clinical outcome
Research Papers
A Methodology of Analysis for Monitoring Treatment Progression with 19-Channel Z-Score Neurofeedback (19ZNF) in a Single-Subject Design
19-Channel Z-Score Neurofeedback (19ZNF) is a modality using 19-electrodes with real-time normative database z-scores, suggesting effective clinical outcomes in fewer sessions than traditional neurofeedback. Thus, monitoring treatment progression and clinical outcome is necessary. The area of focus in this study was a methodology of quantitative analysis for monitoring treatment progression and clinical outcome with 19ZNF. This methodology is noted as the Sites-of-Interest, which included repeated measures analyses of variance (rANOVA) and t-tests for z-scores; it was conducted on 10 cases in a single subject design. To avoid selection bias, the 10 sample cases were randomly selected from a pool of 17 cases that met the inclusion criteria. Available client outcome measures (including self-report) are briefly discussed. The results showed 90 % of the pre-post comparisons moved in the targeted direction (z = 0) and of those, 96 % (80 % Bonferroni corrected) of the t-tests and 96 % (91 % Bonferroni corrected) of the rANOVAs were statistically significant; thus indicating a progression towards the mean in 15 or fewer 19ZNF sessions. All cases showed and reported improvement in all outcome measures (including quantitative electroencephalography assessment) at case termination
View Full Paper →The Effects of Individual Upper Alpha Neurofeedback in ADHD: An Open-Label Pilot Study
Standardized neurofeedback (NF) protocols have been extensively evaluated in attention-deficit/hyperactivity disorder (ADHD). However, such protocols do not account for the large EEG heterogeneity in ADHD. Thus, individualized approaches have been suggested to improve the clinical outcome. In this direction, an open-label pilot study was designed to evaluate a NF protocol of relative upper alpha power enhancement in fronto-central sites. Upper alpha band was individually determined using the alpha peak frequency as an anchor point. 20 ADHD children underwent 18 training sessions. Clinical and neurophysiological variables were measured pre- and post-training. EEG was recorded pre- and post-training, and pre- and post-training trials within each session, in both eyes closed resting state and eyes open task-related activity. A power EEG analysis assessed long-term and within-session effects, in the trained parameter and in all the sensors in the (1–30) Hz spectral range. Learning curves over sessions were assessed as well. Parents rated a clinical improvement in children regarding inattention and hyperactivity/impulsivity. Neurophysiological tests showed an improvement in working memory, concentration and impulsivity (decreased number of commission errors in a continuous performance test). Relative and absolute upper alpha power showed long-term enhancement in task-related activity, and a positive learning curve over sessions. The analysis of within-session effects showed a power decrease (“rebound” effect) in task-related activity, with no significant effects during training trials. We conclude that the enhancement of the individual upper alpha power is effective in improving several measures of clinical outcome and cognitive performance in ADHD. This is the first NF study evaluating such a protocol in ADHD. A controlled evaluation seems warranted due to the positive results obtained in the current study.
View Full Paper →Clinical Perspectives of 19-Channel Z-Score Neurofeedback: Benefits and Limitations
Z-Score neurofeedback has expanded to include 19-channel models (19ZNF) such that clinicians now have the option to use from 1 to 19 electrodes in a z-score neurofeedback protocol. Benefits and limitations of this new model are discussed from the clinical perspective of an early adopter of 19ZNF who has more than 4 years of experience with this modality after having several years of experience with QEEG-guided NF (QNF). Comparisons between QNF and 19ZNF are discussed. It has been suggested that 19ZNF can bring about positive clinical outcomes in fewer sessions than traditional NF, which matches the author's experience (average of 38 with QNF vs. an average of 11 with 19ZNF). Unique implications of 19ZNF that have not yet been discussed in the literature, such as the advantage of once-per-week sessions, or questions about whether there could be times when change can occur too fast, are introduced. Directions for future research to further evaluate 19ZNF are suggested.
View Full Paper →Near-Infrared Spectroscopy in Schizophrenia: A Possible Biomarker for Predicting Clinical Outcome and Treatment Response
Functional near-infrared spectroscopy (fNIRS) is a relatively new technique that can measure hemoglobin changes in brain tissues, and its use in psychiatry has been progressing rapidly. Although it has several disadvantages (e.g., relatively low spatial resolution and the possibility of shallow coverage in the depth of brain regions) compared with other functional neuroimaging techniques (e.g., functional magnetic resonance imaging and positron emission tomography), fNIRS may be a candidate instrument for clinical use in psychiatry, as it can measure brain activity in naturalistic position easily and non-invasively. fNIRS instruments are also small and work silently, and can be moved almost everywhere including schools and care units. Previous fNIRS studies have shown that patients with schizophrenia have impaired activity and characteristic waveform patterns in the prefrontal cortex during the letter version of the verbal fluency task, and part of these results have been approved as one of the Advanced Medical Technologies as an aid for the differential diagnosis of depressive symptoms by the Ministry of Health, Labor and Welfare of Japan in 2009, which was the first such approval in the field of psychiatry. Moreover, previous studies suggest that the activity in the frontopolar prefrontal cortex is associated with their functions in chronic schizophrenia and is its next candidate biomarker. Future studies aimed at exploring fNIRS differences in various clinical stages, longitudinal changes, drug effects, and variations during different task paradigms will be needed to develop more accurate biomarkers that can be used to aid differential diagnosis, the comprehension of the present condition, the prediction of outcome, and the decision regarding treatment options in schizophrenia. Future fNIRS researches will require standardized measurement procedures, probe settings, analytical methods and tools, manuscript description, and database systems in an fNIRS community.
View Full Paper →Obsessive Compulsive Disorder and the Efficacy of qEEG-Guided Neurofeedback Treatment: A Case Series
While neurofeedback (NF) has been extensively studied in the treatment of many disorders, there have been only three published reports, by D.C. Hammond, on its clinical effects in the treatment of obsessive compulsive disorder (OCD). In this paper the efficacy of qEEG-guided NF for subjects with OCD was studied as a case series. The goal was to examine the clinical course of the OCD symptoms and assess the efficacy of qEEG guided NF training on clinical outcome measures. Thirty-six drug resistant subjects with OCD were assigned to 9–84 sessions of QEEG-guided NF treatment. Daily sessions lasted 60 minutes where 2 sessions with half-hour applications with a 30 minute rest given between sessions were conducted per day. Thirty-three out of 36 subjects who received NF training showed clinical improvement according to the Yale-Brown obsessive-compulsive scale (Y-BOCS). The Minnesota multiphasic inventory (MMPI) was administered before and after treatment to 17 of the subjects. The MMPI results showed significant improvements not only in OCD measures, but all of the MMPI scores showed a general decrease. Finally, according to the physicians' evaluation of the subjects using the clinical global impression scale (CGI), 33 of the 36 subjects were rated as improved. Thirty-six of the subjects were followed for an average of 26 months after completing the study. According to follow-up interviews conducted with them and/or their family members 19 of the subjects maintained the improvements in their OCD symptoms. This study provides good evidence for the efficacy of NF treatment in OCD. The results of this study encourage further controlled research in this area.
View Full Paper →The LENS (Low Energy Neurofeedback System): A Clinical Outcomes Study on One Hundred Patients at Stone Mountain Center, New York
Introduction. The Low Energy Neurofeedback System (LENS) developed by Dr. Len Ochs (2006a) uses feedback in the form of a radio frequency carrier wave, administered at a positive offset frequency from the person's own dominant EEG frequency. Although it is an unusual biofeedback procedure, the feedback being invisible and the subject passive, clinical evidence supports the efficacy of the LENS across a spectrum of conditions. Published research studies (Schoenberger, Shifflet, Esty, Ochs, & Matheis, 2001; Donaldson, Sella, & Mueller, 1998; Mueller, Donaldson, Nelson, & Layman, 2001) have shown the effectiveness of the LENS method with traumatic brain injury (TBI) and with fibromyalgia. No study to date has evaluated LENS treatment across the spectrum of disorders and with a significantly large sample. This study was devised to address these issues. The study hypotheses were that the LENS treatment would be effective in reducing both systematic symptom ratings and measurements of EEG amplitudes, and that the therapeutic effect would produce the most rapid improvements in early sessions of treatment. Method. "Blinded" research associates selected the first 100 patients from approximately 300 case files that met the following inclusion criteria: the person had received at least 10 treatment sessions, completed an initial CNS questionnaire, and that session-by-session subjective symptom ratings (SSRF) had been obtained. Patients ranged from 6 to 80 years old, almost evenly divided between male and female, with a wide range of symptoms and comorbid DSM-IV diagnoses. Results. Data were statistically analyzed for significance and corelational variables. Average symptom ratings across 15 major problem areas (e.g., anxiety, mood disturbance, attentional problems, fatigue, pain, sleep problems, etc.) showed significant improvements (p < .0001) from beginning to end of treatment. After an average of only 20 treatments the mean average of patient symptom ratings (0-10) declined from 7.92 to 3.96, a 50% improvement. Equally significant was the drop in EEG amplitude at the highest amplitude electrode site (HAS; p < .0001) as well as a lesser but still significant decrease at Cz (p < .002). A final analysis of the average symptom score with the HAS score showed them to be highly correlated. All hypotheses were confirmed. Conclusions. LENS treatment appears to be very efficient and effective in rapidly reducing a wide range of symptoms. It particularly produces rapid improvements in the first five to six sessions. Recommendations for future research are provided. Copyright © by The Haworth Press, Inc. All rights reserved.
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