qeeg and neurofeedbackbridgesnky.org/public/2015 little qeeg.pdf · 2017-08-29 · 9th annual nky...

9th Annual NKY TBI Conference 3/27/2015

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QEEG andNeurofeedback

www.LITTLEPSYCH.comBRIDGES, 03-27-15

Introduction – Kirk D. Little, Psy.D.

[email protected]

President Little Psychological Services, PLLC

President-Elect International Society for

Neuroeedback and Research (ISNR)

President Brain Injury Alliance of Kentucky (NKY

Branch)

Specialization in Behavioral Medicine / Neuro-

Cognitive Rehabilitation (TBI, LD, ADHD, Asperger’s, etc.)

Board Certified in Neurofeedback (BCIA-EEG)

Overview

1. What is a QEEG Brain Scan?

2. Why is it important?

3. How do we make sense of them?

4. How do we use it as a guide for tx?

5. What is Neurofeedback?

6. Case examples.


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What is the EEG?

� Electro = Electricity

� Encephalo = Brain

� Graphy = Write Down

EEG = A squiggly line representing the

brain’s electrical output.

EEG Assessment Setup

10-20 System

Inattention


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EEG: It’s in the Squiggles

Made you look

Multi-tasking

� Reduces your ability to take in information,

process that information & make decisions, and react

quickly to those decisions

EEG Quantified

1- Import of digital EEG data involves the following steps: 1- Down-sample or up-sample to 128 Hz, 2- Baseline the EEG by filtering at < 1 Hz and > 40 Hz (5th order Butterworth

filters and creating values from zero time to negative time to allow the filter to start at time point = 0); 3- After each edit selection baseline the spliced selections of EEG by filtering a second time at < 1 Hz and > 40 Hz.

2- Amplifier equilibration is computed as the difference between the normative database amplifier characteristics in microvolts based on the frequency response of a calibrated sine wave from 1 to 40 Hz. The equilibration ratio for each EEG machine manufacturer is a coefficient in all of the subsequent spectral computations in the list of EEG machines in

the File > Open window. The FFT (Fast Fourier Transform) parameters are: epoch = 2 seconds at a sample rate of 128 sample/sec = 256 digital time points and a frequency

range from 0.5 to 40 Hz at a resolution of 0.5 Hz using a cosine taper window. Each 2 second FFT is 101 rows (frequencies 0 to 50 Hz) X 19 columns (electrode locations) = 1,919 element cross-spectral matrix for each subject. NeuroGuide uses the same equations as used by the Key Institute (see Key Institute equations 10 to 19 in the Key

Institute Help Manual) and Bendat and Piersol, 1980; Otnes and Enochson, 1978 which are standard equations. The N in the Key Institute cross-spectrum equations 16 and

17 is the number of 2 second windows that are used in the computation of the average FFT which is the sum of the spectra from 2 second windows/N. The last whole integral of 256 points marks the end of window summation and averaging. The N sub T (Key Inst. equation 17) is the number of time frames per FFT window = 256 at 128 samples

per second. A detailed documentation of the mathematical equations for the Fourier Transform and the Power Spectrum and Power Spectral Density is available at

http://www.appliedneuroscience.com/Coherence&Phase-Web.pdf.

3- In order to minimize the effects of windowing in the FFT (Kaiser and Sterman, J. Neurotherapy, 4(3): 85-92, 2001) a EEG sliding average of the 256 point FFT cross-spectral matrix was computed for each normal subjects edited EEG by advancing in 64 point steps (75% overlap) and recomputing the FFT and continuing with the 64 point sliding window of

256 point FFT cross-spectrum for the entire edited EEG record. Each of the 101 frequencies for each 19 channels is log10 transformed to better approximate a normal

distribution. The total number of 2 second windows is the number that is entered into the analysis of variance and t-tests and it is used to compute the degrees of freedom for a given statistical test.

4- The FFT mean, variance, standard deviation, sum of squares, and squared sum of the real (cosine) and imaginary (sine) coefficients of the cross-spectral matrix is computed across the sliding average of edited EEG for all 19 leads for the total number of 101 frequencies and 1,919 log transformed elements for each subject at 0.5 Hz resolution.

This creates the following eight basic spectral measurement sets and their derivatives 1- Cross-Spectral Power (square root of the sums of squares of the real and imaginary

coefficients); 2- Auto-Spectral Power which is the diagonal of the cross-spectral matrix where the imaginary coefficient = 0 and power = sine square; 3- Amplitude asymmetry of auto-spectral power = (A-B)/(A+B) x 200 where A = EEG channel 1 and B = EEG channel 2; 4-Coherence = square of the cross-spectrum divided by the product of the two

auto-spectra; 5- Phase = arctangent of the ratio of the real/imaginary components for frequencies from 0.5 to 50 Hz,; 6- Real coefficients; 7- Imaginary coefficients and 8 Peak

Frequency = sum (freq. x abs. power(freq))/sum abs. power(freq), e.g., (4.0x2+4.5x4+5.0x2)/(2+4+2) = 4.5 Hz). (Bendat and Piersol "Engineering applications of correlation and spectral analysis", John Wiley & Sons, NY, 1980; Otnes and Enochson "Digital time series analysis", Wiley-Interscience, 1978; Press et al, "Numerical recipes in C".

Mathematics

“Quantitative” EEG


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QEEG “Maps”

QEEG Maps cont...

EEG Qualities

oAmplitude = Size (Big or Small)

oFrequency = Speed (Fast or Slow)

oMorphology = Shape (Sharp, SquareO)

oConnectivity = Synchronicity (coherence)

0-4Hz 4-8Hz 8-12Hz 13-36Hz 36-42Hz

Delta Theta Alpha Beta Gamma


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Clinical Correlates

Delta = Deep sleep or brain lesion

Theta = Drowsiness and early sleep

Alpha = Relaxed, awake, internal focus

SMR = Turning off of the motor system

Beta = Aroused, active cortical processing

Gamma = The Binding Rhythm

MRI - Limitations

MRI is a snapshot of the

brain. It is a static

image that measures

large scale (gross)

abnormalities.

It is not able to detect

most brain injuries

What is Biofeedback?

Controlling your biology using electronic

monitoring equipment


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What is Biofeedback cont...

3 Necessary Steps:

1. Detect and measure biological process and amplify the

signal

2. Convert the electrical signals into an easily

understandable form (e.g. 77oF, 172 lbs.)

3. “Show” the signal to the subject as soon as possible after

the event has occurred

What is Biofeedback cont...

Types of Biofeedback

Temperature (Vasoconstriction)

EDR (ElectroDermal Response) (GSR, SC)

EMG (Electromyography)

BPM (Respiration)

HRV (Heart Rate Variability)

HEG (Hemoencephalography)

**EEG (Electroencephalography) – a.k.a.

Neurofeedback


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Biofeedback setup

EEG Feedback Setup

2 Channels of EEG


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History

Sterman’s Cats (Brain Research, 1967)

History cont9� Sterman and Fairchild tested NASA’s

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

� Inject same mg/kg of fuel into each cat

• Cats show usual toxic prodrome After 1 hr, all usually go into grand mal

� Of 50, 7 cats showed prodrome with delayed seizures and 3 without seizing.

� Examining his data carefully, including who made up his sample, he realized the seizure thresholds changed in cats who underwent SMR training

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

History cont9

Sterman

NFB with humans with seizure

disorders.

Decrease in seizure severity and

frequency with SMR training.

Seizures and motor calmness.


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History cont9.

*Meta-Analysis (19 Studies)

82% demonstrated significant (>30%) seizure

reduction,

Average reduction exceeded 50%.

Studies reported reduction in seizure severity.

About 5% had complete control for up to one year

even when anticonvulsants were reduced or

entirely withdrawn.

* Sterman, MB (2000). Basic Concepts and Clinical Findings in the Treatment of Seizure Disorders with EEG Operant

Conditioning. Clinical EEG, 31(1), 45-55.

History cont9

Johnathan Walker, MD

Using QEEG as Guide

➢ 100% success with partial complex seizures

➢ All patients seizure free

➢ Many stopped anticonvulsants

(Walker and Kozlowski, 2005)

History cont9

5X/week

4X/year

16 yr old Teen Epilepsy


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History cont.

Lubar & Shouse (1976)

First ADHD Study

Single Subject ABA

design

Increase SMR (12-14)

Decrease Theta (4-8)

Goal = Reduce

Hyperkinesis

History cont9


oSMR increased to 3X Baseline

oDecreased out of seat behaviors

oImproved Attention in class

oDecreased self-stimulation

History cont9


Procedure was reversed in

a blind fashion and the child

was trained to inhibit the

SMR and to increase the

theta

After 35 sessions, the child

had regressed completely to

baseline measured by EEG

and school performance


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History cont9


Child was retrained 28

sessions

Behavior gains returned

Medications were

removed – gains were

maintained

2 year follow up

History cont9

*Meta-Analysis (15 studies)

N= 1,194 ADHD individuals

Five RCG studies had been completedGevensleben et al, 09; Holtmann et al, 09; Bakhshayesh, 07; Levesque et al,

2006 ; DeBeus and Kaiser, in press.

One sham treatment control Three active controls:

Computerized attention training, EMG feedback

Level 5 – Efficacious and Specific (highest rating)

*Arns , Ridder, Strehl, Breteler & Coenen (2009) Efficacy of Neurofeedback Treatment in ADHD: The Effects on

Attention, Impulsivity & Hyperactivity: A Meta-Analysis. Clinical EEG and Neuroscience.

History cont9

Arns, et. al 2010


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Functional Localization

To some extent function is

localized

During activation of local

cell columns, increases in

glucose consumption and

oxygen utilization are

reflected in hemodynamic

and electrical activity.

e.g. PET scans....

Neurology Case Studies

Focal damage to the central parietal region in the area of the posterior cingulate (Pz) typically results in perseveration.

Posner & Raichle (1997) noted that this was the release component of the attentional network.

Coherence & White MatterA2 The Cingulum: Connects frontal and parietal lobes with the temporal lobes (thru cingulate gyrus from Fz toPz).

A3 The Uncinate: connects inferior frontal regions and orbital frontal regions (Fp1:BA 10/11) with anterior temporal (Visual/ Memory).

A5 The Arcurate: Connects Wernickes and Brocas (F7: BA 45,46,47) (Verbal/ Memory).

A6 The Superior Longitudinal Fasciculus.

A4 The Inferior Longitudinal Fasciculus.


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Blast Injuries

Evidence of disrupted functional connectivity in

the brain after combat-related blast injury

Scott R. Sponheim , Kathryn A. McGuire , Seung Suk Kang, Nicholas D. Davenport, Selin

Aviyente d, Edward M. Bernat e, Kelvin O. Lim

NeuroImage 54 (2011)

DAI in TBI with DTI

JOURNAL OF NEUROTRAUMA Volume 24, Number 5, 2007 Pp. 753–765

Diffuse Axonal Injury in Severe Traumatic Brain Injury Visualized Using High-Resolution Diffusion Tensor Imaging

JIAN XU, INGE-ANDRE RASMUSSEN, JR., JIM LAGOPOULOS, and ASTA HÅBERG

Coherence - Examples


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The Promise of Neurofeedback

60 yr old female

Nurse kicked and

beaten by patient

Part of mTBI wait-list

controlled Study


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120

1 3 5 7 9 11

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Memory

Attention

Uncertainty

Worthlessness

Performance

Linear (Memory)

Linear (Attention)

Linear (Worthlessness)

Linear (Uncertainty)

Linear (Performance)


Pre Mid Post

35

40

45

50

55

60

65

70

75

Time

T-S

co

re

60 Year Old Female TBI

DEP

ANX

SOM

Pre-tx Mid-tx Post-tx

50

55

60

65

70

75

80

85

90

Treatment Time

Se

ve

rity

of

Sym

pto

ms


Somatic Complaints

Functional Complaints

Muscular Bracing


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Pre-tx Mid-tx Post-tx

40

50

60

70

80

90

100

110

Treatment Time

Se

ve

rity

of

Sym

pto

ms


Tension

Cog Dysfx

Fx Deficits

Pain sensitivity

Pessimism

Intrvl Fragility

Pre-tx Mid Post F-up

70

75

80

85

90

95

100

105

110

115

120

Treatment Time

Co

gn

itiv

e A

bilit

ies

60 Year Old Female mTBI

GCF

GCP

IPS

IPA

Attn

Reas

Mem

Spat

RT


Pre-tx Mid Post F-up

80

85

90

95

100

105

Treatment Time

Te

st S

co

res

60 Year Female mTBI

GCF

Cog Avg



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Case Study

24 yr old female

496 Individual tx sessions

Severe panic, depression,

cutting, binge eating

Multiple Hospitalizations

By 12th session, symptoms

getting steadily worse

Case Study cont9

24 yr old female

3x/wk Individual tx sessions

Multiple medication changes

during training – seeing

psychiatrist 1X/wk

Then, changed training to

F3: calm, happy “for several

hours”

By session 20, mood stable

for entire weekend

Case Study cont9

24 yr old female


By session 33, got a job,

planning return to work

By session 40, reports quick

return to baseline after

relational upset / nap

Maps look relatively stable,

so modify protocol to F7-Cz


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Case Study cont9

24 yr old female


Multiple medication changes

during training – seeing

psychiatrist 1X/wk

By session 40, mood stable

for entire weekend

Case Study cont9

24 yr old female


now. No emergency calls in

weeks.

By session 45 Better fxing

Happiest in her “entire life”

On session 54 “surge” of

flashbacks / memories

Change to Fz-Cz (FCz-POz)

Case Study cont9

24 yr old female

77 NFB session total over

10 months

Moved OOState to attend

Graduate school in

Psychiatric nursing

No cutting, no depression,

occasions anxiety, no panic,

occasional “emotional

eating” when stressed


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Case Study – Migraine

50 Year old Woman

2nd Car Accident

Diffuse excess theta

frontal focus

Excessive Hibeta

Central

Main prob = Migraines

High Anxiety –

Inattention / forgetful

Case Study – Migraine

Would come in with

Migraine / neck pain

By end of session, pain

totally gone “0”

17 Sessions total until

PIP insurance cut off

the txs, claiming not

medically necessary

They still pay for meds!

Case Study - Migraine

-60% -24% -19%

-61% -24% -42%


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Case Studies – Alexia 8 fem

Case Studies - Alexia

Case Studies - Alexia


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Case Study – Bipolar Teen

Case Study - Bipolar

Dramatic Improvements


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Case Study - Statistics

Case Study – Asperger’s



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Can NFB Make You Smarter?

Tansey (1991): Average of 20 points improvement

in IQ in 24 children

Linden (1996): Average of 9 IQ points

Thompson and Thompson (1998): Average of 12

IQ points

Lubar (1995): Statistically sign. increase in IQ

Othmer (1999): Average of 23 IQ points

Orlando and Rivera (2004): Statistically significant

improvement in verbal and full scale IQ scores.

Take Away Message

•Like muscles, your brain gets stronger with

training – these are permanent, physical

changes that are useful in all areas of life

–More intense & longer concentration

–Staying calm under stress

–Faster reaction times, higher IQ, etc.


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For More Information

www.ISNR.org (International Society for

Neurofeedback and Research)

www.bcia.org (Biofeedback Certification

International Alliance)

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Discussion

[email protected]

MENSA, 12-6-14

Neuroplasticity

It is now clear that the intrinsic

circuitry of the nervous system can

be modified throughout life.

Encyclopedia of Neuroscience

B. Kolba Neuronal Plasticity after Cortical Damage, pp. 727-731

University of Lethbridge, Canada


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Neuroplasticity

Plastic Modification of Surviving Neurons

•Augmented dendritic branching

•Synaptogenesis

•Modified receptor density

•Modified transmitter uptake

P. Rapp, 2010

Neuroplasticity cont9

The CNS is constantly adjusting to

experience

E.g. Taxi Driver’s Brains on the job

With Practice, Brain’s Grow

BRODMANN (SKIL)


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Enduring Effects Autism-Coben, 2014

qeeg and neurofeedbackbridgesnky.org/public/2015 little qeeg.pdf · 2017-08-29 · 9th annual nky...

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