Tuesday, April 04, 2006

Neurofeedback for ADD and others with brain disregulation

The diagnoiss of ADD is somewhat of a creatation of our fast pace society. We have the mass media, the marketing culture, the technological "revolution" and decreasing family values to thank for the exponential "diagnosis" of ADD. Unless there is some definitive pathological "damage" in the brain and nervous system, the behavioral aspects of ADD is artificially described as a "disorder" without a frugal palatable solution to the ADD "disorder".

By merely describing a disorder in detail does not signify an understanding. Thus, the controversy. Even if there is a pathological etiology, the end result of being able to function at a higher capability is worth exploring (at least, for the affected patient).

However, the main stream allopathic medical community may not be so excited about welcoming an "untested" theurapeutic modality, such as neurofeedback. This can be compared with the plight of the Chiropratic field some three decades earlier whereby their theurpeutic modality was often disregarded as "non-medical and non-mainstream" and not worthy of health insurance reimbursement acknowledgement.

Look what a few decades has done for Chiropractic. With that as my introducing premise, I will share with my audience the benefits of neurofeedback as a treatment modality for the ADD person and others who may wish to use this as an adjunct theurapy to mainstream "medical" management.

What is nueurofeedback?

Neurofeedback is direct training of brain function, by which the brain learns to function more efficiently. We observe the brain in action from moment to moment. We show that information back to the person and we reward the brain for changing its own activity to more appropriate patterns.

This is a gradual learning process. It applies to any aspect of brain function that we can measure. Neurofeedback is also called EEG biofeedback, because it is based on electrical brain activity, the electroencephalogram, or EEG. Neurofeedback is training in self-regulation. It is simply biofeed- back applied to the brain directly. Self-regulation is a necessary part of good brain function. Self-regulation training allows the system (the central nervous system) to function better

What are the benefits of neurofeedback?

Neurofeedback addresses problems of brain disregulation. These happen to be numerous. They include the anxiety-depression spectrum, attention deficits disorder, behavior disorders, various sleep disorders, headaches, migraines, PMS, and emotional disturbances. It is also useful for organic brain conditions such as seizures, the autism spectrum, and cerebral palsy.

The ADD/ADHD symptoms may go away. So, does this mean the person is cured? Well, from another prosepcetive, is this the same endpoint? The jury is out.

Indeed, with neurofeedback the symptoms may be entirely suppressed. A person with diagnosed Attention Deficit Disorder may be able to train the brain to pay attention, so that condition will no longer be diagnosable.

The analogy would be a person coming in with migraines may no longer have them. (However, that person may still have a greater "vulnerability" to migraines than the average person on the street.) A person with epilepsy may no longer have seizures. (Although that person still retains a vulnerability to seizures.) A child with severe rages and temper tantrums may not have them again.

How is it done?

The electrodes are applied to the scalp to listen in on brainwave activity. The signals are then processed by the computer, and information is extracted regarding certain key brainwave frequencies. (All brainwave frequencies are equal, but some or more equal than others….)

The ebb and flow of this activity is giving back to the person, who attempts to change the brain activity level. This is an active participatory process. Some brain frequencies are promoted while others are diminished through the subject's effort. The information is presented in a video game situation where the person is actively playing the video game with his or her brain activity.

Eventually the brainwave activity is "shaped" toward more desirable, more regulated performance. The frequencies targeted is related to the specific locations on the scalp where we listen in on the brain. These are specific to the conditions we are trying to address and are specific to the individual.

May this be considered a cure for some of these conditions?

In the case of organic brain disorders, it can only be a matter of getting the brain to function better rather than of curing the condition. When it comes to problems of disregulation, we would say that there is not a disease to be cured. Where disregulation is the problem, self-regulation may very well be the remedy. But again the word cure would not apply.

What conditions can it help?

In the Brian Othmer Foundation, they are especially concerned with the more "intractable" brain-based problems of childhood whose needs are not currently being met. This includes first of all seizures and febrile convulsions. It includes the severely disruptive behavior disorders, such as conduct disorder and bipolar disorder. It includes the autistic spectrum and pervasive developmental delay. It includes cerebral palsy, acquired brain injury and birth trauma. Many children have sleep problems that can be helped: bedwetting, nightmares and night terrors, sleep walking, and teeth grinding.

They can also be helpful with many of the problems of adolescence: drug-taking, suicidal behavior, ADD/ADHD, anxiety and depression. And we can also help to maintain good brain function as people get older. The good news is that almost any brain, regardless of its level of function, can be trained to function better.

How do you know how to train a particular brain?

Over the years, certain training protocols have been developed that are helpful with certain classes of problems such as attention, anxiety and depression, seizures and migraines, as well as cognitive function. There are a number of assessment tools we use to help us decide which protocols to use. These are simple neurodiagnostic and neuro-psychological tests

Website link is http://www.eeginfo.com/info_what.htm

What is neurodiagnostic and neurophysiological testing?

Neurofeedback addresses issues of brain function, and hence assessment likewise is aimed at measuring function: A continuous performance test called the TOVA ® (Test of Variables of Attention) is used in order to characterize impulsivity and attention. There are other tests of cognitive function and memory. Screenings for certain visual problems that are ordinarily overlooked should be part of the ful work up. Some can measure the EEG with quantitative and statistical assessments, a technique referred to as Quantitative EEG, or simply qEEG.

What is Quantitative EEG (qEEG)?

QEEG is one of the modern brain imaging techniques. PET, SPECT and fMRI scans look at how metabolic activity is distributed in the brain, the qEEG looks at how electrical activity is distributed over the scalp. In terms of imaging, nothing else is as fast in revealing brain activity as the qEEG. It is also completely non-invasive, and can be done in a clinician's office. It is well suited to the needs of the neurofeedback clinician. Often a qEEG will be recommended for clients with clients with brain injury or developmental disorders, in order to help determine the path toward improved function.

What happens if neurofeedback clients are taking medications?

With successful neurofeedback training, the medications targeting brain function may be decreased or no longer needed. The brain takes over more of the role of regulating itself. This decrease in medications may be significant in the therapeutic treatment plan. The managing physician should be communicated regarding the neurofeedback progress and medication adjusted accordingly.

Is neurofeedback treatment covered by health insurance?

There are insurance codes for biofeedback, under which neurofeedback is covered. And there are codes for combining psychotherapy with biofeedback/neurofeedback. However, coverage for chronic mental health concerns is rarely adequate in the United States, so patients may have to advocate strongly with their insurance company for reimbursement.

The typical per-session fee ranges from $50 to 125 depending on the part of the country and the qualifications of the professional. In addition, there are costs of assessment, which are usually billed separately.

Is home-training a possibility?

Many of the conditions treatable with neurofeedback involve long-term training, as the brain's capacity to function is gradually enhanced. For some children, neurofeedback may remain a useful challenge over their life span. To make this economically viable, remote training is an available option for parents.

Remote training refers to home training under the (remote) supervision of a clinician. After parents have had their child trained with a clinician for at least twenty sessions, they may transition to remote training and continue on that basis, consulting with the clinician regularly to monitor progress and determine changes in protocol. Then training can be done frequently and consistently, on an affordable basis.

Does neurofeedback sound like a real breakthrough? Yes. And should I be hopeful for my child? Again, Yes. The most significant scientific frontier in health care at this time is to understand how our brain functions. We are beginning to learn the brain's "operating system," (or the software equalevant to your computer) and these findings are not without clinical implications and controversy.

Using neurofeedback is like installing/downloading a new software to your computer. The goal after the install/download is to make your computer more effective and efficient. The same is true after properly training the functional brain to be more effective and efficient in dealing with the acitivites of daily living.

Neurofeedback has shown to improve almost any functioning brain function better. But it can only promise positive progress, not perfection.

We invite readers to return to this site occasionally for updates on this and other "alternative" theurapeutic modality for the ADD/ADHD and others.

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