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What is Neurofeedback?
1 What is Neurofeedback?
Neurofeedback is a generic term that designates a computerized method of brain observation and training originating from neuroscience. The aim is to record and analyze the activity of neurons in order to optimize the brain’s performance by showing it information about its own functioning. The information collected, called feedback, can be auditory, visual, or even tactile, depending on the neurofeedback system used. All neurofeedback systems have similar basic functions, with a few variations, but they have different graphical environments, different presentations, a specific design and their own levels of training and performance. What is fundamental and common to all neurofeedback systems is the reception of the signal emitted by the brain, its transformation, its analysis by the software and its real-time rendering via the feedback. 1.1. Different tools This book references two therapeutic neurofeedback systems that I use in my own consultation practice: – the Cygnet® neurofeedback/EEG biofeedback system based on the Othmer method, EEG Info, a first-generation system (created in the 1980s under the name of the EEG Spectrum, which became EEG Info in 2002) and presented, in this book, under the name of classic neurofeedback;
4
Neurofeedback
– the NeurOptimal® system based on the Zengar method, a secondgeneration system that developed out of classic neurofeedback (created in 1996 under the name of NeuroCare®, which later became NeurOptimal®). In this book, it is called dynamic neurofeedback. There are several other kinds of tools to observe electrical neural activity designed by companies involved in neuroscience research and also in connection with the medical community. Not all of the systems presented below are intended for neurotherapy, unlike the Cygnet® and NeurOptimal® systems. Some of the most well-known medical instruments used to observe the brain include: – EEG: electroencephalogram; – fMRI: functional magnetic resonance imaging; – MEG: magnetoencephalography; – fNIRS: functional near-infrared spectroscopy; – HEG: hemoencephalography. And among the instruments that can be used to train the brain, aside from the two tools cited above that I use in my own practice: – LoRETA: low-resolution electromagnetic tomography. These tools allow brain activity to be “visualized” thanks to blood flow (like magnetic resonance imagery) and also thanks to the modification of the impedance of the skin which signals an electrical activation of the brain in one zone or another (magnetoencephalography). The feedback sent is addressed to the therapist and not the patient, unlike therapeutic neurofeedback. Concretely, brain imaging will inform the therapist about the areas of blood flow in the brain and provide information about how it operates. It is not intended, a priori, to be used by patients directly in order for them to act on their own brains to modify their functioning, although this is entirely possible. Therapeutic neurofeedback informs the practitioner about the cerebral activity of the patient, but above all, it informs patients about their own brain function, allowing them to eventually try to self-regulate it where appropriate. The process can be referred to as a re-education of the brain.
What is Neurofeedback?
5
My approach as a neurofeedback clinician is to seek to understand, decode, know and discover a new and fascinating world. Accompanying my patients toward a greater well-being, helping them to understand themselves and find themselves defines my personal approach to this therapeutic method. Some research centers, in partnership with companies, are developing and experimenting with therapeutic neurofeedback techniques in order to commercialize them for the general public. This is the case of the INRIA (French Institute for Research in Computer Science and Automation) and the company Mensia Technologies which has already developed neurotherapy tools like the MENSIA KOALATM that targets ADHD. These research groups are not the only ones – far from it – to focus on neuroscience. However, the brain–machine interface is not only used in the medical field. It is the subject of research in many domains outside of health, notably in video games in augmented reality, for example, which are currently booming. 1.2. How a session unfolds The first session lasts between one hour and one and a half hours. During the initial meeting, the patient fills out a questionnaire (history) about various problems that could concern them. The goal of this questionnaire is to then evaluate the changes that are produced. An evolution assessment can be taken after a few brain training sessions, but the brain requires time to regulate itself: the effects of neurofeedback are very rarely immediate. After placing the electrodes, a first measurement (baseline) is taken of the brain’s electrical activity that makes it possible to assess its state (anxiety, stress, emotionality, etc.) to choose the appropriate session. This also makes it possible to verify that the electrodes are correctly positioned and are receiving a good signal. After this first analysis, the person chooses the music or the video support that they want for the brain training session, which lasts about half an hour (Figure 1.1).
6
Neurofeedback
Then, the patient listens to the music and/or watches a video program (dynamic neurofeedback), or carries out tasks appropriate to the session if it consists of active neurofeedback (classic neurofeedback), while the software records the neural activity in the cerebral area where the electrodes are placed. A disturbance in the sound and image signals an imbalance to the brain. This is the feedback. During the session, the person perceives these disturbances in sound and image when the software detects too much variation in the electrical signal. The person’s brain reacts to these disturbances and attempts to regulate itself. Each modification of the sound and image is perceived as a strong alert signal because the brain does not expect it, especially as it is correlated to its own functioning. This is the information return or feedback. It is recommended to move as little as possible and relax so that the software does not have to process interference caused by movements or speech, for example.
Figure 1.1. Example of a neurofeedback session. For a color version of this figure, see www.iste.co.uk/vincent/neurofeedback.zip
The classic neurofeedback system has – in addition to feedback – a reward system that signals to the brain when it maintains a stable equilibrium. This reward can be auditory, visual or tactile. Feedback signals an imbalance and therefore a modification to carry out; the reward indicates an adapted response and a stable and balanced state to maintain, and even to reinforce.
What is Neurofeedback?
7
At the end of the session, the patient and the practitioner exchange their impressions: the person can talk about their experience, the mental images or bodily sensations that they may have perceived. The practitioner explains their analysis of different markers on the screen, which can allow the person to understand what happened, better comprehend their own functioning better, and find ways to move forward more efficiently. Depending on the system, the practitioner may carry out a second measurement of the brain’s state (dynamic neurofeedback) in order to potentially establish a preliminary assessment of effects that are likely to occur and draw a first draft of the changes that are possible. Possible does not mean that these changes will necessarily take place! The following sessions last one hour. To better support this process, the practitioner considers the patient’s evolution and experience. The practitioner then adapts the next session accordingly. As time and the sessions progress, the brain learns and modifies itself, but how the system functions often appears to be mysterious. Most patients and their families are curious to know how it works and why the brain reacts to the feedback. A doctor friend told me one day: “It’s a wonderful tool, but I cannot recommend it because I do not understand how it works. If someone asked me, I would not know what to say.” To which one of his colleagues responded: “From the moment that it works, it takes off! Do we really know how most of the medications that we prescribe work? And yet!” Here is what, for my part, I understand about how the two neurofeedback systems that I use function.
Neurofeedback is a generic term that designates a computerized method of brain observation and training originating from neuroscience. The aim is to record and analyze the activity of neurons in order to optimize the brain’s performance by showing it information about its own functioning. The information collected, called feedback, can be auditory, visual, or even tactile, depending on the neurofeedback system used. All neurofeedback systems have similar basic functions, with a few variations, but they have different graphical environments, different presentations, a specific design and their own levels of training and performance. What is fundamental and common to all neurofeedback systems is the reception of the signal emitted by the brain, its transformation, its analysis by the software and its real-time rendering via the feedback. 1.1. Different tools This book references two therapeutic neurofeedback systems that I use in my own consultation practice: – the Cygnet® neurofeedback/EEG biofeedback system based on the Othmer method, EEG Info, a first-generation system (created in the 1980s under the name of the EEG Spectrum, which became EEG Info in 2002) and presented, in this book, under the name of classic neurofeedback;
4
Neurofeedback
– the NeurOptimal® system based on the Zengar method, a secondgeneration system that developed out of classic neurofeedback (created in 1996 under the name of NeuroCare®, which later became NeurOptimal®). In this book, it is called dynamic neurofeedback. There are several other kinds of tools to observe electrical neural activity designed by companies involved in neuroscience research and also in connection with the medical community. Not all of the systems presented below are intended for neurotherapy, unlike the Cygnet® and NeurOptimal® systems. Some of the most well-known medical instruments used to observe the brain include: – EEG: electroencephalogram; – fMRI: functional magnetic resonance imaging; – MEG: magnetoencephalography; – fNIRS: functional near-infrared spectroscopy; – HEG: hemoencephalography. And among the instruments that can be used to train the brain, aside from the two tools cited above that I use in my own practice: – LoRETA: low-resolution electromagnetic tomography. These tools allow brain activity to be “visualized” thanks to blood flow (like magnetic resonance imagery) and also thanks to the modification of the impedance of the skin which signals an electrical activation of the brain in one zone or another (magnetoencephalography). The feedback sent is addressed to the therapist and not the patient, unlike therapeutic neurofeedback. Concretely, brain imaging will inform the therapist about the areas of blood flow in the brain and provide information about how it operates. It is not intended, a priori, to be used by patients directly in order for them to act on their own brains to modify their functioning, although this is entirely possible. Therapeutic neurofeedback informs the practitioner about the cerebral activity of the patient, but above all, it informs patients about their own brain function, allowing them to eventually try to self-regulate it where appropriate. The process can be referred to as a re-education of the brain.
What is Neurofeedback?
5
My approach as a neurofeedback clinician is to seek to understand, decode, know and discover a new and fascinating world. Accompanying my patients toward a greater well-being, helping them to understand themselves and find themselves defines my personal approach to this therapeutic method. Some research centers, in partnership with companies, are developing and experimenting with therapeutic neurofeedback techniques in order to commercialize them for the general public. This is the case of the INRIA (French Institute for Research in Computer Science and Automation) and the company Mensia Technologies which has already developed neurotherapy tools like the MENSIA KOALATM that targets ADHD. These research groups are not the only ones – far from it – to focus on neuroscience. However, the brain–machine interface is not only used in the medical field. It is the subject of research in many domains outside of health, notably in video games in augmented reality, for example, which are currently booming. 1.2. How a session unfolds The first session lasts between one hour and one and a half hours. During the initial meeting, the patient fills out a questionnaire (history) about various problems that could concern them. The goal of this questionnaire is to then evaluate the changes that are produced. An evolution assessment can be taken after a few brain training sessions, but the brain requires time to regulate itself: the effects of neurofeedback are very rarely immediate. After placing the electrodes, a first measurement (baseline) is taken of the brain’s electrical activity that makes it possible to assess its state (anxiety, stress, emotionality, etc.) to choose the appropriate session. This also makes it possible to verify that the electrodes are correctly positioned and are receiving a good signal. After this first analysis, the person chooses the music or the video support that they want for the brain training session, which lasts about half an hour (Figure 1.1).
6
Neurofeedback
Then, the patient listens to the music and/or watches a video program (dynamic neurofeedback), or carries out tasks appropriate to the session if it consists of active neurofeedback (classic neurofeedback), while the software records the neural activity in the cerebral area where the electrodes are placed. A disturbance in the sound and image signals an imbalance to the brain. This is the feedback. During the session, the person perceives these disturbances in sound and image when the software detects too much variation in the electrical signal. The person’s brain reacts to these disturbances and attempts to regulate itself. Each modification of the sound and image is perceived as a strong alert signal because the brain does not expect it, especially as it is correlated to its own functioning. This is the information return or feedback. It is recommended to move as little as possible and relax so that the software does not have to process interference caused by movements or speech, for example.
Figure 1.1. Example of a neurofeedback session. For a color version of this figure, see www.iste.co.uk/vincent/neurofeedback.zip
The classic neurofeedback system has – in addition to feedback – a reward system that signals to the brain when it maintains a stable equilibrium. This reward can be auditory, visual or tactile. Feedback signals an imbalance and therefore a modification to carry out; the reward indicates an adapted response and a stable and balanced state to maintain, and even to reinforce.
What is Neurofeedback?
7
At the end of the session, the patient and the practitioner exchange their impressions: the person can talk about their experience, the mental images or bodily sensations that they may have perceived. The practitioner explains their analysis of different markers on the screen, which can allow the person to understand what happened, better comprehend their own functioning better, and find ways to move forward more efficiently. Depending on the system, the practitioner may carry out a second measurement of the brain’s state (dynamic neurofeedback) in order to potentially establish a preliminary assessment of effects that are likely to occur and draw a first draft of the changes that are possible. Possible does not mean that these changes will necessarily take place! The following sessions last one hour. To better support this process, the practitioner considers the patient’s evolution and experience. The practitioner then adapts the next session accordingly. As time and the sessions progress, the brain learns and modifies itself, but how the system functions often appears to be mysterious. Most patients and their families are curious to know how it works and why the brain reacts to the feedback. A doctor friend told me one day: “It’s a wonderful tool, but I cannot recommend it because I do not understand how it works. If someone asked me, I would not know what to say.” To which one of his colleagues responded: “From the moment that it works, it takes off! Do we really know how most of the medications that we prescribe work? And yet!” Here is what, for my part, I understand about how the two neurofeedback systems that I use function.