Treating Dementia and Traumatic Brain Injury with EEG Biofeedback and 1072nm IR Stimulation

Treating Dementia Treating Dementia and Traumatic Brain and Traumatic Brain

Injury with EEG Injury with EEG Biofeedback and Biofeedback and

1072nm IR 1072nm IR StimulationStimulation

Combat Veterans and Combat Veterans and TBITBI

2/3 of injuries caused 2/3 of injuries caused by IEDsby IEDs

TBI afflictsTBI afflicts >25% of bomb blast >25% of bomb blast

survivors (Walter survivors (Walter Reed Army Medical Reed Army Medical Center)Center)

2/3 of IED survivors 2/3 of IED survivors (Veterans (Veterans Administration)Administration)

40% of injured 40% of injured soldiers (Defense and soldiers (Defense and Veterans Brain Injury Veterans Brain Injury Coalition)Coalition)


““Evidence-based guidelines for diagnosis Evidence-based guidelines for diagnosis and treatment are limited.” and treatment are limited.”

Roughly half of severe TBI “will regain Roughly half of severe TBI “will regain some function, but will be left with some function, but will be left with significant disability.”significant disability.”

Half may be left in a permanent vegetative Half may be left in a permanent vegetative statestate Annals of NeurologyAnnals of Neurology


Mild TBI Symptoms can includeMild TBI Symptoms can include depression, ADHD-like symptoms, depression, ADHD-like symptoms,

headaches, headaches, anxiety, fatigue, irritability, anxiety, fatigue, irritability, temper outbursts and aggression, temper outbursts and aggression, problems with memory, problems with problems with memory, problems with memory, sleep disorders, and sexual memory, sleep disorders, and sexual dysfunction.dysfunction.

Defense & Veterans Head Injury Defense & Veterans Head Injury Program Report (1998) showed no Program Report (1998) showed no effect of cognitive rehabilitation.effect of cognitive rehabilitation.

Biofeedback/Biofeedback/NeurofeedbackNeurofeedback

A method of training increased conscious A method of training increased conscious awareness and control of physiological awareness and control of physiological processesprocesses e.g., pulse oximeter, GSR, EMG or thermometere.g., pulse oximeter, GSR, EMG or thermometer

Mechanism of Action: operantly rewarding Mechanism of Action: operantly rewarding EEG phase, amplitude and/or coherence.EEG phase, amplitude and/or coherence.

Measurement/Intervention technologies:Measurement/Intervention technologies: 1072nm IR + EEG, surface cortical oxygenation1072nm IR + EEG, surface cortical oxygenation

Adjunctive Tools: ROSHI A-V Entrainment, HBOT Adjunctive Tools: ROSHI A-V Entrainment, HBOT

ROSHI A-V Entrainment ROSHI A-V Entrainment

Neurofeedback for TBINeurofeedback for TBI

Ayers, 1987Ayers, 1987

250 head injured clients250 head injured clients Decrease 4-7 Hz, Increase 15-18 Hz, 24 Decrease 4-7 Hz, Increase 15-18 Hz, 24

sessionssessions A return to premorbid function in most A return to premorbid function in most

clientsclients Normalization of phasic spikes, 4-7 Hz Normalization of phasic spikes, 4-7 Hz

activityactivity


Ayers, 1991Ayers, 1991

12 right-hemisphere CHI cases12 right-hemisphere CHI cases Six received NF + psychotherapySix received NF + psychotherapy Decrease 4-7 Hz, Increase 15-18 Hz, 24 Decrease 4-7 Hz, Increase 15-18 Hz, 24

sessionssessions Showed significant improvement in symptomsShowed significant improvement in symptoms

Six controls received psychotherapy aloneSix controls received psychotherapy alone no improvementno improvement


Hoffman et al. (1996a; 1996b)Hoffman et al. (1996a; 1996b) treated 50 patients with mild TBI treated 50 patients with mild TBI average of 40 sessions average of 40 sessions observing a clear trend of significant observing a clear trend of significant

improvement in 24 physical, emotional, improvement in 24 physical, emotional, and cognitive symptomsand cognitive symptoms


Ingo, 2001Ingo, 2001

Twelve moderate TBI patients received NFTwelve moderate TBI patients received NF Rewarded increased 13-20 Hz amplitudeRewarded increased 13-20 Hz amplitude Ten sessionsTen sessions Nine control patients received computer Nine control patients received computer

based attention training (CBT)based attention training (CBT) NF group > improvement in attentional NF group > improvement in attentional

taskstasks


Tinius and Tinius (2000)Tinius and Tinius (2000)

16 MTBI patients, 15 controls16 MTBI patients, 15 controls rewarded normalizing QEEG abnormalities: rewarded normalizing QEEG abnormalities:

Theta and SMR over C3, Cz, and C4Theta and SMR over C3, Cz, and C4 CoherenceCoherence

Significant improvement was observed Significant improvement was observed inin Attentional measures (IVA)Attentional measures (IVA) Neuropsychological symptoms (NIS)Neuropsychological symptoms (NIS) Wisconsin Card Sorting TaskWisconsin Card Sorting Task

Areas of Positive ImpactAreas of Positive Impact

Modulation of arousal levelsModulation of arousal levels

Regulation of sleep/wake cycleRegulation of sleep/wake cycle

Organization of cognitive processesOrganization of cognitive processes

Normalization of sensory processingNormalization of sensory processing

Inhibiting inappropriate motor Inhibiting inappropriate motor responsesresponses

Management of mood and emotionsManagement of mood and emotions

Athletic Performance Athletic Performance EnhancementEnhancement

“It’s definitely from the

neurofeedback I’ve been doing,”

Kaman is enjoying a breakout season, in this his fifth year in the NBA. He ranks among the league leaders in rebounds, blocked shots and double-doubles, and is one of the leading candidates for the league’s most improved player award.

Mind Games:Mind Games:

Several Several members of members of Italy's World Italy's World Cup-winning Cup-winning team, including team, including Andrea Pirlo, Andrea Pirlo, second from second from lower left, did lower left, did extensive extensive neurofeedback neurofeedback in the runup to in the runup to the tournament.the tournament.’’

WSJ,WSJ,July 29, 2006July 29, 2006

QEEGQEEG

e.g,e.g, Trudeau Trudeau et al (1998) et al (1998) showed high showed high discrimant discrimant validity for validity for evaluating evaluating

combat combat veterans with veterans with a history of a history of blast injuryblast injury

The female brainThe female brain

The male brainThe male brain

EpilepsyEpilepsy

Sterman conducted a meta-analysis of 30 Sterman conducted a meta-analysis of 30 years on neurofeedback efficacy with years on neurofeedback efficacy with epilepsyepilepsy

82% of studies showed clinical improvement82% of studies showed clinical improvement

66% showed positive changes to the EEG66% showed positive changes to the EEG

There was an average of 70% seizure There was an average of 70% seizure reduction for both intensity and frequencyreduction for both intensity and frequency

Coma RecoveryComa Recovery Ayers, 1999Ayers, 1999

32 clients in a level 2 coma for > 2 months32 clients in a level 2 coma for > 2 months Green light brightened as 4-7 Hz decreasedGreen light brightened as 4-7 Hz decreased Speakers beeped when Speakers beeped when both both 4-7 Hz 4-7 Hz

decreased and 15-18 Hz increaseddecreased and 15-18 Hz increased 25 of 32 clients came out in one or two 25 of 32 clients came out in one or two

sessionssessions 2 of 32 came out after additional sessions2 of 32 came out after additional sessions 5 were unresponsive to six sessions5 were unresponsive to six sessions


Bounais et al. (2001; 2002)Bounais et al. (2001; 2002)

Classified 27 cases in to seven symptom Classified 27 cases in to seven symptom groupsgroups

Treatment mode depended on pre-treatment Treatment mode depended on pre-treatment QEEGQEEG

Trained to normalize statistically abnormal Trained to normalize statistically abnormal measuresmeasures

Groups’ improvement ranged from 59 to 87%Groups’ improvement ranged from 59 to 87% Improvement correlated significantly to # Improvement correlated significantly to #

sessionssessions


Walker et al. (2002) MTBI patientsWalker et al. (2002) MTBI patients Rewarded normalizing abnormal Rewarded normalizing abnormal

coherence deviations from the QEEGcoherence deviations from the QEEG Up to 40 sessionsUp to 40 sessions >50% improvement in 88% (mean >50% improvement in 88% (mean

72.7%). 72.7%). All patients returned to work.All patients returned to work.

Other Studies: PTSDOther Studies: PTSD

Peniston et al. (1993) reduced Peniston et al. (1993) reduced symptoms of combat-related symptoms of combat-related posttraumatic stress disorders and posttraumatic stress disorders and alcohol abusealcohol abuse

Training alpha-theta synchronizationTraining alpha-theta synchronization Six months of group therapySix months of group therapy

DSM-IV Criteria for Post DSM-IV Criteria for Post Concussive DisorderConcussive Disorder

Head trauma hx of significant cerebral concussion.

Evidence quantified cognitive assessment of difficulty in attention (concentrating, shifting focus of attention, performing simultaneous cognitive tasks), or memory (learning or recalling information).

Three or more occur shortly after trauma and

last > 3 months: Becoming fatigued easily Disordered sleep Headache Vertigo or dizziness Irritability/aggression w/o provocation Anxiety, depression, or affective lability Changes in personality (eg, social or

sexual inappropriateness) Apathy or lack of spontaneity

DSM-IV Post Concussive DSM-IV Post Concussive Disorder (cont.)Disorder (cont.)

Symptom onset follows head trauma or represent a substantial worsening of preexisting symptoms.

The disturbance causes significant impairment in social or occupational functioning and represents a significant decline from a previous level of functioning.

DSM-IV Post Concussive DSM-IV Post Concussive Disorder (cont.)Disorder (cont.)

The symptoms do not meet criteria for dementia due to head trauma and are not better accounted for by another mental disorder (eg, amnestic disorder due to head trauma, personality change due to head trauma).

Clinical ApplicationsClinical Applications

Quietmind Foundation Quietmind Foundation Research AgendaResearch Agenda

ICAD (2009) studied impact of 40 sessions ICAD (2009) studied impact of 40 sessions

of EEG biofeedback on executive of EEG biofeedback on executive functioning functioning (N=27)(N=27)..

1072nm IR stimulation for treating 1072nm IR stimulation for treating dementia dementia

1072nm IR stimulation for Parkinson’s 1072nm IR stimulation for Parkinson’s DiseaseDisease

Prevention Gains PriorityPrevention Gains Priority

““we can’t wait to try to do we can’t wait to try to do prevention until we are absolutely prevention until we are absolutely certain what causes the disease. This certain what causes the disease. This public health emergency is just public health emergency is just going to get out of control if we don’t going to get out of control if we don’t do something.”do something.”

Neil Buckholtz,Neil Buckholtz, Chief of Dementias of Aging, Chief of Dementias of Aging,

National Institute on Aging.National Institute on Aging.

New York Times, June 2, 2010New York Times, June 2, 2010

Literature CitedLiterature Cited Ayers, M. E. (1987). Electroencephalic neurofeedback and closed head injury of 250 individuals. Head Injury Ayers, M. E. (1987). Electroencephalic neurofeedback and closed head injury of 250 individuals. Head Injury

Frontiers. National Head Injury Foundation, 380-392.Frontiers. National Head Injury Foundation, 380-392. Ayers, M. E. (Ayers, M. E. (19911991). A controlled study of EEG neurofeedback training and clinical psychotherapy for right ). A controlled study of EEG neurofeedback training and clinical psychotherapy for right

hemispheric closed head injury. Paper presented at the National Head Injury Foundation, Los Angeles, 1991.hemispheric closed head injury. Paper presented at the National Head Injury Foundation, Los Angeles, 1991. Ayers, ME (1999) Assessing and treating open head trauma, coma, and stroke using real-time digital EEG Ayers, ME (1999) Assessing and treating open head trauma, coma, and stroke using real-time digital EEG

neurofeedback. Introduction to quantitative EEG and neurofeedback. Evans, James R. (Ed); Abarbanel, Andrew neurofeedback. Introduction to quantitative EEG and neurofeedback. Evans, James R. (Ed); Abarbanel, Andrew (Ed); pp. 203-222.(Ed); pp. 203-222.

Bounias, M., Laibow, R. E., Bonaly, A., & Stubblebine, A. N. (2001). EEG-neurobiofeedback treatment of patients Bounias, M., Laibow, R. E., Bonaly, A., & Stubblebine, A. N. (2001). EEG-neurobiofeedback treatment of patients with brain injury: Part 1: Typological classification of clinical syndromes. Journal of Neurotherapy, 5.(4), 23-44.with brain injury: Part 1: Typological classification of clinical syndromes. Journal of Neurotherapy, 5.(4), 23-44.

Bounias, M., Laibow, R. E., Stubbelbine, A. N.,Sandground, H., & Bonaly, A. (2002). EEG-neurobiofeedback Bounias, M., Laibow, R. E., Stubbelbine, A. N.,Sandground, H., & Bonaly, A. (2002). EEG-neurobiofeedback treatment of patients with brain injury Part 4: Duration of treatments as a function of both the initial load of clinical treatment of patients with brain injury Part 4: Duration of treatments as a function of both the initial load of clinical symptoms and the rate of rehabilitation. Journal of Neurotherapy,Q.( 1), 23 -38.symptoms and the rate of rehabilitation. Journal of Neurotherapy,Q.( 1), 23 -38.

Carmen, J.A. (2004) Passive Infrared Hemoencephalography: Four Years and 100 Migraines . Journal of Carmen, J.A. (2004) Passive Infrared Hemoencephalography: Four Years and 100 Migraines . Journal of Neurotherapy, 8(3): 23 – 51Neurotherapy, 8(3): 23 – 51

DeCharms RC, Maeda F, Glover GH, et al. Control over brain activation and pain learned by using real-time DeCharms RC, Maeda F, Glover GH, et al. Control over brain activation and pain learned by using real-time functional MRI. functional MRI. Proc Natl Acad Sci Proc Natl Acad Sci 2005; 102:18626-18631.Hoffman, D. A., Stockdale, S., & Van Egren, L. (1996a). 2005; 102:18626-18631.Hoffman, D. A., Stockdale, S., & Van Egren, L. (1996a). Symptom changes in the treatment of mild traumatic brain injury using EEG neurofeedback [Abstract]. Clinical Symptom changes in the treatment of mild traumatic brain injury using EEG neurofeedback [Abstract]. Clinical Electroencephalography, 27(3),164.Electroencephalography, 27(3),164.

Hoffman, D. A., Stockdale, S., & Van Egren, L. (1996b). EEG neurofeedback in the treatment of mild traumatic Hoffman, D. A., Stockdale, S., & Van Egren, L. (1996b). EEG neurofeedback in the treatment of mild traumatic brain injury [Abstract]. Clinical Electroencephalography, 27(2),6.brain injury [Abstract]. Clinical Electroencephalography, 27(2),6.

Ingo, K (2001). Neurofeedback Therapy of Attention Deficits in Patients with Traumatic Brain Injury. Journal of Ingo, K (2001). Neurofeedback Therapy of Attention Deficits in Patients with Traumatic Brain Injury. Journal of Neurotherapy, Vol 5(1-2), 2001. pp. 19-32.Neurotherapy, Vol 5(1-2), 2001. pp. 19-32.

Salazar AM, Warden, DL, Schwab K, et al. The efficacy of traumatic brain injury cognitivity rehabilityation: a Salazar AM, Warden, DL, Schwab K, et al. The efficacy of traumatic brain injury cognitivity rehabilityation: a prospective, controlled, randomized Trial. Defense & Veterans Head Injury Program Report, October 20, 1998.prospective, controlled, randomized Trial. Defense & Veterans Head Injury Program Report, October 20, 1998.

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Tinius, T. P., & Tinius, K. A (2001). Changes after EEG biofeedback and cognitive retraining in adults with mild Tinius, T. P., & Tinius, K. A (2001). Changes after EEG biofeedback and cognitive retraining in adults with mild traumatic brain injury and attention deficit disorder. Journal of Neurotherapy, 1(2), 27-44.traumatic brain injury and attention deficit disorder. Journal of Neurotherapy, 1(2), 27-44.

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Walker, Jonathan E.; Norman, Charles A.; Weber, Ronald K (2002). Impact of qEEG-guided coherence training for Walker, Jonathan E.; Norman, Charles A.; Weber, Ronald K (2002). Impact of qEEG-guided coherence training for patients with a mild closed head injury. Journal of Neurotherapy, 6(2):31-43patients with a mild closed head injury. Journal of Neurotherapy, 6(2):31-43

Treating Dementia and Traumatic Brain Injury with EEG Biofeedback and 1072nm IR Stimulation

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