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EEG
Main articles: [|Electroencephalography] and [|Neurofeedback] [|Caton] recorded spontaneous electrical potentials from the exposed cortical surface of monkeys and rabbits, and was the first to measure event-related potentials (EEG responses to stimuli) in 1875.[|[][|45][|]] [|Danilevsky] published //Investigations in the Physiology of the Brain//, which explored the relationship between the EEG and states of consciousness in 1877.[|[][|46][|]] [|Beck] published studies of spontaneous electrical potentials detected from the brains of dogs and rabbits, and was the first to document alpha blocking, where light alters rhythmic oscillations, in 1890.[|[][|47][|]] [|Sherrington] introduced the terms [|neuron] and [|synapse] and published the //Integrative Action of the Nervous System// in 1906.[|[][|48][|]] Pravdich-Neminsky photographed the EEG and event related potentials from dogs, demonstrated a 12–14 Hz rhythm that slowed during asphyxiation, and introduced the term electrocerebrogram in 1912.[|[][|49][|]] [|Forbes] reported the replacement of the string galvanometer with a vacuum tube to amplify the EEG in 1920. The vacuum tube became the de facto standard by 1936.[|[][|50][|]] [|Berger] (1924) published the first human EEG data. He recorded electrical potentials from his son Klaus's scalp. At first he believed that he had discovered the physical mechanism for telepathy but was disappointed that the electromagnetic variations disappear only millimeters away from the skull. (He did continue to believe in telepathy throughout his life, however, having had a particularly confirming event regarding his sister). He viewed the EEG as analogous to the ECG and introduced the term elektenkephalogram. He believed that the EEG had diagnostic and therapeutic promise in measuring the impact of clinical interventions. Berger showed that these potentials were not due to scalp muscle contractions. He first identified the alpha rhythm, which he called the Berger rhythm, and later identified the beta rhythm and [|sleep spindles]. He demonstrated that alterations in consciousness are associated with changes in the EEG and associated the beta rhythm with alertness. He described interictal activity (EEG potentials between seizures) and recorded a partial complex seizure in 1933. Finally, he performed the first QEEG, which is the measurement of the signal strength of EEG frequencies.[|[][|51][|]] [|Adrian] and [|Matthews] confirmed Berger's findings in 1934 by recording their own EEGs using a cathode-ray oscilloscope. Their demonstration of EEG recording at the 1935 Physiological Society meetings in England caused its widespread acceptance. Adrian used himself as a subject and demonstrated the phenomenon of alpha blocking, where opening his eyes suppressed alpha rhythms.[|[][|52][|]] [|Gibbs], [|Davis], and [|Lennox] inaugurated clinical electroencephalography in 1935 by identifying abnormal EEG rhythms associated with epilepsy, including [|interictal] spike waves and 3 Hz activity in [|absence seizures].[|[][|46][|]] [|Bremer] used the EEG to show how sensory signals affect vigilance in 1935.[|[][|53][|]] [|Walter] (1937, 1953) named the [|delta waves] and [|theta waves], and the [|contingent negative variation] (CNV), a slow cortical potential that may reflect expectancy, motivation, intention to act, or attention. He located an [|occipital lobe] source for alpha waves and demonstrated that delta waves can help locate brain lesions like tumors. He improved Berger's electroencephalograph and pioneered EEG topography.[|[][|54][|]] Kleitman has been recognized as the "Father of American sleep research" for his seminal work in the regulation of sleep-wake cycles, [|circadian rhythms], the sleep patterns of different age groups, and the effects of [|sleep deprivation]. He discovered the phenomenon of [|rapid eye movement] (REM) sleep with his graduate student Aserinsky in 1953.[|[][|55][|]] Dement, another of Kleitman's students, described the EEG architecture and phenomenology of sleep stages and the transitions between them in 1955, associated REM sleep with dreaming in 1957, and documented sleep cycles in another species, cats, in 1958, which stimulated basic sleep research. He established the Stanford University Sleep Research Center in 1970.[|[][|56][|]] Andersen and Andersson (1968) proposed that thalamic pacemakers project synchronous alpha rhythms to the [|cortex] via thalamocortical circuits.[|[][|57][|]] Kamiya (1968) demonstrated that the alpha rhythm in humans could be [|operantly] conditioned. He published an influential article in //Psychology Today// that summarized research that showed that subjects could learn to discriminate when alpha was present or absent, and that they could use feedback to shift the dominant alpha frequency about 1 Hz. Almost half of his subjects reported experiencing a pleasant "alpha state" characterized as an "alert calmness." These reports may have contributed to the perception of alpha biofeedback as a shortcut to a meditative state. He also studied the EEG correlates of meditative states.[|[][|58][|]] Brown (1970) demonstrated the clinical use of alpha-theta biofeedback. In research designed to identify the subjective states associated with EEG rhythms, she trained subjects to increase the abundance of alpha, beta, and theta activity using visual feedback and recorded their subjective experiences when the amplitude of these frequency bands increased. She also helped popularize biofeedback by publishing a series of books, including //New Mind, New body// (1974) and //Stress and the Art of Biofeedback// (1977).[|[][|59][|]][|[][|60][|]][|[][|61][|]] Mulholland and Peper (1971) showed that occipital alpha increases with eyes open and not focused, and is disrupted by visual focusing; a rediscovery of alpha blocking.[|[][|62][|]] Green and Green (1986) investigated voluntary control of internal states by individuals like Swami Rama and American Indian medicine man Rolling Thunder both in India and at the [|Menninger Foundation]. They brought portable biofeedback equipment to India and monitored practitioners as they demonstrated self-regulation. A film containing footage from their investigations was released as //Biofeedback: The Yoga of the West// (1974). They developed alpha-theta training at the Menninger Foundation from the 1960s to the 1990s. They hypothesized that theta states allow access to unconscious memories and increase the impact of prepared images or suggestions. Their alpha-theta research fostered Peniston's development of an alpha-theta addiction protocol.[|[][|63][|]] Sterman (1972) showed that cats and human subjects could be operantly trained to increase the amplitude of the [|sensorimotor rhythm] (SMR) recorded from the sensorimotor cortex. He demonstrated that SMR production protects cats against drug-induced generalized seizures (tonic-clonic seizures involving loss of consciousness) and reduces the frequency of seizures in humans diagnosed with [|epilepsy]. He found that his SMR protocol, which uses visual and auditory EEG biofeedback, normalizes their EEGs (SMR increases while theta and beta decrease toward normal values) even during sleep. Sterman also co-developed the Sterman-Kaiser (SKIL) QEEG database.[|[][|64][|]] Birbaumer and colleagues (1981) have studied feedback of slow cortical potentials since the late 1970s. They have demonstrated that subjects can learn to control these DC potentials and have studied the efficacy of slow cortical potential biofeedback in treating ADHD, epilepsy, migraine, and schizophrenia.[|[][|65][|]] Lubar (1989) studied SMR biofeedback to treat attention disorders and epilepsy in collaboration with Sterman. He demonstrated that SMR training can improve attention and academic performance in children diagnosed with Attention Deficit Disorder with Hyperactivity (ADHD). He documented the importance of theta-to-beta ratios in ADHD and developed theta suppression-beta enhancement protocols to decrease these ratios and improve student performance.[|[][|66][|]] = =

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= = **NEUROFEEDBACK THERAPY** = toc

Introduction
Neurofeedback is a technique to train the brain to regulate functions of body and mind. When the brain is not functioning optimally, this is often reflected in mental or physical problems. Likewise, many cognitive, emotional, or bodily issues can be traced back to a poorly functioning brain. Training your brain to improve its function can help it take better care of you, just like physical exercise can train your body.

When the brain is not functioning well, this is usually visible in an EEG (electroencephalogram). Restoring function to the brain by means of neurofeedback can alleviate a large variety of physical and emotional problems. Sleep patterns may improve, allowing increased alertness during the day. Neurofeedback can reduce anxiety and depression as well as syndromes such as migraine or chronic pain. Hyperactivity, attention deficit, post-traumatic stress, and emotional instability are also frequently visible as abnormalities in the EEG and as such can be treated.

Neurofeedback treatment can also help with certain specific syndromes and issues, including traumatic brain injury, seizures, autism, and stroke cases. In these instances, the training may not eliminate the cause of the problem, but rather assists the brain to function normally despite the injury.

One of the technique’s great strengths is that it draws upon the brain’s own ability to learn and adapt. Neurofeedback therapy is absolutely non-invasive, and rather than trying to affect the body from outside, it helps the brain to deal with any problems at the foundation. Neurofeedback treatment simply makes certain characteristics of the brain’s operation visible to the conscious mind.

Due in part to the nature of the treatment, neurofeedback training can help both children and adults. In fact, thanks to the innate flexibility of the growing child’s mind, it is especially effective for children. Hyperactivity, attention deficit, temper tantrums, and conduct problems are more often exhibited by children than by adults, and can be effectively treated. Furthermore, once the brain has learned to function normally, the effect is usually lasting, and relapse rarely occurs.

Because neurofeedback therapy trains the brain to operate effectively, its applications are not limited to recovering from injury or coping with problems. Neurofeedback training is also valuable to bring the brain back on track after day-to-day stress, or to facilitate peak performance, for example for professional athletes or corporate executives.

Therapy
Therapy starts with an in-take appointment with client and therapist in order to obtain a description of symptoms. Usually an EEG recording is made, in order to see to what degree the symptoms are reflected in the pattern of brain waves. Based on this recording, the therapist can identify certain frequency bands as areas for improvement, and judge to what degree the symptoms may be resolved using neurofeedback therapy.

Subsequent training sessions are usually about one hour, and are in principle conducted at least once per week. The number of sessions needed to achieve lasting effects differs from person to person and depends on the severity of the ailment, but twenty sessions is a general guideline. Within ten sessions, some improvement is usually noticeable.

The actual biofeedback therapy is painless and non-invasive. The therapist attaches one or more EEG sensors to the scalp. The sensors are read-only; they do not send or do anything to the person’s head. An amplifier and a computer monitor process the signal, and provide the appropriate feedback. Depending on the specific training protocol, this can be displayed in the form of a game, a video, auditory signals, or a combination of these modes. When the client’s brain frequencies show that the brain is generating the desired pattern, the client is rewarded, for example by receiving points in the video game or by receiving an auditory cue.

Similarly, when the brain exhibits dysfunctional behavior corresponding to the clients’ symptoms, the player is discouraged in the video game and the auditory cue is withheld. The brain gradually responds to these cues and ‘learns’ a new, healthy brain-wave pattern.

Results
Because of its wide scope of application, neurofeedback has met its share of the same healthy skepticism that every new approach claiming numerous benefits encounters. Nonetheless, twenty years of clinical experience support the therapy, and there are well-documented clinical reports concerning the effectiveness of neurofeedback for the following therapeutic applications:


 * ** Addiction || ** Anxiety ||
 * ** Attachment Disorder || ** Attention Deficit (Hyperactivity) Disorder (AD(H)D) ||
 * ** Chronic Pain || ** Autoimmune Dysfunction ||
 * ** Depression || ** Chronic Fatigue Syndrome (CFS) ||
 * ** Eating Disorder || ** Conduct Disorder ||
 * ** Learning Disabilities || ** Epilepsy ||
 * ** Personality Disorders || ** Obsessive-Compulsive Disorder ||
 * ** Sleep Disorders || ** Post-Traumatic Stress Disorder ||
 * ** Tourettes Syndrome || ** Stroke / Traumatic Brain Injury (TBI) ||
 * ** Parkinson’s Disease || ** Cognitive Decline in the Elderly ||

Often, neurofeedback can help people “get out of the groove”; it can help break undesirable established mental or behavioral patterns. A lot of the syndromes above are self-feeding: by satisfying an addiction, it becomes stronger, and succumbing to anxiety makes the world seem even scarier, also strengthening the pattern. Neurofeedback can help break such cycles by providing reinforcement for ‘normal’ function. Please see //References,// below, for the actual clinical reports.

In ADHD clients, impulsivity, distractibility, and hyperactivity may all respond to training. This can drastically improve school performance for children. Cognitive function, measured as raw IQ score, may improve as well: three controlled clinical studies found average increases of 10, 19, and 23 IQ points for representative groups of ADHD children.

Maladaptive behavior, especially in children, can change in other ways as well. Temper tantrums, aggression, cruelty, or violence are all aspects of behavior that may experience reduction or become better controllable by the child.

In the case of depression, there can be a gradual recovery of "affect", or emotional responsiveness, and a reduction in effort fatigue. Clients suffering from panic attacks or anxiety tend to experience a gradual improvement in their ability to regulate or control their attacks. Furthermore, both severity and frequency of anxiety episodes and panic attacks reduces until the condition normalizes.

Likewise, neurofeedback therapy of epilepsy clients tends to cause a similar reduction in both frequency and severity of seizures. In agreement with the referring neurologist, the dosage of anticonvulsant medication may ultimately be reduced, which in turn usually leads to a reduction of its side effects.

Side Effects
Neurofeedback therapy has no known side-effects when carried out under professional guidance. This is due to the non-invasive nature of the therapy. Note that although psychosomatic medication may see reduction in the course of the therapy, this is at the discretion of the referring neurologist. Neurofeedback therapy is not ‘anti-medicine’; on the contrary, it often works parallel to pharmaceuticals.

Why it works
The brain is an amazingly adaptable and flexible organ, and as we all know is capable of learning. Like it can learn to direct a body to ride a bicycle, it can also learn to better direct its own functioning, if it is only given feedback about its progress.

When a mature brain is functioning well, and the person is attentive, the EEG shows a particular pattern. When the EEG deviates significantly from the norm, there may be an adverse impact on cognitive, emotional, and physical function. Neurofeedback training challenges the person and the brain to attain and maintain the alert, “high-performance” state. It gives the brain feedback about its progress and, like riding a bicycle, once it has learned to maintain a healthy state, it does not easily forget.

Cost
Sessions typically cost between € 65 and € 105, depending on location, therapist, and additional services rendered. Discounts may be available for payment in advance, or for package deals of a certain number of sessions. At the moment the Fred Foundation Neurofeedback Center offers a package of twenty sessions for € 1300. The rate for separate sessions is € 90 per session.

Insurance
Several medical and psychological insurance plans now cover neurofeedback for various conditions. Among the Dutch insurance companies that do so are //Zwolse Algemene, Delta Lloyd,// and //Stad Rotterdam Verzekering//. Whether an insurance company covers treatment with neurofeedback can depend on the specific symptom or syndrome and the details of the insurance plan. If required, insurance companies can communicate with the therapist, and he or she can provide details of the therapy and the treatment plan.

**References**

You or your doctor may want to know more about neurofeedback, in which case recent published research may be the best place to find information. Note that the neurofeedback therapy discussed here is different from the more common, early alpha-wave training experiments. Below are a few references to relevant resources. All books are available on-line via http://www.amazon.com.

__Books__:

Evans, J.R. (1999), Introduction to Quantitative EEG and Neurofeedback, Academic Press.

Hill, R.W. (2002), Getting rid of Ritalin, Hampton Roads Publ. Co.

Robbins, J. (2001), A Symphony of the Brain, Grove Press.

Wise, A. (2002), Awakening the mind: A Guide to Mastering the Power of your Brain Waves, Tarcher Putman, New York.

__Periodicals__:

International Journal of Psychophysiology Applied Psychophysiology and Biofeedback Cognitive Neuroscience and Neuropsychology

__Websites__:

Fred Foundation: http://www.fredfoundation.org EEG Spectrum International: http://www.eegspectrum.com NeuroTherapy Center for Health: http://www.neurotherapy.us

Finally, the website EEG Spectrum International maintains an excellent database of links to other relevant websites as well as an overview of recent news concerning neurofeedback. For recent developments and additional information, please do not hesitate to either look there or contact us.

Fred Foundation Neurofeedback Center

Oude Loswal 32, 1217 TG Hilversum

Tel: 035-6286895 / 06-20405854, Fax: 035-6286057

E-mail: e.vanbeuningen@fredfoundation.org

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