoms. Research has shown that neurofeedback outcomes compare favorably to those of stimulant medication. Copyright 2005 Wiley Periodicals, Inc

Publication Types: Case Reports Comparative Study Review

PMID: 15723361 [PubMed - indexed for MEDLINE]

Epilepsy Behav. 2005 Mar;6(2):156-66.

Predictors of seizure reduction after self-regulation of slow cortical potentials as a treatment of drug-resistant epilepsy.

Strehl U, Kotchoubey B, Trevorrow T, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany. ute.strehl@uni-tuebingen.de

Variables were identified that predict seizure reduction following self-regulation of slow cortical potentials (SCPs) as part of a behavioral self-management program. A sequence analysis across 52 weeks determined 14 patients to have greater than 50% seizure reduction, 8 patients with less than 50% reduction, and 12 patients without improvement. Three variables accounted for 70% of treatment success: (1) cortical excitability at the beginning of training, (2) epileptic focus, and (3) personality variables. Reduction of complex partial and secondary generalized seizures covaried with SCP control attained in the last training session. EEG spectral parameters and cognitive function appeared unrelated to treatment outcome. Successful patients may be those without large negative SCP amplitudes at the beginning of training, without a left temporal epileptic focus, and who score low on life satisfaction and are highly reactive to stress. Patients with complex partial and secondarily generalized seizures may be more likely to experience seizure reduction if they demonstrate good SCP control at the end of their training.

Publication Types: Comparative Study Research Support, Non-U.S. Gov't

PMID: 15710298 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2004 Dec;29(4):233-43.

The effectiveness of neurofeedback and stimulant drugs in treating AD/HD: part II. Replication.

Rossiter T.

t.rossiter@worldnet.att.net

This study replicated T. R. Rossiter and T. J. La Vaque (1995) with a larger sample, expanded age range, and improved statistical analysis. Thirty-one ADIHD patients who chose stimulant drug (MED) treatment were matched with 31 patients who chose a neurofeedback (EEG) treatment program. EEG patients received either office (n = 14) or home (n = 17) neurofeedback. Stimulants for MED patients were titrated using the Test of Variables of Attention (TOVA). EEG (effect size [ES] = 1.01-1.71) and MED (ES = 0.80-1.80) groups showed statistically and clinically significant improvement on TOVA measures of attention, impulse control, processing speed, and variability in attention. The EEG group demonstrated statistically and clinically significant improvement on behavioral measures (Behavior Assessment System for Children, ES = 1.16-1.78, and Brown Attention Deficit Disorder Scales, ES = 1.59). TOVA gain scores for the EEG and MED groups were not significantly different. More importantly, confidence interval and nonequivalence null hypothesis testing confirmed that the neurofeedback program produced patient outcomes equivalent to those obtained with stimulant drugs. An effectiveness research design places some limitations on the conclusions that can be drawn.

Publication Types: Clinical Trial

PMID: 15707253 [PubMed - indexed for MEDLINE]

J Physiol Anthropol Appl Human Sci. 2005 Jan;24(1):139-42.

Biographics art "I know me": image generation aiming at EEG control by biofeedback.

Matsunaga K, Genda E.

Graduate School of Design, Faculty of Design, Department of Visual Image Design, Kyushu Institute of Design, Kyushu University, Fukuoka, Japan. kosuke@rms.kyushu-id.ac.jp

"I know me" is an interactive artwork that produces images based on EEG measurements from human participants. Although artists have previously made some interactive image works, we considered using human physiological information as input because it reflects human feelings better. In this research we were interested in information about human's mental states, such as anger or sadness. Brain activity was observed with EEG, subjected to Fourier analysis and converted into an animation based on a Lissajous curve.We generated images corresponding to alpha or beta waves activity in real time and showed them to the observer. The observer understood his own mental condition from looking at the images, and could potentially control his own mental state with this interactive device.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 15684560 [PubMed - indexed for MEDLINE]

Cyberpsychol Behav. 2004 Oct;7(5):519-26.

Neurofeedback training with virtual reality for inattention and impulsiveness.

Cho BH, Kim S, Shin DI, Lee JH, Lee SM, Kim IY, Kim SI.

Department of Biomedical Engineering, Hanyang University, Seoul, Korea.

In this research, the effectiveness of neurofeedback, along with virtual reality (VR), in reducing the level of inattention and impulsiveness was investigated. Twenty-eight male participants, aged 14-18, with social problems, took part in this study. They were separated into three groups: a control group, a VR group, and a non-VR group. The VR and non-VR groups underwent eight sessions of neurofeedback training over 2 weeks, while the control group just waited during the same period. The VR group used a head-mounted display (HMD) and a head tracker, which let them look around the virtual world. Conversely, the non-VR group used only a computer monitor with a fixed viewpoint. All participants performed a continuous performance task (CPT) before and after the complete training session. The results showed that both the VR and non-VR groups achieved better scores in the CPT after the training session, while the control group showed no significant difference. Compared with the other groups, the VR group presented a tendency to get better results, suggesting that immersive VR is applicable to neurofeedback for the rehabilitation of inattention and impulsiveness.

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 15667046 [PubMed - indexed for MEDLINE]

IEEE Trans Neural Syst Rehabil Eng. 2004 Dec;12(4):387-97.

Low-resolution electromagnetic tomography neurofeedback.

Congedo M, Lubar JF, Joffe D.

Department of Psychology of the University of Tennessee, Knoxville, TN 37996-0900, USA. loretabiofeedback@yahoo.com

Through continuous feedback of the electroencephalogram (EEG) humans can learn how to shape their brain electrical activity in a desired direction. The technique is known as EEG biofeedback, or neurofeedback, and has been used since the late 1960s in research and clinical applications. A major limitation of neurofeedback relates to the limited information provided by a single or small number of electrodes placed on the scalp. We establish a method for extracting and feeding back intracranial current density and we carry out an experimental study to ascertain the ability of the participants to drive their own EEG power in a desired direction. To derive current density within the brain volume, we used the low-resolution electromagnetic tomography (LORETA). Six undergraduate students (three males, three females) underwent tomographic neurofeedback (based on 19 electrodes placed according to the 10-20 system) to enhance the current density power ratio between the frequency bands beta (16-20 Hz) and alpha (8-10 Hz). According to LORETA modeling, the region of interest corresponded to the Anterior Cingulate (cognitive division). The protocol was designed to improve the performance of the subjects on the dimension of sustained attention. Two hypotheses were tested: 1) that the beta/alpha current density power ratio increased over sessions and 2) that by the end of the training subjects acquired the ability of increasing that ratio at will. Both hypotheses received substantial experimental support in this study. This is the first application of an EEG inverse solution to neurofeedback. Possible applications of the technique include the treatment of epileptic foci, the rehabilitation of specific brain regions damaged as a consequence of traumatic brain injury and, in general, the training of any spatial specific cortical electrical activity. These findings may also have relevant consequences for the development of brain-computer interfaces.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 15614994 [PubMed - indexed for MEDLINE]

Int J Psychophysiol. 2005 Jan;55(1):23-34.

ERPs correlates of EEG relative beta training in ADHD children.

Kropotov JD, Grin-Yatsenko VA, Ponomarev VA, Chutko LS, Yakovenko EA, Nikishena IS.

Laboratory for Neurobiology of Action Programming, Institute of the Human Brain of Russian Academy of Sciences, ul. Academica Pavlova 12a, 197376 St. Petersburg, Russia.

Eighty-six children (ages 9-14) with attention deficit hyperactivity disorder (ADHD) participated in this study. Event-related potentials (ERPs) were recorded in auditory GO/NOGO task before and after 15-22 sessions of EEG biofeedback. Each session consisted of 20 min of enhancing the ratio of the EEG power in 15-18 Hz band to the EEG power in the rest of spectrum, and 7-10 min of enhancing of the ratio of the EEG power in 12-15 Hz to the EEG power in the rest of spectrum with C3-Fz electrodes' placements for the first protocol and C4-Pz for the second protocol. On the basis of quality of performance during training sessions, the patients were divided into two groups: good performers and bad performers. ERPs of good performers to GO and NOGO cues gained positive components evoked within 180-420 ms latency. At the same time, no statistically significant differences between pre- and post-training ERPs were observed for bad performers. The ERP differences between post- and pretreatment conditions for good performers were distributed over frontal-central areas and appear to reflect an activation of frontal cortical areas associated with beta training.

Publication Types: Comparative Study Research Support, Non-U.S. Gov't

PMID: 15598513 [PubMed - indexed for MEDLINE]

Clin Neurophysiol. 2005 Jan;116(1):56-62.

Brain-computer interface (BCI) operation: signal and noise during early training sessions.

McFarland DJ, Sarnacki WA, Vaughan TM, Wolpaw JR.

Laboratory of Nervous System Disorders, New York State Department of Health, Wadsworth Center, P.O. Box 509, Empire State Plaza, Albany, NY 12201, USA. mcfarlan@wadsworth.org

OBJECTIVE: People can learn to control mu (8-12 Hz) or beta (18-25 Hz) rhythm amplitude in the electroencephalogram (EEG) recorded over sensorimotor cortex and use it to move a cursor to a target on a video screen. The recorded signal may also contain electromyogram (EMG) and other non-EEG artifacts. This study examines the presence and characteristics of EMG contamination during new users' initial brain-computer interface (BCI) training sessions, as they first attempt to acquire control over mu or beta rhythm amplitude and to use that control to move a cursor to a target. METHODS: In the standard one-dimensional format, a target appears along the right edge of the screen and 1s later the cursor appears in the middle of the left edge and moves across the screen at a fixed rate with its vertical movement controlled by a linear function of mu or beta rhythm amplitude. In the basic two-choice version, the target occupies the upper or lower half of the right edge. The user's task is to move the cursor vertically so that it hits the target when it reaches the right edge. The present data comprise the first 10 sessions of BCI training from each of 7 users. Their data were selected to illustrate the variations seen in EMG contamination across users. RESULTS: Five of the 7 users learned to change rhythm amplitude appropriately, so that the cursor hit the target. Three of these 5 showed no evidence of EMG contamination. In the other two of these 5, EMG was prominent in early sessions, and tended to be associated with errors rather than with hits. As EEG control improved over the 10 sessions, this EMG contamination disappeared. In the remaining two users, who never acquired actual EEG control, EMG was prominent in initial sessions and tended to move the cursor to the target. This EMG contamination was still detectable by Session 10. CONCLUSIONS: EMG contamination arising from cranial muscles is often present early in BCI training and gradually wanes. In those users who eventually acquire EEG control, early target-related EMG contamination may be most prominent for unsuccessful trials, and may reflect user frustration. In those users who never acquire EEG control, EMG may initially serve to move the cursor toward the target. Careful and comprehensive topographical and spectral analyses throughout user training are essential for detecting EMG contamination and differentiating between cursor control provided by EEG control and cursor control provided by EMG contamination. SIGNIFICANCE: Artifacts such as EMG are common in EEG recordings. Comprehensive spectral and topographical analyses are necessary to detect them and ensure that they do not masquerade as, or interfere with acquisition of, actual EEG-based cursor control.

Publication Types: Comparative Study Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

PMID: 15589184 [PubMed - indexed for MEDLINE]

HNO. 2005 Jan;53(1):29-37.

[Neurofeedback-based EEG alpha and EEG beta training. Effectiveness in patients with chronically decompensated tinnitus]

[Article in German]

Schenk S, Lamm K, Gündel H, Ladwig KH.

Institut und Poliklinik für Psychosomatische Medizin, Psychotherapie und Medizinische Psychologie, Klinikum rechts der Isar, München.

BACKGROUND: Persisting tinnitus is an often devastating disease condition with restricted and rarely successful therapeutic options. PATIENTS AND METHODS: The present study investigates the therapeutic effect of short term neurofeedback-based EEG-Alpha- and EEG-Beta-training in 40 patients suffering from "chronic decompensated tinnitus". Patients were assigned to the Alpha or Beta group according to results of an initial EEG monitored stress-test. Four patients were excluded because they showed abnormal reactions in both EEG patterns. RESULTS: During 12 sessions, 23 patients succeeded to increase EEG Alpha activity by 16% (p< or =0.042) while 13 patients achieved no decrease of EEG Beta activity. However, both groups showed a significant reduction of subjective tinnitus annoyance by the end of the therapy (p< or =0.001) CONCLUSIONS: The results indicate that neurofeedback may represent a new promising technique in the therapy of chronic decompensated tinnitus. However, it remains to be established whether the reduction of tinnitus annoyance results from the altered brain activity patterns supported by the neurofeedback learning process.

Publication Types: Clinical Trial English Abstract

PMID: 15565424 [PubMed - indexed for MEDLINE]

Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):163-76, viii.

Neurofeedback treatment of epilepsy.

Walker JE, Kozlowski GP.

Neurotherapy Center of Dallas, 12870 Hillcrest Road, Suite 201, Dallas, TX 75230, USA. neurotherapycenter@sbcglobal.net

With electroencephalographic (EEG) biofeedback (or neurofeedback), it is possible to train the brain to de-emphasize rhythms that lead to generation and propagation of seizure and emphasize rhythms that make seizures less likely to occur. With recent improvements in quantitative EEG measurement and improved neurofeedback protocols, it has become possible in clinical practice to eliminate seizures or reduce the amount of medication required to control them. In this article, the history of neurofeedback for epilepsy is presented followed by discussions of the relevant neurophysiology of epilepsy. A model of how neurofeedback might raise the seizure threshold is then presented. Clinical experience using a quantitative EEG-guided approach is described, including a representative case study.

Publication Types: Review

PMID: 15564057 [PubMed - indexed for MEDLINE]

Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):137-62, vii.

Electroencephalogram biofeedback for reading disability and traumatic brain injury.

Thornton KE, Carmody DP.

Center for Health Psychology, Suite 2A, 2509 Park Avenue, South Plainfield, NJ 07080, USA. ket@chp-neurotherapy.com

The application of electroencephalogram (EEG) biofeedback with reading disability and traumatic brain injury (TBI) is relatively recent. There are many studies regarding the effectiveness (improving attention and IQ scores) of EEG biofeedback in patients with attention deficit hyperactivity disorder, who are known to have a high rate of comorbidity for learning disabilities. This suggests the possibility that EEG biofeedback specifically aimed at remediating reading disability and TBI would be effective. This article provides strong initial support for this idea and provides reason to believe that assessment and training under task conditions are likely to be fruitful. Given the significance of these problems and the absence of very effective alternatives for remediation of these conditions, efforts to complete the needed research seem warranted. Clinical use of this intervention seems to be warranted with informed consent.

Publication Types: Review

PMID: 15564056 [PubMed - indexed for MEDLINE]

Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):125-36, vii.

Applicability of brain wave biofeedback to substance use disorder in adolescents.

Trudeau DL.

Department of Family Practice and Community Health, Medical School, University of Minnesota, 420 Delaware Street Southeast, Minneapolis, MN 55455-0392, USA. trude003@tc.umn.edu

Neurofeedback treatment for addictions in adults is probably efficacious, and several reported approaches are described with their indications. Neurofeedback is promising as a treatment modality for adolescents, especially those with stimulant abuse and attention and conduct problems. It is attractive as a medication-free, neurophysiologic, and self-actualizing treatment for a substance-based, brain-impaired and self-defeating disorder. More research, beginning with case reporting, is needed to assess use and efficacy in adolescents.

Publication Types: Review

PMID: 15564055 [PubMed - indexed for MEDLINE]

Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):105-23, vii.

Neurofeedback with anxiety and affective disorders.

Hammond DC.

Physical Medicine and Rehabilitation, University of Utah School of Medicine, PM&R 30 No 1900 East, Salt Lake City, UT 84132-2119, USA. D.C.Hammond@m.cc.utah.edu

A robust body of neurophysiologic research is reviewed on functional brain abnormalities associated with depression, anxiety, and obsessive-compulsive disorder. A review of more recent research finds that pharmacologic treatment may not be as effective as previously believed. A more recent neuroscience technology, electroencephalographic (EEG) biofeedback (neurofeedback), seems to hold promise as a methodology for retraining abnormal brain wave patterns. It has been associated with minimal side effects and is less invasive than other methods for addressing biologic brain disorders. Literature is reviewed on the use of neurofeedback with anxiety disorders, including posttraumatic stress disorder and obsessive-compulsive disorder, and with depression. Case examples are provided.

Publication Types: Review

PMID: 15564054 [PubMed - indexed for MEDLINE]

Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):83-104, vi.

Critical validation studies of neurofeedback.

Gruzelier J, Egner T.

Division of Neuroscience and Psychological Medicine, Imperial College London, St. Dunstan's Road, London W6 8RF, United Kingdom. j.gruzelier@imperial.ac.uk

The field of neurofeedback training has proceeded largely without validation. In this article the authors review studies directed at validating sensory motor rhythm, beta and alpha-theta protocols for improving attention, memory, and music performance in healthy participants. Importantly, benefits were demonstrable with cognitive and neurophysiologic measures that were predicted on the basis of regression models of learning to enhance sensory motor rhythm and beta activity. The first evidence of operant control over the alpha-theta ratio is provided, together with remarkable improvements in artistic aspects of music performance equivalent to two class grades in conservatory students. These are initial steps in providing a much needed scientific basis to neurofeedback.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 15564053 [PubMed - indexed for MEDLINE]

Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):55-82, vi.

Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: rationale and empirical foundation.

Monastra VJ.

FPI Attention Disorders Clinic, 2102 East Main Street, Endicott, NY 13760, USA. poppidoc@aol.com

During the past three decades, electroencephalographic (EEG) biofeedback has emerged as a nonpharmacologic treatment for attention-deficit/hyperactivity disorder (ADHD). This intervention was derived from operant conditioning studies that demonstrated capacity for neurophysiologic training in humans and other mammals and targets atypical patterns of cortical activation that have been identified consistently in neuroimaging and quantitative EEG studies of patients diagnosed with ADHD. This article presents the rationale for EEG biofeedback and examines the empirical support for this treatment using efficacy guidelines established by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neuronal Regulation. Based on these guidelines, EEG biofeedback is considered to be "probably efficacious" for the treatment of ADHD and merits consideration as a treatment for patients who are stimulant "nonresponders." Although research findings published to date indicate positive clinical response in approximately 75% of patients treated in controlled group studies, additional randomized, controlled trials are needed to provide a better estimate of the robustness of this treatment.

Publication Types: Review

PMID: 15564052 [PubMed - indexed for MEDLINE]

Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):1-19, v.

Emerging brain-based interventions for children and adolescents: overview and clinical perspective.

Hirshberg LM, Chiu S, Frazier JA.

The NeuroDevelopment Center, 260 West Exchange Street, Suite 302, Providence, RI 02903, USA. lhirshberg@neruodevelopmentcenter.com

Electroencephalogram biofeedback (EBF), repetitive transcranial magnetic stimulation (rTMS), and vagal nerve stimulation (VNS) are emerging interventions that attempt to directly impact brain function through neurostimulation and neurofeedback mechanisms. This article provides a brief overview of each of these techniques, summarizes the relevant research findings, and examines the implications of this research for practice standards based on the guidelines for recommending evidence based treatments as developed by the American Academy of Child and Adolescent Psychiatry for attention deficit hyperactivity disorder (ADHD). EBF meets the "Clinical Guidelines" standard for ADHD, seizure disorders, anxiety, depression, and traumatic brain injury. VNS meets this same standard for treatment of refractory epilepsy and meets the lower "Options" standard for several other disorders. rTMS meets the standard for "Clinical Guidelines" for bipolar disorder, unipolar disorder, and schizophrenia. Several conditions are discussed regarding the use of evidence based thinking related to these emerging interventions and future directions.

Publication Types: Review

PMID: 15564050 [PubMed - indexed for MEDLINE]

Child Adolesc Psychiatr Clin N Am. 2005 Jan;14(1):xiii-xvii.

Emerging interventions.

Hirshberg LM, Chiu S, Frazier JA.

The NeuroDevelopment Center, 260 West Exchange Street, Suite 302, Providence, RI 02903, USA. lhirshberg@neruodevelopmentcenter.com

PMID: 15564049 [PubMed - indexed for MEDLINE]

Clin Neurophysiol. 2004 Nov;115(11):2452-60.

The effects of neurofeedback training on the spectral topography of the electroencephalogram.

Egner T, Zech TF, Gruzelier JH.

Division of Neuroscience and Psychological Medicine, Faculty of Medicine, Imperial College London, UK. tegner@fmri.columbia.edu

OBJECTIVE: To investigate the impact of EEG frequency band biofeedback (neurofeedback) training on spectral EEG topography, which is presumed to mediate cognitive-behavioural training effects. In order to assess the effect of commonly applied neurofeedback protocols on spectral EEG composition, two studies involving healthy participants were carried out. METHODS: In Experiment 1, subjects were trained on low beta (12-15 Hz), beta1 (15-18 Hz), and alpha/theta (8-11 Hz/5-8 Hz) protocols, with spectral resting EEG assessed before and after training. The specific associations between learning indices of each individual training protocol and changes in absolute and relative spectral EEG topography was assessed by means of partial correlation analyses. Results of Experiment 1 served to generate hypotheses for Experiment 2, where subjects were randomly allocated to independent groups of low beta, beta1, and alpha/theta training. Spectral resting EEG measures were contrasted prior and subsequent to training within each group. RESULTS: Only few associations between particular protocols and spectral EEG changes were found to be consistent across the two studies, and these did not correspond to expectations based on the operant contingencies trained. Low-beta training was found to be somewhat associated with reduced post-training low-beta activity, while more reliably, alpha/theta training was associated with reduced relative frontal beta band activity. CONCLUSIONS: The results document that neurofeedback training of frequency components does affect spectral EEG topography in healthy subjects, but that these effects do not necessarily correspond to either the frequencies or the scalp locations addressed by the training contingencies. The association between alpha/theta training and replicable reductions in frontal beta activity constitutes novel empirical neurophysiological evidence supporting inter alia the training's purported role in reducing agitation and anxiety. SIGNIFICANCE: These results underline the complexity of the neural dynamics involved EEG self-regulation and emphasize the need for empirical validation of predictable neurophysiological outcomes of training EEG biofeedback protocols.

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 15465432 [PubMed - indexed for MEDLINE]

Stud Health Technol Inform. 2002;85:89-95.

Clinical test for Attention Enhancement System.

Cho BH, Ku J, Jang D, Lee J, Oh M, Kim H, Lee J, Kim J, Kim I, Kim S.

Department of Biomedical Engineering, College of Medicine, Hanyang University, Seoul, Korea.

Attention Deficit Hyperactivity Disorder (ADHD) is a childhood syndrome characterized by short attention span, impulsiveness, and hyperactivity, which often leads to learning disabilities and various behavioral problems. The prevalence rates for ADHD varied from a low of 2.0% to a high of 6.3% in 1992 statistics, and it may be higher now. Using Virtual Environments and Neurofeedback, we have developed an Attention Enhancement System for treating ADHD. And we made a clinical test. Classroom-based virtual environments are constructed for intimacy and intensive attention enhancement. In this basic virtual environment, subjects performed some training sessions. There are two kinds of training sessions. One is Virtual Reality Cognitive Training (VRCT) and the other is Virtual Reality Neurofeedback Training (VRNT). In VRNT, we made a change in the virtual environment by Neurofeedback. Namely, if the Beta ratio is greater than the specified threshold level, the change as positive reinforce is created in the virtual environment. 50 subjects, aged 14 to 18, who had committed crimes and had been isolated in a reformatory took part in this study. They were randomly assigned to one of five 10-subject groups: a control Group, two placebo groups, and two experimental groups. The experimental groups and the placebo groups underwent 10 sessions over two weeks. The control group underwent no training session during the same period of time. While the experimental groups used HMD and Head Tracker in each session, the placebo groups used only a computer monitor. Consequently, only the experimental Groups could look around the virtual classroom. Besides that, Placebo Group 1 and Experimental Group 1 performed the same task(Neurofeedback Training), and Placebo Group 2 and Experimental Group 2 also performed the same task(Cognitive Training). All subjects Continuous Performance Task(CPT) before and after all training sessions. In the number of correct answers, omission errors and signal detection index (d'), the subjects' scores from CPT showed significant improvement (p<0.01) after all of the training sessions, while control group indicated no significant change. And experimental groups showed significant difference (p<0.01) with placebo groups. Lastly, the Virtual Reality Neurofeedback training group and the Virtual Reality Cognitive training group indicated not significant difference. Our System is supposed to enhance subjects' attention and lead their behavioral improvement. And also, we can conclude that virtual reality training (both Neurofeedback training and Cognitive training) has an advantage for attention enhancement compared with desk-top training.

Publication Types: Clinical Trial Comparative Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 15458066 [PubMed - indexed for MEDLINE]

Z Kinder Jugendpsychiatr Psychother. 2004 Jul;32(3):187-200.

[Neurofeedback for the treatment of attention-deficit/hyperactivity disorder (ADHD) in childhood and adolescence]

[Article in German]

Holtmann M, Stadler C, Leins U, Strehl U, Birbaumer N, Poustka F.

Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt. holtmann@em.uni-frankfurt.de

INTRODUCTION: A variety of non-pharmacological treatments for ADHD have failed to prove their effectiveness. The basis of evidence for neurofeedback (or EEG-biofeedback) has improved recently. Neurofeedback is aiming at an improvement of ADHD core-symptoms via the voluntary modification of abnormal neurophysiologic parameters, e.g. EEG-frequency spectrum and event-related potentials. METHODS: Our review presents an overview of the current research on neurofeedback for the treatment of ADHD. RESULTS: In three controlled studies short-term effects of feedback matched those of stimulant treatment. Neurofeedback lead to significant improvement of attention, impulsivity and hyperactivity, without adversive side effects. Additionally, there was a persistent amelioration of EEG parameters, while stimulants did not lead to a comparable normalization. Results on the stability of feedback effects are encouraging but are based on small numbers of patients. CONCLUSION: Neurofeedback is a promising approach for the treatment of children with ADHD. However, there is a demand for further controlled studies using standardized diagnostic criteria, sufficient sample sizes and appropriate measures and follow-up.

Publication Types: English Abstract Review

PMID: 15357015 [PubMed - indexed for MEDLINE]

Chest. 2004 Aug;126(2):352-61.

Biofeedback treatment for asthma.

Lehrer PM, Vaschillo E, Vaschillo B, Lu SE, Scardella A, Siddique M, Habib RH.

Department of Psychiatry, Robert Wood Johnson Medical School, The University of Medicine and Dentistry of New Jersey, Piscataway, NJ 08854, USA. lehrer@umdnj.edu

STUDY OBJECTIVES: We evaluated the effectiveness of heart rate variability (HRV) biofeedback as a complementary treatment for asthma. PATIENTS: Ninety-four adult outpatient paid volunteers with asthma. SETTING: The psychophysiology laboratory at The University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, and the private outpatient offices of participating asthma physicians. INTERVENTIONS: The interventions were as follows: (1) a full protocol (ie, HRV biofeedback and abdominal breathing through pursed lips and prolonged exhalation); (2) HRV biofeedback alone; (3) placebo EEG biofeedback; and (4) a waiting list control. DESIGN: Subjects were first prestabilized using controller medication and then were randomly assigned to experimental groups. Medication was titrated biweekly by blinded asthma specialists according to a protocol based on National Heart, Lung, and Blood Institute guidelines, according to symptoms, spirometry, and home peak flows. MEASUREMENTS: Subjects recorded daily asthma symptoms and twice-daily peak expiratory flows. Spirometry was performed before and after each weekly treatment session under the HRV and placebo biofeedback conditions, and at triweekly assessment sessions under the waiting list condition. Oscillation resistance was measured approximately triweekly. RESULTS: Compared with the two control groups, subjects in both of the two HRV biofeedback groups were prescribed less medication, with minimal differences between the two active treatments. Improvements averaged one full level of asthma severity. Measures from forced oscillation pneumography similarly showed improvement in pulmonary function. A placebo effect influenced an improvement in asthma symptoms, but not in pulmonary function. Groups did not differ in the occurrence of severe asthma flares. CONCLUSIONS: The results suggest that HRV biofeedback may prove to be a useful adjunct to asthma treatment and may help to reduce dependence on steroid medications. Further evaluation of this method is warranted.

Publication Types: Clinical Trial Comparative Study Randomized Controlled Trial Research Support, U.S. Gov't, P.H.S.

PMID: 15302717 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2004 Jun;29(2):113-20.

Auditory discrimination training for the treatment of tinnitus.

Flor H, Hoffmann D, Struve M, Diesch E.

Department of Cognitive and Clinical Neuroscience, University of Heidelberg, Central Institute of Mental Health, Quadrat J5, 68159 Mannheim, Germany. flor@zi-mannheim.de

This paper presents a series of 12 cases of chronic tinnitus patients who participated in 4 weeks of auditory discrimination training either close to or far removed from the tinnitus frequency. The training was based on the assumption that tinnitus is related to a shift of the representation of the tinnitus frequency in auditory cortex outside of the normal tonotopic map and that training close to but not removed from the tinnitus frequency should result in a reduction in the severity of the tinnitus. Tinnitus severity was measured 4 times per day during the entire treatment and other tinnitus-related variables were assessed 1 week before and 1 month posttreatment. The comparison of the training close to as compared to remote from the tinnitus frequency did not yield a statistically significant difference. However, a post hoc analysis revealed that patients who engaged in regular training as compared to those who practiced irregularly were significantly more successful in reducing tinnitus severity independent of the trained frequencies. Treatment success was best predicted by days of training and general activity levels. The data suggest that auditory discrimination training shows a dose response effect irrespective of training location and that treatment success is also related to psychological variables. For more substantial changes in multiple variables an extended training period with additional consideration of emotional variables would be necessary. In addition, controls for nonspecific training effects need to be implemented.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 15208974 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2004 Jun;29(2):95-112.

The effectiveness of neurofeedback and stimulant drugs in treating AD/HD: Part I. Review of methodological issues.

Rossiter T.

t.rossiter@worldnet.att.net

The paper examines major criticisms of AD/HD (Attention Deficit/Hyperactivity Disorder) neurofeedback research using T. R. Rossiter and T. J. La Vaque (1995) as an exemplar and discusses relevant aspects of research methodology. J. Lohr, S. Meunier, L. Parker, and J. P. Kline (2001), D. A. Waschbusch and G. P. Hill (2001), and J. P. Kline, C. N. Brann, and B. R. Loney (2002) criticized Rossiter and La Vaque for (1) using an active treatment control; (2) nonrandom assignment of patients; (3) provision of collateral treatments; (4) using nonstandardized and invalid assessment instruments; (5) providing artifact contaminated EEG feedback; and (6) conducting multiple non-alpha protected t tests. The criticisms, except those related to statistical analysis, are invalid or are not supported as presented by the authors. They are based on the critics' unsubstantiated opinions; require redefining Rossiter and La Vaque as an efficacy rather than an effectiveness study; or reflect a lack of familiarity with the research literature. However, there are broader issues to be considered. Specifically, what research methodology is appropriate for studies evaluating the effectiveness of neurofeedback and who should make that determination? The uncritical acceptance and implementation of models developed for psychotherapy, pharmacology, or medical research is premature and ill-advised. Neurofeedback researchers should develop models that are appropriate to the technology, treatment paradigms, and goals of neurofeedback outcome studies. They need to explain the rationale for their research methodology and defend their choices.

Publication Types: Review

PMID: 15208973 [PubMed - indexed for MEDLINE]

IEEE Trans Biomed Eng. 2004 Jun;51(6):1062-6.

BCI Competition 2003--Data set IIa: spatial patterns of self-controlled brain rhythm modulations.

Blanchard G, Blankertz B.

Fraunhofer FIRST (IDA), D-12489 Berlin, Germany. gilles.blanchard@first.fraunhofer.de

A brain-computer interface (BCI) is a system that should in its ultimate form translate a subject's intent into a technical control signal without resorting to the classical neuromuscular communication channels. By using that signal to, e.g., control a wheelchair or a neuroprosthesis, a BCI could become a valuable tool for paralyzed patients. One approach to implement a BCI is to let users learn to self-control the amplitude of some of their brain rhythms as extracted from multichannel electroencephalogram. We present a method that estimates subject-specific spatial filters which allow for a robust extraction of the rhythm modulations. The effectiveness of the method was proved by achieving the minimum prediction error on data set IIa in the BCI Competition 2003, which consisted of data from three subjects recorded in ten sessions.

Publication Types: Comparative Study Evaluation Studies Research Support, Non-U.S. Gov't Validation Studies

PMID: 15188879 [PubMed - indexed for MEDLINE]

IEEE Trans Biomed Eng. 2004 Jun;51(6):1011-8.

Brain-computer communication and slow cortical potentials.

Hinterberger T, Schmidt S, Neumann N, Mellinger J, Blankertz B, Curio G, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72076 Tübingen, Germany. thilo.hinterberger@uni-tuebingen.de

A thought translation device (TTD) has been designed to enable direct brain-computer communication using self-regulation of slow cortical potentials (SCPs). However, accuracy of SCP control reveals high intersubject variability. To guarantee the highest possible communication speed, some important aspects of training SCPs are discussed. A baseline correction of SCPs can increase performance. Multichannel recordings show that SCPs are of highest amplitude around the vertex electrode used for feedback, but in some subjects more global distributions were observed. A new method for control of eye movement is presented. Sequential effects of trial-to-trial interaction may also cause difficulties for the user. Finally, psychophysiological factors determining SCP communication are discussed.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Validation Studies

PMID: 15188872 [PubMed - indexed for MEDLINE]

IEEE Trans Biomed Eng. 2004 Jun;51(6):971-4.

An EEG-driven brain-computer interface combined with functional magnetic resonance imaging (fMRI).

Hinterberger T, Weiskopf N, Veit R, Wilhelm B, Betta E, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen 72076, Germany. thilo.hinterberger@uni-tuebingen.de

Self-regulation of slow cortical potentials (SCPs) has been successfully used to prevent epileptic seizures as well as to communicate with completely paralyzed patients. The thought translation device (TTD) is a brain-computer interface (BCI) that was developed for training and application of SCP self-regulation. To investigate the neurophysiological mechanisms of SCP regulation the TTD was combined with functional magnetic resonance imaging (fMRI). The technical aspects and pitfalls of combined fMRI data acquisition and EEG neurofeedback are discussed. First data of SCP feedback during fMRI are presented.

Publication Types: Evaluation Studies Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Validation Studies

PMID: 15188866 [PubMed - indexed for MEDLINE]

Epilepsy Behav. 2004 Apr;5(2):216-23.

Clinical efficacy of galvanic skin response biofeedback training in reducing seizures in adult epilepsy: a preliminary randomized controlled study.

Nagai Y, Goldstein LH, Fenwick PB, Trimble MR.

Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK. y.nagai@ion.ucl.ac.uk

We investigated the effect of galvanic skin response (GSR) biofeedback training on seizure frequency in patients with treatment-resistant epilepsy. Eighteen patients with drug-refractory epilepsy were randomly assigned either to an active GSR biofeedback group (n = 10) or to a sham control biofeedback group (n = 8). Biofeedback training significantly reduced seizure frequency in the active biofeedback group (P = 0.017), but not the control group (P > 0.10). This was manifest as a significant between-group difference in seizure reduction (P 0.01). Furthermore, there was a correlation between degree of improvement in biofeedback performance and reduction of seizure frequency (rho = 0.736, P = 0.001), confirming that the effect of biofeedback treatment was related to physiological change. Our findings highlight the potential therapeutic value of GSR biofeedback in reducing seizure frequency in patients with drug-resistant epilepsy.

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 15123023 [PubMed - indexed for MEDLINE]

J Child Health Care. 2004 Mar;8(1):69-81.

ADHD and drug therapy: is it still a valid treatment?

Doggett AM.

School of Education, Colorado State University, USA. doggett@lamar.colostate.edu

The purpose of this article is to discuss alternative treatments other than drug therapy for Attention-Deficit/Hyperactive Disorder (ADHD) in educational settings. There is an increasing body of knowledge that supports interventions for improving cognitive outcomes without the use of medication. The article explores the risks to ADHD children, shows the potential linkage between gifted children and ADHD, explores recent brain research, and examines various alternative treatment options. Information is presented on alternative treatments such as cognitive behavioral therapies, educational interventions, electroencephalograph (EEG) neuro-feedback, and diet.

Publication Types: Review

PMID: 15090116 [PubMed - indexed for MEDLINE]

J Neurophysiol. 2004 May;91(5):1990-8.

Synaptic interactions between thalamic and cortical inputs onto cortical neurons in vivo.

Fuentealba P, Crochet S, Timofeev I, Steriade M.

Laboratoire de Neurophysiologie, Faculté de Médecine, Université Laval, Québec G1K 7P4, Canada.

To study the interactions between thalamic and cortical inputs onto neocortical neurons, we used paired-pulse stimulation (PPS) of thalamic and cortical inputs as well as PPS of two cortical or two thalamic inputs that converged, at different time intervals, onto intracellularly recorded cortical and thalamocortical neurons in anesthetized cats. PPS of homosynaptic cortico-cortical pathways produced facilitation, depression, or no significant effects in cortical pathways, whereas cortical responses to thalamocortical inputs were mostly facilitated at both short and long intervals. By contrast, heterosynaptic interactions between either cortical and thalamic, or thalamic and cortical, inputs generally produced decreases in the peak amplitudes and depolarization area of evoked excitatory postsynaptic potentials (EPSPs), with maximal effect at approximately 10 ms and lasting from 60 to 100 ms. All neurons tested with thalamic followed by cortical stimuli showed a decrease in the apparent input resistance (R(in)), the time course of which paralleled that of decreased responses, suggesting that shunting is the factor accounting for EPSP's decrease. Only half of neurons tested with cortical followed by thalamic stimuli displayed changes in R(in). Spike shunting in the thalamus may account for those cases in which decreased synaptic responsiveness of cortical neurons was not associated with decreased R(in) because thalamocortical neurons showed decreased firing probability during cortical stimulation. These results suggest a short-lasting but strong shunting between thalamocortical and cortical inputs onto cortical neurons.

Publication Types: Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

PMID: 15069096 [PubMed - indexed for MEDLINE]

Int Tinnitus J. 2002;8(2):87-93.

Neurofeedback and quantitative electroencephalography.

Weiler EW, Brill K, Tachiki KH, Schneider D.

NeuroNet GmbH, St. Annenstrasse 10, 66606 St. Wendel, Germany. neuronet@t-online.de

This study was conducted in an attempt to determine the efficacy of neurofeedback (NFB) in the treatment of patients suffering from vertigo or tinnitus. Results indicated that after NFB, power for delta and theta bands was reduced; however, an increase of power was noted for the alpha bands. Furthermore, normalization was observed for the vestibular evoked potentials (VestEP). After NFB, a normalization of the VestEP was also demonstrated in a patient suffering from a bilateral tinnitus. A follow-up study (12 months after NFB) demonstrated that the VestEP were normal.

Publication Types: Case Reports

PMID: 14763216 [PubMed - indexed for MEDLINE]

J Atten Disord. 2003 Sep;7(1):43-55.

EEG biofeedback vs. placebo treatment for attention-deficit/hyperactivity disorder: a pilot study.

Heywood C, Beale I.

Arohanui Special School, Te Atatu South, Auckland, New Zealand. cheywood2@compuserve.com

METHOD: Seven children diagnosed with attention-deficit hyperactivity disorder (ADHD) were trained using a standard EEG biofeedback treatment protocol designed to alter SMR/theta ratios and reduce behavioral symptomatology diagnostic of ADHD. During alternate periods they were also trained using a placebo protocol that was identical to the treatment protocol, save that the association between EEG patterns and feedback to the participants was random. Single-case design elements were used to control for the effects of internal validity threats such as maturation, history, and treatment order. Two participants failed to complete all training sessions, and the effects of training on behavior were analyzed both including and excluding these non-completers. RESULTS: When all participants were included in analyses that controlled for overall trend, EEG biofeedback was found to be no more effective than the placebo control condition involving non-contingent feedback, and neither procedure resulted in improvements relative to baseline levels. When overall behavioral trends unrelated to training were not controlled for and non-completers were excluded from the analysis, it could be mistakenly concluded that EEG biofeedback is significantly more effective than placebo and that the effect sizes involved are moderate to large. These results indicate that many previous reports of the efficacy of EEG biofeedback for ADHD, particularly those presenting series of single cases, might well have been based on spurious findings.

Publication Types: Clinical Trial Randomized Controlled Trial

PMID: 14738180 [PubMed - indexed for MEDLINE]

Clin Neurophysiol. 2004 Jan;115(1):131-9.

EEG biofeedback of low beta band components: frequency-specific effects on variables of attention and event-related brain potentials.

Egner T, Gruzelier JH.

Department of Cognitive Neuroscience and Behaviour, Faculty of Medicine, Imperial College London, St Dunstan's Road, London W6 8RF, UK. te2111@columbia.edu

OBJECTIVE: To test a common assumption underlying the clinical use of electroencephalographic (EEG) biofeedback training (neurofeedback), that the modulation of discreet frequency bands is associated with frequency-specific effects. Specifically, the proposal was assessed that enhancement of the low beta components sensorimotor rhythm (SMR: 12-15 Hz) and beta1 (15-18 Hz) affect different aspects of attentional processing. METHODS: Subjects (n=25) were randomly allocated to training with either an SMR or beta1 protocol, or to a non-neurofeedback control group. Subjects were assessed prior and subsequent to the training process on two tests of sustained attention. The neurofeedback participants were also assessed on target P300 event-related potential (ERP) amplitudes in a traditional auditory oddball paradigm. RESULTS: Protocol-specific effects were obtained in that SMR training was associated with increased perceptual sensitivity 'd prime' (d'), and reduced omission errors and reaction time variability. Beta1 training was associated with faster reaction times and increased target P300 amplitudes, whereas no changes were evident in the control group. CONCLUSIONS: Neurofeedback training of SMR and beta1 band components led to significant and protocol-specific effects in healthy subjects. The data can be interpreted as indicating a general attention-enhancing effect of SMR training, and an arousal-enhancing effect of beta1 training.

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 14706480 [PubMed - indexed for MEDLINE]

Rehabilitation (Stuttg). 2003 Dec;42(6):371-7.

[EEG-based communication--a new concept for rehabilitative support in patients with severe motor impairment]

[Article in German]

Neuper C, Müller GR, Staiger-Sälzer P, Skliris D, Kübler A, Birbaumer N, Pfurtscheller G.

Ludwig-Boltzmann Institut für Medizinische Informatik und Neuroinformatik, Technische Universität Graz.

This paper describes a paralyzed patient diagnosed with severe infantile cerebral palsy, trained over a period of several months to use an EEG-based brain-computer interface (BCI) for verbal communication. The patient learned to "produce" two distinct EEG patterns by mental imagery and to use this skill for BCI-controlled spelling. The EEG feedback training was conducted at a clinic for Assisted Communications, supervised from a distant laboratory with the help of a telemonitoring system. As a function of training sessions significant learning progress was found, resulting in an average accuracy level of 70% correct responses for letter selection. At present, "copy spelling" can be performed with a rate of approximately one letter per minute. The proposed communication device, the "Virtual Keyboard", may improve actual levels of communication ability in completely paralyzed patients. "Telemonitoring-assisted" training facilitates clinical application in a larger number of patients.

Publication Types: English Abstract Research Support, Non-U.S. Gov't

PMID: 14677109 [PubMed - indexed for MEDLINE]

Cochrane Database Syst Rev. 2003;(4):CD002029.

Update in: Cochrane Database Syst Rev. 2005;(4):CD002029.

Update of: Cochrane Database Syst Rev. 2001;(4):CD002029.

Psychological treatments for epilepsy.

Ramaratnam S, Baker GA, Goldstein L.

Department of Neurology, Apollo Hospitals, 21 Greams Lane, Off Greams Road, Madras, Tamil Nadu, India, 60006.

BACKGROUND: Psychological interventions such as relaxation therapy, cognitive behaviour therapy, electroencephalogram (EEG) bio-feedback and educational interventions have been used alone or in combination in the treatment of epilepsy, to reduce the seizure frequency and improve the quality of life. OBJECTIVES: To assess whether the treatment of epilepsy with psychological methods is effective in reducing seizure frequency and/or leads to a better quality of life. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trial register (11 June 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 2, 2003), MEDLINE (on 11 June 2003) and cross references from identified publications. SELECTION CRITERIA: Randomized or quasi-randomized studies assessing one or more types of psychological or behaviour modification techniques for people with epilepsy. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the trials for inclusion and extracted data. Primary analyses were by intention to treat. Outcomes included reduction in seizure frequency and quality of life. MAIN RESULTS: We found three small trials (50 participants) of relaxation therapy. They were of poor methodological quality and a meta-analysis was therefore not undertaken. No study found a significant effect of relaxation therapy on seizure frequency. One trial found cognitive behavioural therapy to be effective in reducing depression, among people with epilepsy with a depressed affect, whilst another did not.One trial of group cognitive therapy found no significant effect on seizure frequency. Two trials of combined relaxation and behaviour therapy and one of EEG bio-feedback and four of educational interventions did not provide sufficient information to assess their effect on seizure frequency. Combined use of relaxation and behaviour modification was found beneficial for anxiety and adjustment in one study. In one study EEG bio-feedback was found to improve the cognitive and motor functions in individuals with greatest seizure reduction. Educational interventions were found to be beneficial in improving the knowledge and understanding of epilepsy, coping with epilepsy, compliance to medication and social competencies. REVIEWER'S CONCLUSIONS: In view of methodological deficiencies and limited number of individuals studied, we have found no reliable evidence to support the use of these treatments and further trials are needed.

Publication Types: Review

PMID: 14583944 [PubMed - indexed for MEDLINE]

Brain Res Cogn Brain Res. 2003 Oct;17(3):599-611.

Neuromagnetic imaging of cortical oscillations accompanying tactile stimulation.

Cheyne D, Gaetz W, Garnero L, Lachaux JP, Ducorps A, Schwartz D, Varela FJ.

Neuromagnetic Imaging Laboratory, Department of Diagnostic Imaging, Hospital for Sick Children Research Institute, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. douglas.cheyne@utoronto.ca

We applied a new method of imaging frequency-specific changes in brain activity in humans during a finger brushing task in order to measure changes in cortical rhythms during tactile stimulation. Neuromagnetic recordings were conducted in five subjects using a whole-head MEG system during tactile stimulation of the right index finger, with or without visual feedback, and while viewing another individual's index finger being stimulated. Volumetric images of changes in source power relative to pre-stimulus baseline levels were computed with 2 mm resolution over the entire brain using a minimum-variance beamforming algorithm (synthetic aperture magnetometry). Onset of tactile stimulation produced a brief (200-300 ms) suppression of mu band (8-15 Hz) and beta band (15-30 Hz) cortical activity in the primary somatosensory and primary motor cortex, respectively, followed by a bilateral increase in beta band activity ('beta rebound') in motor cortex. This pattern of suppression/rebound was absent when subjects observed finger brushing or brushing motions without receiving stimulation. In contrast, these conditions resulted in bilateral increases in beta band activity in sensorimotor areas and decreased power in the alpha (8-12 Hz) band in primary visual areas. These results show that spatially filtered MEG provides a useful method for directly imaging the temporal sequence of changes in cortical rhythms during transient tactile stimulation, and provide evidence that observation of tactile input to another individual's hand, or object motion itself, can influence independent rhythmic activity in visual and sensorimotor cortex.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 14561448 [PubMed - indexed for MEDLINE]

Chest. 2003 Oct;124(4):1500-11.

Reduction in ventilatory response to CO2 with relaxation feedback during CO2 rebreathing for ventilator patients.

Holliday JE, Lippmann M.

Medical Services, Veterans Affairs Medical Center, St. Louis MO 63106, USA. HoillidayJEH@msn.com

BACKGROUND: Previous studies have shown that relaxation biofeedback reduced the amount of time spent receiving ventilation for difficult-to-wean patients. OBJECTIVE: The present study was begun to test the hypothesis that the underlying mechanism of biofeedback ventilator weaning was the reduction of neural respiratory drive (NRD). DESIGN: Prospective. SETTING: Pulmonary Medicine division in a Veterans Affairs hospital and the St. Louis Regional Medical Center. SUBJECTS: Twenty-four patients who were receiving mechanical ventilation were randomly assigned to either the biofeedback group or the control group. INTERVENTION: Respiratory relaxation feedback (RFB) was administered while a single variable, PaCO(2), was input to the respiratory control system and the output was measured. While rebreathing 7% CO(2)/93% O(2), the biofeedback group received a CO(2) trial session and a CO(2) RFB session, and the control group received a CO(2) trial session and a CO(2) no-feedback (NFB) session. Measurements and results: There was a significant (p < 0.05) reduction in respiratory and EEG parameters for the RFB group at maximal end-tidal CO(2) (mean [+/- SE], 70 +/- 0.2 mm Hg) between the CO(2) trial and the CO(2) RFB session compared to the control group where there was no significant difference between the results of the CO(2) trial and the CO(2) NFB session. The mean values for the CO(2) trial and CO(2) RFB session for the biofeedback group were as follows: occlusion pressure 0.1 s from the onset of inspiration, 8.42 +/- 1.08 and 6.48 +/- 0.78 cm H(2)O (which reflects NRD), respectively; minute inspiratory ventilation, 15.84 +/- 0.81 and 13.91 +/- 0.72 L/min, respectively; mean inspiratory flow, 670 +/- 2.28 and 581 +/- 35 mL/s, respectively; respiration rate, 32 +/- 2.28 and 31.2 +/- 2.58 breaths/min, respectively; and chest background electromyography, 4.89 +/- 0.71 and 3.54 +/- 0.54 microV, respectively. The mean electroencephalograph outputs for the CO(2) trial and CO(2) RFB session for the biofeedback group were as follows: mean EEG frequency, 14.78 +/- 0.98 and 13.06 +/- 0.59 Hz, respectively; and beta EEG power, 3.1 +/- 0.03 and 2.39 +/- 0.19, microV(2), respectively; and gamma EEG power, 2.96 +/- 0.34 and 2.24 +/- 0.24 microV(2), respectively. CONCLUSION: We conclude that the decrease in respiratory parameters reflecting NRD induced by RFB represents a key mechanism for the previously demonstrated effectiveness of biofeedback in reducing weaning time from mechanical ventilation.

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 14555586 [PubMed - indexed for MEDLINE]

Clin Electroencephalogr. 2003 Jul;34(3):145-52.

EEG and behavioral changes following neurofeedback treatment in learning disabled children.

Fernández T, Herrera W, Harmony T, Díaz-Comas L, Santiago E, Sánchez L, Bosch J, Fernández-Bouzas A, Otero G, Ricardo-Garcell J, Barraza C, Aubert E, Galán L, Valdés R.

Instituto de Neurobiología, Universidad Nacional Autónoma de México, Juriquilla, QRO. 76230, México.

Neurofeedback (NFB) is an operant conditioning procedure, by which the subject learns to control his/her EEG activity. On one hand, Learning Disabled (LD) children have higher values of theta EEG absolute and relative power than normal children, and on the other hand, it has been shown that minimum alpha absolute power is necessary for adequate performance. Ten LD children were selected with higher than normal ratios of theta to alpha absolute power (theta/alpha). The Test Of Variables of Attention (TOVA) was applied. Children were divided into two groups in order to maintain similar IQ values, TOVA values, socioeconomical status, and gender for each group. In the experimental group, NFB was applied in the region with highest ratio, triggering a sound each time the ratio fell below a threshold value. Noncontingent reinforcement was given to the other group. Twenty half-hour sessions were applied, at a rate of 2 per week. At the end of the 20 sessions, TOVA, WISC and EEG were obtained. There was significant improvement in WISC performance in the experimental group that was not observed in the control group. EEG absolute power decreased in delta, theta, alpha and beta bands in the experimental group. Control children only showed a decrease in relative power in the delta band. All changes observed in the experimental group and not observed in the control group indicate better cognitive performance and the presence of greater EEG maturation in the experimental group, which suggests that changes were due not only to development but also to NFB treatment.

Publication Types: Clinical Trial Controlled Clinical Trial Research Support, Non-U.S. Gov't

PMID: 14521276 [PubMed - indexed for MEDLINE]

Fiziol Cheloveka. 2003 Jul-Aug;29(4):54-61.

[Effect of the individual CNS features on the efficiency of the relaxation biofeedback training in 9-10 years old children]

[Article in Russian]

Gorev AS, Semenova OA.

PMID: 13677198 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2003 Sep;28(3):241-53.

Neurofeedback training for a patient with thalamic and cortical infarctions.

Bearden TS, Cassisi JE, Pineda M.

Jackson State University, Jackson, Mississippi, USA. fmb041@bellsouth.net

One year after a left posterior and thalamic stroke, a 52-year-old male participant was treated with 14 weeks of theta reduction neurofeedback training. Imaging studies revealed left temporal, parietal, occipital, and bilateral thalamic infarctions along the distribution of the posterior cerebral artery. Neuropsychological testing demonstrated severe verbal memory, naming, visual tracking, and fine motor deficits. Additionally, alexia without agraphia was present. A pretraining quantitative electroencephalograph (QEEG) found alpha attenuation, lack of alpha reactivity to eye opening, and excessive theta activity from the left posterior head region. Neurofeedback training to inhibit 4-8 Hz theta activity was conducted for 42 sessions from left hemisphere sites. Over the course of the training, significant reductions in theta amplitude occurred from the training sites as assessed from the post-session baseline periods. Posttraining, a relative normalization of the QEEG was observed from the left posterior head region.

Publication Types: Case Reports

PMID: 12964455 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2003 Sep;28(3):217-31.

EEG-based communication and control: speed-accuracy relationships.

McFarland DJ, Wolpaw JR.

Laboratory of Nervous System Disorders, Wadsworth Center, New York State Department of Health, State University of New York, Albany, New York, USA. mcfarlan@wadsworth.org

People can learn to control mu (8-12 Hz) or beta (18-25 Hz) rhythm amplitude in the EEG recorded over sensorimotor cortex and use it to move a cursor to a target on a video screen. In our current EEG-based brain-computer interface (BCI) system, cursor movement is a linear function of mu or beta rhythm amplitude. In order to maximize the participant's control over the direction of cursor movement, the intercept in this equation is kept equal to the mean amplitude of recent performance. Selection of the optimal slope, or gain, which determines the magnitude of the individual cursor movements, is a more difficult problem. This study examined the relationship between gain and accuracy in a 1-dimensional EEG-based cursor movement task in which individuals select among 2 or more choices by holding the cursor at the desired choice for a fixed period of time (i.e., the dwell time). With 4 targets arranged in a vertical column on the screen, large gains favored the end targets whereas smaller gains favored the central targets. In addition, manipulating gain and dwell time within participants produces results that are in agreement with simulations based on a simple theoretical model of performance. Optimal performance occurs when correct selection of targets is uniform across position. Thus, it is desirable to remove any trend in the function relating accuracy to target position. We evaluated a controller that is designed to minimize the linear and quadratic trends in the accuracy with which participants hit the 4 targets. These results indicate that gain should be adjusted to the individual participants, and suggest that continual online gain adaptation could increase the speed and accuracy of EEG-based cursor control.

Publication Types: Clinical Trial Research Support, U.S. Gov't, P.H.S.

PMID: 12964453 [PubMed - indexed for MEDLINE]

IEEE Trans Neural Syst Rehabil Eng. 2003 Jun;11(2):181-4.

Learning to control brain rhythms: making a brain-computer interface possible.

Pineda JA, Silverman DS, Vankov A, Hestenes J.

Cognitive Science Department 0515, University of California, San Diego, La Jolla, CA 92093, USA. pineda@cogsci.ucsd.edu

The ability to control electroencephalographic rhythms and to map those changes to the actuation of mechanical devices provides the basis for an assistive brain-computer interface (BCI). In this study, we investigate the ability of subjects to manipulate the sensorimotor mu rhythm (8-12-Hz oscillations recorded over the motor cortex) in the context of a rich visual representation of the feedback signal. Four subjects were trained for approximately 10 h over the course of five weeks to produce similar or differential mu activity over the two hemispheres in order to control left or right movement in a three-dimensional video game. Analysis of the data showed a steep learning curve for producing differential mu activity during the first six training sessions and leveling off during the final four sessions. In contrast, similar mu activity was easily obtained and maintained throughout all the training sessions. The results suggest that an intentional BCI based on a binary signal is possible. During a realistic, interactive, and motivationally engaging task, subjects learned to control levels of mu activity faster when it involves similar activity in both hemispheres. This suggests that while individual control of each hemisphere is possible, it requires more learning time.

Publication Types: Clinical Trial Validation Studies

PMID: 12899268 [PubMed - indexed for MEDLINE]

IEEE Trans Neural Syst Rehabil Eng. 2003 Jun;11(2):133-7.

EEG changes accompanying learned regulation of 12-Hz EEG activity.

Delorme A, Makeig S.

Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California at San Diego, La Jolla 92093-0961, USA. arno@salk.edu

We analyzed 15 sessions of 64-channel electroencephalographic (EEG) data recorded from a highly trained subject during sessions in which he attempted to regulate power at 12 Hz over his left- and right-central scalp to control the altitude of a cursor moving toward target boxes placed at the top-, middle-, or bottom-right of a computer screen. We used infomax independent component analysis (ICA) to decompose 64-channel EEG data from trials in which the subject successfully up- or down-regulated the measured EEG signals. Applying time-frequency analysis to the time courses of activity of several of the resulting 64 independent EEG components revealed that successful regulation of the measured activity was accompanied by extensive, asymmetrical changes in power and coherence, at both nearby and distant frequencies, in several parts of cortex. A more complete understanding of these phenomena could help to explain the nature and locus of learned regulation of EEG rhythms and might also suggest ways to further optimize the performance of brain-computer interfaces.

Publication Types: Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

PMID: 12899255 [PubMed - indexed for MEDLINE]

IEEE Trans Neural Syst Rehabil Eng. 2003 Jun;11(2):120-3.

The thought-translation device (TTD): neurobehavioral mechanisms and clinical outcome.

Birbaumer N, Hinterberger T, Kübler A, Neumann N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, D-72074 Tübingen, Germany.

The thought-translation device (TTD) consists of a training device and spelling program for the completely paralyzed using slow-cortical brain potentials (SCP). During the training phase, the self-regulation of SCPs is learned through visual-auditory feedback and positive reinforcement of SCPs; during the spelling phase, patients select letters or words with their SCPs. A psychophysiological system for detection of cognitive functioning in completely paralyzed patients is an integral part of the TTD. The neurophysiological and anatomical basis of SCP-regulation was investigated by recording of BOLD-response in functional magnetic resonance imaging. Results showed involvement of basal ganglia and premotor cortex for required SCP positivity. The clinical outcome of 11 paralyzed patients using the TTD and quality of life of severely paralyzed patients is described. First attempts to improve learning of brain regulation with transcranial magnetic stimulation were successful.

Publication Types: Evaluation Studies Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

PMID: 12899251 [PubMed - indexed for MEDLINE]

IEEE Trans Neural Syst Rehabil Eng. 2003 Jun;11(2):117-9.

Developing wearable bio-feedback systems: a general-purpose platform.

Bianchi L, Babiloni F, Cincotti F, Arrivas M, Bollero P, Marciani MG.

Neuroscience Department, Università degli Studi di Roma Tor Vergata, 00133 Rome, Italy, theboss@luigibianchi.com

Microprocessors, even those in PocketPCs, have adequate power for many real-time biofeedback applications for disabled people. This power allows design of portable or wearable devices that are smaller and lighter, and that have longer battery life compared to notebook-based systems. In this paper, we discuss a general-purpose hardware/software solution based on industrial or consumer devices and a C++ framework. Its flexibility and modularity make it adaptable to a wide range of situations. Moreover, its design minimizes system requirements and programming effort, thus allowing efficient systems to be built quickly and easily. Our design has been used to build two brain computer interface systems that were easily ported from the Win32 platform.

Publication Types: Evaluation Studies

PMID: 12899250 [PubMed - indexed for MEDLINE]

J Neurol Neurosurg Psychiatry. 2003 Aug;74(8):1117-21.

Predictors of successful self control during brain-computer communication.

Neumann N, Birbaumer N.

Institute of Medical Psychology and Behavioural Neurobiology, University of Tuebingen, Gartenstrasse 29, 72074 Tuebingen, Germany. nicola.neumann@uni-tuebingen.de

OBJECTIVES: Direct brain-computer communication uses self regulation of brain potentials to select letters, words, or symbols from a computer menu to re-establish communication in severely paralysed patients. However, not all healthy subjects, or all paralysed patients acquire the skill to self regulate their brain potentials, and predictors of successful learning have not been found yet. Predictors are particularly important, because only successful self regulation will in the end lead to efficient brain-computer communication. This study investigates the question whether initial performance in the self regulation of slow cortical potentials of the brain (SCPs) may be positively correlated to later performance and could thus be used as a predictor. METHODS: Five severely paralysed patients diagnosed with amyotrophic lateral sclerosis were trained to produce SCP amplitudes of negative and positive polarity by means of visual feedback and operant conditioning strategies. Performance was measured as percentage of correct SCP amplitude shifts. To determine the relation between initial and later performance in SCP self regulation, Spearman's rank correlations were calculated between maximum and mean performance at the beginning of training (runs 1-30) and mean performance at two later time points (runs 64-93 and 162-191). RESULTS: Spearman's rank correlations revealed a significant relation between maximum and mean performance in runs 1-30 and mean performance in runs 64-93 (r= 0.9 and 1.0) and maximum and mean performance in runs 1-30 and mean performance in runs 162-191 (r=1.0 and 1.0). CONCLUSIONS: Initial performance in the self regulation of SCP is positively correlated with later performance in severely paralysed patients, and thus represents a useful predictor for efficient brain-computer communication.

Publication Types: Evaluation Studies

PMID: 12876247 [PubMed - indexed for MEDLINE]

Exp Brain Res. 2003 Sep;152(1):113-22. Epub 2003 Jun 27.

Brain areas activated in fMRI during self-regulation of slow cortical potentials (SCPs).

Hinterberger T, Veit R, Strehl U, Trevorrow T, Erb M, Kotchoubey B, Flor H, Birbaumer N.

Institute of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Gartenstrasse 29, 72074 Tübingen, Germany.

In humans, surface-negative slow cortical potentials (SCPs) originating in the apical dendritic layers of the neocortex reflect synchronized depolarization of large groups of neuronal assemblies. They are recorded during states of behavioural or cognitive preparation and during motivational states of apprehension and fear. Surface positive SCPs are thought to indicate reduction of cortical excitation of the underlying neural networks and appear during behavioural inhibition and motivational inertia (e.g. satiety). SCPs at the cortical surface constitute summated population activity of local field potentials (LFPs). SCPs and LFPs may share identical neural substrates. In this study the relationship between negative and positive SCPs and changes in the BOLD signal of the fMRI were examined in ten subjects who were trained to successfully self-regulate their SCPs. FMRI revealed that the generation of negativity (increased cortical excitation) was accompanied by widespread activation in central, pre-frontal, and parietal brain regions as well as the basal ganglia. Positivity (decreased cortical excitation) was associated with widespread deactivations in several cortical sites as well as some activation, primarily in frontal and parietal structures as well as insula and putamen. Regression analyses revealed that cortical positivity was predicted with high accuracy by pallidum and putamen activation and supplementary motor area (SMA) and motor cortex deactivation, while differentiation between cortical negativity and positivity was revealed primarily in parahippocampal regions. These data suggest that negative and positive electrocortical potential shifts in the EEG are related to distinct differences in cerebral activation detected by fMRI and support animal studies showing parallel activations in fMRI and neuroelectric recordings.

Publication Types: Comparative Study Research Support, Non-U.S. Gov't

PMID: 12830347 [PubMed - indexed for MEDLINE]

Neuroreport. 2003 Jul 1;14(9):1221-4.

Ecological validity of neurofeedback: modulation of slow wave EEG enhances musical performance.

Egner T, Gruzelier JH.

Department of Cognitive Neuroscience and Behaviour, Faculty of Medicine, Imperial College London, UK. t.egner@imperial.ac.uk

Biofeedback-assisted modulation of electrocortical activity has been established to have intrinsic clinical benefits and has been shown to improve cognitive performance in healthy humans. In order to further investigate the pedagogic relevance of electroencephalograph (EEG) biofeedback (neurofeedback) for enhancing normal function, a series of investigations assessed the training's impact on an ecologically valid real-life behavioural performance measure: music performance under stressful conditions in conservatoire students. In a pilot study, single-blind expert ratings documented improvements in musical performance in a student group that received training on attention and relaxation related neurofeedback protocols, and improvements were highly correlated with learning to progressively raise theta (5-8 Hz) over alpha (8-11 Hz) band amplitudes. These findings were replicated in a second experiment where an alpha/theta training group displayed significant performance enhancement not found with other neurofeedback training protocols or in alternative interventions, including the widely applied Alexander technique.

Publication Types: Comparative Study Research Support, Non-U.S. Gov't Validation Studies

PMID: 12824763 [PubMed - indexed for MEDLINE]

Neurosci Lett. 2003 Jul 17;345(2):89-92.

Electroencephalographic(EEG)-based communication: EEG control versus system performance in humans.

Sheikh H, McFarland DJ, Sarnacki WA, Wolpaw JR.

Laboratory of Nervous System Disorders, Wadsworth Center, New York State Department of Health and State University of New York, Empire State Plaza, Albany, NY 12201, USA. sheikh@wadsworth.org

People can learn to control electroencephalographic (EEG) sensorimotor rhythm amplitude so as to move a cursor to select among choices on a computer screen. We explored the dependence of system performance on EEG control. Users moved the cursor to reach a target at one of four possible locations. EEG control was measured as the correlation (r(2)) between rhythm amplitude and target location. Performance was measured as accuracy (% of targets hit) and as information transfer rate (bits/trial). The relationship between EEG control and accuracy can be approximated by a linear function that is constant for all users. The results facilitate offline predictions of the effects on performance of using different EEG features or combinations of features to control cursor movement.

Publication Types: Comparative Study Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

PMID: 12821178 [PubMed - indexed for MEDLINE]

Clin Neurophysiol. 2003 Jun;114(6):1053-68.

Spatial spectra of scalp EEG and EMG from awake humans.

Freeman WJ, Holmes MD, Burke BC, Vanhatalo S.

Division of Neurobiology, Department of Molecular & Cell Biology, University of California, LSA 142, MC 3200, Berkeley, CA 94720, USA. wfreeman@socrates.berkeley.edu

OBJECTIVE: Evaluate spectral scaling properties of scalp electroencephalogram (EEG) and electromyogram (EMG), optimal spacing of electrodes, and strategies for mitigating EMG. METHODS: EEG was recorded referentially from 9 subjects with a 64 channel linear array (electrodes 3mm apart) placed parasagittally or transversely on forehead or occiput, at rest with eyes open or closed, or with deliberate EMG. Temporal (PSD(t)) and spatial (PSD(x)) power spectral densities were calculated with one-dimensional fast Fourier transform (FFT) for comparison with earlier analyses of intracranial EEG. RESULTS: Scaling of PSD(t) from scalp resembled that from pia: near-linear decrease in log power with increasing log frequency (1/f(alpha)). Scalp PSD(x) decreased non-linearly and more rapidly than PSD(x) from pia. Peaks in PSD(t) (especially 4-12Hz) and PSD(x) (especially 0.1-0.4 cycles/cm) revealed departures from 1/f(alpha). EMG power in PSD(t) was more "white" than 1/f(alpha). CONCLUSIONS: Smearing by dura-skull-scalp distorts PSD(x) more than PSD(t) of scalp EEG from 1/f(alpha) scaling at the pia. Spatial spectral peaks suggest that optimal scalp electrode spacing might be approximately 1cm to capture non-local EEG components having the texture of gyri. Mitigation of EMG by filtering is unsatisfactory. A criterion for measuring EMG may support biofeedback for training subjects to reduce their EMG. SIGNIFICANCE: High-density recording and log-log spectral display of EEG provide a foundation for holist studies of global human brain function, as an alternative to network approaches that decompose EEG into localized, modular signals for correlation and coherence.

Publication Types: Comparative Study Research Support, U.S. Gov't, Non-P.H.S.

PMID: 12804674 [PubMed - indexed for MEDLINE]

IEEE Trans Neural Syst Rehabil Eng. 2003 Mar;11(1):54-9.

Implementation of a telemonitoring system for the control of an EEG-based brain-computer interface.

Müller GR, Neuper C, Pfurtscheller G.

Department of Medical Informatics, Institute of Biomedical Engineering, University of Technology Graz, 8010 Graz, Austria.

By the use of a brain-computer interface (BCI), it is possible for completely paralyzed patients, who have lost their ability to speak, to have a new possibility to communicate with their environment. The training with such a BCI system can be performed at the patient's home, if there is a responsible person present who is familiar with the system. This person has to adjust different parameters and to adapt the training individually to each patient. Since this function is usually taken over by the developers of the system, the number of patients who can be included in regular BCI training is restricted due to geographical distances. This paper describes the implementation of a telemonitoring system, which makes it possible for the developer to control and supervise the BCI training from his or her own place of work. First experiences with a patient living far away from the developer's lab are reported.

Publication Types: Evaluation Studies Research Support, Non-U.S. Gov't

PMID: 12797726 [PubMed - indexed for MEDLINE]

Int J Psychophysiol. 2003 May;48(2):221-45.

Theory, methods and new directions in the psychophysiology of the schizophrenic process and schizotypy.

Gruzelier JH.

Cognitive Neuroscience and Behaviour, Medial Faculty, Imperial College London, St. Dunstan's Road, London, W6 8RF, UK. j.gruzelier@ic.ac.uk

Theoretical and methodological issues in the psychophysiology of the schizophrenic process are reviewed. These include the importance of schizotypy with its compensatory abilities as well as deficits for elucidating the processes of development and prevention of schizophrenia. The importance of individual differences, syndromes and single case studies. The recognition that this is a dynamic and fluctuating illness and hence the relevance of functional neurophysiology, including the role of imbalances in hemispheric activation in ontogeny, developmental course, expression of symptoms, the effects of neuroleptics and recovery process, and the influence of stress a precipitant of breakdown. The role of thalamo-cortical activation systems. The particular value of electrocortical measures including the interrelations of electroencephalographic rhythms throughout the spectrum, and relations of gamma, dynamic core neuronal complexity, connectivity and sensory gating with experiences of unreality and disturbances of consciousness.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 12763575 [PubMed - indexed for MEDLINE]

Clin Neurophysiol. 2003 Mar;114(3):399-409.

Clinical application of an EEG-based brain-computer interface: a case study in a patient with severe motor impairment.

Neuper C, Müller GR, Kübler A, Birbaumer N, Pfurtscheller G.

Department of Medical Informatics, Ludwig-Boltzmann Institute for Medical Informatics and Neuroinformatics, University of Technology Graz, Graz Austria. neuper@tugraz.at

OBJECTIVE: This case study describes how a completely paralyzed patient, diagnosed with severe cerebral palsy, was trained over a period of several months to use an electroencephalography (EEG)-based brain-computer interface (BCI) for verbal communication. METHODS: EEG feedback training was performed in the patient's home (clinic), supervised from a distant laboratory with the help of a 'telemonitoring system'. Online feedback computation was based on single-trial analysis and classification of specific band power features of the spontaneous EEG. Task-related changes in brain oscillations over the course of training steps was investigated by quantifying time-frequency maps of event-related (de-)synchronization (ERD/ERS). RESULTS: The patient learned to 'produce' two distinct EEG patterns, beta band ERD during movement imagery vs. no ERD during relaxing, and to use this for BCI-controlled spelling. Significant learning progress was found as a function of training session, resulting in an average accuracy level of 70% (correct responses) for letter selection. 'Copy spelling' was performed with a rate of approximately one letter per min. CONCLUSIONS: The proposed BCI training procedure, based on electroencephalogram (EEG) biofeedback and concomitant adaptation of feature extraction and classification, may improve actual levels of communication ability in locked-in patients. 'Telemonitoring-assisted' BCI training facilitates clinical application in a larger number of patients.

Publication Types: Case Reports Research Support, Non-U.S. Gov't

PMID: 12705420 [PubMed - indexed for MEDLINE]

Brain Res Brain Res Protoc. 2003 Mar;11(1):27-37.

The Madrid card sorting test (MCST): a task switching paradigm to study executive attention with event-related potentials.

Barceló F.

Department of Psychology, University of the Balearic Islands, Ctra. Valldemossa km 7.5, 07071 Palma de Mallorca, Spain. f.barcelo@uib.es

Event-related potentials (ERPs) provide valuable information about the fast brain dynamics subserving cognitive functions such as attention and working memory. Most ERP studies employ cognitive paradigms with a fixed task-set (i.e., press a button to coloured targets), but few have measured ERPs time-locked to shifts in set using a task-switching paradigm. The Madrid card sorting test (MCST) is a dual task protocol in which feedback cues signal unpredictable shifts in set (i.e., from 'sort cards by colour' to 'sort cards by shape'). This protocol allows for an integrated analysis of ERPs to both feedback cues and target card events, providing separate ERP features for the shifting, updating, and rehearsal of attention sets in working memory. Two of these ERP indices are the frontal and posterior aspects of the P300 response. Feedback cues that direct a shift in set also elicit a frontally distributed P3a potential (300-400 ms). Instead, target card events evoke increasingly larger posterior P3b (350-600 ms) activity as the new task set becomes gradually rehearsed. The observed modulations in the frontal and posterior aspects of the P300 response system are interpreted from current models of prefrontal cortex function in the executive control of attention.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 12697260 [PubMed - indexed for MEDLINE]

Neuropsychologia. 2003;41(8):1028-36.

Conscious perception of brain states: mental strategies for brain-computer communication.

Neumann N, Kübler A, Kaiser J, Hinterberger T, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Gartenstrasse 29, D-72074 Tuebingen, Germany. nicola.neumann@uni-tuebingen.de

Direct brain-computer communication utilises self-regulation of brain potentials to select letters, words or symbols from a computer menu. In this study a completely paralysed (locked-in) patient learnt to produce slow cortical potential (SCP) shifts to operate a binary spelling device. After hundreds of training sessions he gave a detailed description of his mental strategies for self-regulation. His cognitive strategies matched with the electrocortical changes perfectly. Thus he produced a contingent negative variation (CNV) with images of preparation such as an arrow being drawn on a bow. To produce a positive potential shift he imagined the arrow shooting up from the bow. To suppress potential shifts he tried to stop thinking. The study demonstrates that patients become sensitive for their brain states with increasing self-regulation practice. The use of conscious cognitive strategies may, however, be incompatible with the complete automatization of the self-regulation skill.

Publication Types: Case Reports Research Support, Non-U.S. Gov't

PMID: 12667538 [PubMed - indexed for MEDLINE]

Indian J Med Sci. 2002 Aug;56(8):376-80.

Management of attention deficit/hyperactivity disorder--use of an effective paradigm.

Dixit SP, Pandey MN, Dubey GP.

Centre of Psychosomatic and Biofeedback Medicine, Institute of Medical Sciences, Banaras Hindu University.

The management of ADHD poses a great problem before the psychologists, psychiatrists and different behavioural scientists. The multi-model approach, combining pharmacologic with different non-pharmacologic interventions, is more effective than any form of therapy. In the present study the theta feedback, a non-pharmacologic technique, has shown beneficial role among the low medicated ADHD cases. The present study also signifies the role of multi-model intervention in the management of ADHD.

Publication Types: Clinical Trial Controlled Clinical Trial

PMID: 12645162 [PubMed - indexed for MEDLINE]

Phys Med Rehabil Clin N Am. 2003 Feb;14(1 Suppl):S93-109.

Neuromuscular electrical stimulation for motor relearning in hemiparesis.

Chae J.

Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA. jchae@metrohealth.org

Neuromuscular electrical stimulation may have an important role in improving the motor function of stroke survivors. Active, repetitive movement training mediated by transcutaneous cyclic and EMG-triggered NMES may facilitate the motor recovery of stroke survivors. Multicenter, double-blinded, randomized clinical trials should be pursued to confirm the motor-relearning effects of transcutaneous NMES and to define appropriate prescriptive specifications. Intramuscular EMG-controlled NMES may be superior to transcutaneous systems and is presently undergoing preliminary randomized clinical trials. Neuroprostheses systems may provided the highest level of goal-oriented activity and cognitive investments, which may lead to significant motor relearning. Implementation of clinically viable neuroprosthesis systems, however, will probably require additional technical developments including more reliable control paradigms and methods for blocking undesirable muscle contractions. In view of the dynamic nature of the present health care environment, the future of NMES technology is difficult to predict. By necessity, scientists and clinicians must continue to explore new ideas and to improve on the present systems. Components will be smaller, more durable, and more reliable. Control issues will remain critical for both motor relearning and neuroprosthetic applications, and the implementation of cortical control is likely to dictate the nature of future generations of NMES systems. Finally, consumers will direct future developments. In the present health care environment, where cost has become an overwhelming factor in the development and implementation of new technology, the consumer will become one of technology's greatest advocates. The usual drive toward greater complexity will be tempered by the practical issues of clinical implementation, where patient acceptance is often a function of a tenuous balance between the burden or cost associated with using a system and the system's impact on the user's life.

Publication Types: Research Support, U.S. Gov't, P.H.S. Review

PMID: 12625640 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2002 Dec;27(4):261-70.

EEG signature and phenomenology of alpha/theta neurofeedback training versus mock feedback.

Egner T, Strawson E, Gruzelier JH.

Department of Cognitive Neuroscience and Behaviour, Faculty of Medicine, Imperial College of Science, Technology and Medicine, St. Dunstan's Road, London W6 8RF, United Kingdom. t.egner@ic.ac.uk

Alpha/theta (a/t) neurofeedback training has in the past successfully been used as a complementary therapeutic relaxation technique in the treatment of alcoholism. In spite of positive clinical outcomes, doubts have been cast on the protocol's specificity when compared to alternative relaxation regimes. This study investigated the basic tenet underlying the a/t training rationale, that accurate a/t feedback representation facilitates the generation of these frequency components. Two groups of healthy volunteers were randomly assigned to either (a) real contingent a/t feedback training or (b) a noncontingent mock feedback control condition. The groups were compared on measures of theta/alpha (t/a) ratios within and across training sessions, as well as activational self-report scales after each session. The contingent a/t feedback group displayed significant within-session t/a ratio increments not evident in the mock control group, as well as higher overall t/a ratios in some but not all of the training sessions. No differences were found between the groups in terms of subjective activational phenomenology, in that both groups reported significantly lower levels of activation after training sessions. The data demonstrate that irrespective of considerations of clinical relevance, accurate a/t neurofeedback effectively facilitates production of higher within-session t/a ratios than do noncontingent feedback relaxation.

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 12557453 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2002 Dec;27(4):231-49.

The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder.

Monastra VJ, Monastra DM, George S.

FPI Attention Disorders Clinic, 2102 E. Main Street, Endicott, New York 13760, USA. poppidoc@aol.com

One hundred children, ages 6-19, who were diagnosed with attention-deficit/hyperactivity disorder (ADHD), either inattentive or combined types, participated in a study examining the effects of Ritalin, EEG biofeedback, and parenting style on the primary symptoms of ADHD. All of the patients participated in a 1-year, multimodal, outpatient program that included Ritalin, parent counseling, and academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants also received EEG biofeedback therapy. Posttreatment assessments were conducted both with and without stimulant therapy. Significant improvement was noted on the Test of Variables of Attention (TOVA; L. M. Greenberg, 1996) and the Attention Deficit Disorders Evaluation Scale (ADDES; S. B. McCarney, 1995) when participants were tested while using Ritalin. However, only those who had received EEG biofeedback sustained these gains when tested without Ritalin. The results of a Quantitative Electroencephalographic Scanning Process (QEEG-Scan; V. J. Monastra et al., 1999) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school.

Publication Types: Clinical Trial

PMID: 12557451 [PubMed - indexed for MEDLINE]

Cyberpsychol Behav. 2002 Dec;5(6):565-80.

An evaluation model for psychoeducational interventions using interactive multimedia.

Beale IL.

HopeLab, Palo Alto, California 94301, USA. ibeale@hopelab.org

A review of published evaluations of psychoeducational interventions using interactive digital multimedia shows that evaluations typically address only some of the areas that collectively would constitute a comprehensive evaluation. There appears to be a need for an accepted standard for these evaluations, based on a general evaluation model that encompasses all relevant aspects of development, efficacy and use of multimedia interventions. A comprehensive model is proposed which includes special features of multimedia interventions that lead to unique evaluation requirements. The model integrates relevant aspects of program evaluation and clinical trials models in order to provide a unique model that includes all the evaluation domains relevant to digital multimedia interventions. These include evaluation of intervention theory, intervention design strategies, the formative process, intervention efficacy (process and outcome) and contextual issues such as evaluability assessment, reporting and stakeholder issues. The application of individual components of the model is illustrated with reference to problems in the evaluation literature on a particular type of digital multimedia intervention, electroencephalographic biofeedback for Attention-Deficit/Hyperactivity Disorder. The model should be useful for researchers planning evaluations of digital multimedia interventions, especially in the psychoeducational domain. This paper provides a theoretical and evidential background for the evaluation model, and includes a checklist and flowchart for the planning and conduct of the evaluation.

Publication Types: Evaluation Studies Research Support, Non-U.S. Gov't

PMID: 12556120 [PubMed - indexed for MEDLINE]

Int J Psychophysiol. 2003 Jan;47(1):75-85.

The effect of training distinct neurofeedback protocols on aspects of cognitive performance.

Vernon D, Egner T, Cooper N, Compton T, Neilands C, Sheri A, Gruzelier J.

Department of Cognitive Neuroscience and Behaviour, Imperial College London, Charing Cross Hospital, St. Dunstans Road, London W6 8RF, UK. d.vernon@ic.ac.uk

The use of neurofeedback as an operant conditioning paradigm has disclosed that participants are able to gain some control over particular aspects of their electroencephalogram (EEG). Based on the association between theta activity (4-7 Hz) and working memory performance, and sensorimotor rhythm (SMR) activity (12-15 Hz) and attentional processing, we investigated the possibility that training healthy individuals to enhance either of these frequencies would specifically influence a particular aspect of cognitive performance, relative to a non-neurofeedback control-group. The results revealed that after eight sessions of neurofeedback the SMR-group were able to selectively enhance their SMR activity, as indexed by increased SMR/theta and SMR/beta ratios. In contrast, those trained to selectively enhance theta activity failed to exhibit any changes in their EEG. Furthermore, the SMR-group exhibited a significant and clear improvement in cued recall performance, using a semantic working memory task, and to a lesser extent showed improved accuracy of focused attentional processing using a 2-sequence continuous performance task. This suggests that normal healthy individuals can learn to increase a specific component of their EEG activity, and that such enhanced activity may facilitate semantic processing in a working memory task and to a lesser extent focused attention. We discuss possible mechanisms that could mediate such effects and indicate a number of directions for future research.

Publication Types: Comparative Study Research Support, Non-U.S. Gov't

PMID: 12543448 [PubMed - indexed for MEDLINE]

Int J Neurosci. 2002 Sep;112(9):1047-57.

Covariation of spectral and nonlinear EEG measures with alpha biofeedback.

Fell J, Elfadil H, Klaver P, Röschke J, Elger CE, Fernández G.

Department of Epileptology, University of Bonn, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany. juergen.fell@ukb.uni-bonn.de

This study investigated how different spectral and nonlinear EEG measures covaried with alpha power during auditory alpha biofeedback training, performed by 13 healthy subjects. We found a significant positive correlation of alpha power with the largest Lyapunov-exponent, pointing to an increased dynamical instability of the EEG accompanying alpha enhancement. Alpha power amplification, moreover, was significantly correlated with a decrease of spectral entropy within the alpha range. This outcome reflects a sharpening of the alpha peak during biofeedback training. The fact that the sharpening effect clearly preceded the increase of alpha amplitude could be exploited in future biofeedback settings.

Publication Types: Comparative Study

PMID: 12487094 [PubMed - indexed for MEDLINE]

Zh Vyssh Nerv Deiat Im I P Pavlova. 2002 Sep-Oct;52(5):563-9.

[Neurophysiological mechanisms of acquisition of fear-resistance habit controlled by biological feedback displayed by skin galvanic response]

[Article in Russian]

Popova EI, Ivonin AA, Shuvaev VT, Mikheev VF.

Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg.

The aim of the study was to reveal a probable structural-functional basis of emotional self-regulation processes within the framework of cortex--basal ganglia interaction using on-line computer analysis of the EEG. The tested subjects were unable to overcome the emotional stress increasing in the process of decision making under conditions of high responsibility for the results of task solving. Striving to hold their social positions these subjects created a stable psychological set to keep their high responsibility and resist the relaxation tendency. Such a set facilitated the acceptance of the task for volitional effort to resist fear controlled by a biofeedback displayed in skin galvanic reaction.

Publication Types: Clinical Trial English Abstract

PMID: 12449833 [PubMed - indexed for MEDLINE]

Med Hypotheses. 2002 Jun;58(6):433-8.

Long-term biophysical synchronization for prevention of addiction spectrum formation in high risk children and adolescents: theory and practice.

Naisberg Y.

Kfar Yidud Rehabilitation Center, Netanya, Israel. neisberg@netvision.co.il

To date the sequence of events that inevitably leads to addiction has not been defined. The author presents five consecutive risk factors of addiction-loop formation with a spectrum including aggression, sexual disorders, addiction abuse and factitious disorders in children and adolescents at risk, which can be counteracted with five protective factors for addiction-free states: 1. Sleep correction under EEG for night-time transitory homeostatic resynchronizaion (THR); 2. Biofeedback training under EEG for daytime THR; 3. Standardized competent coping skills training; 4. Standardized anti-stress techniques training for stress-free social encounters; 5. Addiction aversion training with socially compatible placebos. We believe that with trained quantified THR over the circadian cycle, appropriate coping skills and anti-stress techniques, predictable addiction-loop formation can be weakened or eliminated. A significant negative correlation between enhanced addiction aversion and a reduced drive for addictive agents can lead to addiction-free states.

PMID: 12323107 [PubMed - indexed for MEDLINE]

Usp Fiziol Nauk. 2002 Jul-Sep;33(3):79-96.

[Biofeedback training and human functional state control]

[Article in Russian]

Fedotchev AI, Bondar' AT, Kim EV.

Institute of Cell Biophysics RAS, Pushchino.

Biofeedback (BFB) training paradigm has outstanding place among various approaches to non-phrarmacological human functional state correction. Being an universal way for voluntary self-regulation of physiological functions, it is characterized by efficacy, accessibility and absence of side effects. However, the lack of fundamental knowledge about the BFB mechanisms leads to existence of numerous difficulties and problems that seriously limit the BFB possibilities. Most difficulties seem to concern the problem of adequate choice of BFB type or parameter being voluntary controlled via feedback signals. Some ways to solve this problem are drown on the base of general systems theory. It is shown that BFB procedures could be especially effective in conditions of close interaction between the BFB mechanisms and the central regulatory mechanisms. Such interaction could be reacheb by utilization of certain characteristics of brain electrical activity reflected in the electroencephalogram (EEG). The most perspective seems to be the utilization of discrete narrow band EEG spectral components, individual resonance EEG oscillators or some correlates of human EEG amplitude modulation processes.

Publication Types: English Abstract Review

PMID: 12298154 [PubMed - indexed for MEDLINE]

NeuroRehabilitation. 2002;17(1):69-80.

The improvement/rehabilitation of auditory memory functioning with EEG biofeedback.

Thornton KE.

Center for Health Psychology, Ste. 2a, 2509 Park Ave. S. Plainfield, NJ 07080, USA. chp.ket@worldnet.att.net

Five clinical case studies (1 normal, 3 brain injured and 1 subject who had a left frontal hematoma) are presented which addressed the effectiveness of EEG biofeedback for auditory memory impairment. A normative QEEG activation database of 59 right-handed subjects was developed, which delineated the QEEG variables which were positively related to auditory memory performance (paragraphs). Persons who had experienced a brain injury underwent the same procedure employed in the development of the database. The person's values on the effective parameters of memory functioning were determined. EEG biofeedback interventions were determined by the individual's deviation from the normative reference group in terms of the relevant QEEG parameters of effective auditory memory (paragraph recall). Improvements ranged from 39% subjects who had a follow up assessment that occurred from one month to one year following termination of treatment.

Publication Types: Case Reports Comparative Study

PMID: 12016349 [PubMed - indexed for MEDLINE]

Neurosci Lett. 2002 May 24;324(3):205-8.

Modulation of slow cortical potentials by transcranial magnetic stimulation in humans.

Kübler A, Schmidt K, Cohen LG, Lotze M, Winter S, Hinterberger T, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Gartenstrasse 29, 72074 Tuebingen, Germany. andrea.kuebler@uni-tuebingen.de

We studied the effects of transcranial magnetic stimulation (TMS) on slow cortical potentials (SCPs) of the brain elicited during performance of a feedback and reward task. Ten healthy participants were trained to self-regulate their SCP amplitude using visual feedback and reward for increased or decreased amplitudes. Subjects participated in 27 runs (each comprising 70 trials) under three different conditions: single-pulse TMS delivered with the coil centered over Cz (vertex), over a lateral scalp position (LSP), which increased task difficulty, and in the absence of stimulation. Cz stimulation led to a non-significant enhancement of negative SCPs, while LSP stimulation led to a significant increase of positive SCPs. These results are consistent with the idea that enhanced task difficulty, as in LSP stimulation, enhances cognitive processing load leading to an increase of positive SCPs. Additionally, the data raise the hypothesis that TMS delivered to bilateral midcentral regions could modulate the amplitude of negative SCPs.

PMID: 12009524 [PubMed - indexed for MEDLINE]

Neurourol Urodyn. 2002;21(3):214-24.

Cerebral electrical response on urinary bladder filling: first experimental findings.

Bross S, Schumacher S, Scheepe JR, Braun PM, Alken P, Jünemann KP.

Neuro-Urological Laboratory, Department of Urology, University Hospital Mannheim of the University of Heidelberg, Heidelberg, Germany. stephan.bross@uro.ma.uni-heidelberg.de

Micturition disorders in neurologic diseases are often combined with reduced bladder sensation. Bladder sensation is important to time the void appropriately and to prevent bladder overdistension. We attempted to evaluate cerebral evoked potentials by bladder distension to objectively determine bladder sensation. In six rabbits, cerebral evoked potentials were evaluated by averaging cerebral responses to bladder distension. We stimulated the bladder with a computerized air pump system, resulting in repeated filling and emptying of the bladder. The number of stimulations, stimulation intensity, and different electroencephalograph electrode positions (both mastoids and frontal) were investigated. In all rabbits, cerebral evoked potentials were observed after 500 stimulations when stimulation pressure exceeded a certain threshold. Optimum response was observed after 1,000 stimulations. The latency of response of the frontal electrode position was observed after the mastoidal response with a significant delay of approximately 0.8 seconds. The latencies were significantly different when using different stimulation intensities. At lower intensity (mean pressure, 16.6 mm Hg), the response was observed after 4.531 +/- 0.909 seconds. At higher intensity (mean pressure, 19.0 mm Hg), cerebral response was observed after a latency of 3.971 +/- 0.735 seconds. We conclude that recording of cerebral evoked potentials by bladder distension is possible, resulting in an objective evaluation of afferent pathways from the bladder. In combination with subjective perception of bladder fullness, this finding may be a conceivable basis for a biofeedback training program to recover bladder sensation in patients with reduced bladder sensation. Copyright 2002 Wiley-Liss, Inc.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 11948715 [PubMed - indexed for MEDLINE]

Minim Invasive Neurosurg. 2002 Mar;45(1):19-23.

A non-invasive communication device for the paralyzed.

Kaiser J, Kübler A, Hinterberger T, Neumann N, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, Eberhard-Karls-University of Tübingen, Gartenstrasse 29, 72074 Tübingen, Germany. jochen.kaiser@uni-tuebingen.de

An EEG-based communication system has been developed to re-establish communication in severely paralyzed patients who operate the device by generating shifts of their slow cortical potentials. Training to gain control over slow cortical potentials was based on visual feedback and operant conditioning strategies. The vertical movement of a graphic signal on a computer screen informs the patients about the course of their slow cortical potential amplitude. Positive slow cortical potential shifts move the cursor up, negative shifts move it down. These shifts are then translated into binary responses. When a patient has achieved reliable control over his/her slow cortical potential shifts, these responses can be used to select or reject items presented at the bottom of the screen. As learning processes and applications differ considerably between patients, the present paper describes the data from one patient with amyotrophic lateral sclerosis. After about three months of training, this patient gained stable, near-perfect control over his slow cortical potentials. This skill enabled him to operate a specially designed program to communicate messages to his caregivers.

Publication Types: Case Reports Research Support, Non-U.S. Gov't

PMID: 11932820 [PubMed - indexed for MEDLINE]

Conscious Cogn. 2002 Mar;11(1):98-113.

Can humans perceive their brain states?

Kotchoubey B, Kübler A, Strehl U, Flor H, Birbaumer N.

Department of General Psychology, University of Padua, Padua, Italy. boris.kotchoubey@uni-tuebingen.de

Although the brain enables us to perceive the external world and our body, it remains unknown whether brain processes themselves can be perceived. Brain tissue does not have receptors for its own activity. However, the ability of humans to acquire self-control of brain processes indicates that the perception of these processes may also be achieved by learning. In this study patients learned to control low-frequency components of their EEG: the so-called slow cortical potentials (SCPs). In particular "probe" sessions, the patients estimated the quality of the SCP shift they had produced in the preceding trial. The correspondence between the recorded SCP amplitudes and the subjective estimates increased with training. The ability to perceive the SCPs was related to the ability to control them; this perception was not mediated by peripheral variables such as changes in muscle tonus and cannot be reduced to simple vigilance monitoring. These data provide evidence that humans can learn to perceive the neural activity of their brain. Alternative interpretations are discussed. Copyright 2002 Elsevier Science (USA).

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 11883990 [PubMed - indexed for MEDLINE]

Rehabilitation (Stuttg). 2002 Feb;41(1):48-52.

[Mental activity hand orthosis control using the EEG: a case study]

[Article in German]

Pfurtscheller G, Müller G, Korisek G.

Abteilung für medizinische Informatik, Institut für Elektro- und biomedizinische Technik, Technische Universität Graz, Osterreich. pfu@dpmi.tu-graz.ac.at

A report is given on the realization of a steering mechanism of a hand orthosis for a patient with paraplegia. An EEG-based Brain-Computer Interface (BCI) was used here for the first time, transferring purely mental activity to a control signal. This means that the patient has the capability to open or close the hand orthosis only by imagination of a movement. At this time, after a training period of about four months, the patient is able to move the hand orthosis with a certainty of almost hundred percent. The restored grasp function was verified by a grasp function test. Results are compared to those obtained using a conventional EMG-controlled orthosis.

Publication Types: Case Reports English Abstract

PMID: 11830792 [PubMed - indexed for MEDLINE]

Biomed Tech (Berl). 1998;43 Suppl 3:67-71.

[GOFI--a neurofeedback system for child and adolescent psychiatry]

[Article in German]

Heinrich H, Nelson K, Moll GH, Rothenberger A.

Kinder- und Jugendpsychiatrie, Universität Göttingen v. Siebold-Str. 5, 37075 Göttingen.

PMID: 11776226 [PubMed - indexed for MEDLINE]

Neuroreport. 2001 Dec 21;12(18):4155-9.

Learned self-regulation of EEG frequency components affects attention and event-related brain potentials in humans.

Egner T, Gruzelier JH.

Department of Cognitive Neuroscience and Behaviour, Faculty of Medicine Imperial College of Science, Technology and Medicine, St Dunstan's Rd, London W6 8RF, UK.

Learned enhancement of EEG frequency components in the lower beta range by means of biofeedback has been reported to alleviate attention deficit hyperactivity disorder (ADHD) symptoms. In order to elucidate frequency-specific behavioural effects and neurophysiological mediators, this study applied neurofeedback protocols to healthy volunteers, and assessed impact on behavioural and electrocortical attention measures. Operant enhancement of a 12-15 Hz component was associated with reduction in commission errors and improved perceptual sensitivity on a continuous performance task (CPT), while the opposite relation was found for 15-18 Hz enhancement. Both 12-15 Hz and 15-18 Hz enhancement were associated with significant increases in P300 event-related brain potential amplitudes in an auditory oddball task. These relations are interpreted as stemming from band-specific effects on perceptual and motor aspects of attention measures.

PMID: 11742256 [PubMed - indexed for MEDLINE]

Arch Phys Med Rehabil. 2001 Nov;82(11):1533-9.

Brain-computer communication: self-regulation of slow cortical potentials for verbal communication.

Kübler A, Neumann N, Kaiser J, Kotchoubey B, Hinterberger T, Birbaumer NP.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany. andrea.kuebler@uni-tuebingen.de

OBJECTIVE: To test a training procedure designed to enable severely paralyzed patients to communicate by means of self-regulation of slow cortical potentials. DESIGN: Application of the Thought Translation Device to evaluate the procedure in patients with late-stage amyotrophic lateral sclerosis (ALS). SETTING: Training sessions in the patients' homes. PARTICIPANTS: Two male patients with late-stage ALS. INTERVENTIONS: Patients learned voluntary control of their slow cortical potentials by means of an interface between the brain and a computer. Training was based on visual feedback of slow cortical potentials shifts and operant learning principles. The learning process was divided into small steps of increasing difficulty. MAIN OUTCOME MEASURES: Accuracy of self-control of slow cortical potentials (percentage of correct responses). Learning progress calculated as a function of training session. RESULTS: Within 3 to 8 weeks, both patients learned to self-regulate their slow cortical potentials and to use this skill to select letters or words in the Language Support Program. CONCLUSIONS: This training schedule is the first to enable severely paralyzed patients to communicate without any voluntary muscle control by using self-regulation of an electroencephalogram potential only. The protocol could be a model for training patients in other brain-computer interface techniques. Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Publication Types: Case Reports Research Support, Non-U.S. Gov't

PMID: 11689972 [PubMed - indexed for MEDLINE]

Cochrane Database Syst Rev. 2001;(4):CD002029.

Update in: Cochrane Database Syst Rev. 2003;(4):CD002029.

Psychological treatments for epilepsy.

Ramaratnam S, Baker GA, Goldstein L.

Department of Neurology, Apollo Hospitals, 21 Greams Lane, Off Greams Road, Madras, Tamil Nadu, India, 60006. rsridharan@vsnl.com

BACKGROUND: Psychological interventions such as relaxation therapy, cognitive behaviour therapy, EEG bio-feedback and educational interventions have been used alone or in combination in the treatment of epilepsy, to reduce the seizure frequency and improve the quality of life. OBJECTIVES: To assess whether the treatment of epilepsy with psychological methods is effective in reducing seizure frequency and/or leads to a better quality of life. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trial register, the Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2001), MEDLINE using OVID (1966 - May 2001) and cross references from identified publications. SELECTION CRITERIA: Randomized or quasi-randomized studies assessing one or more types of psychological or behaviour modification techniques for patients with epilepsy. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the trials for inclusion and extracted data. Primary analyses were by intention to treat. Outcomes included reduction in seizure frequency, and quality of life. MAIN RESULTS: We found three small trials (50 patients) of relaxation therapy. They were of poor methodological quality and a meta-analysis was therefore not undertaken. No study found a significant effect of relaxation therapy on seizure frequency. One trial found cognitive behavioural therapy to be effective in reducing depression, among people with epilepsy with a depressed affect, whilst another did not. One trial of group cognitive therapy found no significant effect on seizure frequency. Two trials of combined relaxation and behaviour therapy and one of EEG bio-feedback and two of educational interventions did not provide sufficient information to assess their effect on seizure frequency. Combined use of relaxation and behaviour modification was found beneficial for anxiety and adjustment in one study. In one study EEG bio-feedback was found to improve the cognitive and motor functions in subjects with greatest seizure reduction. Educational interventions were found to be beneficial in improving the knowledge and understanding of epilepsy, improving compliance to medication and improving social competencies. REVIEWER'S CONCLUSIONS: In view of methodological deficiencies and limited number of patients studied, we have found no reliable evidence to support the use of these treatments and further trials are needed.

Publication Types: Review

PMID: 11687134 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2001 Sep;26(3):215-26.

Change: detection and modification.

Montgomery DD.

Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida 33314, USA. montgom@nova.edu

Because human physiology is always changing, one of the challenges for those interested in biofeedback applications is how to establish techniques to determine if the biofeedback has altered the physiology. This paper explores some of the areas of concern and some solutions that have been reported.

PMID: 11680285 [PubMed - indexed for MEDLINE]

Fiziol Cheloveka. 2001 May-Jun;27(3):5-13.

[Effect of EEG sensorimotor rhythm and beta1-rhythm biological feedback on attention parameters]

[Article in Russian]

Grin'-Iatsenko VA, Kropotov IuD, Ponomarev VA, Chutko LS, Iakovenko EA.

Publication Types: Clinical Trial

PMID: 11548426 [PubMed - indexed for MEDLINE]

Brain Res Cogn Brain Res. 2001 Aug;12(1):117-30.

Feedback-dependent modulation of isometric force control: an EEG study in visuomotor integration.

Rearick MP, Johnston JA, Slobounov SM.

Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA. mrearick@asu.edu

The primary purpose of this investigation was to examine the cortical mechanisms underlying visuomotor integration in an experiment directly manipulating visual feedback (control-signal gain) as participants executed a grasping task. This was accomplished by assessing human electroencephalograms in both time and frequency domains and relating these measures to the performance accuracy of isometric force control. The basic experimental manipulation consisted of subjects controlling a grip dynamometer and the subsequent force trace displayed on a computer monitor at various magnitudes of force output and control-signal gain. Several findings from this study were of interest. First, the effects of control-signal gain and its interplay with the magnitude of force were most evident across the parietal and frontocentral electrode locations--areas specifically related to multi-modal sensory evaluation (parietal lobe) and higher-order movement control (supplementary and mesial premotor areas). Second, electroencephalography (EEG) measures in the time domain, i.e., slow-wave potentials, were sensitive to control-signal gain only during the ramp phase of force production (period of reaching the target force), not the static phase (period of maintaining the target force level). Third, EEG measures within the frequency domain (event-related desynchronization), unlike the slow-wave potential measures, were sensitive to control-signal gain during the static phase of force production--a sensitivity that was directly related to improvements in the accuracy of isometric force control. The findings of this investigation are described in relation to the existent literature on human visuomotor integration with special attention paid to the distinct spatial and temporal electrocortical patterns exhibited under varying degrees of visual feedback and magnitudes of force output during grasping.

Publication Types: Clinical Trial

PMID: 11489615 [PubMed - indexed for MEDLINE]

Ann N Y Acad Sci. 2001 Jun;931:342-58.

EEG biofeedback treatment of ADD. A viable alternative to traditional medical intervention?

Ramirez PM, Desantis D, Opler LA.

Doctoral Program in Clinical Psychology at Long Island University (Brooklyn Campus), Brooklyn, New York 11201, USA.

Literature searches dating back to 1968 were conducted through Psychlit and Medline services to review the scientific literature on EEG biofeedback treatment of ADD. While anecdotal and case reports cite promising evidence, methodological problems coupled with a paucity of research precludes any definitive conclusions as to the efficacy of enhanced alpha and hemisphere-specific EEG biofeedback training. One of the more promising EEG biofeedback treatment paradigms involves theta/beta training. Studies have reported that academic, intellectual, and behavioral gains have been attained with this approach. Significant behavioral and cognitive changes have also been reported following SMR training. However, research into these treatment approaches has also been marred by methodological inadequacies and lack of sufficient follow-up studies. A number of recommendations for future research into this treatment approach are made.

Publication Types: Review

PMID: 11462752 [PubMed - indexed for MEDLINE]

Ann N Y Acad Sci. 2001 Jun;931:310-41.

Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD).

Arnold LE.

Department of Psychiatry, Ohio State University, Columbus, Ohio 43210, USA. arnold.6@osu.edu

A previous review of alternative treatments (Tx) of ADHD--those other than psychoactive medication and behavioral/psychosocial Tx--was supplemented with an additional literature search focused on adults with ADHD. Twenty-four alternative Tx were identified, ranging in scientific documentation from discrediting controlled studies through mere hypotheses to positive controlled double-blind clinical trials. Many of them are applicable only to a specific subgroup. Although oligoantigenic (few-foods) diets have convincing double-blind evidence of efficacy for a properly selected subgroup of children, they do not appear promising for adults. Enzyme-potentiated desensitization, relaxation/EMG biofeedback, and deleading also have controlled evidence of efficacy. Iron supplementation, magnesium supplementation, Chinese herbals, EEG biofeedback, massage, meditation, mirror feedback, channel-specific perceptual training, and vestibular stimulation all have promising prospective pilot data, many of these tests reasonably controlled. Single-vitamin megadosage has some intriguing pilot trial data. Zinc supplementation is hypothetically supported by systematic case-control data, but no systematic clinical trial. Laser acupuncture has promising unpublished pilot data and may be more applicable to adults than children. Essential fatty acid supplementation has promising systematic case-control data, but clinical trials are equivocal. RDA vitamin supplementation, non-Chinese herbals, homeopathic remedies, and antifungal therapy have no systematic data in ADHD. Megadose multivitamin combinations are probably ineffective for most patients and are possibly dangerous. Simple sugar restriction seems ineffective. Amino acid supplementation is mildly effective in the short term, but not beyond 2-3 months. Thyroid treatment is effective in the presence of documented thyroid abnormality. Some alternative Tx of ADHD are effective or probably effective, but mainly for certain patients. In some cases, they are the Tx of choice, and initial evaluation should consider the relevant etiologies. A few have failed to prove effective in controlled trials. Most need research to determine whether they are effective and/or to define the applicable subgroup. Some of them, although not safer than standard Tx, may be preferable for an etiologic subgroup.

Publication Types: Review

PMID: 11462750 [PubMed - indexed for MEDLINE]

Psychophysiology. 2001 Jul;38(4):685-93.

Manipulation of frontal EEG asymmetry through biofeedback alters self-reported emotional responses and facial EMG.

Allen JJ, Harmon-Jones E, Cavender JH.

Department of Psychology, University of Arizona, Tucson 85721-0068, USA. jallen@u.arizona.edu

Individual differences in resting asymmetrical frontal brain activity have been found to predict subsequent emotional responses. The question of whether frontal brain asymmetry can cause emotional responses has yet to be addressed. Biofeedback training designed to alter the asymmetry of frontal brain activity was therefore examined. Eighteen right-handed female participants were randomly assigned to receive biofeedback training designed to increase right frontal alpha relative to left frontal alpha (n = 9) or to receive training in the opposite direction (n = 9). Five consecutive days of biofeedback training provided signals of reward or nonreward depending on whether the difference between right (F4) and left (F3) frontal alpha exceeded a criterion value in the specified direction. Systematic alterations of frontal EEG asymmetry were observed as a function of biofeedback training. Moreover, subsequent self-reported affect and facial muscle activity in response to emotionally evocative film clips were influenced by the direction of biofeedback training.

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov't

PMID: 11446582 [PubMed - indexed for MEDLINE]

Epilepsia. 2001 Mar;42(3):406-16.

Modification of slow cortical potentials in patients with refractory epilepsy: a controlled outcome study.

Kotchoubey B, Strehl U, Uhlmann C, Holzapfel S, König M, Fröscher W, Blankenhorn V, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany. boris.kotchoubey@uni-tuebingen.de

PURPOSE: To compare self-regulation of low-frequency EEG components (slow cortical potentials, SCPs) with other methods of seizure control for patients with drug-refractory partial epilepsy and to separate the real anticonvulsive effect from placebo effects. METHODS: Results of a treatment program of SCP self-regulation (experimental group) are compared with two groups of patients, one of which learned self-control of respiratory parameters (end-tidal CO2 and respiration rate: RES group); the other received medication with new anticonvulsive drugs (AEDs) in combination with psychosocial counseling (MED group). Clinical, cognitive, behavioral, and personality measures were assessed before and after treatment. In addition, to control for placebo responses, patients repeatedly estimated their beliefs in the efficiency of the respective treatment, their satisfaction and expectations, and the quality of the relationship with their therapists. RESULTS: SCP and MED groups showed a significant decrease of seizure frequency, but the RES group did not. Clear positive changes in the sociopsychological adjustment were obtained in all three groups, with the maximal improvement being attained in the RES group. CONCLUSIONS: All kinds of therapy result in considerable improvement of patients' emotional state, which may in part be due to potential placebo effects: however, this improvement is not related to the quality of the therapeutic effect proper (i.e., seizure reduction). Traditional double-blind control group designs are inappropriate for behavioral interventions or treatments with psychoactive pharmacologic drugs. Rather, specific tests can be developed to control the placebo effect and to separate it from the genuine therapeutic effects.

Publication Types: Clinical Trial Comparative Study Controlled Clinical Trial Research Support, Non-U.S. Gov't

PMID: 11442161 [PubMed - indexed for MEDLINE]

J Clin Psychol. 2001 Jul;57(7):933-52.

Treatment of fibromyalgia incorporating EEG-Driven stimulation: a clinical outcomes study.

Mueller HH, Donaldson CC, Nelson DV, Layman M.

Myosymmetries International Inc., Edmonton, Alberta, Canada. myoed@telusplanet.com

Thirty patients from a private clinical practice who met the 1990 American College of Rheumatology criteria for fibromyalgia syndrome (FS) were followed prospectively through a brainwave-based intervention known as electroencephalograph (EEG)-driven stimulation or EDS. Patients were initially treated with EDS until they reported noticeable improvements in mental clarity, mood, and sleep. Self-reported pain, then, having changed from vaguely diffuse to more specifically localized, was treated with very modest amounts of physically oriented therapies. Pre- to posttreatment and extended follow-up comparisons of psychological and physical functioning indices, specific FS symptom ratings, and EEG activity revealed statistically significant improvements. EDS appeared to be the prime initiator of therapeutic efficacy. Future research is justified for controlled clinical trials and to better understand disease mechanisms. Copyright 2001 John Wiley & Sons, Inc.

PMID: 11406805 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2001 Mar;26(1):23-37; discussion 61-5.

Comment in: Appl Psychophysiol Biofeedback. 2001 Mar;26(1):17-21.

The ethical use of placebo controls in clinical research: the Declaration of Helsinki.

La Vaque TJ, Rossiter T.

Clinical Psychophysiology Center, Rogers Memorial Hospital, Milwaukee, Wisconsin 53704, USA. tlavaque@gbonline.com

Medical ethicists have questioned the use of no-treatment (placebo and sham procedure) controlled studies of new therapies when safe and effective standard therapies are available for use as an active or "equivalence" control. Current ethical principles of conduct for biomedical research specifically prohibit designs that withhold or deny "the best proven diagnostic and therapeutic" treatment to any participant in a clinical study, including those individuals who consent to randomization into a control group. Studies of psychophysiological therapies are often criticized on the grounds they lack a placebo or sham treatment control group. This paper briefly reviews the history of the problem and discusses the ethical standards that govern human research as derived from the Nuremberg Code and the Declaration of Helsinki. An examination of the problem with regard to research involving EEG biofeedback therapy for Attention-Deficit/Hyperactivity Disorder, Traumatic Brain Injury, and depression serves to highlight the issues. It is concluded that the active treatment control (treatment equivalence) design is most appropriate for those clinical studies examining disorders for which there is a known, effective treatment. Sham- or placebo-controlled studies are ethically acceptable for those disorders for which no effective treatment is available.

Publication Types: Historical Article

PMID: 11387859 [PubMed - indexed for MEDLINE]

J Head Trauma Rehabil. 2001 Jun;16(3):260-74.

Flexyx Neurotherapy System in the treatment of traumatic brain injury: an initial evaluation.

Schoenberger NE, Shif SC, Esty ML, Ochs L, Matheis RJ.

Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey, USA. nschoen1@midsouth.rr.com

OBJECTIVE: To conduct a preliminary experimental evaluation of the potential efficacy of Flexyx Neurotherapy System (FNS), an innovative electroencephalography (EEG)-based therapy used clinically in the treatment of traumatic brain injury (TBI). PARTICIPANTS: Twelve people aged 21 to 53 who had experienced mild to moderately severe closed head injury at least 12 months previously and who reported substantial cognitive difficulties after injury, which interfered with their functioning. DESIGN: Participants were randomly assigned to an immediate treatment group or a wait-list control group and received 25 sessions of FNS treatment. They were assessed at pretreatment, posttreatment, and follow-up with standardized neuropsychological and mood measures. RESULTS: Comparison of the two groups on outcome measures indicated improvement after treatment for participants' reports of depression, fatigue, and other problematic symptoms, as well as for some measures of cognitive functioning. Most participants experienced meaningful improvement in occupational and social functioning. CONCLUSION: On the basis of these results, FNS appears to be a promising new therapy for TBI and merits more extensive evaluation.

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, U.S. Gov't, P.H.S.

PMID: 11346448 [PubMed - indexed for MEDLINE]

Curr Treat Options Neurol. 2001 May;3(3):257-270.

Childhood Migraine Headache Syndromes.

Prensky A.

Saint Louis Children's Hospital, One Children's Place, Suite 12E25, Saint Louis, MO 63178, USA. Prensky@kids.wustl.edu

The treatment of migraine headache in children depends on the following: a) defining the underlying cause; b) the frequency of the attacks; and c) the severity of the disability produced by the pain. Any medication taken to relieve pain is most effective if taken at maximum dose at the onset of the headache. The dose should be the maximum recommended by weight or age. Triptans are also more effective if used early. Over-the-counter (OTC) analgesics are often effective in relieving pediatric headache and should be tried before prescription drug therapy is attempted. The more frequent a child's headaches are, the greater the danger that repeated doses of pain medications, including those purchased OTC, will lead to a chronic headache syndrome as the medication is reduced. Recurrent severe headaches, occurring more than once a week and resulting in interruption of normal activities or poor concentration, need to be treated with prophylactic medications taken daily so that the number of headaches can be reduced. Amitriptyline, propanolol, and periactin are the most frequently used drugs to block headaches, but valproate, verapamil, or other calcium channel blockers and other antidepressants are also useful. Biofeedback, relaxation, or cognitive therapies can also reduce headache frequency in children with both migraine and tension headaches. Headaches that are intractable to oral medication for the acute relief of pain may respond more rapidly to an efficiently absorbed drug administered by nasal spray or subcutaneously. The initial dose of an injectable drug should be given in a situation where a physician is immediately available. Recurrent headaches that have occurred over more than 6 months and that are associated with a normal neurologic examination are almost never caused by an intracranial lesion. Routine CT and MRI scans or an electroencephalogram (EEG) are generally unnecessary for these patients because these scans are rarely of value in these patients unless there is a history of another neurologic disorder or the headaches are focal, relentless, and worsening over time.

PMID: 11282041 [PubMed - as supplied by publisher]

Clin Neurophysiol. 2001 Mar;112(3):551-4.

Self-initiation of EEG-based communication in paralyzed patients.

Kaiser J, Perelmouter J, Iversen IH, Neumann N, Ghanayim N, Hinterberger T, Kübler A, Kotchoubey B, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, Eberhard-Karls-University, Gartenstrasse 29, 72074, Tübingen, Germany. jochen.kaiser@uni-tuebingen.de

OBJECTIVES: Severely paralyzed patients could learn to voluntarily generate slow cortical potential (SCP) shifts in their electroencephalogram and to use these signals to operate a communication device. To enhance the patients' autonomy, the present study describes the development of a permanently available communication system that can be turned on and off by locked-in patients without external assistance. A skill necessary for turning the system on is the ability to regulate one's slow potentials in the absence of continuous feedback. METHODS: A stepwise learning approach was employed to train two paralyzed patients to regulate their SCPs without continuous feedback. Elements of the original communication system were gradually removed and elements of the new stand-by mode were introduced. RESULTS: At the end of the learning procedure, both patients achieved correct response rates of above 84% in training sessions without continuous feedback. This skill enabled them to turn the communication device on and off without assistance from others. CONCLUSIONS: These findings suggest that severely paralyzed individuals can learn to operate an EEG-based communication device autonomously.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 11222979 [PubMed - indexed for MEDLINE]

HNO. 2001 Jan;49(1):29-35.

[Neurofeedback in therapy of tinnitus]

[Article in German]

Gosepath K, Nafe B, Ziegler E, Mann WJ.

Römerwallklinik, Klinik für Neurootologische Erkrankungen, Mainz.

BACKGROUND AND OBJECTIVE: Biofeedback is known as a possibility to control physiologic processes like body temperature or heart frequency. Neurofeedback is a form of biofeedback linked to aspects of the electrical activity of the brain such as frequency, location or amplitude of specific EEG activity. It has been successfully used in patients with closed head injury, hyperactivity disorder or epilepsy. PATIENTS/METHODS: In this study 40 patients with tinnitus were treated with neurofeedback.They trained to upregulate the amplitude of their alpha-activity and downregulate the amplitude of beta-activity during muscle relaxation and acoustic orientation on sounds or music in order to suppress their tinnitus. RESULTS: After 15 sessions of training 24 patients with a duration of their tinnitus for an average of 1 year showed significant increase of alpha-amplitudes while 16 patients with duration of their tinnitus on an average of 7 years showed a decrease of beta-amplitudes without any change in alpha-activity. After the training all patients had a significant reduction of the score in the tin nitusquestionaire of Gobel and Hiller. In a control-group of 15 persons without tinnitus we didn't see any changes of alpha- or beta-amplitudes during the same training. CONCLUSIONS: In conclusion neurofeedback is a new therapy for patients with tinnitus. Patients get the possibility of selfcontrol and therefore of influence on their disease.

Publication Types: Clinical Trial Comparative Study English Abstract

PMID: 11219406 [PubMed - indexed for MEDLINE]

Psychophysiology. 2000 Nov;37(6):757-65.

Rate of force development and the lateralized readiness potential.

Ray WJ, Slobounov S, Mordkoff JT, Johnston J, Simon RF.

Department of Psychology, The Pennsylvania State University, University Park 16802, USA. wjr@psu.edu

We examined the relationship between force and rate of force development aspects of movement dynamics and electroencephalogram motor components as reflected in the lateralized readiness potential (LRP). Using self-paced tasks, in Studies 1 and 3 we investigated whether differential speed and accuracy constraints in discrete and repetitive finger force production tasks influenced the LRP. These studies showed that speed tasks produced larger LRP than accuracy tasks regardless of whether the movement type was discrete or repetitive. In Studies 2 and 4 we studied four conditions with two levels of force and two levels of rate of force development. The largest LRPs were found with the greatest rate of force development. Overall, the four studies demonstrated that preparation for differential rates of force development is a major component reflected in the LRP.

Publication Types: Research Support, U.S. Gov't, Non-P.H.S.

PMID: 11117456 [PubMed - indexed for MEDLINE]

J Head Trauma Rehabil. 2000 Dec;15(6):1285-96.

Improvement/rehabilitation of memory functioning with neurotherapy/QEEG biofeedback.

Thornton K.

Psychologist, Center for Health Psychology, South Plainfield, New Jersey, USA.

This article presents a new approach to the remediation of memory deficits by studying the electrophysiological functioning involved in memory and applying biofeedback techniques. A Quantitative EEG (QEEG) activation database was obtained with 59 right-handed subjects during two auditory memory tasks (prose passages and word lists). Memory performance was correlated with the QEEG variables. Clinical cases were administered the same QEEG activation study to determine their deviations from the values that predicted success for the reference group. EEG biofeedback interventions were designed to increase the value (to normal levels) of the specific electrophysiological variable that was related to successful memory function and deviant in the subject. Case examples are presented that indicate the successful use of this intervention style in normal subjects and in subjects with brain injury; improvement cannot be fully explained by spontaneous recovery, given the time postinjury. Five cases (two normal, two subjects with brain injury, and one subject who had stereotactic surgery of the hippocampus for seizure control) are presented. Improvements ranged from 68% to 181% in the group of patients with brain injury, as a result of the interventions.

Publication Types: Case Reports

PMID: 11056409 [PubMed - indexed for MEDLINE]

Appl Ergon. 2000 Aug;31(4):377-82.

The effectiveness of activating electrical devices using alpha wave synchronisation contingent with eye closure.

Craig A, Tran Y, McIsaac P, Moses P, Kirkup L, Searle A.

Department of Health Sciences, University of Technology, NSW Sydney, Australia. a.craig@uts.edu.au

Increases in alpha wave amplitude occur with eye closure (EC) and decreases occur when the eyes are opened (EO). The research reports in this paper emphasise effectiveness of people using these alpha wave changes to activate electrical devices. Effectiveness was measured in terms of time taken and errors made when selecting the correct device. Ten non-disabled subjects significantly decreased the time taken and errors made to activate correctly a device using a six-option environmental control system (ECS) in the laboratory. In addition, a severely disabled person was shown to use the ECS successfully to control her television in her home environment. This research demonstrates that alpha wave manipulation contingent with EC and EO can be the basis for a reliable and quick switching system for controlling electrical devices. Applications to disability are discussed.

Publication Types: Evaluation Studies Research Support, Non-U.S. Gov't

PMID: 10975664 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2000 Jun;25(2):103-15.

Evaluation of a psychophysiologically controlled adaptive automation system, using performance on a tracking task.

Freeman FG, Mikulka PJ, Scerbo MW, Prinzel LJ, Clouatre K.

Psychology Department, Old Dominion University, Norfolk, Virginia 23529-0267, USA.

Three experiments were conducted to evaluate the performance of a psychophysiologically controlled adaptive automation system. Subjects were asked to perform a compensatory tracking task while their electroencephalogram (EEG) was recorded and an engagement index was derived from the EEG, using the alpha, beta, and theta bandwidths: beta/(alpha + theta) and beta/theta. In Experiment I, EEG was recorded from three different sites: frontal, parietal, and temporal. Although tracking performance did not differ as a function of site, the number of task mode allocations was greater under a negative feedback contingency than under a positive feedback contingency. This effect was seen primarily from frontal sites. Experiments II and III evaluated the adaptive automation system, using extended runs under positive and negative feedback with either a slope (Experiment II) or absolute (Experiment III) criterion used to drive the system. Using either criterion, performance was found to be significantly better under negative feedback. Future evaluation and use of psychophysiologically controlled adaptive automation systems are discussed.

Publication Types: Clinical Trial Research Support, U.S. Gov't, Non-P.H.S.

PMID: 10932335 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2000 Jun;25(2):93-101.

Stress reduction by technology? An experimental study into the effects of brainmachines on burnout and state anxiety.

Ossebaard HC.

Trimbos-Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.

Stress and burnout are widely acknowledged as major causes of societal and individual problems in the Western world. In order to reduce material and immaterial expenses, increased efforts are made to enhance relaxation and stress reduction. Based on neuropsychological findings, alternative ways have been explored, one of them being the application of so-called brain wave synchronizers, which are said to induce a relaxation response by entraining alpha brain-wave activity (8-13 Hz) through audiovisual stimulation. A double blind, quasi-experiment was conducted among employees at a Dutch addiction care center to investigate the possible effects of two distinct brainmachine programs on burnout and anxiety. Subjects in both conditions showed a significant, immediate decrease in state anxiety as assessed by Spielberger's State-Trait Anxiety Inventory (STAI) and reported a range of subjective effects. However, a long-term effect on burnout, as measured with Maslach's Burnout Inventory (MBI-NL), could not be established. A long-term effect on anxiety (STAI), as investigated by interrupted time-series measurement, could not be established either. These and other findings suggest that the major claims with respect to these machines cannot hold over time, although pleasant short-term effects do occur. Individual differences in baseline responsivity, the stable character of burnout dimensions, or the ill-defined nature of relaxation, or a combination of these, may account for these results.

Publication Types: Clinical Trial Randomized Controlled Trial

PMID: 10932334 [PubMed - indexed for MEDLINE]

IEEE Trans Rehabil Eng. 2000 Jun;8(2):216-9.

Current trends in Graz Brain-Computer Interface (BCI) research.

Pfurtscheller G, Neuper C, Guger C, Harkam W, Ramoser H, Schlögl A, Obermaier B, Pregenzer M.

Department of Medical Informatics, Institute for Biomedical Engineering, University of Technology Graz, Austria. pfu@dpmi.tu-graz.ac.at

This paper describes a research approach to develop a brain-computer interface (BCI) based on recognition of subject-specific EEG patterns. EEG signals recorded from sensorimotor areas during mental imagination of specific movements are classified on-line and used e.g. for cursor control. In a number of on-line experiments, various methods for EEG feature extraction and classification have been evaluated.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 10896192 [PubMed - indexed for MEDLINE]

IEEE Trans Rehabil Eng. 2000 Jun;8(2):211-4.

Brain-computer interfaces based on the steady-state visual-evoked response.

Middendorf M, McMillan G, Calhoun G, Jones KS.

Middendorf Scientific Services, Inc., Medway, OH 45341, USA.

The Air Force Research Laboratory has implemented and evaluated two brain-computer interfaces (BCI's) that translate the steady-state visual evoked response into a control signal for operating a physical device or computer program. In one approach, operators self-regulate the brain response; the other approach uses multiple evoked responses.

PMID: 10896190 [PubMed - indexed for MEDLINE]

IEEE Trans Rehabil Eng. 2000 Jun;8(2):208-11.

A natural basis for efficient brain-actuated control.

Makeig S, Enghoff S, Jung TP, Sejnowski TJ.

Collaborators: Jung TP.

Naval Health Research Center, San Diego, CA 92186, USA. scott@salk.edu

The prospect of noninvasive brain-actuated control of computerized screen displays or locomotive devices is of interest to many and of crucial importance to a few 'locked-in' subjects who experience near total motor paralysis while retaining sensory and mental faculties. Currently several groups are attempting to achieve brain-actuated control of screen displays using operant conditioning of particular features of the spontaneous scalp electroencephalogram (EEG) including central mu-rhythms (9-12 Hz). A new EEG decomposition technique, independent component analysis (ICA), appears to be a foundation for new research in the design of systems for detection and operant control of endogenous EEG rhythms to achieve flexible EEG-based communication. ICA separates multichannel EEG data into spatially static and temporally independent components including separate components accounting for posterior alpha rhythms and central mu activities. We demonstrate using data from a visual selective attention task that ICA-derived mu-components can show much stronger spectral reactivity to motor events than activity measures for single scalp channels. ICA decompositions of spontaneous EEG would thus appear to form a natural basis for operant conditioning to achieve efficient and multidimensional brain-actuated control in motor-limited and locked-in subjects.

Publication Types: Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 10896189 [PubMed - indexed for MEDLINE]

IEEE Trans Rehabil Eng. 2000 Jun;8(2):203-5.

Parallel man-machine training in development of EEG-based cursor control.

Kostov A, Polak M.

Faculty of Rehabilitation Medicine, The University of Alberta, Edmonton, Canada.

A new parallel man-machine training approach to brain-computer interface (BCI) succeeded through a unique application of machine learning methods. The BCI system could train users to control an animated cursor on the computer screen by voluntary electroencephalogram (EEG) modulation. Our BCI system requires only two to four electrodes, and has a relatively short training time for both the user and the machine. Moving the cursor in one dimension, our subjects were able to hit 100% of randomly selected targets, while in two dimensions, accuracies of approximately 63% and 76% was achieved with our two subjects.

PMID: 10896187 [PubMed - indexed for MEDLINE]

IEEE Trans Rehabil Eng. 2000 Jun;8(2):198-202.

Direct control of a computer from the human central nervous system.

Kennedy PR, Bakay RA, Moore MM, Adams K, Goldwaithe J.

Neural Signals Inc., Atlanta, GA 30341, USA.

We describe an invasive alternative to externally applied brain-computer interface (BCI) devices. This system requires implantation of a special electrode into the outer layers of the human neocortex. The recorded signals are transmitted to a nearby receiver and processed to drive a cursor on a computer monitor in front of the patient. Our present patient has learned to control the cursor for the production of synthetic speech and typing.

Publication Types: Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. Research Support, U.S. Gov't, P.H.S.

PMID: 10896186 [PubMed - indexed for MEDLINE]

IEEE Trans Rehabil Eng. 2000 Jun;8(2):190-3.

The thought translation device (TTD) for completely paralyzed patients.

Birbaumer N, Kübler A, Ghanayim N, Hinterberger T, Perelmouter J, Kaiser J, Iversen I, Kotchoubey B, Neumann N, Flor H.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany.

The thought translation device trains locked-in patients to self-regulate slow cortical potentials (SCP's) of their electroencephalogram (EEG). After operant learning of SCP self-control, patients select letters, words or pictograms in a computerized language support program. Results of five respirated, locked-in-patients are described, demonstrating the usefulness of the thought translation device as an alternative communication channel in motivated totally paralyzed patients with amyotrophic lateral sclerosis.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 10896183 [PubMed - indexed for MEDLINE]

IEEE Trans Rehabil Eng. 2000 Jun;8(2):188-90.

A virtual reality testbed for brain-computer interface research.

Bayliss JD, Ballard DH.

Department of Computer Science, University of Rochester, NY 14627, USA. bayliss@cs.rochester.edu

Virtual reality promises to extend the realm of possible brain-computer interface (BCI) prototypes. Most of the work using electroencephalograph (EEG) signals in VR has focussed on brain-body actuated control, where biological signals from the body as well as the brain are used. We show that when subjects are allowed to move and act normally in an immersive virtual environment, cognitive evoked potential signals can still be obtained and used reliably. A single trial accuracy average of 85% for recognizing the differences between evoked potentials at red and yellow stop lights will be presented and future directions discussed.

Publication Types: Research Support, U.S. Gov't, Non-P.H.S. Research Support, U.S. Gov't, P.H.S.

PMID: 10896182 [PubMed - indexed for MEDLINE]

J Rehabil Res Dev. 2000 Jan-Feb;37(1):53-63.

A practical EMG-based human-computer interface for users with motor disabilities.

Barreto AB, Scargle SD, Adjouadi M.

Department of Electrical and Computer Engineering, Florida International University, Miami 33174, USA.

In line with the mission of the Assistive Technology Act of 1998 (ATA), this study proposes an integrated assistive real-time system which "affirms that technology is a valuable tool that can be used to improve the lives of people with disabilities." An assistive technology device is defined by the ATA as "any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities." The purpose of this study is to design and develop an alternate input device that can be used even by individuals with severe motor disabilities. This real-time system design utilizes electromyographic (EMG) biosignals from cranial muscles and electroencephalographic (EEG) biosignals from the cerebrum's occipital lobe, which are transformed into controls for two-dimensional (2-D) cursor movement, the left-click (Enter) command, and an ON/OFF switch for the cursor-control functions. This HCI system classifies biosignals into "mouse" functions by applying amplitude thresholds and performing power spectral density (PSD) estimations on discrete windows of data. Spectral power summations are aggregated over several frequency bands between 8 and 500 Hz and then compared to produce the correct classification. The result is an affordable DSP-based system that, when combined with an on-screen keyboard, enables the user to fully operate a computer without using any extremities.

PMID: 10847572 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 2000 Mar;25(1):13-32.

Self-regulation of slow cortical potentials in children with migraine: an exploratory study.

Siniatchkin M, Hierundar A, Kropp P, Kuhnert R, Gerber WD, Stephani U.

Department of Medical Psychology, Neurological Clinic of Kiel University, Germany. siniatchkin@med-psych.uni-kiel.de

Migraine patients are characterized by increased amplitudes of slow cortical potentials (SCPs), representing pronounced excitability of cortical networks. The present study investigated the efficiency of biofeedback training of SCPs in young migraineurs. Ten children suffering from migraine without aura participated in 10 feedback sessions. They were compared with 10 healthy children for regulation abilities of cortical negativity and with 10 migraineurs from the waiting list for clinical efficacy. During the first two sessions, the migraine children were characterised by lacking ability to control cortical negativity, especially during transfer trials, compared with healthy controls. However, there was no difference following 10 sessions of training. Feedback training was accompanied by significant reduction of cortical excitability. This was probably responsible for the clinical efficacy of the training; a significant reduction of days with migraine and other headache parameters was observed. It is suggested that normalization of the threshold regulation of cortical excitability during feedback training may result in clinical improvement.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 10832507 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 1999 Dec;24(4):261-5.

Reliability of infrared plethysmography in BVP biofeedback therapy and the relevance for clinical application.

Speckenbach U, Gerber WD.

Psychiatric and Neurological Clinic, Friedrich-Ebert Hospital, Neumünster, Germany. speckenbach@med-psych.uni-kiel.de

Biofeedback methods are well established as behavioral techniques for the therapy of various psychophysiological diseases. The forms of feedback generally employed are muscle activity (electromyogram), skin temperature, brain activity (electroencephalogram), and vasomotoricity. The latter technique, which employs plethysmographic feedback, has been studied most extensively in the therapy of migraine (vasoconstriction training, blood volume pulse training). Although the clinical efficacy has been demonstrated in several studies, little is known about the psychometric properties of this technique. This study examined the intrasession and intersession reliability of the pulse volume amplitude (PVA). The results showed that the PVA measurements within a single biofeedback session were highly reliable. Repositioning of the probe within the session resulted in a lower correlation coefficient, but one that was still sizable and significant. The PVA values from different sessions were not reliable (or comparable).

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 10789002 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 1999 Dec;24(4):213-33.

Changes in EEG power spectra during biofeedback of slow cortical potentials in epilepsy.

Kotchoubey B, Busch S, Strehl U, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany.

The goal of the study was to explore parallel changes in EEG spectral frequencies during biofeedback of slow cortical potentials (SCPs) in epilepsy patients. Thirty-four patients with intractable focal epilepsy participated in 35 sessions of SCP self-regulation training. The spectral analysis was carried out for the EEG recorded at the same electrode site (Cz) that was used for SCP feedback. The most prominent effect was the increase in the theta 2 power (6.0-7.9 Hz) and the relative power decrement in all other frequency bands (particularly delta 1, alpha 2 and beta 2) in transfer trials (i.e., where patients controlled their SCPs without continuous feedback) compared with feedback trials. In the second half of the training course (i.e., sessions 21-35) larger power values in the delta, theta, and alpha bands were found when patients were required to produce positive versus negative SCP shifts. Both across-subject and across-session (within-subject) correlations between spectral EEG parameters, on the one hand, and SCP data, on the other hand, were low and inconsistent, contrary to high and stable correlations between different spectral variables. This fact, as well as the lack of considerable task-dependent effects during the first part of training, indicates that learned SCP shifts did not directly lead to the specific dynamics of the EEG power spectra. Rather, these dynamics were related to nonspecific changes in patients' brain state.

Publication Types: Clinical Trial Research Support, Non-U.S. Gov't

PMID: 10788999 [PubMed - indexed for MEDLINE]

Biull Eksp Biol Med. 2000 Feb;129(2):139-41.

[Restoration of interhemispheric symmetry of the bioelectrical brain activity in patients with neurasthenic syndrome by bioacoustic correction]

[Article in Russian]

Konstantinov KV, Sizov VV, Miroshnikov DB, Esimbaeva VN, Gabdrakhmanov SIu, Klimenko VM.

Publication Types: Clinical Trial

PMID: 10732229 [PubMed - indexed for MEDLINE]

J Psychosom Res. 2000 Feb;48(2):161-9.

Blood pressure biofeedback treatment of white-coat hypertension.

Nakao M, Nomura S, Shimosawa T, Fujita T, Kuboki T.

Department of Psychosomatic Medicine, University of Tokyo School of Medicine, Tokyo, Japan. mnakao@hsph.harvard.edu

OBJECTIVE: The objective of the study was to compare blood pressure (BP) biofeedback treatment (BF) effects between white-coat hypertension and essential hypertension. METHODS: Fifteen white-coat hypertensive out-patients and 23 essential hypertensive out-patients were randomly assigned to groups A or B. Subjects in group A underwent BF once a week for a total of four sessions. Those in group B visited the clinic only to measure BP and later underwent the same BF. RESULTS: In group A, BPs of white-coat hypertensives and essential hypertensives were significantly reduced by 22/11 and 14/8 mmHg, respectively. In group B, they were unchanged during the same period but later suppressed by BF. Under BF, pulse and respiratory rates were significantly higher, and elevation of diastolic BP due to mental stress testing was better suppressed in white-coat hypertensives than in essential hypertensives. CONCLUSION: This treatment was effective in both types of hypertension, and pressor response to stress seems to be important in the differentiated BF effect.

Publication Types: Clinical Trial Randomized Controlled Trial

PMID: 10719133 [PubMed - indexed for MEDLINE]

Voen Med Zh. 2000 Jan;321(1):46-9.

[Bioacoustical psychocorrection in neurotic disorders]

[Article in Russian]

Dybov MD, Shevchenko VF, Sitnikov AG.

PMID: 10701351 [PubMed - indexed for MEDLINE]

Exp Aging Res. 2000 Jan-Mar;26(1):15-35.

Learning and self-regulation of slow cortical potentials in older adults.

Kotchoubey B, Haisst S, Daum I, Schugens M, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany. boris.kotchoubey@uni-tuebingen.de

Two groups of subjects, aged 20-28 and 50-64, respectively, matched for health status and verbal abilities, learned to control their slow cortical potentials (SCP) in a feedback paradigm by producing, on command, SCP shifts in either positive or negative direction. Both groups were able to differentiate significantly between the positivity task and the negativity task, with the differentiation score being only slightly (and not significantly) lower in older than in younger subjects. In all conditions, however, significantly more negative brain responses were obtained in older than in younger subjects. This effect was larger in the positivity task versus negativity task, and larger in trials without continuous SCP feedback versus trials with feedback. Additionally four learning tasks were carried out with all subjects. The older group demonstrated substantial performance deficits in two tasks with explicit learning (verbal and visual). In contrast, implicit learning (perceptual learning and skill acquisition) was not impaired with age. The results are at odds with the idea of general age-related learning deficit and concur with the hypothesis that only explicit, but not implicit, learning processes are compromised in older subjects. The pattern of consistently more negative SCP shifts produced by elderly subjects may indicate their impaired cortical inhibition. Another interpretation, which does not exclude the inhibitory deficit hypothesis but seems to better agree with other psychophysiological data, may be that older subjects have disturbance in the system controlling arousal and effort.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 10689554 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 1999 Sep;24(3):197-202.

Perceived and physiological indicators of relaxation: as different as Mozart and Alice in chains.

Burns J, Labbé E, Williams K, McCall J.

Department of Psychology, University of South Alabama, Mobile 36688, USA.

The effects of listening to different types of music on perceived and physiological indicators of relaxation were evaluated. Fifty-six undergraduate students, 24 males and 32 females, mean age of 21, were randomly assigned to listen to classical, hard rock, self-selected relaxing music, or no music. Participants' relaxation level, skin temperature, muscle tension and heart rate were evaluated before and after exposure to a music condition. Analyses of variance using baseline measures as covariates indicated that skin temperature decreased for all conditions (p = 0.001) and the classical, self-selected relaxing music and no music groups reported significant increases in feelings of relaxation (p = 0.004). These results partially support the hypothesis that classical and self-selected relaxing music can increase perceptions of relaxation to a greater degree than listening to hard rock music. However, no differences were found between different types of music on physiological indicators of arousal. Implications for using music to reduce stress were discussed.

Publication Types: Clinical Trial Randomized Controlled Trial

PMID: 10652638 [PubMed - indexed for MEDLINE]

Clin Electroencephalogr. 2000 Jan;31(1):45-55.

Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning.

Sterman MB.

Department of Neurobiology, School of Medicine, University of California at Los Angeles 90085-1763, USA.

Two issues concerning sensorimotor EEG operant conditioning, or biofeedback, as a therapeutic modality for the treatment of seizure disorders are the focus of this review. The first relates to the question of whether relevant physiological changes are associated with this procedure. This question is addressed through review of an extensive neurophysiological literature that is likely unfamiliar to many clinicians but that documents both immediate and sustained functional changes that are consistent with elevation of seizure thresholds. The second focuses on the clinical efficacy of this method and whether it should carry the designation of "experimental". This designation is challenged through an assessment of over 25 years of peer-reviewed research demonstrating impressive EEG and clinical results achieved with the most difficult subset of seizure patients.

Publication Types: Review

PMID: 10638352 [PubMed - indexed for MEDLINE]

Clin Electroencephalogr. 2000 Jan;31(1):38-44.

EEG operant conditioning (biofeedback) and traumatic brain injury.

Thatcher RW.

Bay Pines VA Medical Center, University of South Florida College of Medicine and Defense and Veterans Head Injury Program, Washington D.C., USA.

A review is presented of the currently sparse literature about EEG operant conditioning or biofeedback as a treatment to reduce symptomology and patient complaints following a traumatic brain injury. The paper also evaluates the general use of quantitative EEG (QEEG) to assess traumatic brain injury and to facilitate EEG biofeedback treatment. The use of an age matched reference normative QEEG database and QEEG discriminant function are presented as a method to evaluate the nature or neurological basis of a patient's complaints as well as to individualize an efficient and optimal feedback protocol and to help evaluate the efficacy of the biofeedback therapy. Univariate and multivariate statistical issues are discussed, different classes of experimental designs are described and then a "double blind" research study is proposed in an effort to encourage future research in the area of EEG biofeedback for the treatment and rehabilitation of traumatic brain injury.

Publication Types: Research Support, U.S. Gov't, Non-P.H.S. Review

PMID: 10638351 [PubMed - indexed for MEDLINE]

Clin Electroencephalogr. 2000 Jan;31(1):30-7.

Treatment of attention deficit hyperactivity disorder with neurotherapy.

Nash JK.

Behavioral Medicine Associates, Inc., MN 55434, USA.

Significant public health concerns exist regarding our current level of success in treating ADHD. Medication management is very helpful in 60-70% of patients. Side effects, lack of compliance and the fact that stimulant medications cannot be given late in the day limit the benefits largely to school hours. While stimulants improve behavior and attention, less of an effect has been noted on academic and social performance. Continuing concerns exist about long-term safety, and studies on long-term cardiovascular and neurophysiological effects have not been carried out. Neurotherapy for ADHD offers an effective alternate for patients whose treatment is limited by side effects, poor medication response and in cases in which the patients and/or their parents refuse to consider medications. Studies indicate clinical improvement is largely related to measurable improvements in the EEG signature, evidenced by declining theta/beta ratios over frontal/central cortex and/or reduced theta/alpha band amplitudes.

Publication Types: Review

PMID: 10638350 [PubMed - indexed for MEDLINE]

Clin Electroencephalogr. 2000 Jan;31(1):23-9.

Self regulation of electrocortical activity in schizophrenia and schizotypy: a review.

Gruzelier J.

Division of Neuroscience and Psychological Medicine, Imperial College Medical School, London, U.K.

Contrary to the belief that schizophrenic patients will be unable to learn self control of electrocortical activity due to attentional and motivational deficits, the two studies which have investigated this, both involving operant conditioning of slow cortical potentials, have demonstrated that self regulation can take place. This was particularly true of a study of interhemispheric control. Learning difficulties were found to be more to do with sustaining motivation towards the end of sessions or training programs, rather than in initial learning. Schizotypical features in the normal population have in the case of anhedonia been associated with slower learning, while withdrawn introversion has been associated with faster learning. In view of the affirmative evidence and advances in understanding the functional significance of electroencephalographic (EEG) rhythms, the undertaking of therepeutic regimens with electrocortical operant conditioning is warranted in the schizophrenia spectrum.

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 10638349 [PubMed - indexed for MEDLINE]

Clin Electroencephalogr. 2000 Jan;31(1):13-22.

The treatment of addictive disorders by brain wave biofeedback: a review and suggestions for future research.

Trudeau DL.

University of Minnesota, Academic Health Center, Department of Family Practice and Community Health and Minneapolis Veterans Affairs Medical Center, USA.

Publication Types: Review

PMID: 10638348 [PubMed - indexed for MEDLINE]

Clin Electroencephalogr. 2000 Jan;31(1):7-12.

An EEG biofeedback protocol for affective disorders.

Rosenfeld JP.

Department of Psychology, Northwestern University, Evanston, Illinois 60208-2710, USA.

Publication Types: Review

PMID: 10638347 [PubMed - indexed for MEDLINE]

Clin Electroencephalogr. 2000 Jan;31(1):1-6.

A review of EEG biofeedback treatment of anxiety disorders.

Moore NC.

Brain Research Center, Mercer University School of Medicine, Macon, GA 31207, USA.

Alpha, theta and alpha-theta enhancements are effective treatments of the anxiety disorders (Table 1). Alpha suppression is also effective, but less so (Table 2). Perceived success in carrying out the task plays an important role in clinical improvement. Research is needed to find out how much more effective they are than placebo, and which variables are important for efficacy. Variables needing study are: duration of treatment, type and severity of anxiety, number and type of EEG waveforms used, pretreatment with other kinds of feedback, position and number of electrodes, and presence of concomitant medication.

Publication Types: Review

PMID: 10638346 [PubMed - indexed for MEDLINE]

Clin Electroencephalogr. 2000 Jan;31(1):V-VII.

The state of EEG biofeedback therapy (EEG operant conditioning) in 2000: an editor's opinion.

Duffy FH.

Publication Types: Editorial

PMID: 10638345 [PubMed - indexed for MEDLINE]

IEEE Trans Rehabil Eng. 1999 Dec;7(4):413-9.

Frequency component selection for an EEG-based brain to computer interface.

Pregenzer M, Pfurtscheller G.

Department of Medical Informatics, Institute of Biomedical Engineering. Graz University of Technology and Ludwig-Boltzmann Institute for Medical Informatics and Neuroinformatics, Austria.

A new communication channel for severely handicapped people could be opened with a direct brain to computer interface (BCI). Such a system classifies electrical brain signals online. In a series of training sessions, where electroencephalograph (EEG) signals are recorded on the intact scalp, a classifier is trained to discriminate a limited number of different brain states. In a subsequent series of feedback sessions, where the subject is confronted with the classification results, the subject tries to reduce the number of misclassifications. In this study the relevance of different spectral components is analyzed: 1) on the training sessions to select optimal frequency bands for the feedback sessions and 2) on the feedback sessions to monitor changes.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 10609628 [PubMed - indexed for MEDLINE]

Adv Neurol. 1999;81:281-90.

Control of cortical excitability in epilepsy.

Kotchoubey B, Strehl U, Holzapfel S, Schneider D, Blankenhorn V, Birbaumer N.

Institute for Medical Psychology, University of Tübingen, Germany.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 10609024 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 1999 Jun;24(2):91-105.

How does biofeedback reduce clinical symptoms and do memories and beliefs have biological consequences? Toward a model of mind-body healing.

Wickramasekera I.

Saybrook Graduate School, Stanford Medical School, CA, USA.

Changes in the magnitude and direction of physiological measures (EMG, EEG, temperature, etc.) are not strongly related to the reduction of clinical symptoms in biofeedback therapy. Previously, nonspecified perceptual, cognitive, and emotional factors related to threat perception (Wickramasekera, 1979, 1988, 1998) may account for the bulk of the variance in the reduction of clinical symptoms. The mean magnitude of these previously nonspecified or placebo factors is closer to 70% when both the therapist and patient believe in the efficacy of the therapy. This powerful placebo effect is hypothesized to be an elicited conditioned response (Wickramasekera, 1977a, 1977c, 1980, 1985) based on the memory of prior healings. These memories of healing are more resistant to extinction if originally acquired on a partial rather than continuous reinforcement schedule. High and low hypnotic ability in interaction with threat perception (negative affect) is hypothesized to contribute to both the production and reduction of clinical symptoms. High and low hypnotic ability respectively are hypothesized to be related to dysregulation of the sympathetic and parasympathetic arms of the autonomic nervous system. Biofeedback is hypothesized to be most effective for reducing clinical symptoms in people of low to moderate hypnotic ability. For people high in trait hypnotic ability, training in self-hypnosis or other instructional procedures (e.g., autogenic training, progressive muscle relaxation, mediation, CBT, etc.) will produce the most rapid reduction in clinical symptoms.

Publication Types: Review

PMID: 10575537 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 1998 Dec;23(4):265-72; 273-5.

Regarding the database for the Peniston alpha-theta EEG biofeedback protocol.

Graap K, Freides D.

Emory University, Department of Psychology, Atlanta, GA 30322, USA.

Five papers by Peniston and colleagues, which constitute the basic literature for alpha-theta EEG biofeedback treatment for alcoholism and posttraumatic stress disorder, are reviewed. As a result, we raise three questions: (a) Are the samples studied independent? (b) What was the clinical status of the participants prior to treatment? (c) What treatment did the participants actually receive? In seeking answers to these questions we aim to strengthen the database for neurofeedback with specific procedural information so that claims of efficacy can be tested and accepted or rejected on an objective basis.

Publication Types: Review

PMID: 10457816 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 1998 Dec;23(4):243-63.

Neurofeedback combined with training in metacognitive strategies: effectiveness in students with ADD.

Thompson L, Thompson M.

ADD Centre, Mississauga, Ontario, Canada.

A review of records was carried out to examine the results obtained when people with Attention Deficit Disorder (ADD) received 40 sessions of training that combined neurofeedback with the teaching of metacognitive strategies. While not a controlled scientific study, the results, including pre- and post-measures, are consistent with previously published research concerning the use of neurofeedback with children. A significant addition is that a description of procedures is included. The 111 subjects, 98 children (age 5 to 17) and 13 adults (ages 18 to 63), attended forty 50-min sessions, usually twice a week. Feedback was contingent on decreasing slow wave activity (usually 4-7 Hz, occasionally 9-11 Hz) and increasing fast wave activity (15-18 Hz for most subjects but initially 13-15 Hz for subjects with impulsivity and hyperactivity). Metacognitive strategies related to academic tasks were taught when the feedback indicated the client was focused. Some clients also received temperature and/or EDR biofeedback during some sessions. Initially, 30 percent of the children were taking stimulant medications (Ritalin), whereas 6 percent were on stimulant medications after 40 sessions. All charts were included where pre- and post-testing results were available for one or more of the following: the Test of Variables of Attention (TOVA, n = 76), Wechsler Intelligence Scales (WISC-R, WISC-III, or WAIS-R, n = 68), Wide Range Achievement Test (WRAT 3, n = 99), and the electroencephalogram assessment (QEEG) providing a ratio of theta (4-8 Hz) to beta (16-20 Hz) activity (n = 66). Significant improvements (p < .001) were found in ADD symptoms (inattention, impulsivity, and variability of response times on the TOVA), in both the ACID pattern and the full-scale scores of the Wechsler Intelligence Scales, and in academic performance on the WRAT 3. The average gain for the full scale IQ equivalent scores was 12 points. A decrease in the EEG ratio of theta/beta was also observed. These data are important because they provide an extension of results from earlier studies (Lubar, Swartwood, Swartwood, & O'Donnell, 1995; Linden, Habib, & Radojevic, 1996). They also demonstrate that systematic data collection in a private educational setting produces helpful information that can be used to monitor students' progress and improve programs. Because this clinical work is not a controlled scientific study, the efficacious treatment components cannot be determined. Nevertheless, the positive outcomes of decreased ADD symptoms plus improved academic and intellectual functioning suggest that the use of neurofeedback plus training in metacognitive strategies is a useful combined intervention for students with ADD. Further controlled research is warranted.

Publication Types: Clinical Trial

PMID: 10457815 [PubMed - indexed for MEDLINE]

Biomed Tech (Berl). 1999 Jun;44(6):158-62.

Hidden Markov models used for the offline classification of EEG data.

Obermaier B, Guger C, Pfurtscheller G.

Ludwig Boltzmann Institute for Medical Informatics and Neuroinformatics, University of Technology, Graz. obermai@dpmi.tu-graz.ac.at

Hidden Markov models (HMM) are introduced for the offline classification of single-trail EEG data in a brain-computer-interface (BCI). The HMMs are used to classify Hjorth parameters calculated from bipolar EEG data, recorded during the imagination of a left or right hand movement. The effects of different types of HMMs on the recognition rate are discussed. Furthermore a comparison of the results achieved with the linear discriminant (LD) and the HMM, is presented.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 10427911 [PubMed - indexed for MEDLINE]

Schweiz Rundsch Med Prax. 1999 May 20;88(21):946-9.

[Psychofonia--a neurophysiologic music therapy in migraine]

[Article in German]

Meister M, Einsle R, Brunner J, Rhyner K.

Medizinische Klinik, Kantonsspital Glarus.

Migraine and other functional disorders are common and often difficult to treat. Alternative treatment modalities are clearly warranted and gain more widespread acceptance. Psychofonia is a new form of music therapy for treating migraine patients. For each patient an individualized sound pattern is created based on his individual EEG by using computer technology. In a cohort study we investigated prospectively 55 migraine patients treated with this EEG-based music therapy. 56% of the patients showed an improvement of at least 50% of their symptoms after a twelve months treatment period. Our results suggest that this form of music therapy is effective in treating migraine patients and should be studied in a prospective, randomized, controlled trial.

Publication Types: English Abstract

PMID: 10412281 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 1998 Sep;23(3):189-202.

Behavioral psychophysiological intervention in a mentally retarded epileptic patient with brain lesion.

Holzapfel S, Strehl U, Kotchoubey B, Birbaumer N.

Epilepsy Center Kork, Kehl-Kork, Germany.

Behavioral psychophysiological treatment entailing Slow Cortical Potential (SCP) biofeedback training and behavioral self-control training was conducted with a 27-year-old male epileptic patient (seizures for 23 years) with Wechsler IQ 64 who underwent callosotomy. The patient had 12/week secondary generalized tonic-clonic seizures. The treatment, consisting of 43 SCP training sessions and 22 behavioral control sessions, yielded a highly significant reduction of seizure frequency to about 7.5/week; such a decrease had never been observed after administration of new anticonvulsant drugs, nor after the callosotomy. During SCP feedback training, the patient was able to produce highly-significant cortical differentiation of SCPs of about 4 microV. In addition, he developed several new behaviors indicating growing ability of self-perception and self-regulation. These findings suggest that a combination of SCP biofeedback with behavioral treatment of epilepsy can be used even in mentally retarded patients with organic brain disorders.

Publication Types: Case Reports Research Support, Non-U.S. Gov't

PMID: 10384250 [PubMed - indexed for MEDLINE]

Clin Neurophysiol. 1999 Apr;110(4):683-6.

Negative potential shifts and the prediction of the outcome of neurofeedback therapy in epilepsy.

Kotchoubey B, Strehl U, Holzapfel S, Blankenhorn V, Fröscher W, Birbaumer N.

Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany. boris.kotchobey@uni-tuebingen.de

About two-thirds of epilepsy patients who learn to control their slow cortical potential shifts (SCP) reduce their seizure rate, but the remaining third does not demonstrate clinical improvement. In the present study, this finding was replicated in a group of 27 patients with focal epilepsy. We found that patients who consistently produced larger negative SCP in all conditions during the first phase of treatment, showed no decrease in seizure frequency during the six-month follow-up, as compared with the three-month baseline phase. The large negative SCP explained about one-third of the variance of the clinical outcome. Age, medication, seizure history, or the localization of focus were found to be unrelated to clinical improvement.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 10378738 [PubMed - indexed for MEDLINE]

Forsch Komplementarmed. 1999 Feb;6(1):60.

[Psychophonics--essence, demonstration of effective of and indications for a new cerebral audio regulation therapy]

[Article in German]

Fricker B.

Schweizerische Fördergesellschaft der Psychofonie, Bilten, Schweitz.

PMID: 10213887 [PubMed - indexed for MEDLINE]

Exp Brain Res. 1999 Jan;124(2):223-32.

The thought translation device: a neurophysiological approach to communication in total motor paralysis.

Kübler A, Kotchoubey B, Hinterberger T, Ghanayim N, Perelmouter J, Schauer M, Fritsch C, Taub E, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany.

A thought translation device (TTD) for brain-computer communication is described. Three patients diagnosed with amyotrophic lateral sclerosis (ALS), with total motor paralysis, were trained for several months. In order to enable such patients to communicate without any motor activity, a technique was developed where subjects learn to control their slow cortical potentials (SCP) in a 2-s rhythm, producing either cortical negativity or positivity according to the task requirement. SCP differences between a baseline interval and an active control interval are transformed into vertical or horizontal cursor movements on a computer screen. Learning SCP self regulation followed an operant-conditioning paradigm with individualized shaping procedures. After prolonged training over more than 100 sessions, all patients achieved self-control, leading to a 70-80% accuracy for two patients. The learned cortical skill enabled the patients to select letters or words in a language-supporting program (LSP) developed for inter-personal communication. The results demonstrate that the fast and stable SCP self-control can be achieved with operant training and without mediation of any muscle activity. The acquired skill allows communication even in total locked-in states.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 9928845 [PubMed - indexed for MEDLINE]

Biomed Tech (Berl). 1998;43 Suppl:254-5.

[Technical realization of a neural feedback system]

[Article in German]

Fink A, Ivanova G, Henning G, Griessbach G, Müller D.

Institut für Biomedizinische Technik und Informatik, Technische Universität Ilmenau.

PMID: 9859348 [PubMed - indexed for MEDLINE]

Percept Mot Skills. 1998 Oct;87(2):623-33.

Quantitative electroencephalogram of posterior cortical areas of fluent and stuttering participants during reading with normal and altered auditory feedback.

Rastatter MP, Stuart A, Kalinowski J.

Department of Communication Sciences and Disorders, East Carolina University, Greenville 27858-4353, USA. RASTATTERM@MAIL.ECU.EDU

In the left and right hemisphere, posterior quantitative electroencephalogram Beta band activity (13.5-25.5 Hz) of seven adult participants who stutter and seven age-matched normal controls was obtained while subjects read text under three experimental conditions of normal auditory feedback, delayed auditory feedback, and frequency-altered feedback. Data were obtained from surface electrodes affixed to the scalp using a commercial electrode cap. Electroencephalogram activity was amplified, band-pass analog-filtered, and then digitized. During nonaltered auditory feedback, stuttering participants displayed Beta band hyperreactivity, with the right temporal-parietal lobe region showing the greatest activity. Under conditions of delayed auditory feedback and frequency-altered auditory feedback, the stuttering participants displayed a decrease in stuttering behavior accompanied by a strong reduction in Beta activity for the posterior-temporal-parietal electrode sites, and the left hemisphere posterior sites evidenced a larger area of reactivity. Such findings suggest than an alteration in the electrical fields of the cortex occurred in the stuttering participants under both conditions, possibly reflecting changes in neurogenerator status or current dipole activity. Further, one could propose that stuttering reflects an anomaly of the sensory-linguistic motor integration wherein each hemisphere generates competing linguistic messages at hyperreactive amplitudes.

PMID: 9842614 [PubMed - indexed for MEDLINE]

Biol Psychiatry. 1998 Dec 1;44(11):1196-9.

Neurofeedback treatment of pseudoseizure disorder.

Swingle PG.

Department of Psychiatry, Harvard Medical School, USA.

BACKGROUND: Previous research has shown that the suppression of theta wave activity and the enhancement of sensorimotor rhythm (SMR) through electroencephalographic (EEG) biofeedback is an effective treatment for epilepsy. The current research reports the results of EEG biofeedback treatment for patients presenting with seizure behaviors in the absence of eliptiform EEG activity. METHODS: In addition to psychotherapy, 3 patients, 2 women and 1 man, were trained, using EEG feedback once per week, to reduce the ratio of theta band to SMR band EEG amplitudes. RESULTS: The results showed that reductions in seizure activity were related to reductions in the theta-SMR ratio. CONCLUSIONS: These findings support the view that theta-SMR feedback training, in conjunction with psychotherapy, is an effective adjunctive treatment for pseudoseizure disorder.

Publication Types: Case Reports

PMID: 9836025 [PubMed - indexed for MEDLINE]

Neurosci Lett. 1998 Sep 11;253(3):159-62.

Learned changes of brain states alter cognitive processing in humans.

Mohr B, Pulvermüller F, Schleichert H.

Sozialwissenschaftliche Fakultät, Fachgruppe Psychologie, Universität Konstanz, Germany. bettina.mohr-pulvermueller@uni-konstanz.de

Humans can learn to intentionally control their brain states based on information about their own electrocortical activity. Using an operant conditioning technique, twelve healthy volunteers were trained to shift their slow cortical potentials recorded from left-hemispheric language cortices in the positive versus negative direction. After training, six subjects who achieved reliable control of left-hemispheric brain responses showed substantial modification of word processing. During conditioned negative shifts of cortical potentials (activation condition), responses to words were substantially speeded, whereas lexical decisions were slower during positive shifts of slow cortical potentials (inhibition condition). No comparable difference was seen in trained participants who failed to achieve control over slow cortical potentials. Additional data suggest that the effect was not related to perception, attention, or motor processes. Thus, operant conditioning can produce focal cortical activity dynamics and thereby modify specific higher cortical processes such as access to words. This finding may open new perspectives on neuropsychological rehabilitation based on operant conditioning of brain responses.

Publication Types: Research Support, Non-U.S. Gov't

PMID: 9792235 [PubMed - indexed for MEDLINE]

Neurosci Behav Physiol. 1998 Jul-Aug;28(4):366-75.

Adaptive regulation of the nonlinear dynamics of electrical activity of the brain.

Mogilevskii AYa , Derzhiruk LP, Panchekha AP, Derzhiruk EA.

B. I. Verkin Low-Temperature Physical-Technical Institute, Ukraine.

A programmable system was used to provide contingent reinforcement of EEG cycles corresponding to a selected criterion in a dynamic regime. Use of automated reinforcing stimulation of emotionally positive zones of the hypothalamus led to a significant increase in the number of cycles with the characteristics specified by the dynamic regime within the dominant EEG frequency bands. This effect lasted for some time after withdrawal of reinforcing stimulation, and then died down gradually. These changes in the EEG activity structure did not occur in conditions of nonassociated hypothalamic stimulation. Pseudoreinforced background EEG cycles showed complex nonlinear dynamics with competitive interactions between processes in which the large dimensionality of the attractor was difficult to interpret because of indeterminacy in the trends of the dominant process. In contingent hypothalamic stimulation, the form of the correlation integral changed towards a predominance of a single nonlinear process determining all the activity recorded. In fact, a single dominant nonlinear process was formed, which became responsible for the entire dynamics of the system with concordance of its internal structure.

PMID: 9762706 [PubMed - indexed for MEDLINE]

Arch Phys Med Rehabil. 1998 Sep;79(9):1029-33.

Answering questions with an electroencephalogram-based brain-computer interface.

Miner LA, McFarland DJ, Wolpaw JR.

Wadsworth Center, New York State Department of Health and State University of New York, Albany 12201-0509, USA.

OBJECTIVE: To demonstrate that humans can learn to control selected electroencephalographic components and use that control to answer simple questions. METHODS: Four adults (one with amyotrophic lateral sclerosis) learned to use electroencephalogram (EEG) mu rhythm (8 to 12Hz) or beta rhythm (18 to 25Hz) activity over sensorimotor cortex to control vertical cursor movement to targets at the top or bottom edge of a video screen. In subsequent sessions, the targets were replaced with the words YES and NO, and individuals used the cursor to answer spoken YES/NO questions from single- or multiple-topic question sets. They confirmed their answers through the response verification (RV) procedure, in which the word positions were switched and the question was answered again. RESULTS: For 5 consecutive sessions after initial question training, individuals were asked an average of 4.0 to 4.6 questions per minute; 64% to 87% of their answers were confirmed by the RV procedure and 93% to 99% of these answers were correct. Performances for single- and multiple-topic question sets did not differ significantly. CONCLUSIONS: The results indicate that (1) EEG-based cursor control can be used to answer simple questions with a high degree of accuracy, (2) attention to auditory queries and formulation of answers does not interfere with EEG-based cursor control, (3) question complexity (at least as represented by single versus multiple-topic question sets) does not noticeably affect performance, and (4) the RV procedure improves accuracy as expected. Several options for increasing the speed of communication appear promising. An EEG-based brain-computer interface could provide a new communication and control modality for people with severe motor disabilities.

Publication Types: Research Support, U.S. Gov't, P.H.S.

PMID: 9749678 [PubMed - indexed for MEDLINE]

Neurosci Lett. 1998 Aug 21;252(3):171-4.

Self-regulation of slow cortical potentials in completely paralyzed human patients.

Kuebler A, Kotchoubey B, Salzmann HP, Ghanayim N, Perelmouter J, Hömberg V, Birbaumer N.

Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany. andrea.kuebler@uni-tuebingen.de

The study was intended to answer the question whether self-regulation of brain activity can be operantly learnt when the brain is disconnected from motor periphery. Two neurological patients with nearly complete motor paralysis learned bi-directional control of their slow cortical potentials (SCP) at vertex. After 4-6 weeks training both patients could reliably differentiate between SCP shifts in a negative versus positive direction. With one patient, training has been continued for a subsequent 4 months, which resulted in precise self-control, i.e. the patient was able to produce positive SCP shifts on command with an accuracy of about 95%. This indicates that self-regulation of cortical excitability (as manifested in the SCP) does not require feedback loops from the periphery. Although we cannot rule out that healthy subjects may employ behavioral strategies such as muscle contractions or changes in breathing, obviously humans can also control their SCP without using these strategies.

Publication Types: Case Reports Research Support, Non-U.S. Gov't

PMID: 9739988 [PubMed - indexed for MEDLINE]

Integr Physiol Behav Sci. 1998 Apr-Jun;33(2):176-207.

Electroencephalographic biofeedback methodology and the management of epilepsy.

Lubar JF.

University of Tennessee-Memphis, USA.

Currently considerable research is being directed toward developing methodologies for controlling internal processes. An applied branch of the basic field of psychophysiology, known as biofeedback, has developed to fulfill clinical needs related to such control. Current scientific and popular literature abounds with numerous examples of how biofeedback is being used. For example, germinal studies by Kamiya (1962), and later work by Lynch and Paskewitz (1971), Beatty (1973), as well as many others have shown that the EEG alpha rhythm (8 to 13 Hz) recorded from occipital regions of the human brain can be behaviorally manipulated when feedback or reward is provided for changing the density of this activity. Other researchers have provided evidence that theta activity (4 to 7 Hz) and the beta activity (greater than 14 Hz) can also be controlled by humans and analogs of this activity have been conditioned in animals as well (Green, Green and Walters, 1971). In addition to the work that has been carried out with the EEG, researchers such as Engle and Bleecker (1973) have indicated that it might be possible to control cardiac arrhythmias through biofeedback. Studies by Elder et al. (1973) have provided some hope that blood pressure in humans might also be conditioned. Also, considerable effort has been directed to the control of responses from single muscles with particular applied emphasis in neuromuscular rehabilitation, control of muscle tension for tension headaches and the management of migraine headaches through vasomotor conditioning (Brudny et al., 1974; Basmajian, 1963, 1971; Sargent et al., 1973).

Publication Types: Research Support, Non-U.S. Gov't Review

PMID: 9737738 [PubMed - indexed for MEDLINE]

Altern Ther Health Med. 1998 Sep;4(5):44-52, 54-60, 62.

Heart-focused attention and heart-brain synchronization: energetic and physiological mechanisms.

Song LZ, Schwartz GE, Russek LG.

Department of Psychology, University of Arizona, Tucson, USA.

CONTEXT: Many relaxation, meditation, and imagery techniques that implicitly or explicitly involve focused attention on the body, including qigong, massage, and noncontact therapeutic touch, purportedly employ energetic and physiological mechanisms. OBJECTIVE: To show that, from a perspective of dynamical energy systems, relaxed self-attention enhances connectivity between the brain and body. This enhanced connectivity may be achieved by at least 2 mechanisms: (1) physiological mechanisms employing peripheral negative feedback loops, and (2) bioelectromagnetic mechanisms involving direct energetic resonance between the peripheral organ and the brain. DESIGN: 19 channels of electroencephalogram, 1 electrocardiogram, and 2 channels of electro-oculogram were recorded from 22 subjects who focused their attention on their heartbeats or eye movements, with and without kinesthetic (touch) biofeedback to increase somatic awareness. RESULTS: Analyses of the electroencephalogram synchronized with the electrocardiogram revealed significant effects for heart-focused attention, primarily with touch biofeedback, following the contraction of the ventricles (possibly reflecting increased baroreceptor and somatosensory feedback); and significant effects for heart-focused attention, with and without touch biofeedback, preceding the contraction of the ventricles (possibly reflecting direct electromagnetic interactions between the heart and the brain). CONCLUSIONS: These findings suggest that energetic and physiological mechanisms may be involved in techniques in which the goal is to promote mind-body integration and health.

PMID: 9737031 [PubMed - indexed for MEDLINE]

Brain Res Cogn Brain Res. 1998 Jul;7(1):49-56.

Effects of cortical polarization on mental arithmetic.

Pauli P, Schleichert H, Bourne LE Jr, Birbaumer N.

University of Tübingen, Institute of Medical Psychology and Behavioral Neurobiology, Tübingen, Germany paul.pauli@uni-tuebingen.de

A biofeedback procedure was used to influence participants' cortical polarity before the presentation of single digit multiplication problems. To ensure that participants could solve the problems by direct memory retrieval of arithmetic facts, only nine different multiplication problems were used, and participants received extensive pre-experimental practice on these problems. After biofeedback training, cortical positivity before problem presentation was associated with faster response initiation times, a measure of mental calculation time, for correctly solved problems and with more multiplication errors than cortical negativity. Response execution time, a measure of motor speed, was not affected by cortical polarity. The shift in positivity from the amplitude of the slow cortical potential (SCP) before problem presentation to the amplitude of the positive slow wave (pSW) after problem presentation was less in positivity-required compared to negativity-required trials, mainly because of the manipulation of SCP starting points by biofeedback. We assume that cortical positivity is associated with direct retrieval of arithmetic facts, more precisely with the inhibition of incorrect answers. Cortical positivity before task presentation results in a reduced positive shift, a sign of less inhibition before answer production. The effect of less inhibition during positivity-required trials is to produce faster responses and more errors. The opposite might to be true of cortical negativity. Copyright 1998 Elsevier Science B.V.

Publication Types: Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S.

PMID: 9714730 [PubMed - indexed for MEDLINE]

Neurosci Behav Physiol. 1998 May-Jun;28(3):330-5.

"Brain music" in the treatment of patients with insomnia.

Levin YaI .

Department of Nervous Diseases, Faculty of Postgraduate Professional Education, I. M. Sechenov Moscow Medical Academy.

The effects of a new nonpharmacological method of treating insomnia-"brain music"-were studied. The method is based on the transformation of the EEG into music using a special algorithm developed by the authors. Sleep polygrams were recorded and analyzed, and EEG segments corresponding to different sleep phases were identified using standard criteria, and were transformed into music. Patients listened to the resulting audio cassettes before going to sleep. Clinical, questionnaire, psychological, and electrophysiological (polysomnographic, electroencephalographic) methods were used before and after 15-day treatment courses in 58 patients with insomnia, who were divided into two groups: group 1 (44 patients) formed the experimental group, and group 2 (14 patients) formed the "placebo" group (in whom the "brain music" of a different patient was used). "Brain music" was found to have positive effects in more than 80% of the insomniac patients both from the point of view of subjective sensations and in terms of objective studies, i.e. neuropsychological and neurophysiological investigations. The high efficacy of "brain music" in patients with insomnia was combined with an absence of side effects and complications.

Publication Types: Clinical Trial

PMID: 9682240 [PubMed - indexed for MEDLINE]

Appl Psychophysiol Biofeedback. 1997 Dec;22(4):227-45.

Direction of temperature control in the thermal biofeedback treatment of vascular headache.

Blanchard EB, Peters ML, Hermann C, Turner SM, Buckley TC, Barton K, Dentinger MP.

Center for Stress and Anxiety Disorders, University at Albany-SUNY, New York 12203, USA.

In order to test for the specific therapeutic effects of thermal biofeedback (TBF) for hand warming on vascular headache (HA), 70 patients with chronic vascular HA were randomly assigned to TBF for hand warming, TBF for hand cooling, TBF for stabilization of hand temperature, or biofeedback to suppress alpha in the EEG. Patients in each condition initially had high levels of expectation of therapeutic benefit and found the treatment rationales highly credible. Participants in each condition received 12 treatment sessions on a twice-per-week basis. Based on daily HA diary data gathered for 4 weeks prior to treatment and 4 weeks after treatment, HA Index was significantly (p = .003) reduced as was HA medication consumption. There were no differential reductions in HA Index or Medication Index among the four conditions. Global self-reports of improvement gathered at the end of the post-treatment monitoring period also did not differ among the four conditions. We were unable to demonstrate a specific effect of TBF for hand warming on vascular HA activity.

Publication Types: Clinical Trial Randomized Controlled Trial Research Support, U.S. Gov't, P.H.S.

PMID: 9595177 [PubMed - indexed for MEDLINE]

Neurosci Behav Physiol. 1998 Jan-Feb;28(1):8-16.

Functional rearrangements in the human brain during emotional self-regulation with biological feedback.

Popova EI, Mikheev VF, Shuvaev VT, Ivonin AA, Chernyakov GM.

Laboratory for the Physiology of Higher Nervous Activity, I. P. Pavlov Institute of Physiology, Russian Academy of Sciences, St. Petersburg.

The concept that functional psychopathology producing phobic syndromes is mediated by a specific deficiency in the integrative activity of the brain as a loss or partial limitation of the ability to recognize subjective experiences was used to develop a special method for mobilizing the selective attention of patients to the time course of subjective states. The fact of recognition of a state was demonstrated by the patient's ability to reproduce it by achieving specific parameters in a biological feedback test based on skin electrical responses. Success was positively reinforced by avoidance of an anxiously expected electrical stimulus. After successful training, patients could spontaneously adaptively correct their general daily behavior. Computer analysis of EEG traces revealed the specific structural-functional features of various states provoked during training.

PMID: 9513971 [PubMed - indexed for MEDLINE]

J Clin Neurophysiol. 1997 Nov;14(6):529-38.

Timing of EEG-based cursor control.

Wolpaw JR, Flotzinger D, Pfurtscheller G, McFarland DJ.

Wadsworth Center for Laboratories and Research, New York State Department of Health and State University of New York, Albany 12201-0509, USA.

Recent studies show that humans can learn to control the amplitude of electroencephalography (EEG) activity in specific frequency bands over sensorimotor cortex and use it to move a cursor to a target on a computer screen. EEG-based communication could be a valuable new communication and control option for those with severe motor disabilities. Realization of this potential requires detailed knowledge of the characteristic features of EEG control. This study examined the course of EEG control after presentation of a target. At the beginning of each trial, a target appeared at the top or bottom edge of the subject's video screen and 1 sec later a cursor began to move vertically as a function of EEG amplitude in a specific frequency band. In well-trained subjects, this amplitude was high at the time the target appeared and then either remained high (i.e., for a top target) or fell rapidly (i.e., for a bottom target). Target-specific EEG amplitude control began 0.5 sec after the target appeared and appeared to wax and wane with a period of approximately 1 sec until the cursor reached the target (i.e., a hit) or the opposite edge of the screen (i.e., a miss). Accuracy was 90% or greater for each subject. Top-target errors usually occurred later in the trial because of failure to reach and/or maintain sufficiently high amplitude, whereas bottom-target errors usually occurred immediately because of failure to reduce an initially high amplitude quickly enough. The results suggest modifications that could improve performance. These include lengthening the intertrial period, shortening the delay between target appearance and cursor movement, and including time within the trial as a variable in the equation that translates EEG into cursor movement.

Publication Types: Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S.

PMID: 9458060 [PubMed - indexed for MEDLINE]

Zh Vyssh Nerv Deiat Im I P Pavlova. 1997 Sep-Oct;47(5):898-907.

[Differences in human evoked visual potentials depending on the capacity for the self-regulation of their parameters by feedback]

[Article in Russian]

Mnatsakanian EV.

The individual characteristics of the VEP spatio-temporal patterns were studied depending on a capability of a subject for VEP biofeedback conditioning. Thirty two healthy adult volunteers had to modify their N100-P200 VEP component (Cz derivation) within a selected time window in order to increase the number of trials in which the amplitude of the segment from the beginning of the sample to the positive peak exceeded a definite threshold. In addition to traditional visual assessment of topographical maps, the statistical analysis of multichannel VEPs and component analysis for Cz, O1, and O2 were carried out for each discrete time sample. The differences were observed in the spatio-temporal VEP patterns for successful and unsuccessful performance. In the background sessions, the central and occipital P200 components were much the same in the subjects which succeeded in task performance, whereas the central component was noticeably higher than the occipital one in the subjects who were unsuccessful in biofeedback control. During successful performance, there was a reduction of the occipital P200. Thus, the relationships of VEP components in the central and occipital derivations can predict successful biofeedback conditioning and may reflect the prevalence of verbal and non-verbal thinking.

Publication Types: Comparative Study English Abstract

PMID: 9454470 [PubMed - indexed for MEDLINE]

Med Tekh. 1997 Sep-Oct;(5):30-3.

[Measurement and estimation system for monitoring physiologic parameters of man and biological feedback training]

[Article in Russian]

Egorov AV.

A flexible instrumental programmed system realizing the biological feedback (BFB) method and permitting an easy tuning of the channels and parameters for treatment and reflection of physiological information is designed. A measurement and estimation real-time medical system for monitoring and BFB training is described, based on visual programming. An example of practical clinical application of the system to BFB training for the EEG rhythms is offered.

Publication Types: English Abstract

PMID: 9445978 [PubMed - indexed for MEDLINE]