Brainwave Activity:

Types of Brainwaves and Stimulated Behaviors

Understanding Brain Mapping:

How to Interpret qEEG Maps and Track Trends

Types of Neurofeedback:

Single-Channel and 19-Channel

Operant Conditioning:

The Science Behind Neurofeedback

The 10/20 System

Electrode Placement

The Results:

The Final Product

Saturday, April 18, 2015

Identifying Disorders: ADHD

What is ADD/ADHD?

Attention Deficit Disorder is a neurological disorder which affects an individuals attention span, attentiveness, and ability to concentrate. People with ADD often find that focusing on tasks is very difficult, which can affect work/academic performance.

Symptoms:

1. Inattentiveness - Unable to focus on instructions
2. Hyperactivity - Unable to sit still, may seem very restless or fidgety
3. Short Attention Span - Unable to concentrate on tasks for a long period of time
4. Impulsiveness - Unable to control impulsive outbursts, emotions, or actions

ADHD in young children can often be mistaken for childish behavior, and may actually be late maturation. However, by age 5, most children have learned to sit quietly and respect instructions. At this stage, identifying ADD may be easier, as children affected by the disorder will still behave in a hyperactive/inattentive way.

What Causes ADD?

ADD is typically caused by irregular functioning of the frontal lobes, the executive action center of the brain. Abnormal blood flow to these regions, which correlate to certain brainmaps, cause behavioral problems. On the neural level: irregular electrical activity in the brain causes issues in the neurotransmission process: the proper amount of neurotransmitters are not fired across the synaptic gap. In ADD's case, the amount of dopamine (which is associated with sleep, mood, learning, and attention) is deficient. Medications that treat ADD force more dopamine to be produced to counteract the disorder. Acquisition of this disease is also hereditary. Children are very likely to get ADD if one or both parents have it.

Identifying ADD with Brainmaps

While brainmaps are not necessary for the identification of ADD, they can certainly be a helpful tool in both diagnosis and treatment. My internship adviser, Bob Gurney, participated in a research study with the creators of the NX Link Database (NYU Medical School). After analyzing the brainmaps of thousands of people with ADD, depression, obsessive compulsive disorder, etc., they created diagnosis tables containing the most common similarities between brainmaps of clients who had the same diseases. Each table contains subtypes, the most common different ways a disorder can manifest itself in the brainmaps. For example, ADD can be caused by both excessive Theta waves and Beta waves in the frontal lobes. On a brainmap, those two situations look completely different -- and yet, they result in the same disorder. These tables that were created became the NX Link discriminant database, which I described in the previous post. Clients brainwaves are compared against these norm tables for each disease, resulting in a very precise analysis/diagnosis. These tables have been tested in many countries on their native poplations, such as Japan, Nigeria, and Russia, and have proved their accuracy. Below are the subtypes for ADD, including a general symptoms list.

These are useful keys to identifying ADD in a map. If these signs are noticed, it is possible the patient has ADD.
a. New York University Medical School QEEG Normative Database Discriminant Analysis suggests the presence of Attention Deficit Hyperactivity Disorder (p<=0.025). This is merely the line printed on a QEEG if a patient is diagnosed with ADD with the NX Link.
b. Elevated frontal Theta, Alpha, and Beta (excessive Theta, Alpha, and Beta waves in the frontal lobes)
c. Reduced Delta (insufficient Delta waves in all regions of the brain)
d. Absence of expected ADHD Right frontal Theta and Alpha Asymmetry

Now these are the visual subtypes.
Normal Brain
This is what a completely normal brain with absolutely no problems should look like on the brainmap (0 standard deviations). While this is impossible, it gives the database a norm. 

Elevated Beta Subtype of ADD/ADHD
According to the key on the right, this patient has 3 standard deviations of Beta waves above the norm. As mentioned before,the fast Beta waves are produced when focusing on tasks or when concentration is necessary. However, too much blood flow, like above, can overclock the brain, causing a short attention span.

Elevated Theta Subtype of ADD/ADHD
ADD can also manifest itself in this subtype. The patient above has excessive Theta waves in the frontal regions (low blood flow there). The frontal lobes are in charge of completing tasks, executive action, and decisiveness. The excessive slow Theta waves (which are associated with drowsiness) cause sluggishness. This results in difficulty when focusing, and inattentiveness. Children with this subtype often can't pay attention because Theta is associated with daydreaming and relaxation. 

Elevated Alpha Subtype of ADD/ADHD
This patient has excessive Alpha waves in their frontal lobes. Alpha waves are the resting frequency of the brain. Imagine pulling up your car to a red light. The resting frequency of the car is analogous to the Alpha waves of the brain. If the resting frequency is too great, the brain will be working in overdrive -- the patient will tend to be more restless. This can also be a form of ADD. 


Identifying Disorders: Introduction

To identify many neurological problems and diseases, doctors and psychologists often use a type of brain-mapping system. Before demonstrating how brainmaps can help professionals, I will give you an overview of all types of neural imaging. This is the first post of "Identifying Disorders," in which I will demonstrate how neural imaging can identify various disorders. There are two specific types of brain mapping: structural and functional

Structural mapping can include MRI's, Cranial Ct Scans, etc. These maps show the structure of bones in the skull and surface of the brain. They are extremely useful when trying to identify structural problems, such as a skull fracture, brain tissue damage, etc. However, they give no insight into the actual functioning of the brain, so are not much help when identifying purely neurological problems.
MRI which shows the structure of the brain.
Functional mapping is very different. While it may not help identify structural problems, this form of imaging identifies issues with the way the brain is operating. A brain may be structurally sound, but could be operating differently from the normal. The two most popular types of functional mapping are SPECT scans and QEEG maps.

SPECT scans are nuclear image tests. Radioactive materials are injected into the patient's blood stream, and blood flow throughout the body is analyzed. This creates a color coded 3-D image of the region in question, allowing doctors to see where blood flow is irregular. SPECT scans are used for all parts of the body, however, in the brain, they can be as effective as QEEG maps. The blood flow in different parts of the brain give insight into whether that region is functioning properly or not. Irregular blood flow could indicate disorders or damage.
SPECT scan showing levels of blood flow
Analyzing SPECT scans (activity = blood flow)
Insufficient/Excessive blood flow to areas of the brain can cause performance problems in an individual. For example, excessive blood flow to the frontal lobes may cause hyperactivity and impulsiveness, while insufficient blood flow may cause inattentiveness and sluggish decisiveness.

QEEG maps are the images to which I have been referring to throughout my project. This method measures brainwave activity to identify problems. For an example of a QEEG, please see my previous posts.

Brainwaves and blood flow are actually very closely related. More fast wave activity in a certain region of the brain causes more blood flow. More slow wave activity causes less blood flow to that region. To make it simpler to understand in later posts, I have created a set of rules.

Fast waves: Beta
Resting frequency waves: Alpha
Slow Waves: Theta, Delta

Increased Beta / Decreased Beta = More blood flow / Less blood flow
Increased Alpha / Decreased Alpha = blood flow / blood flow
Increased Theta / Decreased Theta = Less blood flow / More blood flow.

So actually, the two types of brainmaps can be used together to create an even more accurate report. However, very few patients choose this route, as it is very pricey. So if SPECT scans can identify so many problems, why aren't they a popular method of disorder treatment? Firstly, they only identify the problems. SPECT scans only are used for diagnosis and offer no paired form of treatment. Secondly, they use radiation to measure blood flow, so health risks are abundant, especially in children, the elderly, and pregnant women. QEEG reports measure the various brainwaves, so they can be used in accordance with neurofeedback therapy treatment. In addition they are significantly less expensive ($400- $600) than SPECT scans ($1,200).  But I will also be referring to blood flow in the next posts, as it is an important concept to understand how disorders affect the brain.

Thursday, April 16, 2015

Neurofeedback Databases: NX Link

I realize that I haven't been posting for the last three weeks. I was busy with college decisions and deciding which college to attend. But with that decided, I will once again post regularly.

In an earlier post, I explained the uses of the Neurorep database, and how I create maps using its saved files. However, Scottsdale Neurofeedback Institute's most heavily weighted database is the NX Link Database, created by New York University's Medical School.

Creating the Brainmaps

First, I the patient's raw EEG file is imported into the host computer folder. These files (for both Eyes Open training and Eyes closed) contain the patient's amplified brainwaves. Then topographic tables are normalized -- in other words, the brainmaps/keys are labeled in a select way. Each brainmap is color coded, each color depicting a level of standard deviation from the norm. Examples will be explained later in this post. Then, the maps and brainwave files are printed and combined into a single file, the most important of which is depicted below.
 
The brainmaps are separated into columns and rows: the columns are the different brainwaves, and the rows each display the EEG information in a different way. 
 
Absolute Power: (Row 1 above) This row compares the patient's EEG to a database of normal brains, comparing each brainwave to z-scored norms. For example, the patient's Theta waves are compared to normal levels of Theta waves for an individual of their sex, handedness, and age.

Relative Power: (Row 2 above) This row compares the patient's EEG to a database of normal brains, comparing the relative levels between all the brainwaves to the relative levels of the z-scored norms. For example, a patient's Theta levels might be high compared to the norm, but their Theta/Beta ratio could be normal. This would balance out the behavioral side effects that merely excessive Theta would cause.

Power Asymmetry:/Coherence (Rows 3 & 4 above) This row compares how much the brainwaves in each hemisphere compare to those of the other hemisphere. If there is a significant deviation, it could indicate communication problems between the different parts of the brain. The electricity flowing between those regions might be irregular, and, as a result, could help identify larger neurological problems. Coherence measures how fast the regions of the brain communicate with each other. If the brain's electricity is sluggish, or even over-connected, it could indicate a form of brain damage/traumatic brain injury.

Each different interpretation of the brainwaves gives the doctor a better understanding of each individual's unique situation. Just one interpretation is not enough to diagnose, as only multiple montages could produce a relatively accurate diagnosis. 

Discriminants

Although the brainmaps themselves can be valuable tools for diagnosis, the discriminant databases are designed specifically for this purpose. The NX Link database is stored with brianwave norms for various symptoms and disorders; they compare the patient's data to each norm to determine whether the disorder is a possibility or not. For example, the NX Link may determine, after analyzing the EEG, that a patient may have Attention Deficit Disorder because their brainmaps bear similarities to those of an individual with a common case of ADD. 

After assessing which symptoms/disorders are probably causing the problems (using brainmaps), I run the patient's file through each discriminant by testing them for each symptom. The system then prints the likeliness of the patient having/developing that disorder. While not being absolutely accurate, the discriminant tool of the NX Link is invaluable for diagnosis.