QEEG-guided neurofeedback is based on normalizing dysregulated brain regions that relate to specific clinical presentation. With ASD, this means that the approach is specific to each individual’s QEEG subtype patterns and presentation. The goal of neurofeedback with ASD is to correct amplitude abnormalities and balance brain functioning, while coherence neurofeedback aims to improve the connectivity and plasticity between brain regions. This tailored approach has implications that should not be underestimated. . . . Clinicians, including the authors, have had amazing results with ASD, including significant speech and communication improvements, calmer and less aggressive behavior, increased attention, better eye contact, and improved socialization. Many of our patients have been able to reduce or eliminate their medications after completion of QEEG-guided neurofeedback.

Preface by By James Neubrander, MD

Parents of children with autism know me (JN) as a physician who uses various biomedical treatments to help children move toward recovery. Several years ago, I was introduced to the powerful modality of QEEG-guided neurofeedback. This treatment uses EEG biofeedback, also known as neurofeedback, guided by the QEEG, or quantitative electroencephalogram. Neurofeedback has since become an important addition to my practice because it offers therapeutic options that are not possible through biomedical treatments alone.

To date, I have obtained QEEGs on hundreds of children with autism and have watched the neurofeedback process help them take one or more steps forward on their roads to recovery. That is why it pleases me to have been asked by Autism Science Digest to write this article to introduce QEEG and QEEG-guided neurofeedback for children with autism as one more important treatment option for parents to consider.

Although I have prescribed many neurofeedback sessions for my clients, I cannot claim to be an expert in QEEG interpretation. In that regard, I defer to those who evaluate my patients’ EEg tracings and subsequently recommend appropriate neurofeedback protocols that my neurofeedback technicians then implement. My coauthors (Ml, Jg, and Ck), whose biographies speak for themselves, are some of the most respected names in the field of QEEG and QEEG-guided neurofeedback. In this paper, they provide an overview of the science behind the process, a theoretical platform, and an outline of the benefits this treatment can offer to the many children who have attention-deficit or attention-deficit/hyperactivity disorder (ADD/ADHD), Asperger’s syndrome, pervasive developmental disorder-not otherwise specified (PDD-NOS), or autism spectrum disorder (ASD).

“I have obtained QEEGs on hundreds of children with autism and have watched the
neurofeedback process help them take one or more steps forward on their roads to recovery.”

Download or Read the full PDF here.

AUTISM SCIENCE DIGEST: THE JOURNAL OF AUTISMONE – ISSUE 03

by Elizabeth L. Stroebel, Ph.D., BCIA-C

The metamorphosis of an egg into a caterpillar, to a cocoon, to a butterfly is an awesome phenomenon because it is relatively rapid; maturity is achieved in a few weeks and it can proceed full circle in complete view of the observer. The changes occurring within a child are equally cataclysmic, but are cloaked by a deceptive surface appearance of a “cute miniature person.” Many adults are prone to expect, first:that given food, support and time, this miniature adult will grow up; and, second: that there is little reason to expect significant variation and marked individual differences in the speed and nature of the developmental process, although while questioning the truth and reliability of the adult world. ugh substantive research in childhood development has shown otherwise.

However, under the observable superficial behavior, the “still water” of the engaging child runs very deep indeed and on many structural levels. Truman Capote’s novel Other Voices, Other Rooms captures the child’s challenge to interpret voice intonation and intention, as he questions the truth and reliability of the adult world and the enigma of the surrounding environments outside his own inner world. Observe the child who ultimately travels alone and leaves us in his search of self through the maze of this universe and beyond.

Curiously, thus begins the process of the very foundations of biofeedback and structural constructs, as they are intrinsically intertwined in this child’s internal milieu. In reviewing the field of structuralism relative to self-regulation, structuralist theory in general promotes the belief that underlying the immediate conscious experience, there is a complete network of components which pervades all human intellectual, emotional, ideological and self-actualization. (Claude Levi-Strauss).

Within a child’s ever changing view of his world, structural constructs dominate this internal milieu as codes operating at many levels: the symbolic representing the ‘depth and secrecy’ of knowing how a thing should be; the hermeneutic sorting and sifting the ambiguity of events and interpretations between the child’s internal and external environment; the semantic assigning the child’s own descriptive language and context; and the active playing out in motion ones physiological, emotional, mental topography. Children absorb themselves into an alliance with the natural world where they establish their connection and importance in the larger scheme of things. I am I and who are you?

What is there about children?

Children are uniquely human, individual, poetic, and infinitely complex. While the child may not understand these complex dynamics, nonetheless, the child experiences his own unique physical sensations in response to the vibrations within his environment. Like long tangled string, the child bobs and weaves along his little journey into the larger scheme of things and is driven by an internal highly sophisticated cross current of signaling systems that sometimes go awry. Heretofore, these covert interactions were not observable to the outside except through overt behavior and communication.

Biofeedback: the healthy break through and the way in

The Biofeedback process facilitates a time-travel adventure and is the “way in”, states one adolescent, and “then I can do it by myself on the way out.” Biofeedback is a two-way express ticket to inner and outer space. With concrete evidence, the youngster observes and negotiates with his organism by self-regulating his breathing patterns, quieting the heart rhythms, hand warming, reducing inappropriate muscle tension, dysponesis hits the spot (Stroebel, E. 2005), interrupting hyper vigilance, etc. Another youngster described biofeedback as a “Traveling road show where I am the star and can get inside myself and see on the computer screen what’s going on so I can change it!” – a pragmatic translation that says, “This is healthy for me.”

Small kids love the idea that they can run the show and organize a trip inside to talk to their blood and guts, converse with their brain, and to send messages through the nerves to the cells-the red anger and angst, light blue sadness and hurt, and the yellow soothing talk all traveling down the integral highways from the brain to the heart and other places of choice-a back and forth shuttle. Kids are empowered to sooth the physical and emotional spots that hurt. The Voice of the Child is now recognized in health-care as the essential key to developing interactive strategies for wellness and a substantive quality of life. Thus the child’s more silent spring within nurtures an intuitive sense of body-knowing just how a thing should be.

Explanations for parents and care-givers

Biofeedback is a safe and enjoyable non-invasive process, which involves a partnership between the child, the computerized equipment, and initially the guide. One youngster described this partnership as “The way to zip inside and peek at the mechanics so you can fix them with a “tune up!”

Step one

Sophisticated technical equipment monitors and displays for observation the constantly shifting interactions between the child’s signaling systems in the brain from his thoughts, emotions, feelings, and with his self report about his physical bodily sensations and overall physiological activity.

With a clear goal that individuals have healthy power to make changes and along with child oriented instructions, the child is spurred on by his own inquisitiveness and curiosity. The child learns specific experiential and cognitive skills, which he uses to fuel his own control tower for change. Neurofeedback with its multi monitoring capability records brain wave activity and subsequently shapes change with tailored training protocols. Peripheral Biofeedback facilitates changes in skin temperature, muscular activity, heart rate variability, sweat gland responses, respiratory function, and other body functions. Bingo! Twice the power for optimal health is achieved when combining neurofeedback and peripheral biofeedback.

Step two

Simultaneously, the data is fed back in real time in age appropriate non-threatening audio and visually fun graphics for the child’s viewing.

Step three

Through an enjoyable process, the youngster can assess, discuss, and redirect ‘brain messages’ with therapeutic strategies for internal changes, i.e., self-regulate over- breathing, interrupt sustained muscle tension, or refocus impaired concentration. With practice, he can achieve an ‘alert mind and calm body’ to reduce or eliminate physical discomfort, control anxiety, improve concentration and enhance performance.

Step four

The child learns how to transfer assisted biofeedback self-regulation skills into his daily life. The outcome is that this process actively impacts physical health, social behaviors, performance, achievement and overall sense of self esteem.

Biofeedback: the internal frontier

Biofeedback has opened up a once unfathomed “internal frontier” for unlimited healthy emotional and physical growth. Biofeedback applications for the classroom beginning in preschool already have a positive track record since the early eighties (Stroebel,E 1981) for increased performance, self-confidence in ability to learn and enjoyment in the process Pediatric health-care in general has twenty plus years of efficacy in prevention and in healing. The emergence of integrative medicine promises even greater potential for the prevention of illness and impact on the disease process, along with effective strategies in pain management and for repair. For children whose lives have been damaged by a childhood too harsh, biofeedback offers a way for them to trust in an observable safe process where they have positive internal control. They can rediscover the goodness of self and emotionally and physically heal from trauma. Self-regulation empowers the child to initiate healthy change from what hurts to what feels better by self-induced learning and transfer skills as an automatic part of his responses.

The challenge

Pediatric biofeedback challenges us to teach self-regulation as a life long skill. Even amidst the expected rapid physical and emotional developmental changes, the child benefits. As the child’s life vacillates between joyous times, normal daily stressors and unexpected traumatic experiences, the learned response to these can shape for life the individual’s choice of how to manage these challenges either in a healthy or destructive way. With biofeedback, the child has additional strategies in place for healthy solutions no matter what the challenge.

Life long skill

Some youngsters feel there isn’t any solution, no way out, as their distress invades every aspect of life. Biofeedback is not only a way out, but an on-going healthy life long tool. Not exempt from strain on their organism, and not always able to self-correct without assistance, children possess a native sense of order which seems in contradiction to the sometimes outward appearance of disorder. Their physiology is affected by the relentless demands from the external and internal environment which overrides the inherent basic body safety mechanisms for self-regulation.

The empowered child

A seven year old with a chronic illness calls biofeedback “serious fun when things are yucky.” Affirm to parents that the child has a magnificent self-tool to reaffirm his importance in his treatment plan and in a wellness model to exchange dialogue with health-care providers and family. Tangible strategies empower the child to deal with both the invisible invaders of illness-chronic and acute pain sensations(Carter, B. 1998), life-threatening conditions and accompanying grief; and children suffering from neglect and abuse, seemingly uncontrollable anxiety, attachment and abandonment issues, defiant/oppositional behavior, aggressiveness, learning disabilities and attention deficits,hyperactivity, struggling families to improve communication, and school and peer related difficulties.

Healthy power within

Adults ask if young people can really understand and implement the biofeedback process. Kids are autonomic biofeedback whizzes. With eyes open, they whiz up and around the learning curve of self-regulation of their body safety mechanisms, i.e., adjusting breathing patterns, slowing down inappropriate racing feelings, calming upset stomachs, interrupting tension headaches, warming cold hands, interrupting faulty bracing and managing pain sensations. And that is just the beginning. They teach You!

Children show a remarkable capability of intrinsic and kinesthetic understanding of complex physiology and behavior with-out all the definition.Their Kiddie Physie is a bag full of healthy tools, metaphors, stories, strategies and sixteen healthy body friends (Stroebel, E (2006) as biofeedback buddies to help lead the way. Kids engage in unlimited safe pathways with visualization, guided imagery, and self-talk. Biofeedback calls upon all sensory capacities, imagination, and always grounded with safe exits.

Parent’s role

Most parents hurt when their child hurts. Telling youngsters “not to worry” or to “just take it easy” without strategies to do so doesn’t help long term. And often increases anxiousness. Biofeedback provides a family partnership in wellness and enhanced communication.

Benefits

Biofeedback is important to an enhanced quality of life.

Conclusion

The last word- “I like biofeedback. It listens to me and I listen to it.” (Child age 6)

References

Biofeedback Magazine. (2005) Winter Vol 33. “Dysponesis hits the spot: A translation for and by children. Association for Applied Psychophysiology and Biofeedback.

Capote, Truman (1994) Other Voices, Other Rooms. Vintage Books. New York. 1994

Carter, Bernadette (1998) Perspectives on Pain. Mapping the Territory. Arnold Press. London. 1998.

Leach, Edmund (1979) Claude Levi-Strauss. Viking Press. New York

Stroebel, E. L. (2006) Der Kiddie Quieting Reflex-Stess-management in Kindergarten und Schule. Pirker-Binder, Ingrid. Biofeedback in der Praxis, Springer. Wien.

Stroebel, Elizabeth L. (2007) Kiddie QR: A Choice for Children. Revised 2007 –Comprehensive Program.Stroebel, Elizabeth L. Science 81. October. Kiddie Stress American Association for the Advancement of Science.

Contact: elizabethstroebel@hotmail.com

About The Author

Elizabeth Stroebel is an internationally known lecturer and specialist in the field of applied psychophysiology for children and adolescents and co-chair of the Education Section Assoc. for Applied Psychophysiology and Biofeedback. A parent of three children and former high school and university teacher, Liz has additionally been allied with the field of applied psychophysiology for thirty years. For twelve years, she worked in the UK with Professor Linford Rees, past president of the British Medical Association and contributed to developing programs in medical settings in London, Israel and Paris. One of her major contributions to both health-care and education is The Kiddie Quieting Response: A Choice for Children, revised 2007. She is currently authoring a program incorporating the Quieting Reflex techniques for children with chronic pain and life-threatening illness.

A second and more potent alternative, in vivo desensitization, is exposing the phobic patient to the actual stimuli, e.g., taking the patient on the Boston Shuttle from LaGuardia to Logan airport after teaching relaxation and breathing strategies. This can be quite expensive, time consuming, and not always practical. Furthermore, it can be dangerous if not handled properly.

As an example of what can happen to an otherwise rational person, a successful attorney reported the following scenario, which led to her referral and subsequent treatment here at Behavioral Associates. After years of avoiding travel by air, Ms. R finally succumbed to pressure from the senior partners at her law firm to fly to California to meet with an mportant prospective client. It had become clear to Ms. R. that her superiors were becoming impatient with her “unwillingness” to fly and she feared being passed over for a partner position. So she entered treatment for this problem with me, here at Behavioral Associates.

Fear of flying can be broken down into several categories. Some people are afraid of the landing and takeoff only, while others fear the “trapped in” feeling they experience when the plane has been cruising during mid-flight. Others dread the turbulence. Ms. R. began her panic attack somewhere over the middle of the country when she realized she could not actually “steer” the plane. She was watching two obese women eating their lunch several rows ahead of her and began to imagine danger. She quickly walked up the aisle and implored them to move, saying, “You ladies are really fat and I’m sure you’re going to tip over the plane. I want one of you to get up and sit across the aisle so we are properly balanced!” When they refused, her anxiety escalated and she ran to the door of the jet and tried to open it. She was tackled and restrained by several passengers and flight attendants and was, for the most part, quite miserable (and embarrassed) for the rest of the flight to Los Angeles. She took the train home several days later and sought treatment here in New York.

A promising compromise for treating phobias is the marriage of computerized virtual reality and computerized biofeedback. Virtual reality therapy (VRT) is a breakthrough technique that allows patients to experience and actively interact with computer-generated graphics that mimic real life situations. Airplane phobics, for example, will put on a set of special glasses with headphones that generate the three dimensional experience of actually being in a plane, going down the runway, taking off, cruising through turbulence, and landing. The technology induces a sense of deep immersion into the virtual world that is similar to hypnosis; the sense of realism is enhanced because the program invites interaction with the virtual world during the “flight,” e.g., modifying the angle of looking out the window, fastening the seat belt, reading a magazine, changing stations while listening to music on the radio, etc. The patient feels as if he is actually in a plane flying! This represents a significant advance in the field of exposure therapy because the therapist has full control of the environment.

I have been experimenting with an interesting strategy of combining GSR feedback with a virtual reality training model to help phobic patients deal with fear of flying. I have divided the treatment sessions into two distinct phases that appear to be effective in reducing anxiety reduction rapidly. The first phase involves simulated exposure to the plane taking off, with the virtual reality glasses on, “experiencing” flying, turbulence, landing — all the experiences of an actual flight. During this time, I am monitoring GSR activity (the patient gets no GSR feedback, since this is only a dependent variable). In this phase the patient sees and hears things that closely resemble actual flight. The virtual reality experience is
considered successful to the extent that the patient becomes immersed or captivated. Patients report better “immersion” when I dim the lights, close the blinds, and place a darkened hood over their heads to reduce outside light. The self reported level of immersion is generally corroborated by the GSR data.

Phase 11 involves providing visual GSR feedback (no virtual reality glasses) while the patient receives only auditory exposure to the virtual reality software. The sounds of take-off, flying, turbulence, and landing all come blasting through the computer’s speakers (engine noise on the software is quite compelling). Throughout this treatment stage, the patient engages in diaphragmatic breathing designed to produce respiratory sinus arrhythmia (RSA), a benign cardiac condition associated with deep relaxation. I use a five second in, five second out diaphragmatic breathing procedure to enhance generalization.

I rotate the order of the phases throughout the treatment cycle. Thus, the audio (jet engine noise) takes on greater meaning because it has been paired, via classical conditioning, with the visual exposure that the virtual reality experience delivers. Patients are quite intrigued when I show them graphs of their raw GSR data. Furthermore, seeing objective data increases credibility from the patient’s point of view: they see and learn just how truly frightened they have become, leading to increased compliance with the treatment protocol. Also, it provides an objective method to assess progress from session to session.

It is my belief that the protocol succeeds because patients are finally able to both monitor and ultimately control their physiological responses as the interactive scenario unfolds before their eyes. We have never had this luxury before, and the combining of biofeedback and virtual reality gives us these tools. In vitro and in vivo desensitization have been merged and fortified by the potential to realistically interact with the phobic environment; as GSR feedback replaces the need for Subjective Units of Distress (SUD) scales, virtual reality replaces the need for patient visualization. However, virtual reality and biofeedback treatment are still not potent enough to stand alone and to significantly offset the typical phobic response. Fortunately, in combination, they appear to strengthen each other, completing a loop that finally allows meaningful feedback and authentic counter-conditioning. Technology marches on, resting on the shoulders of Wolpe’s (1958) counter-conditioning technique.
–
Robert H. Reiner, Ph. D.
Executive Director
Behavioral Associates
114 E 90th ST
NY NY 10128
212.860.8500 x14
rhr3ba@gmail.com
www.behavioralassociates.com

Author: By Elizabeth Landau (CNN) – When you’re under pressure from work and family and the emails don’t stop coming, it’s hard to stop your mind from jumping all over the place.

But scientists are finding that it may be worth it to train your brain to focus on something as simple as your breath, which is part of mindfulness meditation.

A new study, published in the Proceedings of the National Academy of Sciences, is the latest in a hot emerging field of research examining how meditation relates to the brain. It shows that people who are experienced meditators show less activity in the brain’s default mode network, when the brain is not engaged in focused thought.

The default mode network is associated with introspection and mind wandering. Typically, drifting thoughts tend to focus on negative subjects, creating more stress and anxiety. It has also been linked to attention-deficit hyperactivity disorder and Alzheimer’s disease.

Researchers looked at experienced meditators and trained novices. There were 12 in the “experienced” category, with an average of more than 10,000 hours of mindfulness meditation experience (Malcolm Gladwell’s “Outliers” suggests that it takes 10,000 hours to be an expert at something), and 12 healthy volunteers who were novices in meditation.

Each volunteer was instructed to engage in three types of meditation: concentration (attention to the breath), love-kindness (wishing beings well) and choiceless awareness (focus on whatever comes up). Scientists looked at their brain activity during these meditations with functional magnetic resonance imaging (fMRI).

Across all of these types of meditation, the experienced meditators showed less activity in the default mode network than in the novices. The experienced participants also reported less mind wandering than the novices. Interestingly, experienced meditators also showed increased connectivity between certain brain networks during meditation and non-meditation.

“It doesn’t matter what they’re doing, they have an altered default mode network,” said Dr. Judson Brewer, medical director of the Yale University Therapeutic Neuroscience Clinic and lead author of the study. “We were pretty excited about that, because it suggests that these guys are paying attention a lot more.”

From this particular study, researchers can’t say whether meditating is beneficial to the brain. But, viewed in conjunction with other studies showing the positive effects of mindfulness training for depression, substance abuse, anxiety and pain disorders, it seems to have promise. Also, a 2010 study found that people tend to be more unhappy when they their mind is wandering.

“Putting all those together, we might be able to start get at what the mechanisms of mindfulness are,” Brewer said.

But the study does not address the issue of cause: Is meditation changing the brain, or do people who already have these brain patterns get interested in meditation?

from http://www.clickondetroit.com/How-meditating-may-help-your-brain/-/1719524/4802480/-/7f3pwl/-/index.html

Biofeedback: Can you Teach your Body to lose Stress?

When it comes to stress relief methods for me, the devil is in the execution. More likely than not, I will stack whatever it is (or an article or book about it) on my bedside table and expect it to sink in through magic and osmosis. Alas …

I got a call early last week from my friend Parvathi, who works for a Washington clinical psychologist specializing in cognitive therapy for patients with anxiety and obsessive-compulsive disorder. “You need to check out some of these biofeedback devices for stress,” she said. “My doctor has a few of them in the office. He lends them out to patients who are having anxiety.”

I was skeptical. When I actually saw a picture of one of them, the question was obvious: How do you reduce stress by sticking your finger into a socket thingy and breathing for a while?

“Biofeedback is remarkable,” said Erik Peper, a San Francisco State University professor who has been involved in self-regulation and stress management for decades as both a teacher and a clinician.

He proceeded to lead me through a 30-second breathing exercise on the phone that left me lightheaded. “You see? Even small changes in your breathing can make a significant difference in your physiology — in your body, mind and emotions.”

(Read the full article here)

Protocol for Exporting J&J Data

1. After recording your session, exit out of J&J.

2. A small window will pop up in the middle of the screen asking you to select and name a client.

3. Click “Save to Database” and then “Export.”

4. A new window will pop up. On the top left, click on “HR/IBI” and make sure to double check where your file will be saved by clicking on the drop down menu. Also double check all the signals that will be exported in the bottom right hand side of the window.

5. Click ok. Your data should be exported in IBI format to the file you have chosen to save it in.

Protocol for HRV Biofeedback manual cleanup using Kubios HRV

1. Open Kubios HRV software, then open your data through this program in the File dropdown menu.

2. At the same time, open up the actual notepad or excel file that you are cleaning and position the window next to the Finnish program.

3. When you’ve opened the file in the Finnish program, it will show you what it actually looks like on the top right hand portion of the screen in the form of a graph with Time as the X-axis and RR(s) as the Y-axis. Each data point (blue dots in the picture) corresponds to each # in the Notepad or excel file and represents one second of data. The picture will help you to be able to see visually which data points might be ectopic. If the graph looks too hectic and you have trouble being able to see any trends, you can extend the range. There is a box directly under the graph to the very right labeled “Range(s).” To spread out the data, manually type in a smaller # here.

4. To the left hand side of the screen approximately in the middle, there is a box labeled “Remove trend components.” In the Methods dropdown menu, change the option from “None” to “Smoothn Priors.” This will add a curve to the graph by averaging out the center of the data points.

5. Unfortunately, the criteria for deciding what data points to clean is arbitrary. You just have to eyeball the data and see which data points look abnormal and which represent actual significant trends. For example, if the data points gradually go up, then you probably won’t need to delete any, but if there is a small cluster of data points that are far removed from everything else that do not appear to be part of a trend, it would be best to delete them. Remember, it’s better to average out any points that might be ectopic than to leave them as is. Methodologically, it’s probably a good idea to note which sets of data you have removed and to offer an explanation via your observations during the recording session. Ectopic beats can be caused by anything, such as the participant laughing, coughing, moving their hand, changing seating position, etc…

If your data has specific subsections in it (i.e. baseline, paced, stressor, recovery, etc…) and you want to examine each section separately but have not already manually separated them into discrete files, you can manipulate the graph by extending or narrowing the highlighted region to reflect the length of time of these segments. Double click on the graph until a compass appears, then drag the edge of the highlighted portion to correspond with the time segments you have. For example, if you are only interested in examining the paced breathing section which occurs from minutes 5-8, drag the highlighted portion to highlight only these minutes.

The statistics in the report will give you numbers calculated based off the highlighted regions only.

6. Using the picture to gauge which points you’ll need to delete, find these same beats in the notepad or excel file. This step is extremely tedious and the data point may be difficult to find. If you have trouble finding it, you can either use the seconds on the x-axis of the picture in the Finnish program or look at the #s in the file. For example, in the notepad or excel file, if all of the #s are in the 600 range and then you all of a sudden see a # that is 750, it’s probably the one you want to delete. Remember again, each of the data points you see in the Kubios graph represents each of the #s you have in IBI format and correspond by time as well, so if you are specifically looking at an ectopic beat that occurs at the 1 minute marker in Kubios, you can scroll 60 #s down in your data file to find that #.

7. Once you’ve found the data point you want to take out, go to the notepad/excel file and delete it. Replace it with the average of the 2 #s on either side of it, or in other words, the average of the #s directly preceding and following it.

8. Each time you’ve done this, resave the notepad or excel file and reopen it using the Finnish software to see what the new file looks like. This way, you can keep track of the changes you’ve made and not have to repeat any of your work in case something happens.

9. Continue to do this for each and every single file.

10. When you put the data into SPSS, go to the toolbar of the Finnish program and go to “report sheet” under “View” in the top left hand corner.

11. In the Report, look at the left column of data that’s labeled “Time Domain Results.” Under “Statistical Measures,” you’ll see:

-Mean RR*

-STD RR (SDNN)

-Mean HR*

-STD HR

-RMSSD

-NN50

-pNN50

-RR Triangular Index

-TINN

You want to take note of everything but STD of mean HR and NN50 (underlined above).

12. In the bottom left column you’ll see “Frequency Domain Results” that are faintly highlighted blue. Of the 4 columns (peak; power: ms2; power: %; power: n.u.), take notes of the last 2 power columns (% and n.u.) for all bands: VLF, LF, HF, and LF/HF.

13. Still in the Frequency Domain on the right column, you’ll see the parametric spectrum labeled AR Spectrum for Auto-Regressive Peak. Take note of the highest first peak in this graph and its PSD value.

14. Under the Nonlinear Results at the bottom of the report, take note of the SD1 and SD2 under the “Poincare Plot” as well as the Approximate Entropy (ApEn) under the “Other” table. The Approximate Entropy tells you how regular the signal is.

*Each of these measures will be a separate column in SPSS.

Protocol for HRV Biofeedback automatic cleanup using Kubios HRV:

1. Open Kubios HRV software, then open your data through this program in the File dropdown menu.

2. At the same time, open up the actual notepad or excel file that you are cleaning and position the window next to the Finnish program.

3. When you’ve opened the file in the Finnish program, it will show you what it actually looks like on the top right hand portion of the screen in the form of a graph with Time as the X-axis and RR(s) as the Y-axis. Each data point (blue dots in the picture) corresponds to each # in the Notepad or excel file. The picture will help you to be able to see visually which data points might be ectopic. If the graph looks too hectic and you have trouble being able to see any trends, you can extend the range. There is a box directly under the graph to the very right labeled “Range(s).” To spread out the data, manually type in a smaller # here.

4. To the left hand side of the screen approximately in the middle, there is a box labeled “Remove trend components.” In the Methods dropdown menu, change the option from “None” to “Smoothn Priors.” This function averages out your data by finding trends and smoothing out the data points. Graphically, it will add a curve to the graph.

5. If your data has specific subsections in it (i.e. baseline, paced, stressor, recovery, etc…) and you want to examine each section separately but have not already manually separated them into discrete files, you can manipulate the graph by extending or narrowing the highlighted region. Double click on the graph until a compass appears, then drag the edge of the highlighted portion to correspond with the time segments you have. For example, if you are only interested in examining the paced breathing section which occurs from minutes 5-8, drag the highlighted portion to highlight only these minutes.

The statistics in the report will give you numbers calculated based off the highlighted regions only.

6. To the left hand side of the screen above the “Smoothn Priors” area, you will see a section labeled “Auto Correction” with a drop down menu allowing you to manually choose the degree of correction you would like the computer to apply to your data. The degrees of correction range from “very low” to “strong.” This function basically corrects your data for outliers and reflects your data with those outliers averaged out. The amount of auto correction you want to use will vary and depend on each segment of data you have.

Make sure that you document the amount of correction you have decided to use for each piece of data and that you mention this in your methods section.

7. When you put the data into SPSS, go to the toolbar of the Finnish program and go to “report sheet” under “View” in the top left hand corner.

8. In the Report, look at the left column of data that’s labeled “Time Domain Results.” Under “Statistical Measures,” you’ll see:

-Mean RR*

-STD RR (SDNN)

-Mean HR*

-STD HR

-RMSSD

-NN50

-pNN50

-RR Triangular Index

-TINN

You want to take note of everything but STD of mean HR and NN50 (underlined above).

9. In the bottom left column you’ll see “Frequency Domain Results” that are faintly highlighted blue. Of the 4 columns (peak; power: ms2; power: %; power: n.u.), take notes of the last 2 power columns (% and n.u.) for all bands: VLF, LF, HF, and LF/HF.

10. Still in the Frequency Domain on the right column, you’ll see the parametric spectrum labeled AR Spectrum for Auto-Regressive Peak. Take note of the highest first peak in this graph and its PSD value.

11. Under the Nonlinear Results at the bottom of the report, take note of the SD1 and SD2 under the “Poincare Plot” as well as the Approximate Entropy (ApEn) under the “Other” table. The Approximate Entropy tells you how regular the signal is.

*Each of these measures will be a separate column in SPSS.

Explanation of Kubios reports statistics

I. Measures of HRV (Time-Domain Results)

a. SDNN: standard deviation of normal to normal peaks

i. SDNN is said to represent all the cyclic components responsible for variability in the recording period

b. RMSSD: root mean square of successive differences

c. pNN50: percentage of instances in which 2 consecutive R-R intervals differ by more than 50 msecs

i. pNN50 is more useful than the NN50 because the NN50 just tells you how many R-R intervals are greater than 50 msecs. However, without the percentage of how many intervals meet this criterium, the NN50 really becomes just an arbitrary number that can’t be compared to anything

ii. pNN50 also is said to reflect strong vagal modulation without being dependent on homeostatic changes or length of recording period

*are all different measures calculated in slightly different ways that assess the same construct of heart rate variability. The actual ways these 3 statistics are calculated are quite complicated but it’s good to have all of them as extra checks.

*R-R interval or interbeat interval is the heartbeat from R peak to R peak (if you look at an ECG and the heart beat is measured via pQRST). In other words, the RR interval represents the period of time in between each QRS complex)

II. The other measures under Time-Domain Results are unnecessary. The RR triangular index and TINN are complicated statistics that involve some crazy computations, so don’t bother.

III. Frequency-Domain Results (FFT Spectrum)

a.       LF/HF ratio: the only number for LF/HF ratio is under the Power (ms²) column. The people at Kubios just didn’t feel like reporting it multiple times but this is the only number you need even though we generally don’t use the rest of the numbers under the Power (ms²) column. There’s new evidence now that if you take the natural log (ln) of LF and HF, it will give you vagal tone.

b.      Power (%) vs Power (n.u.; “normal unit”): the difference is how they are calculated. Power % = HF/(HF+LF+VLF) whereas Power n.u. = HF/(HF+LF). That is, Power % takes into account the VLF as well. We take both into account but the only important difference seems to lie with individual preference. Different big names in the field prefer different numbers so just report both of them to please everyone.

c.       No skin conductance is reported here simply because Kubios doesn’t do it. They just didn’t take it into account. If you really want to report SC, refer back to your actual numbers in your excel files. Otherwise, SC implies autonomic functioning which is implied in your HF, LF, and VLF ratios, which compare PNS to SNS activity. Up to you!

d.      Frequency Bands (just as a review…)

i.        VLF: represents parasympathetic nervous system (PNS) activity

ii.      LF: blend of SNS + parasympathetic nervous system (PNS) activity

iii.    HF: PNS activity

IV. Frequency-Domain Results (AR Spectrum)

a.       PSD = power spectral density. This is HRV as it varies over time in which the integral (yes as in calculus) of the beats are calculated and shown visually via a graph. The graph shows you high and low frequency power values so that a balance between PNS and SNS functioning can be derived via the PSD s²/Hz. The “smoothin priors” function you clicked on when reporting the data basically takes the graph from the FFT spectrum and smoothes out the irregular parts of the graph so it becomes all nice and pretty and easy to interpret in the AR spectrum.

V. Nonlinear Results

a. SD1 vs SD2 in Poincare Plot: This involves graphing the data points on different axes and giving you the standard deviations of both of those axes. The x-axis (RR_n(s)) is just the R-R interval (refer to part I of this section).

For questions or concerns, contact Christina Huang: chuang3@alliant.edu or Richard Gevirtz, PhD: rgevirtz@alliant.edu

Teen goes from wheelchair to walking in three weeks

It’s the leading cause of debilitating illness in this country but imagine being told as a teenager you’ll spend the rest of your life in a wheelchair.

Eighteen-year-old Ariadne Popma, of Michigan, was determined not to let that happen. A stroke paralyzed her left side two years ago, most likely caused by a blood disorder she has called beta thalassemia.

Electro-stimulation therapy to shock her muscles into working again didn’t work. She couldn’t feel her leg, let alone think about standing on it, until she came to Cleveland and met Dr. Jeffrey Bolek in the Cleveland Clinic’s Motor Control Program.

In three weeks, his therapy not only helped her stand, it helped her walk again. Unlike traditional therapies that electrically stimulate individual muscles, Dr. Bolek’s program forces Ariadne’s brain to tell her body what to do.

“If you can give success in one or two muscles, a lot of the other things fall into place,” Dr. Bolek says.

He also adds his method works faster which may be economical to the patient paying for healthcare. However, the therapy may not work for everyone.

It works as Ariadne walks on the treadmill and watches a monitor in front of her. Two moving lines let her know if she’s hitting her target.

But what keeps her going is the fact that her walking is powering a DVD player that shows a movie. It plays as long as she walks correctly.

“This one actually gives me feedback to use what I need so I can use my muscles accordingly to my brain,” Ariadne says.

The therapy isn’t for everyone but it also helped Ariadne regain control of her left arm. Enough that she can now shuffle cards.

From WKYC-TV

EPI has been through this and similar FDA rulings many, many times over its 30 year history. We are confident in our ability to produce the necessary science and safety data to meet the statutory requirements. However, FDA has consistently acted in an arbitrary and capricious manner in regulatory reviews submitted by EPI regarding CES. Because of this history we are not confident that a fair review is possible by FDA and therefore there is a real risk of CES being removed from the market in our country.

As always, EPI will comply with this rule making process under the guidance of its expert legal team. We will pursue all means necessary, but we need your assistance for CES to remain on the market in the USA. It is vital for the public to take advantage of sharing with FDA, through this public comment period, its opinion, whether expert or lay, of the effectiveness of Alpha-Stim CES. In this proposed rule, FDA is asserting that CES is not effective and therefore CES manufacturers should be required to complete the very expensive and time consuming PMA process. This ruling notes a price tag of $1,000,000 for the preparation of the PMA application by the sponsor (EPI) and an $8,490,000 cost to taxpayers for FDA to review the PMA’s submitted as a result of this action! It is EPI’s expert opinion that there is more than ample scientific evidence in existence to provide “reasonable assurance” that Alpha-Stim CES is safe and effective for its indications.

Please share your comments regarding your experiences with CES, including your opinion of harm that may be done to patients by removing this safe and effective technology from the US market. Please forward your comments to the FDA via the public docket as outlined in the Federal Register in the Electronic or Written Submissions section on page 48062.

The following links will lead you to the Monday, August 8, 2011 Federal Register notice, a Fact Sheet EPI prepared to assist in breaking down the rule making process and the validity of FDA assertions and for background information, we are providing a history of the arbitrary and capricious regulatory handling of CES by the FDA in the last 30 years and the last link is to Dr. Kathy Platoni’s expert opinion letter in response to the Proposed Ruling. The EPI Team is embarrassed that our government could produce such a misguided document under the guise of protecting public health. We pray that our community of support will be able to save CES in the USA! Please act now. We have until November 7, 2011 to be heard.

Please contact me or your Alpha-Stim Team member should you wish to discuss this further or have any questions or concerns.

Sincerely,

Tracey B. Kirsch

President, Electromedical Products International, Inc.

FDA Prop Rule 2011-19957
Prop Rule Fact Sheet
FDA History Alpha-Stim CES
COL PLatoni Letter to FDA

Biofeedback uses physiological measures of muscle tension (EMG), skin perspiration (GSR), temperature , respiration and heart rate variability. Neurofeedback, or EEG biofeedback assesses unhealthy brainwave (EEG) patterns to determine if an athlete is anxious, in the peak attention zone or over-focused and trains their brain to be able to maintain the optimal pattern required for peak performance. The Mind Room combines biofeedback and neurofeedback measures with game video that can be used to train several athletes at one. In addition, using the Mind Room concepts, players are less like to suffer severe injuries and recover from these injuries, including concussions, more quickly and with better long-term results.  These training benefits result in greater player performance and durability, often resulting in Olympic Gold Metals and Team Championships.

The use of biofeedback and neurofeedback are becoming more frequent in sport psychology, especially in the area of concussion assessment (using QEEG assessment) and treatment. Athletes in contact sports, especially hockey and football are increasingly experiencing concussions which not only can significantly interfere with their teams success (i.e. Sidney Crosby in the NHL), but also negatively affect their future sport success and life health.

Additional information is available in a book to be released in June 2011 called “Applications of Biofeedback & Neurofeedback in Sport Psychology” edited by Ben Strack, Ph.D. and Michael Linden, Ph.D., published by the Association of Applied Physiology and Biofeedback (www.aapb.org).

Dr. Linden is a Clinical Psychologist and Nationally Certified in Neurofeedback and Biofeedback.  He is the director of The Attention Learning Center, which has offices located in San Juan Capistrano, Irvine and Carlsbad, California.