Tools used at:
The ADD Centre® &
The Biofeedback Institute of Toronto®
A sample of some of the Tools we use with all clients:
- Electroencephalogram 1 or 2 channels
• Continuous Performance Tests (standardized):
• Questionnaires (specific to the needs of the client)
• Psychophysiological Assessment (NFB + BFB variables (8 channel Thought-Tech Infiniti)
- ADD a ‘B’ LORETA z-score NFB and a ‘C’ transcranial dirct current stimulation (tDCS)
- EEG single or two channel feedback
• Biofeedback including: heart rate variability, heart rate, respiration, skin temperature, muscle tension (emg), skin conduction.
• using Thought-tech 8 channel Infiniti and Thompson: Setting-up-for-clinical-success screens and scripts (available from BFE.org)
• Training in the use of metacognitive strategies (essential for very top scholastic performance and ours are not available in schools or learning centres)
• Captain’s Log (cognitive enhancement program)
NOTE: We make sure all clients integrate into their programs Diet (including supplements as appropriate), sleep (key factor and if insufficient we recommend changing habits before beginning training), exercise (for children sports &/or music and drama are essential factors in improving attention span and academic performance.)
To see an example of a LORETA z-score NFB session look under “Media”.
Low resolution electromagnetic tomography LORETA finds the principle source of EEG waves in the cortex. In simplest terms, imagine microphones hung in 4 rows on the ceiling of a large room. If there is a conversation taking place in one area of that room then the different amplitudes of the voices from that conversation at each of 19 amplifier locations on the ceiling would allow you to deduce where in the room the conversation was taking place. In a similar manner, LORETA mathematics enable the practitioner to infer the source within the cortex of a particular EEG activity. The advantage over traditional neurofeedback is increased specificity of the training and the possibility to train activity at locations not otherwise identifiable by conventional surface EEG. Examples of these areas might include the parahippocampal gyrus (involved in memory and affect) and / or Brodmann Area 25 (involved in depression). It also allows the patient to train up to 24 targeted areas (Brodmann Areas) in terms of amplitude, phase, and coherence of different frequencies at the same time.
Transcranial Direct Current Stimulation (tDCS):
Transcranial Direct Current Stimulation (tDCS) is the application of very small direct electrical current (DC) of about one to two milli-amperes (mA) between an anode (saline soaked pad of about 25 to 38 cm2 ) and a cathode (a slightly larger saline soaked pad of about 38 cm2). The anode (+ve) stimulation will result in excitation of the underlying superficial cortical neurons (but the opposite for neurons deep in the sulci). The cathode stimulation (-ve) will result in cortical inhibition. Surface EEG recording may show that the anodal stimulation increases beta and reduces delta while the cathode stimulation increases delta.
Effects are not long lasting but the time frame for positive change appears to lengthen as more sessions are experienced. At our centres with selected clients, we may do one short 10 to 20 minute session followed by 35 minutes of NFB every day for the first week and then follow this with 2 sessions a week. It is a hypothesis at our centre, that following the tDCS by NFB may encourage long term changes that are known to occur with NFB.
Clinical Effects of tDCS:
There are now a great many controlled studies in the literature. Only a few are mentioned here: In normal volunteers cognitive functions such as verbal fluency and learning improved with anodal stimulation over the temporal-parietal junction (Wernicke’s area) and cathode over the right orbit (Floel et al., 2008). Working memory improves with anodal stimulation of the left dorsolateral prefrontal cortex [DLPFC] and with the cathode over the right orbit (Fregni et al., 2005; Ohn et al., 2008) while both phonemic and semantic verbal fluency improves with the same setting but not when the anode is placed over the right DLPFC (Cattaneo et al., 2011). Lexical retrieval with improvement of naming performance and verbal reaction times occurs with anodal stimulation of the left DLPFC (Fertonani et al., 2009). There have also been shown to be improvements in Parkinson’s disease (Boggio et al., 2006) and in mood in depressed patients (Brunoni et al, 2013, Loo et al, 2012, Fregni et al, 2006, Boggio et al., 2007, Arul-Anandam & Loo, 2009). Some patients with tinnitus may improve with anodal stimulation of the left temporal-parietal cortex (Garin et al., 2011). Children with autism may show improvement in language syntax acquisition with anodal stimulation of the left DLPFC (Hopp, 2011). Anode stimulation of the right motor cortex with cathode stimulation of the left motor cortex will improve functions of the left hand whereas simple anode stimulation of the right motor cortex alone will not (Vines, 2008).
Side Effects of tDCS:
Poreisz (2007) studied side effects and only found mild itching, tingling, moderate fatigue, nausea, and seldom occurring headache. At the time of writing we had not experienced any side effects using this technology.
Passive infra-red hemoencephalography (pIR HEG):
Passive infra-red hemoencephalography (pIR HEG) refers to the use of 1 or 2 infra-red detection sensors to reflect temperature changes in the cortex. Biofeedback practitioners usually use sensors on a headband with the sensors placed over the forehead. The patient observes a feedback screen which shows a line graph with temperature on the ‘y’ axis and time along the ‘x’ axis. The assumption that is made is that the temperature recorded reflects changes in the metabolic activity of the frontal lobes of the brain. If this hypothesis is true then an increase in temperature should correlate with increased metabolic activity and beta activation in the prefrontal area. If this occurs then executive functions may be expected to improve. This effect has been reported by Carmen (Carmen, 2009) who claims to have found improvements in focused attention, memory, organizational ability, mood, planning, and judgment. He has also published on positive effects in the treatment of more than 100 patients who had migraine headaches.
Other Training “Tools”:
Neurofield is being added for special cases. NeuroField pEMF uses norm referenced, z-score, thresholding using the z-score, norm referenced database from Neuroguide. Z-score's are calculated in real time after a pEMF pulse is given to determine which frequency guides the brain to the normative range. Thus NeuroField EEG measures changes in the brain in response to the NeuroField pEMF stimulation. Specific amplitude and frequency changes can be measured for the purpose of guiding the brain so that, hopefully, it can function more effectively.
B. IN ADDITION TO UNDER ‘A’ ABOVE -
Other programs that we use with most clients:
- Wechsler Intelligence Scale (for adults- WAIS, or children – WISC)
• Academic measure such as the Wide Range Achievement Scale, The Peabody Picture Vocabulary Scale,
• Other scales and tests appropriate for the individual
Other Tests for specific groups of clients including:
- Tower of London (use with Asperger’s and autistic spectrum. Also useful with high level cognitive performance enhancement for testing executive functioning)
• EEG – Evoked Potentials (P300) (very sophisticated testing with precise differences compared to ‘normals’ in disorders such as ADHD)
For Training (This is always tailored to the specific needs of the individual) used as an ADDITION to the NFB program above:
- Sound and Light Entrainment as an adjunctive to the NFB (published research for specific symptoms)
C. IN ADDITION TO UNDER ‘A’ ABOVE -
With selected individuals for specific purposes:
- 19 Channel EEG with specific analysis programs such as Neuroguide with LORETA (for precise neuranatomical source of EEG differences compared to a normal data base). Always used with clients who have had a concussion, or have had a complex diagnosis such as depressive disorder or autistic spectrum disorder.
• The Lett, (for memory)
• Microcog, (computereized program measuring cognitive functioning)
• Brain Boy (a sophisticated program from Europe for cognitive assessment and training)
• Lexia (a compterized assessment and training program for reading)
D.) Training Tools:
The following are used as an ADDITION to the NFB program above:
- EEG ‘z’ score training
• Home training for long distance clients – using Thought-tech Procomp2 and Thompson: Setting-up-for-clinical-success screens and scripts which allow for combined NFB + BFB
• SAMONAS sound therapy
• Brain Boy (a sophisticated program from Europe for cognitive assessment and training)
• Stress Eraser
• Wild Divine (Computerized program for heart rate variability training
• Heart Math (not often used because it is incorporated into the biofeedback training.)
• Alpha Stimulation (a great deal of research on specific symptoms)
Other programs are available. We have assessed many other programs and decided not to include them in our program. A client’s time is limited and we attempt to only use the most efficient, effective and well researched programs. There are other effective training tools that could be added but we do not feel they would make a significant difference and they would take time away from the very effective programs that we are using. We are happy to answer your questions concerning our choice of “training tools”.
Andrea Reid-Cheung, M.A., CCC, BCIA-EEG
Andrea carries out Individual and Parent Group counselling sessions for selected clients