FREQUENTLY ASKED QUESTIONS
Image courtesy of Applied Neuroscience
What is Neurofeedback?
1. Neurofeedback involves putting a cap on the head that has 19 electrode channels. These channels record a patient's EEG or brain waves with eyes opened and eyes closed.
2. Then these brainwaves are compared to a normal data base. If the patient's brainwaves are 2 or more standard deviations above or below the mean of the normal data base and these brainwaves are found in the area of the brain
that matches the patient's symptoms, these areas are targeted. This is called a quantitative EEG (qEEG).
3. The patient comes back and the cap is placed back on. Then the patient is watching a monitor which may have something like a car on a race track. Every time the right brain waves occur by chance, the car will move on the
5. The patient learns how to move the car and thus change the brain waves each time the car moves.
6. Once this is done, the time the patient has to keep the car moving is extended until the brain waves turn back to normal.
(For more detail and the science behind Neurofeedback,, see NEUROFEEDBACK Specific under FAQs category)
IS ALL NEUROFEEDBACK ALIKE?
LORETA neurofeedback unscrambles brain wave frequencies beneath every electrode and matches these specific
brain waves to deeper structures in the brain which allows for specificity and localization similar to that of
functional MRI methods.
Neurofeedback use to take 40 -80 sessions with traditional Surface qEEG neurofeedback. However, LORETA neurofeedback takes fewer sessions because it reaches deeper structures.
The new Research Domain Criteria set up by the National Institute of Mental Health targets dysfunctional circuits.
Since LORETA neurofeedback targets deeper structures and is simialr to functional MRI neurofeedback, it is ideal for use under these criteria.
WHAT CREDENTIALS SHOULD A CLINICIAN HAVE TO DO NEUROFEEDBACK?
The FDA has approved many machines (amplifiers) for use for neurofeedback because there is little harm that occurs from these machines. These machines and software programs can be bought and used by many people. It is wise to ask the clinician whether they have training in neuroscience. It may be wise to ask if a clinician is board certified by the
Biofeedback Certification International Alliance (BCIA) or supervised by someone who is. If you are interested in LORETA neurofeedback, ask if this is the system they use.
Also, a clinician should do a thorough bio-psycho-social evaluation with information from multiple sources before doing neurofeedback. Many conditions like seizures and thyroid problems can look like ADHD and neurofeedback would not be appropriate in those patient's. Those medical conditions need to be treated first.
In addition, LORETA neurofeedback should never be used as a stand alone intervention. Other problems like
learning disorders should be tested for and appropriate interventions at the school level should also be addressed. Many
other factors need to be explored before neurofeedback can occur and this is addressed in a thorough bio-psycho-social evaluation.
What is the History of Neurofeedback? (See slides under "More")
First description of EEG by Berger, 1929
First use of EEG alpha blocking response which followed classic Pavlovian conditioning 1941 Jasper, et al, Knott, et al
First, to discover SMR-Sterman, 1969 while experimenting with cats and operational conditioniing while recording events with an EEG
Operational Conditioning with Cats-Cat was connected to EEG to record what happened during operational conditioning
Traditional conditioning where a lever is pushed and food comes into a bowl=now cat presses lever when hungry.
Next, a new element was introduced to the experiment: a tone. If the cat pressed the lever while the tone was on, the dose of chicken broth and milk would not be delivered.
The cat had to wait for the tone to stop before it could press the lever and get the reward.
Sterman observed that while the cat was waiting for the tone to stop, it entered a unique state of consciousness.
It remained absolutely still, though extremely alert, anticipating when the tone would stop.
Accompanying this motor stillness , a specific rhythmic frequency of12Hz to 15Hz over a specific part of the brain was seen (which he called the sensorimotorfrequency or SMR).
Sterman wanted to see if he could teach the cat how to produce that specific frequency at will.
No lever was used, instead, if the cat produced a half second of the SMR frequency, he were given a shot of the broth and milk.
Cat would produce in anticipation of broth and milk
Over time the cats learned how to produce the frequency at will.
Both Sterman and Lubar utilized Operant Conditioning
First use of Sensorimotor Rhythm Training over sensory motor cortex to decrease seizures was done by: Sterman, 1972 in animals and Lubar, 1976 in humans.
What is Integrative or Functiuonal Psychiatry?
Functional Psychiatry looks for the underlying cause of the disease while Integrative Psychiatry promotes health, prevents illness and helps raise awareness of “disease” (rather than merely managing symptoms) by using traditional and non-traditional interventions. Such interventions may include, but are not limited to, neurofeedback, natural products, like herbs, meditation, nutrition deficiences, diet, genetic testing and exercise. Integrative Psychiatry pertains to integrative and complementary interventions that only pertain to psychiatry.
Why was Complementary, Alternative and Integrative Medicine not incorporated into Western Medical Schools?
Acupuncture arrives in the West, with the strongest influence in France in 1800’s and in U.S. by way of William Osler, M.D.(father of medicine) who began using in late 1800s.
However, in 1910 the Flexner Report on medical education was commissioned by the Carnegie Foundation for the advancement of teaching. This resulted in restrictions of what could be taught in medical schools and the focus became acute care.
Great depression followed and Medicare was created which developed the concept that a “war against disease” would be established.
President Roosevelt allotted money for research and medical education placed basic sciences above clinical care.
The discovery of penicillin led to the “magic bullet” mentality for fixing everything. This led to the huge growth in hospitals and money spent to fix everything.
Managed care was created to slim down costs.
Hence a reduction in services and payments for services occurred and devaluation of time spent with the practitioner occurred.
Many therapies were simply eliminated from managed care (acupuncture, neurofeedback, homeopathy, etc.)
What was forgotten was the question as to why diseases occurred-if someone had HBP-what were they eating, were they exercising, how did they respond to stress)
Why are there so many “natural Products sold in the market and what is their level of safety?
In October 1994, the Dietary Supplement Health and Education Act (DSHEA) was signed into law. Before this time, dietary supplements were subject to the same regulatory requirements as were other foods. A firm does not have
to provide FDA with the evidence it relies on to substantiate safety or effectiveness before or after it markets its products. Other than the manufacturer's responsibility to ensure safety, there are no rules that limit a serving
size or the amount of a nutrient in any form of dietary supplements.
This decision is made by the manufacturer and does not require FDA review or approval. By law, manufacturers may make three types of claims for their dietary supplement products:
1. health claims,
2. structure/function claims, and
3. nutrient content claims.
If a dietary supplement label includes structure/function claim, it must state in a "disclaimer" that FDA has not evaluated this claim. The disclaimer must also state that this product is not intended to "diagnose, treat,
cure or prevent any disease," because only a drug can legally make such a claim. Hence, in order to increase research on these products, the National Center for Complementary and Alternative Medicine (NCCAM) was formed at the National Institute on Health in Washington, D.C.
National Center for Complementary and Integrative Medicine(NCCIM) emphasizes symptom reduction, not treatment
Strategic Objectives for NCCIM are:
Advance research on CAM pharmacological and dietary interventions and approaches.
Advance research on mind/body and manipulative/manual CAM interventions.
Increase understanding of “real-world” patterns and outcomes of CAM use and its evidence-based integration into practice and care.
Improve the capacity of the field to carry out rigorous research.
Develop and disseminate objective, evidence-based information regarding the role of CAM interventions for the public and health care providers
What is Personalized Medicine?
As noted by the Federal Drug Adminstration, the term "personalized medicine" is often described as providing "the right patient with the right drug at the right dose at the right time." More broadly, "personalized medicine" may be thought of as the tailoring of medical treatment to the individual characteristics, needs, and preferences of a patient during all stages of care, including prevention, diagnosis, treatment, and follow-up. When qEEG, for instance, is used in order to determine what protocol should be used for LORETA neurofeedback, this process is called personalized medicine.
What is a Cognitive Executive Function Inventory (CEFI) ?
The Purpose of the CEFI
The CEFI is a versatile instrument that can be used to evaluate an individual, using standard scores to compare the youth to a nationally representative norm group. This information can ultimately be used to guide assessment, diagnosis, and treatment planning. The CEFI is also useful in a variety of research contexts and can be used as an effective tool to evaluate the success of an intervention program.
How the CEFI Works
Authored by Jack. A. Naglieri, Ph.D., and Sam Goldstein, Ph.D., the CEFI is the most representative nationally standardized behavior rating scale of executive function. Reliability and validity data indicate it has strong psychometric qualities. With 100 items on a Likert-type scale -90 are distributed among the CEFI scales and 10 on the Positive and Negative Impression Scales - the CEFI offers Parent, Teacher, and Self-Report (12 to 18 years) Forms, allowing for a multi-rater perspective of a youth's executive function. The CEFI can be administered online, via email, or with paper.
Following administration, all CEFI forms can be scored using the MHS QuikScoreTM Format, MHS Scoring Software, or online. There are three types of reports that can be generated from all forms: the Interpretive Report (provides detailed results from one administration), the Progress Monitoring and Treatment Effectiveness Report (provides an evaluation of CEFI score changes over time for up to four administrations from the same rater), and the Comparative report (provides an analysis of scores from two to five different raters).
Intended for use by professionals such as psychologists, school psychologists, clinical social workers, physicians, counselors, psychiatric workers, and pediatric/psychiatric nurses, the CEFI is an effective and reliable tool for evaluating executive function. It can be used pre and post neurofeedback to assess improvements in executive function.
The CEFI was developed to measure a wide spectrum of behaviors associated with executive function. In addition to a Full Scale score, calculated by adding responses to 90 of the items, the CEFI utilizes nine scales to pinpoint targets for intervention.
Scales & Forms
The scales used in the CEFI have been developed to measure a wide spectrum of behaviors associated with executive functioning. The scores which emerge from these scales are based upon a nationally representative normative sample (aged 5 to 18 years) of a diverse group of individuals.
In addition to a Full Scale Score calculated by adding responses to 90 of the items, the CEFI utilizes nine rationally-derived scales to pinpoint targets for intervention:
· Attention - measures how well a youth can avoid distractions, concentrate on tasks, and sustain attention
· Emotion Regulation - measures a youth'scontrol and management of emotions
· Flexibility - describes how well a youth can adapt to circumstances, including problem solving ability
· Inhibitory Control - reflects a youth's control over behavior or impulses
· Initiation - describes a youth's ability to begin tasks or projects without being prompted
· Organization - describes how well a youth manages personal effects, work, or multiple tasks
· Planning - reflects how well a youth develops and implements strategies to accomplish tasks
· Self-Monitoring - describes a youth's self-evaluation of his/her performance or behavior
· Working Memory - measures how a youth keeps important information in mind in order that he/she know what to do and how to do it, including remembering important things, instructions, and steps