Study Objectives: To test whether instrumental conditioning of sensorimotor rhythm (SMR; 12-15 Hz) has an impact on sleep parameters as well as declarative memory performance in humans. Design: Randomized, parallel group design Setting: 10 instrumental conditioning sessions, pre- and posttreatment investigation including sleep evaluations Participants: 27 healthy subjects (13 male) Interventions: SMR-conditioning (experimental group) or randomizedfrequency conditioning (control group); declarative memory task before and after a 90-min nap Measurement and Results: The experimental group was trained to enhance the amplitude of their SMR-frequency range, whereas the control group participated in a randomized-frequency conditioning program (i.e., every session a different 3-Hz frequency bin between 7 and 20 Hz). During pre- and posttreatment the subjects had to attend the sleep laboratory to take a 90-min nap (2:00-3:30 pm) and to perform a declarative memory task before and after sleep. The experimental design was successful in conditioning an increase in relative 12-15 Hz amplitude within 10 sessions (d = 0.7). Increased SMR activity was also expressed during subsequent sleep by eliciting positive changes in different sleep parameters (sleep spindle number [d = 0.6], sleep onset latency [d = 0.7]); additionally, this increased 12-15 Hz amplitude was associated with enhancement in retrieval score computed at immediate cued recall (d = 0.9).

Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation, though their combinatory effect is unknown. We investigated brain plasticity following a combined MI-BCI and tDCS intervention in chronic subcortical stroke patients with unilateral upper limb disability. Nineteen patients were randomized into tDCS and sham-tDCS groups. Diffusion and perfusion MRI, and transcranial magnetic stimulation were used to study structural connectivity, cerebral blood flow (CBF), and corticospinal excitability, respectively, before and 4 weeks after the 2-week intervention. After quality control, thirteen subjects were included in the CBF analysis. Eleven healthy controls underwent 2 sessions of MRI for reproducibility study. Whereas motor performance showed comparable improvement, long-lasting neuroplasticity can only be detected in the tDCS group, where white matter integrity in the ipsilesional corticospinal tract and bilateral corpus callosum was increased but sensorimotor CBF was decreased, particularly in the ipsilesional side. CBF change in the bilateral parietal cortices also correlated with motor function improvement, consistent with the increased white matter integrity in the corpus callosum connecting these regions, suggesting an involvement of interhemispheric interaction. The preliminary results indicate that tDCS may facilitate neuroplasticity and suggest the potential for refining rehabilitation strategies for stroke patients.

Using EEG based neurofeedback (NF), the activity of the brain is modulated directly and, therefore, the cortical substrates of cognitive functions themselves. In the present study, we investigated the ability of stroke patients to control their own brain activity via NF and evaluated specific effects of different NF protocols on cognition, in particular recovery of memory.

EEG Biofeedback, or Neurofeedback (NFB) training has sufficient research behind it that it is now considered by various institutional bodies and scientific publications to be as effective as any other treatment and superior to most for ADD/ADHD. This support is listed below:

Traumatic brain injuries constitute significant health and societal problems which can be ameliorated with some recent developments in neurofeedback. The field of neurofeedback has evolved from single channel to multiple-site training, and with LORETA Z-score training, deeper levels of the brain can reached. Neurofeedback for traumatic brain injury patients may provide improvements never before possible.

In this review article an overview of the history and current status of neurofeedback for the treatment of ADHD and insomnia is provided. Recent insights suggest a central role of circadian phase delay, resulting in sleep onset insomnia (SOI) in a sub-group of ADHD patients. Chronobiological treatments, such as melatonin and early morning bright light, affect the suprachiasmatic nucleus. This nucleus has been shown to project to the noradrenergic locus coeruleus (LC) thereby explaining the vigilance stabilizing effects of such treatments in ADHD. It is hypothesized that both Sensori-Motor Rhythm (SMR) and Slow- Cortical Potential (SCP) neurofeedback impact on the sleep spindle circuitry resulting in increased sleep spindle density, normalization of SOI and thereby affect the noradrenergic LC, resulting in vigilance stabilization. After SOI is normalized, improvements on ADHD symptoms will occur with a delayed onset of effect. Therefore, clinical trials investigating new treatments in ADHD should include assessments at follow-up as their primary endpoint rather than assessments at outtake. Furthermore, an implication requiring further study is that neurofeedback could be stopped when SOI is normalized, which might result in fewer sessions.

Mild closed head injury (MHI) is a major problem in our society. Traditional methods of treatment such as cognitive rehabilitation or behavioral training are time consuming, expensive, and of questionable effectiveness. Anecdotal reports indicate that neuro-feedback can remediate the symptoms of MHI in a rapid and cost effective way. The purpose of this study is to evaluate whether quantitative electroencephalography (qEEG) guided coherence training is effective in remediating residual symptoms of MHI.

Objective: To determine whether a single session of anodal transcranial direct current stimulation to the left dorsolateral prefrontal cortex improves attention in patients with traumatic brain injury. Design: Double-blinded, cross-over design. Patients: Nine patients with attention deficit after traumatic brain injury. Methods: Patients underwent a computerized contrast reaction time task before and after the administration of real transcranial direct current stimulation (2 mA for 20 min) or sham transcranial direct current stimulation (2 mA for 1 min) to the left dorsolateral prefrontal cortex in a doubleblind, crossover manner.

A personalized treatment approach, tailoring Neurofeedback treatment to the individual ADHD patient, almost doubled the effectiveness for attentional and hyperactivity/impulsivity problems. These results have just been published in the scientific journal ‘Applied Psychophysiology and Biofeedback’. This study is the first scientific study investigating whether personalizing Neurofeedback treatment, based on a so-called quantitative EEG or QEEG, results in a higher effectiveness of this treatment in ADHD.

Insomnia is an epidemic in the US. Neurofeedback (NFB) is a little used, psychophysiological treatment with demonstrated usefulness for treating insomnia. Our objective was to assess whether two distinct Z-Score NFB protocols, a modified sensorimotor (SMR) protocol and a sequential, quantitative EEG (sQEEG)-guided, individually designed (IND) protocol, would alleviate sleep and associated daytime dysfunctions of participants with insomnia. Both protocols used instantaneous Z scores to determine reward condition administered when awake. Twelve adults with insomnia, free of other mental and uncontrolled physical illnesses, were randomly assigned to the SMR or IND group. Eight completed this randomized, parallel group, single-blind study. Both groups received fifteen 20-min sessions of Z-Score NFB. Pre-post assessments included sQEEG, mental health, quality of life, and insomnia status. ANOVA yielded significant post-treatment improvement for the combined group on all primary insomnia scores: Insomnia Severity Index (ISI p\.005), Pittsburgh Sleep Quality Inventory (PSQI p\.0001), PSQI Sleep Efficiency (p\.007), and Quality of Life Inventory (p\.02). Binomial tests of baseline EEGs indicated a significant proportion of excessively high levels of Delta and Beta power (p\.001) which were lowered posttreatment (paired z-tests p\.001). Baseline EEGs showed excessive sleepiness and hyperarousal, which improved post-treatment. Both Z-Score NFB groups improved in sleep and daytime functioning. Post-treatment, all participants were normal sleepers. Because there were no significant differences in the findings between the two groups, our future large scale studies will utilize the less burdensome to administer Z-Score SMR protocol.

This paper describes a case study of a 14-year-old African refugee boy who survived multiple traumas related to war, displacement, and deprivation. Traumatized from the age of 2, his presentation was primarily one of affect dysregulation. In order to address both the core hyperarousal and the unavailability of the necessary cortical and behavioral skills required to regulate affect, an approach was chosen that integrates neurofeedback (electroencephalographic biofeedback) and psychotherapy. We trust that the description of the process provides others with new practice options and an enthusiasm to expand in this direction.

This paper describes a case study of a 14-year-old African refugee boy who survived multiple traumas related to war, displacement, and deprivation. Traumatized from the age of 2, his presentation was primarily one of affect dysregulation. In order to address both the core hyperarousal and the unavailability of the necessary cortical and behavioral skills required to regulate affect, an approach was chosen that integrates neurofeedback (electroencephalographic biofeedback) and psychotherapy. We trust that the description of the process provides others with new practice options and an enthusiasm to expand in this direction.

The literature regarding neurofeedback treatment of anxiety associated with post traumatic stress disorder (PTSD) is reviewed. The results of quantitative electroencephalograph (QEEG) guided neurofeedback training for anxiety in nineteen PTSD patients is analyzed, along with the change in anxiety in four control patients who did not do neurofeedback. Those who did neurofeedback training experienced clinically significant reductions in anxiety, whereas there was no significant change in anxiety in the control group. QEEG-guided neurofeedback appears to be effective in a higher percentage of patients than non– QEEG-guided training in increasing alpha and theta, based on results in the published literature.

Neurofeedback, also known as EEG biofeedback, has been used successfully for the treatment of substance abuse for over 25 years. Built on the work of Kamiya and Green (Budzynski, 1999), Eugene Peniston published a series of papers using alpha-theta neurofeedback with a Veteran’s Administration (VA) population of Vietnam War veterans diagnosed with alcohol abuse and post-traumatic stress disorder (PTSD) (Peniston & Kulkosky, 1989; Peniston & Kulkosky, 1990; Peniston, Marrinan, Deming, & Kulkosky, 1993). These important ‘Peniston papers’ no doubt facilitated a wave of EEG practitioners who rely on alpha-theta neurofeedback, or its modified forms, to treat substance abuse (as well as PTSD) that continues to this day. Keyword: Addiction

The experimental group was trained to enhance the amplitude of their SMR-frequency range, whereas the control group participated in a randomized-frequency conditioning program (i.e., every session a different 3-Hz frequency bin between 7 and 20 Hz). During pre- and posttreatment the subjects had to attend the sleep laboratory to take a 90-min nap (2:00–3:30 pm) and to perform a declarative memory task before and after sleep. The experimental design was successful in conditioning an increase in relative 12–15 Hz amplitude within 10 sessions (d = 0.7). Increased SMR activity was also expressed during subsequent sleep by eliciting positive changes in different sleep parameters (sleep spindle number [d = 0.6], sleep onset latency [d = 0.7]); additionally, this increased 12–15 Hz amplitude was associated with enhancement in retrieval score computed at immediate cued recall (d = 0.9).

Following acute TBI rehabilitation there have been a limited number of strategies that have been used in the treatment of cognitive disorders. These methods have included restorative cognitive rehabilitation procedures that utilize stimulation and practice (e.g., of vigilance with a computer intervention); strategy cognitive rehabilitation (e.g., utilizing visualization, creating associations), compensatory cognitive rehabilitation strategies; and medications (e.g., cognitive enhancing medications directed at arousal, attention and/or memory). All of these methodologies provide at best modest improvements, but it is still common for patients with TBI to be told that after a year and a half they have obtained about all of the improvement that they can expect, and that, therefore, they must simply adjust to the current state of affairs. There is, however, another rehabilitation strategy that is commonly underutilized, but which holds definite potential to provide further assistance in cognitive rehabilitation. This method is neurofeedback (EEG biofeedback).

The following is from Vincent Monastra’s book (2008), Unlocking the Potential of Patients with ADHD. He is a respected researcher in this field and has published an earlier review of the research literature which was cited on-line in the CHADD “What We Know” series. That review is outdated and the following update is a more current reflection on the scientific research into the utility of neurofeedback for attention issues.

Brain injury appears to affect from 132 to 367 people per 100,000. Traditional methods for diagnosing mild head injury, such as medical history, CAT scan and MRI, often show normal test results even though patients complain of significant neurocognitive dysfunctions. Robert Thatcher compiled a normative reference EEG database in 1979. The norms were replicated in several studies. These EEG databases allow a patient's EEG to be compared with a reference population. An emerging and promising treatment approach to mild head injury is the use of Quantitative EEG technology and EEG neurofeedback training.

Long used to treat medical conditions such as attention deficit hyper activity disorder, epilepsy and dementia, it is begging to emerge as a tool for pro and amateur athletes alike -- with neurofeedback machines even starting to show up at some local public golf courses.

In relation to the research reviewed earlier on the presence of a frontal alpha asymmetry in depression, Rosenfeld [77] developed a neurofeedback protocol for modifying this asymmetry. This ALAY protocol (which stands for alpha asymmetry; F4 _ F3/F3 + F4, with a reference electrode at Cz) has been used in case studies [35,36,78] with encouraging preliminary results, but no controlled research has been conducted. Baehr et al [78] did 1- to 5-year follow-ups on patients treated with the ALAY protocol and documented that the changes in depression were enduring and that the frontal alpha asymmetry not only had changed at the end of treatment but that this physiologic asymmetry continued to be reversed on long-term follow-ups. This is of particular relevance because several studies [42,79–81] have found that after pharmacologic treatment that produced a remission of depression, the frontal alpha asymmetry remained unchanged, which suggests that patients in drug treatment continue to have a biologic vulnerability to future depression.