visual analogue scale (VAS)
Research Papers
Self-Directed Neurofeedback Treatment for Subjective Tinnitus Patients Evaluated by Multimodal Functional Imaging
Neurofeedback (NFB) is a relatively novel approach to the treatment of tinnitus, and prior studies have demonstrated that the increases in alpha activity rather than reduced delta power seem to drive these NFB-related improvements in tinnitus symptoms. The present study was therefore designed to explore whether the implementation of an alpha training protocol with a portable neurofeedback apparatus would achieve improvements in tinnitus patient symptoms. In this study, 38 tinnitus patients underwent NFB training while 18 were enrolled in a control group. The study was single-blinded such that only participants were not aware of their group assignments. Those in the NFB group underwent 15 NFB training sessions over 5 weeks, in addition to pre- and posttraining tests including the Tinnitus Handicap Inventory (THI), Tinnitus Handicap Questionnaire (THQ), visual analog scales (VAS), electroencephalography (EEG), and functional magnetic resonance imaging (fMRI). Our result find that when the THI, THQ, and VAS scores of patients in the two groups were assessed after a 5-week training period, these scores were unchanged in control patients whereas they had significantly improved in the NFB group patients. EEG analyses revealed that the alpha band was increased in the occipital lobe following NFB treatment, while fMRI indicated an increase in regional homogeneity (ReHo) in the right frontal lobe of patients in the NFB group after treatment that was negatively correlated with THI and VAS scores. The results of this analysis indicate that alpha NFB training can be effectively used to reduce tinnitus-related distress and sound perception in patients.
View Full Paper →EEG-Based Anxious States Classification Using Affective BCI-Based Closed Neurofeedback System
Purpose: Anxiety disorder is one of the psychiatric disorders that involves extreme fear or worry, which can change the balance of chemicals in the brain. To the best of our knowledge, the evaluation of anxiety state is still based on some subjective questionnaires and there is no objective standard assessment yet. Unlike other methods, our approach focuses on study the neural changes to identify and classify the anxiety state using electroencephalography (EEG) signals. Methods: We designed a closed neurofeedback experiment that contains three experimental stages to adjust subjects’ mental state. The EEG resting state signal was recorded from thirty-four subjects in the first and third stages while EEG-based mindfulness recording was recorded in the second stage. At the end of each stage, the subjects were asked to fill a Visual Analogue Scale (VAS). According to their VAS score, the subjects were classified into three groups: non-anxiety, moderate or severe anxiety groups. Results: After processing the EEG data of each group, support vector machine (SVM) classifiers were able to classify and identify two mental states (non-anxiety and anxiety) using the Power Spectral Density (PSD) as patterns. The highest classification accuracies using Gaussian kernel function and polynomial kernel function are 92.48 ± 1.20% and 88.60 ± 1.32%, respectively. The highest average of the classification accuracies for healthy subjects is 95.31 ± 1.97% and for anxiety subjects is 87.18 ± 3.51%. Conclusions: The results suggest that our proposed EEG neurofeedback-based classification approach is efficient for developing affective BCI system for detection and evaluation of anxiety disorder states.
View Full Paper →Inhibitory effects of biofeedback electrostimulation therapy on pain and cortisol levels in chronic neuropathic pain: A randomized-controlled trial
Objectives: This study aims to investigate the effectiveness of biofeedback electrostimulation therapy (BEST) in chronic neuropathic pain and to evaluate changes in perceived level of pain and level of blood cortisol before and after treatment. Patients and methods: This single-blind, prospective, randomized-controlled study included a total of 20 patients (8 males, 12 females; mean age: 53.5-13.8; range, 31 to 82 years) with chronic neuropathic pain between January 2014 and June 2014. The patients were randomized to BEST (n=10) or placebo (n=10) group. Pain was measured using the Visual Analog Scale, and serum cortisol levels were measured before and after treatment. Results: There was no significant difference in the baseline demographics, diagnosis, and treatment modalities between the groups. Approximately 50% patients in the treatment group reported that the treatment was effective, compared to 30% in the placebo group. Pain score reduction after treatment in the BEST group was significant (p 0.05), while it was not significant in the placebo group (p=0.4). Cortisol levels significantly reduced only in the BEST group after treatment (p=0.013). Conclusion: The BEST yields reduction in pain severity and cortisol levels. Based on these results, it seems to be effective in the treatment of chronic neuropathic pain after a single treatment and may be more effective for long-Term management.
View Full Paper →Using EEG Alpha States to Understand Learning During Alpha Neurofeedback Training for Chronic Pain
Objective Alpha-neurofeedback (α-NFB) is a novel therapy which trains individuals to volitionally increase their alpha power to improve pain. Learning during NFB is commonly measured using static parameters such as mean alpha power. Considering the biphasic nature of alpha rhythm (high and low alpha), dynamic parameters describing the time spent by individuals in high alpha state and the pattern of transitioning between states might be more useful. Here, we quantify the changes during α-NFB for chronic pain in terms of dynamic changes in alpha states. Methods Four chronic pain and four healthy participants received five NFB sessions designed to increase frontal alpha power. Changes in pain resilience were measured using visual analogue scale (VAS) during repeated cold-pressor tests (CPT). Changes in alpha state static and dynamic parameters such as fractional occupancy (time in high alpha state), dwell time (length of high alpha state) and transition probability (probability of moving from low to high alpha state) were analyzed using Friedman’s Test and correlated with changes in pain scores using Pearson’s correlation. Results There was no significant change in mean frontal alpha power during NFB. There was a trend of an increase in fractional occupancy, mean dwell duration and transition probability of high alpha state over the five sessions in chronic pain patients only. Significant correlations were observed between change in pain scores and fractional occupancy ( r = −0.45, p = 0.03), mean dwell time ( r = -0.48, p = 0.04) and transition probability from a low to high state ( r = -0.47, p = 0.03) in chronic pain patients but not in healthy participants. Conclusion There is a differential effect between patients and healthy participants in terms of correlation between change in pain scores and alpha state parameters. Parameters providing a more precise description of the alpha power dynamics than the mean may help understand the therapeutic effect of neurofeedback on chronic pain.
View Full Paper →Virtual Reality–Based Biofeedback and Guided Meditation in Rheumatology: A Pilot Study
Objective As technology continues to improve, it plays an increasingly vital role in the practice of medicine. This study aimed to assess the feasibility of the implementation of virtual reality ( VR ) in a rheumatology clinic as a platform to administer guided meditation and biofeedback as a means of reducing chronic pain. Methods Twenty participants were recruited from a rheumatology clinic. These participants included adults with physician‐diagnosed autoimmune disorders who were on a stable regimen of medication and had a score of at least 5 on the pain Visual Analog Scale ( VAS ) for a minimum of 4 days during the prior 30 days. VAS , part of most composite outcome measurements in rheumatology, is an instrument used to assess pain that consists of a straight line with the endpoints ranging from “no pain at all” and “pain as bad as it could be.” Patients were randomized into two groups that differed in the order in which they experienced the two VR modules. One module consisted of a guided meditation ( GM ) environment, whereas the other module consisted of a respiratory biofeedback ( BFD ) environment. Data on pain and anxiety levels were gathered before, during, and after the two modules. Results The three most common diagnoses among participants were rheumatoid arthiritis ( RA ), lupus, and fibromyalgia. There was a significant reduction in VAS scores after BFD and GM ( P values = 0.01 and 0.04, respectively). There was a significant reduction in Facial Anxiety Scale after the GM compared with the BFD ( P values = 0.02 and 0.08, respectively). Conclusion This novel study demonstrated that VR could be a feasible solution for the management of pain and anxiety in rheumatology patients. Further trials with varying treatment exposures and durations are required to solidify the viability of VR as a treatment option in rheumatology clinics.
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