Simultaneous Training of Slow Cortical Potentials & Coherence in Children with AD/HD using Realtime Z Score Neurofeedback: A Preliminary Study
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1 Simultaneous Training of Slow Cortical Potentials & Coherence in Children with AD/HD using Realtime Z Score Neurofeedback: A Preliminary Study Human Bionics Synergy of Mind and Body Presented by: Don DuRousseau CEO Human Bionics LLC don@humanbionics.com
2 Methods Signals: 32 EEGs, 2 EOGs, 1 ECG, 1 EMG; Tasks: minute eyes closed, 1 minute eyes open & minute split mental math; Analyses: 19 channel Quantitative EEG & LORETA using NeuroGuide Software*; Training: 2 channel Neurofeedback (Nfb), protocol based on symptoms and neurophysiology; Condition 1: Nfb training uses BrainMaster system with Realtime Z score.dll from Applied Neuroscience, Inc. Condition 2: Nfb address Slow Cortical Potentials & Coherence as primary entry to Q guided neurotherapy. NeuroGuide is the product of Applied Neuroscience. Inc.
3 Selection of Nfb Protocol Training locations determined by: 1. QEEG Z score amplitude deviations and neuroanatomical results from LORETA; 2. Symptomology and behavioral/neuropsych evaluations; 3. Severity of Coherence deviation (hypo or hyper). Z score training using BrainMaster_V3. Event Wizard: Amplitude Ex: x = (((ZAP1D+ZAP1T)/2) + ZAP11); Coherence Ex: x = Rng(ZCOD,2,) + Rng(ZCOT,1.,); Protocol updates based on review of Nfb session results; New site selection based on highest to lowest Z score amplitude deviance (considering both symptoms and coherence deviations).
4 Study Participants 1 Male (16 yo) AD/HD; ODD; Separation Anxiety (Concerta 72 mg/day); Nfb sites trained: F3/F4, F3/P4, P3/P4. 1 Female (9 yo) AD/HD; Bed Wetting; Antisocial Behavior (Strattera 3 mg/day); Nfb sites trained: F7/F8, F3/T6, P3/P4. Control: 1 Male (16 yo) No Clinical Symptoms (No Meds); Nfb sites trained: F7/T3, C3/C4, P3/P4.
5 S1 Eyes Closed: 16yo Male: AD/HD; ODD; Sep. T & 2 Sessions Beginning Meds: 72 mg Concerta No Meds 3 days prior to EEG Test Current Meds: None
6 S1 Eyes Open: 16yo Male: AD/HD; ODD; Sep. T & 2 Sessions Beginning Meds: 72 mg Concerta No Meds 3 days prior to EEG Test Current Meds: None
7 *Source: J.D. Elder Quick Assessment (with internal modifications) S1 Qualitative Measures Symptoms Anxious, fearful, uneasiness, worry, concern Inattention, daydreaming, hard to stay on task Sad and Blue, guilt, helpless, hopeless feelings Dull, slow to learn, not sharp Forgetful, failure to recall or remember Spaciness, fogginess, not tuned in Disrupted Sleep, wakes often, difficulty waking Cries Easily, sheds tears, weeps easily Feelings Easily Hurt, vulnerable Low Self esteem, poor self confidence Guilty, feelings of remorse Lack of Motivation, discouraged Confused Thinking, mixed up, baffled Nausea, sickness, upset stomach Loss of Emotional Control, rage, wrath Lethargic, lazy, drowsy, sluggish, fatigue Uncooperative, not helpful Symptoms Racing Thoughts, many thoughts Agitation, upset, disturbed Hyperactive, excessive movement Difficulty Falling Asleep, insomnia Impulsive, spontaneous urge Physical Tension in Body, taut, nervous, tense Pressure in Chest, discomfort, pain in chest Aggressive, hostile, overly assertive, bold Teeth Grinding, jaw clenching, tight jaw Headaches, feeling discomfort, unusual feeling Sensitivity to Touch, hands, feet, face Crawling Sensations on Skin, leg twitches Frustration Level, easily gives up Pain Awareness, long unpleasant sensation Hyper Focused, overly attentive, very focused Sad and Angry, agitated and feeling blue Manipulative, promotes self interest Left Subtotals Right Subtotals Grand Total Left Total Right Total LEFT Scores RIGHT Scores TOTAL Scores Date Feb Mar Mar Apr
8 S1 Quantitative Measures Nfb Training Results F3 Nfb Training Results P4 Nfb Training Results F3/P4 Coherence Z sco re Am p litu d e Delta AVG Theta AVG Alpha AVG Lobeta AVG Beta AVG Linear ( Delta AVG) Linear ( Theta AVG) Z sco re Am p litu d e Delta AVG2 Theta AVG2 Alpha AVG2 Lobeta AVG2 Beta AVG2 Linear ( Delta AVG2) Linear ( Theta AVG2) Z score Am plitude Delta COH Theta COH Alpha COH Lobeta COH Beta COH Linear ( Delta COH) Linear ( Theta COH) Nfb Training Results F3 Nfb Training Results F4 Nfb Training Results F3/F4 Coherence Z score Am plitude Delta AVG Theta AVG Alpha AVG Lobeta AVG Beta AVG Linear ( Delta AVG) Linear ( Theta AVG) Z score Am plitude Delta AVG2 Theta AVG2 Alpha AVG2 Lobeta AVG2 Beta AVG2 Linear ( Delta AVG2) Linear ( Theta AVG2) Z score Am plitude Delta COH Theta COH Alpha COH Lobeta COH Beta COH Linear ( Delta COH) Linear ( Theta COH) Nfb Training Results P3 Nfb Training Results P4 Nfb Training Results P3/P4 Coherence Z sco re A m plitud e Delta AVG Theta AVG Alpha AVG Lobeta AVG Beta AVG Linear ( Delta AVG) Linear ( Theta AVG) Z sco re Am p litud e Delta AVG2 Theta AVG2 Alpha AVG2 Lobeta AVG2 Beta AVG2 Linear ( Delta AVG2) Linear ( Theta AVG2) Z sco re Am p litud e Delta COH Theta COH Alpha COH Lobeta COH Beta COH Linear ( Delta COH) Linear ( Theta COH)
9 S1 Neuropsych Scores At T and after 2 Sessions
10 S2 Eyes Closed: 9yo Female: AD/HD; T & 2 Sessions Beginning Meds: 3 mg Strattera No Meds 3 days prior to EEG Test Current Meds: 3 mg Strattera
11 S2 Eyes Open: 9yo Female: AD/HD; T & 2 Sessions Beginning Meds: 3 mg Strattera No Meds 3 days prior to EEG Test Current Meds: 3 mg Strattera
12 *Source: J.D. Elder Quick Assessment (with internal modifications) **Second QEEG Done on 27 July 7 S2 Qualitative Measures* Symptoms Anxious, fearful, uneasiness, worry, concern Inattention, daydreaming, hard to stay on task Sad and Blue, guilt, helpless, hopeless feelings Dull, slow to learn, not sharp Forgetful, failure to recall or remember Spaciness, fogginess, not tuned in Disrupted Sleep, wakes often, difficulty waking Cries Easily, sheds tears, weeps easily Feelings Easily Hurt, vulnerable Low Self esteem, poor self confidence Guilty, feelings of remorse Lack of Motivation, discouraged Confused Thinking, mixed up, baffled Nausea, sickness, upset stomach Loss of Emotional Control, rage, wrath Lethargic, lazy, drowsy, sluggish, fatigue Uncooperative, not helpful Symptoms Racing Thoughts, many thoughts Agitation, upset, disturbed Hyperactive, excessive movement Difficulty Falling Asleep, insomnia Impulsive, spontaneous urge Physical Tension in Body, taut, nervous, tense Pressure in Chest, discomfort, pain in chest Aggressive, hostile, overly assertive, bold Teeth Grinding, jaw clenching, tight jaw Headaches, feeling discomfort, unusual feeling Sensitivity to Touch, hands, feet, face Crawling Sensations on Skin, leg twitches Frustration Level, easily gives up Pain Awareness, long unpleasant sensation Hyper Focused, overly attentive, very focused Sad and Angry, agitated and feeling blue Manipulative, promotes self interest Left Subtotals Right Subtotals Grand Total Left Total Right Total LEFT Scores RIGHT Scores TOTAL Scores Date May May Jun (Mom) Jun (Dad) Jul (Dad)**
13 S2 Quantitative Measures Nfb Training Results Sessions (P3) Nfb Training Results Sessions (P4) Z score Am plitude Delta AVG Theta AVG Alpha AVG Beta AVG Linear ( Delta AVG) Linear ( Theta AVG) Delta AVG2 Theta AVG2 Alpha AVG2 Beta AVG2 Linear ( Delta AVG2) Nfb Training Results Sessions (P3/P4 Coh) Delta COH Theta COH Alpha COH Beta COH Linear ( Delta COH) Linear ( Theta COH)
14 S2 Quantitative Measures Nfb Training Results F7 Nfb Training Results F8 Nfb Training Results F7/F8 Coherence Delta AVG Theta AVG Alpha AVG Beta AVG Linear ( Delta AVG) Linear ( Theta AVG) Delta AVG2 Theta AVG2 Alpha AVG2 Beta AVG2 Linear ( Delta AVG2) Linear ( Theta AVG2) Delta COH Theta COH Alpha COH Beta COH Linear ( Delta COH) Linear ( Theta COH) Nfb Training Results C3 Nfb Training Results T6 Nfb Training Results C3/T6 Coherence Delta AVG Theta AVG Alpha AVG Beta AVG Linear ( Delta AVG) Linear ( Theta AVG) Delta AVG2 Theta AVG2 Alpha AVG2 Beta AVG2 Linear ( Delta AVG2) Linear ( Theta AVG2) Delta COH Theta COH Alpha COH Beta COH Linear ( Delta COH) Linear ( Theta COH) Nfb Training Results P3 Nfb Training Results P4 Nfb Training Results P3/P4 Coherence Delta AVG Theta AVG Alpha AVG Beta AVG Linear ( Delta AVG) Linear ( Theta AVG) Delta AVG2 Theta AVG2 Alpha AVG2 Beta AVG2 Linear ( Delta AVG2) Linear ( Theta AVG2) Delta COH Theta COH Alpha COH Beta COH Linear ( Delta COH) Linear ( Theta COH)
15 S2 Neuropsych Scores At T and after 2 Sessions
16 C1 Eyes Closed: 16yo Male: Lack of T & 2 Sessions Beginning Meds: None No Meds 3 days prior to EEG Test Current Meds: None
17 C1 Eyes Open: 16yo Male: Lack of T & 2 Sessions Beginning Meds: None No Meds 3 days prior to EEG Test Current Meds: None
18 *Source: J.D. Elder Quick Assessment (with internal modifications) C1 Qualitative Measures* Symptoms Anxious, fearful, uneasiness, worry, concern Inattention, daydreaming, hard to stay on task Sad and Blue, guilt, helpless, hopeless feelings Dull, slow to learn, not sharp Forgetful, failure to recall or remember Spaciness, fogginess, not tuned in Disrupted Sleep, wakes often, difficulty waking Cries Easily, sheds tears, weeps easily Feelings Easily Hurt, vulnerable Low Self esteem, poor self confidence Guilty, feelings of remorse Lack of Motivation, discouraged Confused Thinking, mixed up, baffled Nausea, sickness, upset stomach Loss of Emotional Control, rage, wrath Lethargic, lazy, drowsy, sluggish, fatigue Uncooperative, not helpful Symptoms Racing Thoughts, many thoughts Agitation, upset, disturbed Hyperactive, excessive movement Difficulty Falling Asleep, insomnia Impulsive, spontaneous urge Physical Tension in Body, taut, nervous, tense Pressure in Chest, discomfort, pain in chest Aggressive, hostile, overly assertive, bold Teeth Grinding, jaw clenching, tight jaw Headaches, feeling discomfort, unusual feeling Sensitivity to Touch, hands, feet, face Crawling Sensations on Skin, leg twitches Frustration Level, easily gives up Pain Awareness, long unpleasant sensation Hyper Focused, overly attentive, very focused Sad and Angry, agitated and feeling blue Manipulative, promotes self interest Left Subtotals Right Subtotals Grand Total Left Total Right Total LEFT Scores RIGHT Scores TOTAL Scores Date Mar Mar April 1 6 April
19 C1 Quantitative Measures Nfb Training Results F7 Nfb Training Results T3 Nfb Training Results F7/T3 Coherence Delta AVG Theta AVG Alpha AVG Lobeta AVG Beta AVG Linear ( Delta AVG) Linear ( Theta AVG) Delta AVG2 Theta AVG2 Alpha AVG2 Lobeta AVG2 Beta AVG2 Linear ( Delta AVG2) Linear ( Theta AVG2) Delta COH Theta COH Alpha COH Lobeta COH Beta COH Linear ( Delta COH) Linear ( Theta COH) Nfb Training Results C3 Nfb Training Results C4 Nfb Training Results C3/C4 Coherence Delta AVG Theta AVG Alpha AVG Lobeta AVG Beta AVG Linear ( Delta AVG) Linear ( Theta AVG) Delta AVG2 Theta AVG2 Alpha AVG2 Lobeta AVG2 Beta AVG2 Linear ( Delta AVG2) Linear ( Theta AVG2) Delta COH Theta COH Alpha COH Lobeta COH Beta COH Linear ( Delta COH) Linear ( Theta COH) Nfb Training Results P3 Nfb Training Results P4 Nfb Training Results P3/P4 Coherence Z score Ampliude Delta AVG Theta AVG Alpha AVG Lobeta AVG Beta AVG Linear ( Delta AVG) Linear ( Theta AVG) Z score Ampliude Delta AVG2 Theta AVG2 Alpha AVG2 Lobeta AVG2 Beta AVG2 Linear ( Delta AVG2) Linear ( Theta AVG2) Z score Ampliude Delta COH Theta COH Alpha COH Lobeta COH Beta COH Linear ( Delta COH) Linear ( Theta COH)
20 C1 Neuropsych Scores At T and after 2 Sessions
21 Summary A preliminary study to examine the use of Realtime Z score Neurofeedback with Multimedia Stimuli in the treatment of AD/HD; Our goal was to identify a Stepwise Process for Protocol Development, Training Site Selection, and Evaluation Criteria; Several Limitations to the present study exist: Very Small Sample Size (2 Subjects, 1 Control); Possible Age and Sex Related Differences; Possible Training Disruption Effects; Further studies of realtime Z score training using multimedia stimulation are warranted.
22 Simultaneous Training of Slow Cortical Potentials & Coherence in Children with AD/HD using Realtime Z Score Neurofeedback: A Preliminary Study Human Bionics Synergy of Mind and Body Thank You for Attending!
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