BRAIN BASED THERAPIES
Brain based therapies utilize brain stimulating modalities such as vibration, auricular stimulation to the ear, sound and smell stimulation, eye exercises and visual stimulation to activate specific sides of the brain that may be under-firing.
Neurofeedback (Biofeedback) and Quantitative EEG/Brain Mapping:
What is Neurofeedback?
Neurofeedback is a learning strategy that enables persons to alter their brain waves. It is a technique in which we train the brain to help improve its ability to regulate all bodily functions and to take care of itself. When the brain is not functioning well, evidence of this often shows up in the EEG (Electroencephalogram). By challenging the brain, much as you challenge your body in physical exercise, we can help your brain learn to function better.
How can Neurofeedback help?
A better functioning brain can improve sleep patterns. When you sleep more efficiently, you are more alert during the day. It can help with anxiety and depression, and with syndromes like migraine or chronic pain. Secondly, it can be helpful in managing attention - how well you can persist even at a boring task. Thirdly, it can help you manage the emotions. If the emotions are out of control, that's trainable. If they aren't there---as in lack of empathy, for example---that, too, is trainable.
Finally, there are some specific issues where the EEG neurofeedback training can be helpful, such as in cases of seizures, traumatic brain injury, stroke, and autism. In these instances the training does not so much get rid of the problem as it simply organizes the brain to function better in the context of whatever injury or loss exists.
How is it Done?
An initial interview is done to obtain a description of symptoms, and to get a picture of the health history and family history. Then a Quantitative EEG (QEEG) which may take up to 2 hours. Once QEEG results are obtained then training session can begin. Subsequent training sessions last about 40 minutes to an hour, and are conducted from one to five times per week. Some improvement is generally seen within ten sessions. Once learning is consolidated, the benefit appears to be permanent in most cases.
Training sessions are a painless and non-invasive. One or more sensors are placed on the scalp, and one to each ear. The brain waves are monitored by means of an amplifier and a computer-based instrument that processes the signal and provides the proper feedback. This is displayed to the trainee by means of a video game or other video display, along with audio signals. The trainee is asked to make the video game go with his brain. As activity in a desirable frequency band increases, the video game moves faster, or some other reward is given. As activity in an adverse band increases, the video game is inhibited. Gradually, the brain responds to the cues that it is being given, and a "learning" of new brain wave patterns takes place. The new pattern is one which is closer to what is normally observed in individuals without such disabilities.
What is a Quantitative EEG (QEEG)/Brain Mapping?
QEEG Brain Mapping is a procedure that records electrical activity within the brain from 24 channels. This tool gives us the ability to view the dynamic changes taking place throughout the brain during processing tasks and assist in determining which areas of the brain are fully engaged and processing efficiently.
A Quantitative EEG or QEEG Brain Mapping provides information about the functional organization and disorganization of the brain and its normal development. Each QEEG is compared to a normative database (Neuro Guide) that displays the EEGs of normal brain functioning individuals with your child's brain waves. It serves as a basis for identifying variations in brain function that are associated with different types of neurological disorders as well as assuring that the true underlying cause of the problem is addressed. This brain map provides a baseline to work from in order to know whether or not training sessions are making a positive change.
Brain processing problems often revealed themselves in the QEEG in one or more of the following brain wave categories:
- Absolute Power – How much Brainpower is Available? Absolute Power measurement aids the Neurotherapist in determining whether enough brainpower within a particular frequency range is present at each recording site.
- Relative Power – Who’s In Charge Here?The Relative Power measurement aids the Neurotherapist in determining whether a particular frequency is overpowering other vital brain frequencies.
- Mean Frequency – Are they within Spec? Each frequency band is measured between specific ranges. The average frequency tells us whether or not that specific bandwidth is operating within normal ranges. For example the alpha frequency is measured between 8hz and 13hz. It should peak around 10 hz. Often when we observe it peaking at 9.5hz and below, we observe individuals being tired, error prone or simply misunderstanding vital input information.
- Ratios – Relationships are extremely important. Relationships between the various brain frequencies are compared to those individuals with normal brain functioning. Ratios lower or higher than normal are a sign of inefficiency, in either the brain’s ability to process incoming information, or of attending to and executing specific tasks.
- Asymmetry – The Brain’s Balancing Act. Asymmetry scores reveal to us whether the brain waves between the various parts of the brain are balanced. Excessive activity may indicate an overtiring of brain cells. Insufficient activity may suggest brain cells are not firing sufficiently to maintain proper brain function.
- Coherence – Who’s Talking to Whom? In order for us to understand the complexity of the world and to make and execute decisions the different parts of the brain must share information. Coherence is one of the measurements on how well the brain is able to perform this inner self-talk. This measure gives us an indication of how efficiently our brain is working to connects and disconnects different parts of itself to accomplishes a particular task. Excessive Coherence tends to indicate two or more areas of the brain are “overly connected or locked together.” That is, the brain has become overly dependent on those centers and is not efficiently processing and executing information. This tends to result in poor day-to-day performance. Deficient Coherence is the EEG sign of a brain not able to efficiently connect cortical areas to perform specific tasks. Learning Disabilities may show either (or both) excessive and deficient Coherence characteristics; serious traumatic brain injury classically results in excessive Coherence.
- Phase – Tortoise or the Hare? Many of the brain’s functions are timed events, the energy from one part of the brain arriving at another area at just the right moment to perform a specific task. The QEEG measurement is called Phase. Excessive Phase statistics mean the signals arrive too early; deficient, too late. In either case, the brain is not able to do its job with peak efficiency.
Brain Waves, Neurofeedback, and Autism
Early EEG Neurofeedback researchers were inspired by the reconceptualization of Autism as an attentional problem. An examination of the brainwaves of the autistic patient consistently revealed an abnormal EEG signature. The autistic EEG signature is different from the ADD signature.
The ADD patient doesn’t produce enough Beta (fast) Wave activity, where as most ASD patients produce too much Beta activity. Simply stated, their brains appear to be over focusing and over stimulated.
Neurofeedback Therapy targets the over-production of fast wave activity in the Autistic or Asperger’s patient and trains them to lower it. (Unfortunately, this training is only available to ASD patients who have some capacity to interact with the therapist.) With neurofeedback therapy the patient is taught to recognize their over focusing and to slow it down. (QEEG Map) to diagnosis ASD, as well as the use of continuous performance tests (IVA) to measure Neurofeedback improvements.
QEEG as tool to Dignose Autism Subtypes
Dr. Linden (2004, 2008) of Attention Learning Centers identified six QEEG patterns of Autism and two of Aspergers based on 19 channel EEG recordings and analysis of raw EEG, absolute power, relative power and multivariate connectivity. The six Autism QEEG subtype patterns are:
- High Beta activity which corresponds to obsessing, overfocusing and anxiety
- High Delta/Theta activity which corresponds to cortical slowing and inattention, impulsivity and hyperactivity
- Abnormal EEG/Seizure activity
- Metabolic/Toxic pattern of lower overall EEG activity (voltage)
- Mu activity which corresponds to social skills
- Coherence Abnormalities
The High Beta and coherence subtypes were the most common subtypes, occurring in approximately 50-60 percent of the students with ASD. The Delta/Theta subtype occurred in 30-40 percent, the Abnormal EEG subtype in 33 percent and the Metabolic/Toxic subtype in 10 percent.
The QEEG patterns with students with Asperger’s primarily occurred in the right temporal and parietal regions, sites involved in social and emotional recognition mechanisms. The QEEG patterns of those with Aspergers’ are:
- High Theta/Alpha slowing in the right temporal/parietal areas
- Low coherence between right temporal/parietal brain regions and other regions.
More than one QEEG subtype pattern was frequently present in the students with ASD.
How will you now if Neurofeedback is working?
After a series of training sessions, another QEEG will be performed on your child. You will get to see changes in your child's brainwaves. For examples of how the brain can look different after training sessions, go to the following link (Reading the maps section):
Hemispheric Integration Therapy (HIT)
What is it?
Hemispheric Integration Therapy is a sophisticated system that balances under-connected electrical activity in the brain and strengthens weakened pathways through different sensory and motor activities.
The examination will include the evaluation of the nervous system from the receptors and progressively to the brain. Functional evaluation of vestibular function, cerebellar function, basal ganglia, brain stem, mid brain and lobe of the brain will be performed in order to localize the suspected functional lesion. Lesion localization refers to trying to find the one area of the brain that is malfunctioning and that explains most of the symptoms. At times, there may be several lesions with one primary lesion evident.
We also want to determine if there is laterality to the lesion. That is, is there a sidedness to this problem. We know that the right and left sides of the brain are specialized. For example, we know that the right brain pertains to things such as attention, impulsive behavior, anxiety, concepts, abstract thoughts, issues with reading comprehension, math reasoning, nonverbal communication, appropriate social behavior and gross motor skills. The left brain pertains to things such as difficulty reading (not comprehension), speech delays (verbal communication), auditory processing, motivation and graphomotor skills (handwriting). Dealing with the laterality is part of what is known as hemispheric integration. Realize that most children do not fit solely into one category or the other. It is not as simple as just left and right.
What is treatment like?
Typically the treatment consists of various stimulation to the body through the use of the senses. This may include things such as strengthening exercises, balance and coordination exercises, cognitive exercises, rhythm and timing exercises as well as different types of sounds, lights, taste or smells. The stimulation to it will be performed with the target area of the nervous system in mind in addition to being performed in a progressive matter so as to increase the demand on the nervous system without exceeding the patient’s metabolic capacity. This is a non pharmaceutical approach. The goal of this treatment is too restore as much function as possible within the child as well as reduce or eliminate the need for medication.
Interventions often used in HIT
Brain Based Music
Interactive Metronome Therapy
Exercise with oxygen therapy
Unilateral spinal manipulation
Why does it work and what benefits can be seen?
You can exercise your brain as you exercise the muscles in your body. This can be done through a concept called neuroplasticity. Strengthening and integrating nerve function leads to optimal expression of our humanism. This can lead to improvements in attention, executive function, language (both verbal and nonverbal), social skills, behavioral issues and academic problems. Strengthening these neural circuits and pathways can lead to improved physiologic capacity and learning ability. We are not attempting to teach your child but to increase their ability to learn. Neuroplasticity makes this all possible. In plain English, the brain is not hard wired and it’s structure and function can be changed.
What is Vision Therapy?
Vision therapy -- a type of physical therapy for the eyes and brain -- is a highly effective non-surgical treatment for many common visual problems such as lazy eye, crossed eyes, double vision, convergence insufficiency and some reading and learning disabilities.
In the case of learning disabilities, vision therapy is specifically directed toward resolving visual problems which interfere with reading, learning and educational instruction. Optometrists do not claim that vision therapy is a direct treatment for learning disabilities.
What is involved in a Vision Therapy program?
Vision therapy is --
- a progressive program of vision "exercises" or procedures;
- performed under doctor supervision;
- individualized to fit the visual needs of each patient;
- generally conducted in-office, in once or twice weekly sessions of 30 minutes to an hour;
- occasionally supplemented with procedures done at home between office visits ("home reinforcement" or "homework");
- depending on the case, the procedures are prescribed to:
- help patients develop or improve fundamental visual skills and abilities;
- improve visual comfort, ease, and efficiency;
- change how a patient processes or interprets visual information.
- help patients develop or improve fundamental visual skills and abilities;
Medical equipment can be used in Optometric Vision Therapy programs:
- corrective lenses (regulated medical devices);
- therapeutic lenses (regulated medical devices);
- prism lenses (regulated medical devices);
- optical filters;
- occluders or eye patches
- electronic targets with timing mechanisms;
- computer software;
- balance boards (vestibular device)
- visual-motor-sensory integration training devices
Interactive Metronome (IM):
What is IM?
The Interactive Metronome (IM) is a brain-based rehabilitation assessment and training program developed to directly improve the processing abilities that affect attention, motor planning, and sequencing. This, in turn, strengthens motor skills, including mobility and gross motor function, and many fundamental cognitive capacities such as planning, organizing, and language.
- During IM the individual listens to the steady metronome beat over headphones and performs arm and leg movement patterns at the same time as each metronome beat sound.
- Changing auditory guide sounds tell the individual exactly how accurate the rhythmic timing of his or her movements are as they are occurring.
- The sounds also help the individual recognize when his or her attention is wandering and learn how to get back on task.
Motor planning and sequencing problems have been linked to a variety of developmental, behavioral, and learning challenges. More than a decade of clinical research on IM demonstrates gains in motor planning and sequencing lead to improvements in:
- Attention and Concentrarion
- Language Processing
- Behavior (Aggression and Impulsivity)
- Motor Control and Coordination
- Academic Performance
Who can benefit?
Individuals. with motor planning and sequencing problems, speech and language delays, motor and sensory disorders, learning deficits and various cognitive and physical difficulties may benefit from the 1M program. Adult and pediatric patients. who have benefited from IM include those with:
- Sensory Integration Disorder
- Asperger Syndrome
- Autism Spectrum Disorder
- Cerebral Palsy