Prof. A.V. SRINIVASAN, MD, DM, Ph.D, F.A.A.N, F.I.A.N, EMERITUS PROFESSOR TAMILNADU DR.M.G.R MEDICAL UNIVERSITY CHENNAI

PRESIDENT SABA – INDIAN CHAPTER

11th November 2010

NEURO FEEDBACK TO NEUROLOGY- NEUROLOGIST’S PERSPECTIVES

Einstein’s BrainEinstein’s Brain

1879-19551879-1955

Einstein’s BrainEinstein’s Brain

Einstein died in 1955 at age 76. His Einstein died in 1955 at age 76. His brain was stored by Dr Thomas brain was stored by Dr Thomas Harvey, pathologist, who performed Harvey, pathologist, who performed the autopsy.the autopsy.

Harvey cut the brain into 240 pieces, which he kept in jars at his house. Harvey moved around the country but he always brought the brain with him. He eventually sent parts out to be studied to various researchers in the 1980s and 1990s.

(Reference: Abraham, C., Possessing Genius: The Bizarre Odyssey of Einstein's Brain, New York: St. Martin's Press, 2002)

Einstein’s Brain: Smaller SizeEinstein’s Brain: Smaller Size

1879-19551879-1955

Einstein’s Brain: Parietal lobeEinstein’s Brain: Parietal lobe

Parietal lobesParietal lobes are responsible for visual are responsible for visual and 3-D representation and mathematical and 3-D representation and mathematical reasoning. reasoning.

E’s inferior parietal lobules are E’s inferior parietal lobules are not dividednot divided by major cleftby major cleft• Not seen in 191 controls! Not seen in 191 controls! • Axons were connected in unusual ways Axons were connected in unusual ways

““might have allowed for his brilliance and his ability might have allowed for his brilliance and his ability to put spatial representations into mathematical to put spatial representations into mathematical concepts”concepts”

Einstein’s Brain: HippocampusEinstein’s Brain: Hippocampus

E’s left hippocampal neurons were E’s left hippocampal neurons were larger in 4 of 5 five regions compared larger in 4 of 5 five regions compared to right. to right. • Controls showed minimal and Controls showed minimal and

inconsistent asymmetry. inconsistent asymmetry. • Larger neurons in left hippocampus, DW Larger neurons in left hippocampus, DW

Zaidel noted, imply that Einstein's left Zaidel noted, imply that Einstein's left brain may have had stronger nerve cell brain may have had stronger nerve cell connections between the hippocampus connections between the hippocampus and neocortex than his right. and neocortex than his right.

Einstein’s Brain: Other DifferencesEinstein’s Brain: Other Differences

Total brain weight of only 1,230 grams Total brain weight of only 1,230 grams (average same-aged male = 1,350 (average same-aged male = 1,350 grams). grams).

Thickness of area 9 (prefrontal cortex) Thickness of area 9 (prefrontal cortex) was thinner than that of 5 controls, was thinner than that of 5 controls, but same number of neurons. but same number of neurons. • Thus density of neurons in AE’s brain Thus density of neurons in AE’s brain

greater. greater.

"On the Brain of a Scientist: Albert Einstein”"On the Brain of a Scientist: Albert Einstein” Diamond, Scheibel, & Murphy (1985) Diamond, Scheibel, & Murphy (1985)

Surveyed neurons and glia in left and Surveyed neurons and glia in left and right area 9 (important in planning) and right area 9 (important in planning) and area 39 (language and integration)area 39 (language and integration)• More glial cells per neuron in AE compared More glial cells per neuron in AE compared

to 11 age-matched male controls. to 11 age-matched male controls. • Left area 39 most significant differenceLeft area 39 most significant difference

Conclusion: AE’s neurons may Conclusion: AE’s neurons may have had an increased have had an increased "metabolic need""metabolic need"

Is brain-behavior behavior?Is brain-behavior behavior?

If so, it can be If so, it can be conditioned just conditioned just like other like other behaviorsbehaviors

In 1960s, certain In 1960s, certain rhythms could be rhythms could be “trained”“trained”

Led to Led to Neurotherapy and Neurotherapy and Brain-Computer Brain-Computer interfaces (BCI)interfaces (BCI)

Definition of LearningDefinition of Learning

Learning is an adaptiveLearning is an adaptive11 permanent permanent changechange22 in behavior or behavior in behavior or behavior potentialpotential33 that is produced as a result that is produced as a result of prior experienceof prior experience44

1 occasionally maladaptive such as depressed mental set, 1 occasionally maladaptive such as depressed mental set, obsessionsobsessions

2 not due to fatigue, injury2 not due to fatigue, injury 3 includes tendencies to respond that might not have been 3 includes tendencies to respond that might not have been

testedtested 4 excludes maturation, disease, instinct4 excludes maturation, disease, instinct

Two forms of conditioningTwo forms of conditioning Classical conditioningClassical conditioning

• Hard-wired linkage between stimulus and response (e.g., Hard-wired linkage between stimulus and response (e.g., food and saliva)food and saliva)

• Anything acting as signal of food can produce responseAnything acting as signal of food can produce response

Operant conditioningOperant conditioning• Training linkage between stimulus and response through Training linkage between stimulus and response through

reinforcementreinforcement• behavior strengthened if followed by reinforcementbehavior strengthened if followed by reinforcement• behavior weakened if followed by punishmentbehavior weakened if followed by punishment

• Law of Effect (Thorndike)Law of Effect (Thorndike)• Rewarded behavior is repeatedRewarded behavior is repeated

Components of conditioningComponents of conditioning

AcquisitionAcquisition• initial stage of initial stage of

learning, during learning, during which a response is which a response is established and established and gradually gradually strengthenedstrengthened

Effective pairing of Effective pairing of reinforcementreinforcement

ExtinctionExtinction

• diminishing a conditioned responsediminishing a conditioned response• occurs when an response is not followed by a occurs when an response is not followed by a

rewardreward

Extinction and spontaneous recoveryExtinction and spontaneous recovery

Strengthof CR

Pause

Acquisition(response+ reward)

Extinction(no reward)

Extinction(no reward)

Spontaneousrecovery ofresponse

Weak

Strong

Time

Operant ConditioningOperant Conditioning

Spontaneous recoverySpontaneous recovery• reappearance, after a rest period, of an reappearance, after a rest period, of an

extinguished conditioned responseextinguished conditioned response

GeneralizationGeneralization• tendency for stimuli similar to the conditioned tendency for stimuli similar to the conditioned

stimulus to evoke similar responsesstimulus to evoke similar responses DiscriminationDiscrimination

• Identify specific stimulus from set of similar Identify specific stimulus from set of similar stimuli to evoke similar reinforced responsesstimuli to evoke similar reinforced responses

When you become aware of your own brain activity –you can change it also.

Electrical stimulation of brains (ESB)Electrical stimulation of brains (ESB)

Electrical stimulation of brains of rats - Electrical stimulation of brains of rats - James Olds in 1950s; James Olds in 1950s; • Jacobsen and Torkildsen replicated Jacobsen and Torkildsen replicated

work in humans;work in humans;• some epileptics stimulated some epileptics stimulated

themselves into convulsionsthemselves into convulsions

INTRA-CRANIAL SELF-INTRA-CRANIAL SELF-STIMULATIONSTIMULATION

Rodent wireheadsRodent wireheads• 0.0005 amps whenever rat pushed lever0.0005 amps whenever rat pushed lever• Up to 10,000 bar-presses an hour recorded Up to 10,000 bar-presses an hour recorded • Animals self-stimulate > 24 hrs continuously without Animals self-stimulate > 24 hrs continuously without

rest, and cross electrified grid to gain access to lever rest, and cross electrified grid to gain access to lever • Reward center: Medial forebrain bundle passing through Reward center: Medial forebrain bundle passing through

lateral hypothalamus and ventral tegmentumlateral hypothalamus and ventral tegmentum• Other brain centers are aversive, such as Other brain centers are aversive, such as periaqueductalperiaqueductal

grey matter (PAG)grey matter (PAG)

• Ventral tegmental area (Ventral tegmental area (VTAVTA) neurons manufacture ) neurons manufacture dopaminedopamine and they are under continuous inhibition by and they are under continuous inhibition by gamma-aminobutyric acid (gamma-aminobutyric acid (GABAGABA) system, an important ) system, an important component of the ”final common pathway" of reward, component of the ”final common pathway" of reward, implicated in addiction, mood, and learning.implicated in addiction, mood, and learning.

Delgado, Primate wireheads, and Delgado, Primate wireheads, and Circuitry manCircuitry man

Electrical stimulation of brains Electrical stimulation of brains (intracranial stimulation)(intracranial stimulation)

Pavlov conditioning experimentsPavlov conditioning experiments• Tone for food, buzzer for shock –Tone for food, buzzer for shock –• Moved them closer together in timeMoved them closer together in time• confounded dog fell asleep confounded dog fell asleep

Termed “internal inhibition”Termed “internal inhibition” Animal can close down own Animal can close down own

systems to avoid stresssystems to avoid stress

Neal E Miller trained autonomic functionsNeal E Miller trained autonomic functions• Dogs salivate to get foodDogs salivate to get food• Rats control heartrate to get waterRats control heartrate to get water

History of BiofeedbackHistory of Biofeedback JH Bair, 1901, instrument used to teach ear wigglingJH Bair, 1901, instrument used to teach ear wiggling

In early 20th century, J.H. Schultz in Germany developed a In early 20th century, J.H. Schultz in Germany developed a technique called technique called Autogenic TrainingAutogenic Training. Verbal instructions are . Verbal instructions are used to guide a person to a more relaxed and controlled used to guide a person to a more relaxed and controlled physiological state. physiological state. • The method flourished, and the results were reported upon by The method flourished, and the results were reported upon by

Wolfgang Luthe in 1969 in the United States.Wolfgang Luthe in 1969 in the United States. Increased awareness in Western world of yogic ability to Increased awareness in Western world of yogic ability to

alter physiology volitionally. E.g., a yogi could survive in a alter physiology volitionally. E.g., a yogi could survive in a sealed box by voluntarily reducing his metabolic rate sealed box by voluntarily reducing his metabolic rate significantly, surviving hours with a limited supply of significantly, surviving hours with a limited supply of oxygen. oxygen.

Peripheral biofeedback techniques include Peripheral biofeedback techniques include • GSR, thermal, breathing, cardiac GSR, thermal, breathing, cardiac

History of EEG biofeedbackHistory of EEG biofeedback 1934, Adrian watched his EEG in front of 1934, Adrian watched his EEG in front of

oscillograph and created alpha at willoscillograph and created alpha at will

Alpha biofeedback or deep statesAlpha biofeedback or deep states• Joe Kamiya at Univ of Chicago, 1958+Joe Kamiya at Univ of Chicago, 1958+

Kamiya 1958Kamiya 1958• 1st subject - 60 tones and 60 1st subject - 60 tones and 60

guesses, half rightguesses, half right• 2nd trial, 65 % correct2nd trial, 65 % correct• 3rd 85% correct3rd 85% correct• 4th, after a few mistakes, 400 correct 4th, after a few mistakes, 400 correct

in a rowin a row 1968 first congress in Aspen Colorado, 1968 first congress in Aspen Colorado,

called biofeedbackcalled biofeedback

““Alpha training” adopted by flower Alpha training” adopted by flower culture of late 1960s, and practitioners culture of late 1960s, and practitioners oversold its claimsoversold its claims

1978 Science paper1978 Science paper

History of SMR biofeedbackHistory of SMR biofeedback In 1960s Mercury astronauts In 1960s Mercury astronauts

claimed they saw natives claimed they saw natives waving at them when the flew waving at them when the flew over the Pacific.(i.e., they over the Pacific.(i.e., they hallucinated)hallucinated)

In 1967, Gordon Allies, In 1967, Gordon Allies, inventor of amphetamine, was inventor of amphetamine, was contracted to test toxicity of contracted to test toxicity of the Mercury capsule rocket the Mercury capsule rocket fuel with David Fairchildfuel with David Fairchild

However Allies tested another However Allies tested another chemical compound on chemical compound on himself and shortly died, himself and shortly died, before contract over. Fairchild before contract over. Fairchild asked Sterman to help finish asked Sterman to help finish work.work.

MB StermanMB Sterman

Sterman was studying EEG-Sterman was studying EEG-behavioral correlates in catsbehavioral correlates in cats

If EEG behavior is like any other behavior, it If EEG behavior is like any other behavior, it could be shaped with operant conditioningcould be shaped with operant conditioning

Two prominent rhythms in cat EEG – SMR and PRSTwo prominent rhythms in cat EEG – SMR and PRS• Couldn’t train PRS, but could train SMR Couldn’t train PRS, but could train SMR • More on the PRS laterMore on the PRS later

Cat Wireheads: cortical electrodes, not brain Cat Wireheads: cortical electrodes, not brain stem or hypothalamicstem or hypothalamic

Cats often used in Cats often used in electrophysiology electrophysiology because head size because head size the same the same regardless of regardless of breed, unlike breed, unlike dogsdogs

10 cats trained to produce SMR (sensorimotor 10 cats trained to produce SMR (sensorimotor activity over motor strip) for chicken broth & milkactivity over motor strip) for chicken broth & milk

Acquisition resembles normal Acquisition resembles normal behavior under O.C. trainingbehavior under O.C. training

Classic abundance response at Classic abundance response at extinctionextinction

History of SMR biofeedbackHistory of SMR biofeedback Then Sterman and Fairchild went on to another study, Then Sterman and Fairchild went on to another study,

testing rocket fuel on 50 cats, 10 from Sterman’s previous testing rocket fuel on 50 cats, 10 from Sterman’s previous SMR training study.SMR training study.

Inject 100 mg/kg or so of fuel into each catInject 100 mg/kg or so of fuel into each cat• After one hour, all usually go into grand malAfter one hour, all usually go into grand mal

but not all - 7 delayed, 3 not at all.but not all - 7 delayed, 3 not at all.

• seizure thresholds changed in these 10seizure thresholds changed in these 10

• Not explainable by placebo (“i shall please” in Latin) as Not explainable by placebo (“i shall please” in Latin) as cats didn’t know what to expect, and experimenter blind cats didn’t know what to expect, and experimenter blind because effect was entirely unexpectedbecause effect was entirely unexpected

Sterman et al (1967) showing usual toxic Sterman et al (1967) showing usual toxic prodrome and resistance to MMH-prodrome and resistance to MMH-induced seizures in a subgroupinduced seizures in a subgroup

NASA Rocket fuel

Avg 2 hours+ for seizures with EEG trained cats vs. 1 hour for normal cats

Time

History of SMR biofeedbackHistory of SMR biofeedback Replicated findings in monkeys, then moved to humans at Replicated findings in monkeys, then moved to humans at

colleagues urging.colleagues urging.

Human epilepticsHuman epileptics• First case study published in EEG & Clin NeurophysiologyFirst case study published in EEG & Clin Neurophysiology• N=4 study, 65% seizure reduction, in Epilepsia 1976 N=4 study, 65% seizure reduction, in Epilepsia 1976 • Then n=8, ABA three-year study, Epilepsia 1978Then n=8, ABA three-year study, Epilepsia 1978• Finally, full blown study funded by NIHFinally, full blown study funded by NIH

Sham control, n=24, three yearsSham control, n=24, three years Double yoked n=8, n=8 NF, n=8 log booksDouble yoked n=8, n=8 NF, n=8 log books many went seizure freemany went seizure free controls after study received NFcontrols after study received NF Reliable increase in sleep spindle density and Reliable increase in sleep spindle density and

decreased awakeningsdecreased awakenings

A major study showed 60% reduction A major study showed 60% reduction in seizures 12 months after trainingin seizures 12 months after training

Turf war with medicineTurf war with medicine

In 1982 Sterman’s NIH grant for 3 y was In 1982 Sterman’s NIH grant for 3 y was funded, but then they demanded double funded, but then they demanded double blind after approving the initial design, blind after approving the initial design, then they pulled funding saying goals then they pulled funding saying goals already reachedalready reached

Cost of temporal lobe resection for Cost of temporal lobe resection for epilepsy = $200,000epilepsy = $200,000• Money lost if patient undergoes neurotherapy Money lost if patient undergoes neurotherapy

successfullysuccessfully

Review of 19 studies with EEG Review of 19 studies with EEG Biofeedback for Epilepsy*Biofeedback for Epilepsy*Medical Journal, Jan 2000Medical Journal, Jan 2000

82% of studies demonstrated 82% of studies demonstrated significant seizure reduction significant seizure reduction

Average reduction exceeded 50%.Average reduction exceeded 50%. Studies reported Studies reported reduction in reduction in

seizure severityseizure severity.. About 5% had complete control for About 5% had complete control for

up to one year up to one year

* Sterman, MB (2000). Basic Concepts and Clinical Findings in the * Sterman, MB (2000). Basic Concepts and Clinical Findings in the Treatment of Seizure Disorders with EEG Operant Conditioning. Treatment of Seizure Disorders with EEG Operant Conditioning. Clinical Clinical EEG, 31(1EEG, 31(1), 45-55.), 45-55.

SMR attenuated (compared to cat subdural recordings) but SMR attenuated (compared to cat subdural recordings) but also present at the scalp in humansalso present at the scalp in humans

Mechanisms of SMR trainingMechanisms of SMR training Enhancing Enhancing

GABA GABA circuitry circuitry involved in involved in motor motor regulation, regulation, dampening dampening excitability to excitability to sensorimotor sensorimotor excitationexcitation

10-20 International System of Electrode Placement10-20 International System of Electrode Placement

History of Motoric HyperexcitabilityHistory of Motoric Hyperexcitability

1905: Hyperkinetic syndrome1905: Hyperkinetic syndrome(George Frederic Still, Lancet)(George Frederic Still, Lancet)

• ““wanton destructiveness and a deficit in wanton destructiveness and a deficit in moral behavior”moral behavior”

Now known to be due to slowed maturationNow known to be due to slowed maturation• only partly related to will power, if at allonly partly related to will power, if at all

Lubar (1975) ABA study, n=4Lubar (1975) ABA study, n=4• Cz theta/beta ratioCz theta/beta ratio

Patterns of behavior indicative of ADHDPatterns of behavior indicative of ADHD Inattentive Inattentive

• Easily distracted Easily distracted • Fails to pay attention to detailsFails to pay attention to details

makes careless mistakes makes careless mistakes rarely follows directions completely or properlyrarely follows directions completely or properly

• Forgets things needed to complete tasks (e.g., pencils)Forgets things needed to complete tasks (e.g., pencils)

Hyperactive Hyperactive • Unable to sit still Unable to sit still

Leaves seat when sitting expected or instructed Leaves seat when sitting expected or instructed • Talks non-stop Talks non-stop

Impulsive Impulsive • Unable to suppress impulses Unable to suppress impulses

inappropriate comments or shouts out answers earlyinappropriate comments or shouts out answers early• Hits Hits • Often puts oneself in danger, such as dashes into streetOften puts oneself in danger, such as dashes into street

Attention Deficit Hyperactivity DisorderAttention Deficit Hyperactivity Disorder

ADHD affects 2 million children in USA ADHD affects 2 million children in USA • 5% of all boys5% of all boys• 2% of all girls2% of all girls

~ 60% will remain symptomatic as adults~ 60% will remain symptomatic as adults

1 M children take Rx to control hyperactivity.1 M children take Rx to control hyperactivity.

Genetic component: MZ concordance is 75-91% Genetic component: MZ concordance is 75-91%

EEG frontal slowing due to immature frontal lobe EEG frontal slowing due to immature frontal lobe in impulsive subtypein impulsive subtype

RitalinRitalin

ControversyControversy CCommonly prescribed drug for childrenommonly prescribed drug for children

• Worries about long-term effects. Worries about long-term effects. • No studies on children who have taken No studies on children who have taken

Ritalin > 14 months. Ritalin > 14 months. • Very similar to cocaine in composition Very similar to cocaine in composition

and effectand effect

Monastra study – ADHD and biofeedback Monastra study – ADHD and biofeedback vs. stimulant therapyvs. stimulant therapy

100 ADHD children, ages 6-19, inattentive or combined types 100 ADHD children, ages 6-19, inattentive or combined types 1-year multimodal outpatient program 1-year multimodal outpatient program

• included Ritalin, parent counseling, academic supportincluded Ritalin, parent counseling, academic support 51 with EEG biofeedback 51 with EEG biofeedback

RESULTSRESULTS• Post Tx assessments with and without stimulant therapy. Post Tx assessments with and without stimulant therapy.

Ritalin produced significant improvement on TOVA and ADDESRitalin produced significant improvement on TOVA and ADDES• Did not sustain when Ritalin removedDid not sustain when Ritalin removed

EEG biofeedback group sustained gains when Ritalin removed. EEG biofeedback group sustained gains when Ritalin removed.

First Year of specific First Year of specific Neurofeedback ApplicationNeurofeedback Application

1967 SMR conditioning in general 1967 SMR conditioning in general 1973 Epilepsy 1973 Epilepsy 1975 Peak Performance 1975 Peak Performance 1976 ADHD 1976 ADHD 1977 Addiction 1977 Addiction 1978 Anxiety disorders 1978 Anxiety disorders 1978 Learning disabilities 1978 Learning disabilities 1980 Sleep Disorders 1980 Sleep Disorders 1995 Brain Injury 1995 Brain Injury 1995 Lyme's Disease 1995 Lyme's Disease 1996 CFS 1996 CFS 1997 Mood disorders 1997 Mood disorders

Neurotherapy -startNeurotherapy -start Revives Hess’ CNS Revives Hess’ CNS

model of 1950s model of 1950s • overaroused overaroused • underaroused underaroused

Added by OthmersAdded by Othmers• instabilityinstability

Related issue of Related issue of plasticityplasticity• Cajal thought Cajal thought

adult brain fixedadult brain fixed• finally countered finally countered

by Peter Eriksson by Peter Eriksson 19981998

Most important figure in behavioral Most important figure in behavioral neuroscience (i.e., psychology)neuroscience (i.e., psychology)

Elegant design to counter any Elegant design to counter any intrinsic (non-contextual) rewardintrinsic (non-contextual) reward

Earned PRSEarned PRS

PRS and learningPRS and learning

PRS characteristicsPRS characteristics Reward-based inhibition of MRFReward-based inhibition of MRF

• Mesencephalic Reticular Formation (originally called ARF) – Mesencephalic Reticular Formation (originally called ARF) – turns off the DC, i.e., volitional aspect of mindturns off the DC, i.e., volitional aspect of mind

PRS does not occur initially PRS does not occur initially • animal must be fully habituated to environmentanimal must be fully habituated to environment• any novelty or change will disrupt it. any novelty or change will disrupt it. • Light must also be on for PRS to emerge, even when Light must also be on for PRS to emerge, even when

“light off” is a signal of food delivery trials.“light off” is a signal of food delivery trials.

3-5 s burst indistinguishable from sleep onset or SWS3-5 s burst indistinguishable from sleep onset or SWS

Signal transmission in thalamus (LGN) and cortex is Signal transmission in thalamus (LGN) and cortex is suppressed by PRS (similar to SWS)suppressed by PRS (similar to SWS)

Unresponsive during PRS, like sleepUnresponsive during PRS, like sleep

PRS (6-9 Hz in cats, 8-13 Hz in humans)PRS (6-9 Hz in cats, 8-13 Hz in humans)

Alpha burst reflect preparationAlpha burst reflect preparation

Impact human learningImpact human learning

Field of NeuroregulationField of Neuroregulation

Clinical aspectsClinical aspects• Thalamocortical dysrhythmias Thalamocortical dysrhythmias

CognitionCognition• Time bindingTime binding• Information processing, recruitmentInformation processing, recruitment

ERD and ERSERD and ERS

Feedback Screen

Therapist Monitor

EEG Sensors

NF PracticeNF PracticeTherapist and client/game screenTherapist and client/game screen

Game provides client feedbackGame provides client feedback

Mazes

Space RaceSpace Race

Reward

The Therapist Screen

Raw

Inhibit

Inhibit

Scoring Charts Provide Periodic Feedback

Operant Conditioning

A normal looking EEG is small in heightA normal looking EEG is small in height

Small EEG

Reducing Reducing excessive (tall) slow brain excessive (tall) slow brain waves waves helps the brain function betterhelps the brain function better

Examples of excessive slow brainwaves

Example of EEG Brain MapExample of EEG Brain MapCourtesy of Q-Metrx

This man has way too much alpha with This man has way too much alpha with his eyes open. He’s got problems with his eyes open. He’s got problems with obsessive thinking – getting “stuck”obsessive thinking – getting “stuck”

Slow alpha increased with eyes open. That’s not normal.

PRE/POST ASSESSMENTSPRE/POST ASSESSMENTSMale, age 9. Drawing before Male, age 9. Drawing before

Neurofeedback trainingNeurofeedback training

Male, age 9. Male, age 9. Drawing after 4 Drawing after 4

months of months of Neurofeedback Neurofeedback training, 5/2/95training, 5/2/95

Child’s Family Drawing at Child’s Family Drawing at Beginning of NF - 8/3/94Beginning of NF - 8/3/94

Drawing after Twenty Sessions - Drawing after Twenty Sessions - 9/8/949/8/94

Drawing after forty sessions -Drawing after forty sessions -11/25/9411/25/94

Neurofeedback Outcome 2003Courtesy of Moshe Perl, Ph.D.

89

102

898586

100

86

80

70

8682

68

Inattention Impulsivity Response Time Variability

40

50

60

70

80

90

100

110

120

Sta

nd

ard

Sco

re

Pretreatment 20 sessions 20 or more sessionsneurofeedback

TOVA Summary - 53 Subjects

One year follow-upOne year follow-upCourtesy of Moshe Perl, Ph.D.

103106

949799

105

92 92

80

8884

74

InattentionImpulsivity

Response TimeVariability

40

50

60

70

80

90

100

110

120

Sta

nd

ard

Sco

re

Pretreatment

Post Treatment

14 MonthsFollowup

TOVA Follow-up Summary - (n=16)

Brain-Computer Interface (BCI)Brain-Computer Interface (BCI)Muscle-independent communication channelMuscle-independent communication channel

Two Two general approachesgeneral approaches: : • rhythm generation (neurofeedback approach)rhythm generation (neurofeedback approach)• natural correlates (QEEG assessment approach) natural correlates (QEEG assessment approach)

Greatest obstaclesGreatest obstacles• Humans habituate Humans habituate • Speed is slow, thus motivation must be highSpeed is slow, thus motivation must be high

Training also slower for patients, generally, than normalsTraining also slower for patients, generally, than normals• Interference and distraction (a divided attention task)Interference and distraction (a divided attention task)

Current formulations requires a patient to pay attention to Current formulations requires a patient to pay attention to contents of communication while simultaneously following contents of communication while simultaneously following generative rules of the communication device. generative rules of the communication device.

• Impaired visual systemsImpaired visual systems• Instability, noise and/or lack of our understanding of human Instability, noise and/or lack of our understanding of human

EEGEEG

ApproachesApproaches QEEG approachQEEG approach

• P300P300• VEPVEP

NeurofeedbackNeurofeedback• Motor imageryMotor imagery• SMR incidenceSMR incidence• Slow potentialsSlow potentials

Speeds are generally characters Speeds are generally characters per minuteper minute

ImageryImagery 1. think about nothing1. think about nothing 2. solve multiplication2. solve multiplication 3. mentally rotate3. mentally rotate 4. mentally write a letter to friend4. mentally write a letter to friend 5. visualize numbers being written on board sequentially5. visualize numbers being written on board sequentially

BCI ApplicationsBCI Applications

Workload shuntingWorkload shunting Augmented reality (instead of VR)Augmented reality (instead of VR) Locked-in syndromeLocked-in syndrome

• ALS, encephalitis, brainstem strokeALS, encephalitis, brainstem stroke Quality of life, extreme social restrictionQuality of life, extreme social restriction

• Other applications not yet Other applications not yet imagined or designedimagined or designed

BCI (for kaiser’s notes only)BCI (for kaiser’s notes only)

Team ProjectsTeam Projects EC1 baselineEC1 baseline EO1 baselineEO1 baseline Task 1 Task 1

• Site 1 activates, Site 2 no Site 1 activates, Site 2 no changechange

Task 2 Task 2 • Site 1 no change, Site 2 Site 1 no change, Site 2

activatesactivates EC2 baselineEC2 baseline EO2 baselineEO2 baseline

Limitations: Macrostate, Limitations: Macrostate, Alpha activity only, post-Alpha activity only, post-hoc artifact controlhoc artifact control

Search literature to Search literature to identify two tasks studied identify two tasks studied by EEG or fMRI, and the by EEG or fMRI, and the complementary sitescomplementary sites

Dedicated to my family for Dedicated to my family for making everything worthwhile making everything worthwhile

My sincere thanks to MEDHA SRINVASANSECRETARY- SOCIETY FOR ADVANCEMENT

OF BRAIN ANALYSIS- INDIAN CHAPTER

My sincere thanks to MEDHA SRINVASANSECRETARY- SOCIETY FOR ADVANCEMENT

OF BRAIN ANALYSIS- INDIAN CHAPTER

READ not to contradict or confute

Nor to Believe and Take for Granted

but TO WEIGH AND CONSIDER

THANK YOU