Week 1/Week 2 Update

I realize that this is a little late, but I wanted to better understand what I was observing before I started posting weekly updates. My first day was nothing like I expected -- there were brief introductions then I was thrown right into my work. But I'm not complaining; it was very helpful to begin that early. Initially, I just sat in on training sessions, watching either Jimmy or Josh (the EEG technicians) attach the electrodes to the patient and program their individualized treatment.

The electrodes are placed according to the internationally recognized "10/20 System" of  locations. In a future post, I will discuss all these locations in detail. For now, it is necessary to know that there are 19 possible electrode locations on the scalp. Locations are chosen in accordance with the intent of that particular training session (what behaviors are being targeted). The electrodes are then plugged into an electroencephalogram amplifier, which augments any detected brainwaves so analysis is possible. The amplified waves appear on a computer screen in front of the patient. As mentioned in previous posts, the display helps the patient associate their brainwaves with their mental state, which eventually trains the brain to inhibit/encourage certain associated behaviors.

Types of Neurofeedback
But while all Neurofeedback forms function on the same principle, there are two different types of training.  

Single channel uses two reference electrodes for the ears but only one scalp electrode, which is placed on a single 10/20 location. This type is typically used when the patients disorder/problem isn't complex (only ADD or Depression). The single scalp channel can target certain areas of the brain from the surface and is all that is necessary to treat a relatively simple disorder.  

19 channel neurofeedback uses an electrode cap placed over the scalp to cover all 10/20 locations. This is used for more complex issues, such as multiple disorders or severe conditions. 19 channel has the ability to 3-dimensionally target regions of the brain, and, as a result, can treat multiple issues at once. But this type of training is very new, so all evidence for this type is theoretical. The majority of neurofeedback studies have been conducted with single channel training.  Both types use an amplifier and a monitor setup.

Electrode Cap

Within each type, there are two possible options of treatment: eyes open and eyes closed. These aren't really types of neurofeedback as much as possible treatment routes. So a possible route would be 19 channel eyes open, single channel eyes closed, etc.

Eyes open allows the patient to play a game, or watch a movie with their eyes open. All the while, the patient will be training their brain. If their brainwave levels are too high, the player loses points or the movie will dim.

Eyes closed training shuts out any outside interference with brain activity, such as visual processing. The patient closes their eyes and listens to music. If they are performing well, the music volume stays the same or increases; if they are not, the volume decreases.

I have mostly been watching single channel sessions because they are much less complicated to understand. Within the next few weeks, I will be posting a guide to the training program (how to program a treatment into the single channel computer system) and the setup.

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Brainwaves

Before I can begin describing my daily internship activities, I need to provide some essential background information on common subjects in the field of neurofeedback. Neurofeedback therapy targets specific brainwave frequencies and, based on the desired outcome, encourages/discourages those waves. But what are brainwaves?

Brainwaves
The brain is composed of millions of neurons, or nerve cells, which are able to transfer information through electric signals. Brainwaves are exactly that - the electrical impulse passed between two neurons. To understand how brainwaves are created, it is necessary to discuss structure of a neuron itself.

Neuron Structure and Chemical Signal

In the picture above, the neuron has a cell body (with a nucleus) and several branches called dendrites, which are used to receive signals from other neurons. The dendrites receive an electrical signal, passing it through to the axon. The axon is comprised of Schwann's cells wrapped in a Myelin Sheath, which insulates the electrical signal. After traveling through the axon, the electrical signal travels through the axon terminals into the dendrites of another neuron through a process named neurotransmission.

Neurotransmission triggers the relay of an electrical signal through a chemical action potential (an impulse). The potential travels down the axon, prompting the Na+ and K+ membrane channels to open and release chemicals. This creates a polarization; outside the membrane is positive, inside is negative. The ion channels allow ions to pass in and out of the membrane in accordance with the signal from a previous neutron. The Na+ and subsequent K+ ion releases cause depolarization then repolarization, allowing an electrical impulse to travel down the axon into the axon terminals/synapses. At the synapse (see above), the electrical impulse triggers the release of molecules named neurotransmitters across the gap and into the dendrites of another neuron. The neurotransmitters are carried in vesicles then fired into dendrite receptor sites across the gap. This process allows the electrical signal to continue into another neuron.

Electrical Impulse Down the Axon

 Each band on a EEG report is a grouping/range of brainwave frequencies measured in Hertz (Hz). Essentially, they measure how fast each signal is traveling between neurons. Since brainwaves are sinusoidal, their frequencies and amplitudes give insight into their functions and their significance.  The frequency correlates with the level of mental activity/associated behavior. Below are common properties of periodic waves.

Amplitude - strength/intensity of the wave (height of wave on graph)
Wavelength (λ) - distance between successive wave peaks
Frequency - the rate at which the wave oscillates, often measured in wavelengths/second

The following brainwaves are associated with a particular mental state/behavior that are commonly found on a qEEG report. They are listed in order from largest (highest amplitude to lowest amplitude) along with their corresponding frequencies.

Types of Brainwaves (largest to smallest)

Delta 1/Delta 2 (0-2 Hz / 0-4 Hz): associated with sleep/very deep mental state of relaxation
Theta (4-8 Hz): associated with day-dreaming and an idle state of mind.
Alpha (8-12 Hz): associated with a relaxation period or the transition from mental activity to idleness.
Beta 1/Beta 2 (13-21 Hz / 13-32 Hz): promote mental activity, alertness, concentration, etc.
EMG (25-32 Hz): associated with muscle tension (unimportant in EEG).

Discouraging/encouraging any of these bandwidths during training will discourage/encourage any associated behavior. For example, after a session of beta-decreasing therapy, a client is likely to feel calm and relaxed. Similarly, after theta-decreasing therapy, a client should expect to feel more alert and focused. Below, I have collected examples of each wave's appearance on an EEG.

 

 However, on an EEG, these waves will often be found together. Each line represents all brainwave activity, of all frequencies, from a single location on the scalp. As a result, one line on an EEG will have Beta, Alpha, Theta, etc. waves combined.

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What is Neurfoeedback Therapy?

During my first week of my internship, I have learned so much-- so much that I don't even know where to begin. But before I describe all the grueling details of neurofeedback therapy, let me give you a brief introduction.

What Even Is Neurofeedback Therapy?

Neurofeedback is a form of physical therapy that centers around improving mental performance. During a typical training session, a patient is seated in front of two monitors. Electrodes are placed on their ears and head, allowing the first monitor to display their brainwave frequencies. Based on the goal of the training session, an individualized treatment is programmed into the computer (for example, decreasing beta waves). Throughout the session, the first monitor displays brainwave readings, while the second monitor can be used for visual training, such as playing movies/games.

But how can just seeing brainwave frequencies improve mental performance? Neurofeedback therapy uses self-awareness to promote subconscious mental conditioning. This phenomenon is called "operant conditioning." For example, if a client wanted to feel more focused, their individualized neurofeedback training would discourage theta wave frequencies (see below about types of brainwaves.) The monitor would display a reading of the client's theta wave levels. Through practice and awareness of their levels, the client would eventually understand the correlation between the display and their state of mind, giving him/her the ability to influence the theta wave levels. The brain slowly reconditions itself, manipulating its own brainwaves to receive a reward. In training terms, this reward is given in many forms: more points on a therapy game, a reward sound, or a clearer resolution of the display monitor. If the client's brainwaves are not in accordance with the session's intent, the reward is revoked (the points decrease, a sound is not played, or the screen becomes darker.) All these signals are recorded in a EEG reading. 


The EEG Recording

EEG Recording

EEG stands for "electroencephalogram," and is a recording of all brainwave activity measured from the scalp. Through the use of electrodes, brainwaves can be measured and displayed through EEG. An EEG measures the neural oscillations over a short period of time, often a 30 minute training period. It fully captures all neural voltage fluctuations and records them on a graph (micro-Volts/time). As seen above, the EEG recording fully captures the physical nature of the brainwaves, allowing its various properties to be analyzed after the training session. In the report above, the y-axis lists electrode locations on the patient's scalp (see "The 10/20 System"), while the x-axis is time. In a future post, I will dissect an EEG reading and the significance of all present frequencies.

The qEEG Report 

qEEG stands for a "quantitative electroencephalogram." This report quantifies the brain's numerous electric signals into "bands" of frequencies. This report gives an EEG report some actual meaning. An EEG really means nothing when it is first recorded. It's just a jumble of brainwaves that reflect the patients state of mind; but until a qEEG report is written, an EEG is useless. qEEG uses the EEG data and transforms it into a qualitative analysis, showing what exactly needs to be targeted and where the deficiencies are. Rather than displaying the brainwaves, the qEEG color codes the patients brain itself to depict any abnormalities in specific brain regions. It is often referred to as EEG interpretation and analysis. Below is an example of such a report.

This is often performed as an initial test (to determine what treatment should be used) and a final test (to show improvement). However, a brain map can be very expensive so a large percent of patients do not pursue it. For most, it isn't even necessary -- people with many mental conditions will notice improvement (behavior changes, more focus, etc.) after training, so proof is not really necessary.  

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Introduction and Abstract

Hi everyone! My name is Ananth Kuchibhotla, and I am a senior at BASIS Peoria. Here is a little introduction to my Senior Research Project:

Do you think it’s impossible to increase your iQ and mental capacity? Think again. Neurofeedback therapy manipulates brainwave level to do exactly that: promote neurological growth and advancement. My project will focus on whether or not neurofeedback therapy actually can increase iQ and/or affect an individual’s optimum brain potential. In addition, I will address whether such a revolutionary technology can be applied to treat certain mental conditions characterized by brainwave abnormalities, such as ADD, PTSD, and Social Anxiety Disorder. Under Dr. Gurney of Scottsdale Neurofeedback Institute, I will learn how to conduct therapy sessions, interpret brain scans, and track performance progress. Not only will I be interning under Dr. Gurney, I will also be training the patients and programming the therapies myself. I will understand the correlation between such brain conditions and mental stability and levels of performance. After undergoing my internship, I will research how exactly the brain’s electricity is managed and transformed into forms of expression and certain degrees of mental capacity.

I am so excited to work with Scottsdale Neurofeedback Institute on this project. I have already met the staff and they seem happy to help! I will mostly be working with Dr. Robert Gurney and his EEG technicians, Josh and Jimmy. Tomorrow is my first day. Wish me luck.

For more information on the Scottsdale Neurofeedback Institute, please visit: http://scottsdaleneurofeedback.com/

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