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Kleih SC, Botrel L. Inconclusive results of slow cortical potential neurofeedback for the treatment of chronic post-stroke attention deficits. Front Hum Neurosci 2024; 18:1301622. [PMID: 38646162 PMCID: PMC11026669 DOI: 10.3389/fnhum.2024.1301622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/06/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Individuals who have suffered a stroke may experience long-lasting cognitive impairments that can worsen if left untreated. We investigated whether voluntary control of slow cortical potentials (SCP) through neurofeedback would help alleviate chronic post-stroke symptoms of impaired attention. Methods The study initially enrolled twenty-eight participants, but due to a high drop-out rate, only sixteen participants completed eight SCP neurofeedback training sessions within three to four weeks. During these sessions, we gave feedback to the participants on their ability to regulate SCPs on a computer screen. Results Our findings showed a non-significant increase in SCP regulation towards cortical negativity. On the behavioral level, we found improved test values in the divided attention and attentional flexibility subtests of the test battery for attention performance. However, we cannot eliminate the possibility that nonspecific effects influenced or caused our results. We have not observed any improvement regarding the effects of attention deficits on participants' daily lives. We identified five individuals who could gain SCP control successfully and consistently towards negativity. In this group of responders, we observed an improvement in the test results related to divided attention but no other attention-related improvements. Discussion Based on our observations, results of SCP neurofeedback training for the treatment of attention deficits after a stroke are inconclusive. More research is necessary to determine the effectiveness of SCP neurofeedback in helping stroke survivors cope with attention-related challenges in their daily lives.
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Affiliation(s)
- Sonja C Kleih
- Institute of Psychology, Biological Psychology Clinical Psychology and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Loic Botrel
- Institute of Psychology, Biological Psychology Clinical Psychology and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
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Wilens TE, Stone M, Lanni S, Berger A, Wilson RLH, Lydston M, Surman CB. Treating Executive Function in Youth With Attention Deficit Hyperactivity Disorder: A Review of Pharmacological and Non-Pharmacological Interventions. J Atten Disord 2024; 28:751-790. [PMID: 38178649 DOI: 10.1177/10870547231218925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Executive function (EF) deficits are common in youth with ADHD and pose significant functional impairments. The extent and effect of interventions addressing EF in youth with ADHD remain unclear. METHODS We conducted a systematic literature review using PRISMA guidelines. Included studies were randomized controlled trials of interventions to treat EF in youth with ADHD. RESULTS Our search returned 136 studies representing 11,443 study participants. We identified six intervention categories: nonstimulant pharmacological (N = 3,576 participants), neurological (N = 1,935), psychological (N = 2,387), digital (N = 2,416), physiological (N = 680), and combination (N = 366). The bulk of the evidence supported pharmacological interventions as most effective in mitigating EF, followed by psychological and digital interventions. CONCLUSION A breadth of treatments exists for EF in youth with ADHD. Pharmacological, psychotherapeutic, and digital interventions had the most favorable, replicable outcomes. A lack of outcome standardization across studies limited treatment comparison. More data on the persistence of intervention effects are necessary.
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Affiliation(s)
- Timothy E Wilens
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mira Stone
- Massachusetts General Hospital, Boston, MA, USA
| | | | - Amy Berger
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Craig B Surman
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Bombonato C, Del Lucchese B, Ruffini C, Di Lieto MC, Brovedani P, Sgandurra G, Cioni G, Pecini C. Far Transfer Effects of Trainings on Executive Functions in Neurodevelopmental Disorders: A Systematic Review and Metanalysis. Neuropsychol Rev 2024; 34:98-133. [PMID: 36633797 PMCID: PMC10920464 DOI: 10.1007/s11065-022-09574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/01/2022] [Indexed: 01/13/2023]
Abstract
Executive Functions are a set of interrelated, top-down processes essential for adaptive goal-directed behaviour, frequently impaired across different neurodevelopmental disorders with variable degrees of severity. Many executive-function-training studies in children with neurodevelopmental disorders have focused on near effects, investigating post-treatment improvements on directly trained processes, while enhancements of skills not directly trained, defined as far effects, are less considered, albeit these could be extremely relevant for reducing the negative impact of a disorder's core symptomatology. This systematic review and metanalysis aims to investigate the far effect outcomes after EF training in children with different types of neurodevelopmental disorders. 17 studies met the inclusion criteria for the systematic review, while 15 studies were selected in the metanalysis. An overall statistically significant effect size was found in the majority of far effect outcome measures considered in the studies. In particular, trainings on executive functions determine significant far effects on daily life functioning (0.46, 95% CI: [0.05-0.87]) and clinical symptoms (0.33, 95% CI: [0.15-0.51]). Despite a high variability of the results, intensity, frequency and the laboratory/life contexts dimension seem to be the most influential variables in determining far effects. This systematic review and metanalysis highlights the need to measure far effects of executive function training in neurodevelopmental disorders, selecting treatments not only on directly targeted processes, but also according to far impacts on the functional weakness of the disorder.
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Affiliation(s)
- Clara Bombonato
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
- Tuscan Programme of Neuroscience, University of Florence, Pisa and Siena, Italy
| | - Benedetta Del Lucchese
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
- Tuscan Programme of Neuroscience, University of Florence, Pisa and Siena, Italy
| | - Costanza Ruffini
- Department of Education, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Languages, Florence, Italy
| | - Maria Chiara Di Lieto
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | - Paola Brovedani
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | - Chiara Pecini
- Department of Education, Intercultures, Literatures and Psychology (FORLIPSI), University of Florence, Languages, Florence, Italy
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Lee CSC, Chen TT, Gao Q, Hua C, Song R, Huang XP. The Effects of Theta/Beta-based Neurofeedback Training on Attention in Children with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-analysis. Child Psychiatry Hum Dev 2023; 54:1577-1606. [PMID: 35471754 DOI: 10.1007/s10578-022-01361-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
Neurofeedback training is a common treatment option for attention deficit hyperactivity disorder (ADHD). Given theta/beta-based neurofeedback (T/B NF) training targets at the electrophysiological characteristics of children with ADHD, benefits for attention may be expected. PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science were searched through December 31, 2020. Studies were evaluated with Risk of Bias tools. Within-group effects based on Pre- and Post-treatment comparisons of the Intervention Group, and Between-group effects based on the between-group differences from Pre-treatment to Post-treatment were calculated. Nineteen studies met selection criteria for systematic review, 12 of them were included in meta-analysis. Within-group effects were medium at Post-treatment and large at Follow-up. Between-group analyses revealed that T/B NF was superior to waitlist control and physical activities, but not stimulant medication. Results showed that T/B NF has benefits for attention in children with ADHD, however, cautions should be taken when interpreting the findings.
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Affiliation(s)
- Clara S C Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Ting-Ting Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Qingwen Gao
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Chunzhuo Hua
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Rui Song
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Xiu-Ping Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Wong KP, Qin J, Xie YJ, Zhang B. Effectiveness of Technology-Based Interventions for School-Age Children With Attention-Deficit/Hyperactivity Disorder: Systematic Review and Meta-Analysis of Randomized Controlled Trials. JMIR Ment Health 2023; 10:e51459. [PMID: 37988139 DOI: 10.2196/51459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/05/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is relatively common among school-age children. Technology-based interventions, such as computer-assisted training programs, neurofeedback training, and virtual reality, show promise in regulating the behaviors and cognitive functions of children with ADHD. An increasing number of randomized controlled trials have been conducted to evaluate the effectiveness of these technologies in improving the conditions of children with ADHD. OBJECTIVE This study aims to conduct a systematic review of technological interventions for school-age children with ADHD and perform a meta-analysis of the outcomes of technology-based interventions. METHODS A total of 19 randomized controlled studies involving 1843 participants were selected from a pool of 2404 articles across 7 electronic databases spanning from their inception to April 2022. ADHD behaviors, cognitive functions, learning ability, and quality of life were addressed in this study. RESULTS Random effects meta-analyses found that children with ADHD receiving technology-based intervention showed small and significant effect sizes in computer-rated inattention (standardized mean difference [SMD] -0.35; P<.04), parent-rated overall executive function measured by the Behavior Rating Inventory of Executive Function (SMD -0.35; P<.04), parent-rated disruptive behavior disorder measured by the Child Behavior Checklist (SMD -0.50; P<.001) and Disruptive Behavior Disorder Rating Scale (SMD -0.31; P<.02), and computer-rated visual attention measured by the Continuous Performance Test (SMD -0.42; P<.001) and Reaction Time (SMD -0.43; P<.02). CONCLUSIONS Technology-based interventions are promising treatments for improving certain ADHD behaviors and cognitive functions among school-age children with ADHD. TRIAL REGISTRATION PROSPERO CRD42023446924; https://tinyurl.com/7ee5t24n.
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Affiliation(s)
- Ka Po Wong
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Jing Qin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Bohan Zhang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
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Krell J, Dolecki PK, Todd A. School-Based Neurofeedback Training for Sustained Attention. J Atten Disord 2023:10870547231168430. [PMID: 37122234 DOI: 10.1177/10870547231168430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To determine whether in situ neurofeedback training can be used as a tool to build sustained attention in the general student population and whether gains in attention translate to more effective work habits and learning skills. METHOD Students participated in attention training game-based neurofeedback in situ for a period of 35 sessions of 25 min each. The study was built as a one-group pretest-posttest quasi-experimental design. RESULTS This study supports that classroom-based neurofeedback may be an effective tool to build sustained attention and translate these gains into observable work habits and learning behaviors including planning and organization. CONCLUSION Neurofeedback has shown specificity in the treatment of Attention Deficit Hyperactivity Disorder. Published research has not, however, focused on its efficacy in developing attentional capacities in the general population. The promising results of this exploratory investigation warrant further applied research.
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Neural and functional validation of fMRI-informed EEG model of right inferior frontal gyrus activity. Neuroimage 2023; 266:119822. [PMID: 36535325 DOI: 10.1016/j.neuroimage.2022.119822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/17/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The right inferior frontal gyrus (rIFG) is a region involved in the neural underpinning of cognitive control across several domains such as inhibitory control and attentional allocation process. Therefore, it constitutes a desirable neural target for brain-guided interventions such as neurofeedback (NF). To date, rIFG-NF has shown beneficial ability to rehabilitate or enhance cognitive functions using functional Magnetic Resonance Imaging (fMRI-NF). However, the utilization of fMRI-NF for clinical purposes is severely limited, due to its poor scalability. The present study aimed to overcome the limited applicability of fMRI-NF by developing and validating an EEG model of fMRI-defined rIFG activity (hereby termed "Electrical FingerPrint of rIFG"; rIFG-EFP). To validate the computational model, we employed two experiments in healthy individuals. The first study (n = 14) aimed to test the target engagement of the model by employing rIFG-EFP-NF training while simultaneously acquiring fMRI. The second study (n = 41) aimed to test the functional outcome of two sessions of rIFG-EFP-NF using a risk preference task (known to depict cognitive control processes), employed before and after the training. Results from the first study demonstrated neural target engagement as expected, showing associated rIFG-BOLD signal changing during simultaneous rIFG-EFP-NF training. Target anatomical specificity was verified by showing a more precise prediction of the rIFG-BOLD by the rIFG-EFP model compared to other EFP models. Results of the second study suggested that successful learning to up-regulate the rIFG-EFP signal through NF can reduce one's tendency for risk taking, indicating improved cognitive control after two sessions of rIFG-EFP-NF. Overall, our results confirm the validity of a scalable NF method for targeting rIFG activity by using an EEG probe.
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Chiu HJ, Sun CK, Fan HY, Tzang RF, Wang MY, Cheng YC, Cheng YS, Yeh PY, Chung W. Surface electroencephalographic neurofeedback improves sustained attention in ADHD: a meta-analysis of randomized controlled trials. Child Adolesc Psychiatry Ment Health 2022; 16:104. [PMID: 36536438 PMCID: PMC9764556 DOI: 10.1186/s13034-022-00543-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The efficacy of surface electroencephalographic neurofeedback (EEG-NF) for improving attentional performance assessed by laboratory measures in patients with attention-deficit/hyperactivity disorder (ADHD) remains unclear. METHODS Following the PRISMA guidelines, the PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ScienceDirect, Web of Science, and ClinicalTrials.gov databases were systematically searched for randomized controlled trials on the efficacy of surface EEG-NF against ADHD focusing on attentional performance evaluated by laboratory measures from inception to January 2022. RESULTS Fourteen eligible studies were analyzed. Of the 718 participants involved, 429 diagnosed with ADHD received EEG-NF treatment. Significant improvement in attentional performance in ADHD subjects receiving EEG-NF was noted compared to their comparators (p < 0.01). Besides, there was a significant EEG-NF-associated beneficial effect on sustained attention (Hedges' g = 0.32, p < 0.01), whereas the impact on selective attention (p = 0.57) and working memory (p = 0.59) was limited. Moreover, protocol including beta wave enhancement was superior to that only focusing on reducing theta/beta ratio or modulation of slow cortical potential. Subgroup analyses showed that three sessions per week of EEG-NF produced the best effect, while the efficacy of surface EEG-NF was much poorer (Hedges' g = 0.05) when only studies that blinded their participants from knowledge of treatment allocation were included. No significant difference was noted in the improvement of attentional performance 6-12 months after EEG-NF intervention (n = 3, p = 0.42). CONCLUSIONS Our results demonstrated the satisfactory effectiveness of surface EEG-NF for improving sustained attention, especially when beta wave enhancement was included, despite its failure to sustain a long-term effect. Further large-scale trials are warranted to support our findings.
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Affiliation(s)
- Hsien-Jane Chiu
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hsin-Yi Fan
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, No. 509, Fengping 1St Rd., Daliao Dist, Kaohsiung, Taiwan
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ming-Yu Wang
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ying-Chih Cheng
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Shian Cheng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, No. 509, Fengping 1St Rd., Daliao Dist, Kaohsiung, Taiwan.
| | - Pin-Yang Yeh
- Department of Psychology, College of Medical and Health Science, Asia University, 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan.
| | - Weilun Chung
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, No. 509, Fengping 1St Rd., Daliao Dist, Kaohsiung, Taiwan.
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Patil AU, Madathil D, Fan YT, Tzeng OJL, Huang CM, Huang HW. Neurofeedback for the Education of Children with ADHD and Specific Learning Disorders: A Review. Brain Sci 2022; 12:brainsci12091238. [PMID: 36138974 PMCID: PMC9497239 DOI: 10.3390/brainsci12091238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
Neurofeedback (NF) is a type of biofeedback in which an individual’s brain activity is measured and presented to them to support self-regulation of ongoing brain oscillations and achieve specific behavioral and neurophysiological outcomes. NF training induces changes in neurophysiological circuits that are associated with behavioral changes. Recent evidence suggests that the NF technique can be used to train electrical brain activity and facilitate learning among children with learning disorders. Toward this aim, this review first presents a generalized model for NF systems, and then studies involving NF training for children with disorders such as dyslexia, attention-deficit/hyperactivity disorder (ADHD), and other specific learning disorders such as dyscalculia and dysgraphia are reviewed. The discussion elaborates on the potential for translational applications of NF in educational and learning settings with details. This review also addresses some issues concerning the role of NF in education, and it concludes with some solutions and future directions. In order to provide the best learning environment for children with ADHD and other learning disorders, it is critical to better understand the role of NF in educational settings. The review provides the potential challenges of the current systems to aid in highlighting the issues undermining the efficacy of current systems and identifying solutions to address them. The review focuses on the use of NF technology in education for the development of adaptive teaching methods and the best learning environment for children with learning disabilities.
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Affiliation(s)
- Abhishek Uday Patil
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Deepa Madathil
- Jindal Institute of Behavioural Sciences, O.P. Jindal Global University, Haryana 131001, India
| | - Yang-Tang Fan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan 320315, Taiwan
| | - Ovid J. L. Tzeng
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Centre for Intelligent Drug Systems and Smart Bio-Devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- College of Humanities and Social Sciences, Taipei Medical University, Taipei 106339, Taiwan
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei 106308, Taiwan
- Hong Kong Institute for Advanced Studies, City University of Hong Kong, Hong Kong
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Centre for Intelligent Drug Systems and Smart Bio-Devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Hsu-Wen Huang
- Department of Linguistics and Translation, City University of Hong Kong, Hong Kong
- Correspondence: ; Tel.: +852-3442-2579
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Hasslinger J, Meregalli M, Bölte S. How standardized are “standard protocols”? Variations in protocol and performance evaluation for slow cortical potential neurofeedback: A systematic review. Front Hum Neurosci 2022; 16:887504. [PMID: 36118975 PMCID: PMC9478392 DOI: 10.3389/fnhum.2022.887504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Neurofeedback (NF) aims to alter neural activity by enhancing self-regulation skills. Over the past decade NF has received considerable attention as a potential intervention option for many somatic and mental conditions and ADHD in particular. However, placebo-controlled trials have demonstrated insufficient superiority of NF compared to treatment as usual and sham conditions. It has been argued that the reason for limited NF effects may be attributable to participants' challenges to self-regulate the targeted neural activity. Still, there is support of NF efficacy when only considering so-called “standard protocols,” such as Slow Cortical Potential NF training (SCP-NF). This PROSPERO registered systematic review following PRISMA criteria searched literature databases for studies applying SCP-NF protocols. Our review focus concerned the operationalization of self-regulatory success, and protocol-details that could influence the evaluation of self-regulation. Such details included; electrode placement, number of trials, length per trial, proportions of training modalities, handling of artifacts and skill-transfer into daily-life. We identified a total of 63 eligible reports published in the year 2000 or later. SCP-NF protocol-details varied considerably on most variables, except for electrode placement. However, due to the increased availability of commercial systems, there was a trend to more uniform protocol-details. Although, token-systems are popular in SCP-NF for ADHD, only half reported a performance-based component. Also, transfer exercises have become a staple part of SCP-NF. Furthermore, multiple operationalizations of regulatory success were identified, limiting comparability between studies, and perhaps usefulness of so-called transfer-exercises, which purpose is to facilitate the transfer of the self-regulatory skills into every-day life. While studies utilizing SCP as Brain-Computer-Interface mainly focused on the acquisition of successful self-regulation, clinically oriented studies often neglected this. Congruently, rates of successful regulators in clinical studies were mostly low (<50%). The relation between SCP self-regulation and behavior, and how symptoms in different disorders are affected, is complex and not fully understood. Future studies need to report self-regulation based on standardized measures, in order to facilitate both comparability and understanding of the effects on symptoms. When applied as treatment, future SCP-NF studies also need to put greater emphasis on the acquisition of self-regulation (before evaluating symptom outcomes).
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Affiliation(s)
- John Hasslinger
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- *Correspondence: John Hasslinger
| | - Micaela Meregalli
- Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
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Results of Neurofeedback in Treatment of Children with ADHD: A Systematic Review of Randomized Controlled Trials. Appl Psychophysiol Biofeedback 2022; 47:145-181. [PMID: 35612676 DOI: 10.1007/s10484-022-09547-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/02/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent disorders in children and adolescents. Neurofeedback, a nonpharmaceutical treatment, has shown promising results. To review the evidence of efficacy of neurofeedback as a treatment for children and adolescents with ADHD. A systematic review of the specific scientific studies published in 1995-2021, identifying and analyzing randomized controlled trials (RCT). A total of 1636 articles were identified and 165 met inclusion criteria, of which 67 were RCTs. Neurofeedback training was associated with significant long-term reduction in symptoms of ADHD. Though limitations exist regarding conclusions about the specific effects of neurofeedback, the review documents improvements in school, social, and family environments.
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Schneider H, Riederle J, Seuss S. Therapeutic Effect of Infra-Low-Frequency Neurofeedback Training on Children and Adolescents with ADHD. ARTIF INTELL 2022. [DOI: 10.5772/intechopen.97938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this observational study the outcomes of an EEG-based infra-low-frequency (ILF) neurofeedback intervention on patients with attention deficit (hyperactivity) disorder (ADHD) are presented. The question is addressed whether this computer-aided treatment, which uses a brain-computer-interface to alleviate the clinical symptoms of mental disorders, is an effective non-pharmaceutical therapy for ADHD in childhood and adolescence. In a period of about 15 weeks 196 ADHD patients were treated with about 30 sessions of ILF neurofeedback in an ambulant setting. Besides regular evaluation of the severity of clinical symptoms, a continuous performance test (CPT) for parameters of attention and impulse control was conducted before and after the neurofeedback treatment. During and after the therapy, the patients did not only experience a substantial reduction in the severity of their ADHD-typical clinical symptoms, but also their performance in a continuous test procedure was significantly improved for all examined parameters of attention and impulse control, like response time, variability of reaction time, omission errors and commission errors. In a post neurofeedback intervention assessment 97% of patients reported improvement in symptoms of inattention, hyperactivity or impulsivity. Only 3% of the patients claimed no noticeable alleviation of ADHD-related symptoms. These results suggest that ILF neurofeedback is a clinically effective method that can be considered as a treatment option for ADHD and might help reducing or even avoiding psychotropic medication.
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Sakurada T, Matsumoto M, Yamamoto SI. Individual Sensory Modality Dominance as an Influential Factor in the Prefrontal Neurofeedback Training for Spatial Processing: A Functional Near-Infrared Spectroscopy Study. Front Syst Neurosci 2022; 16:774475. [PMID: 35221936 PMCID: PMC8866872 DOI: 10.3389/fnsys.2022.774475] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/07/2022] [Indexed: 11/23/2022] Open
Abstract
Neurofeedback is a neuromodulation technique used to improve brain function by self-regulating brain activity. However, the efficacy of neurofeedback training varies widely between individuals, and some participants fail to self-regulate brain activity. To overcome intersubject variation in neurofeedback training efficacy, it is critical to identify the factors that influence this type of neuromodulation. In this study, we considered that individual differences in cognitive ability may influence neurofeedback training efficacy and aimed to clarify the effect of individual working memory (WM) abilities, as characterized by sensory modality dominance, on neurofeedback training efficacy in healthy young adults. In particular, we focused on the abilities of individuals to retain internal (tactile or somatosensory) or external (visual) body information in their WM. Forty participants performed functional near-infrared spectroscopy-based neurofeedback training aimed at producing efficient and lower-level activity in the bilateral dorsolateral prefrontal cortex and frontopolar cortex. We carried out a randomized, sham-controlled, double-blind study that compared WM ability before and after neurofeedback training. Individual WM ability was quantified using a target searching task that required the participants to retain spatial information presented as vibrotactile or visual stimuli. Participants who received feedback information based on their own prefrontal activity showed gradually decreasing activity in the right prefrontal area during the neurofeedback training and demonstrated superior WM ability during the target searching task with vibrotactile stimuli compared with the participants who performed dummy neurofeedback training. In comparison, left prefrontal activity was not influenced by the neurofeedback training. Furthermore, the efficacy of neurofeedback training (i.e., lower right prefrontal activity and better searching task performance) was higher in participants who exhibited tactile dominance rather than visual dominance in their WM. These findings indicate that sensory modality dominance in WM may be an influential neurophysiological factor in determining the efficacy of neurofeedback training. These results may be useful in the development of neurofeedback training protocols tailored to individual needs.
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Affiliation(s)
- Takeshi Sakurada
- Department of Robotics, College of Science and Engineering, Ritsumeikan University, Shiga, Japan
- Functional Brain Science Laboratory, Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi, Japan
- Department of Neurosurgery, Jichi Medical University, Tochigi, Japan
- *Correspondence: Takeshi Sakurada,
| | - Mayuko Matsumoto
- Functional Brain Science Laboratory, Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi, Japan
- Graduate School of Systems Engineering and Science, Shibaura Institute of Technology, Saitama, Japan
| | - Shin-ichiroh Yamamoto
- Graduate School of Systems Engineering and Science, Shibaura Institute of Technology, Saitama, Japan
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14
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Korfmacher AK, Hirsch O, Chavanon ML, Albrecht B, Christiansen H. Self-management training vs. neurofeedback interventions for attention deficit hyperactivity disorder: Results of a randomized controlled treatment study. Front Psychiatry 2022; 13:969351. [PMID: 36061275 PMCID: PMC9433654 DOI: 10.3389/fpsyt.2022.969351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Neurofeedback (NF) and self-management training (SMT) may be viable treatment options for patients with attention deficit hyperactivity disorder (ADHD) if they alleviate core symptoms, enhance the patients' self-concept and improve their quality of life (QoL). Aim of the current study is evaluating both interventions accordingly and to test whether specific improvements in core symptoms lead to more general improvements in self-concept and QoL. METHODS In a psychotherapeutic outpatient clinic in Germany, a total of N = 139 children with ADHD were screened for eligibility, of which 111 fulfilled inclusion criteria and participated in the study in accordance with the CONSORT 2010 statement. These were randomly assigned to NF vs. SMT interventions. Changes from pre- to post-intervention in core ADHD symptoms relying on parent and teacher reports (CONNERS 3) and objective tests (Qb-Test) as well as self-concept (interview with the children) and QoL assessments (using the KINDL-R self-report) were compared between patients receiving NF or SMT. RESULTS Significant improvements in ADHD symptoms were achieved similarly in both treatment groups, whilst QoL and self-concept improved after SMT only. CONCLUSION This treatment study provides further evidence that SMT and NF may reduce core symptoms, but SMT may also improve patients' self-concept and QoL and may thus in its current form be the favorable treatment option in naturalistic settings. However, several limitations of the current study implicate that further research is required before definitive conclusions and recommendations for clinical practice can be given. CLINICAL TRIAL REGISTRATION [www.clinicaltrials.gov], identifier [NCT01879644].
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Affiliation(s)
- Ann-Kathrin Korfmacher
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, Siegen, Germany
| | - Mira-Lynn Chavanon
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Björn Albrecht
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Marburg, Germany
| | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Marburg, Germany
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15
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Cabaleiro P, Cueli M, Cañamero LM, González-Castro P. A Case Study in Attention-Deficit/Hyperactivity Disorder: An Innovative Neurofeedback-Based Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010191. [PMID: 35010449 PMCID: PMC8751092 DOI: 10.3390/ijerph19010191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
In research about attention-deficit/hyperactivity disorder (ADHD) there is growing interest in evaluating cortical activation and using neurofeedback in interventions. This paper presents a case study using monopolar electroencephalogram recording (brain mapping known as MiniQ) for subsequent use in an intervention with neurofeedback for a 10-year-old girl presenting predominantly inattentive ADHD. A total of 75 training sessions were performed, and brain wave activity was assessed before and after the intervention. The results indicated post-treatment benefits in the beta wave (related to a higher level of concentration) and in the theta/beta ratio, but not in the theta wave (related to higher levels of drowsiness and distraction). These instruments may be beneficial in the evaluation and treatment of ADHD.
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16
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Jalali P, Sho'ouri N. Neurofeedback Training Protocol Based on Selecting Distinctive Features to Treat or Reduce ADHD Symptoms. Clin EEG Neurosci 2021; 52:414-421. [PMID: 34338564 DOI: 10.1177/15500594211033435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent research has shown that electroencephalography (EEG) theta/beta ratio (TBR) in cases with attention deficit hyperactivity disorder (ADHD) has thus far been reported lower than that in healthy individuals. Accordingly, utilizing EEG-TBR as a biomarker to diagnose ADHD has been called into question. Besides, employing known protocol to reduce EEG-TBR in the vertex (Cz) channel to treat ADHD via neurofeedback (NFB) has been doubted. The present study was to propose a new NFB treatment protocol to manage ADHD using EEG signals from 30 healthy controls and 30 children with ADHD through an attention-based task and to calculate relative power in their different frequency bands. Then, the most significant distinguishing features of EEG signals from both groups were determined via a genetic algorithm (GA). The results revealed that EEG-TBR values in children with ADHD were lower compared with those in healthy peers; however, such a difference was not statistically significant. Likewise, inhibiting alpha band activity and enhancing delta one in F7 or T5 channels was proposed as a new NFB treatment protocol for ADHD. No significant increase in EEG-TBR in the Cz channel among children with ADHD casts doubt on the effectiveness of using EEG-TBR inhibitory protocols in the Cz channel. Consequently, it was proposed to apply the new protocol along with reinforced beta-band activity to treat or reduce ADHD symptoms.
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17
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Sampedro Baena L, la Fuente GACD, Martos-Cabrera MB, Gómez-Urquiza JL, Albendín-García L, Romero-Bejar JL, Suleiman-Martos N. Effects of Neurofeedback in Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review. J Clin Med 2021; 10:jcm10173797. [PMID: 34501246 PMCID: PMC8432262 DOI: 10.3390/jcm10173797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is one of the most frequent neurodevelopmental disorders in childhood and adolescence. Choosing the right treatment is critical to controlling and improving symptoms. An innovative ADHD treatment is neurofeedback (NF) that trains participants to self-regulate brain activity. The aim of the study was to analyze the effects of NF interventions in children with ADHD. A systematic review was carried out in the CINAHL, Medline (PubMed), Proquest, and Scopus databases, following the PRISMA recommendations. Nine articles were found. The NF improved behavior, allowed greater control of impulsivity, and increased sustained attention. In addition, it improved motor control, bimanual coordination and was associated with a reduction in theta waves. NF combined with other interventions such as medication, physical activity, behavioral therapy training, or attention training with brain-computer interaction, reduced primary ADHD symptoms. Furthermore, more randomized controlled trials would be necessary to determine the significant effects.
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Affiliation(s)
- Lucía Sampedro Baena
- San Cecilio Clinical University Hospital, Andalusian Health Service, Avenida del Conocimiento, s/n, 18016 Granada, Spain; (L.S.B.); (M.B.M.-C.)
| | | | - María Begoña Martos-Cabrera
- San Cecilio Clinical University Hospital, Andalusian Health Service, Avenida del Conocimiento, s/n, 18016 Granada, Spain; (L.S.B.); (M.B.M.-C.)
| | - José L. Gómez-Urquiza
- Faculty of Health Sciences, University of Granada, Calle Cortadura del Valle S.N., 51001 Ceuta, Spain; (J.L.G.-U.); (N.S.-M.)
| | - Luis Albendín-García
- Casería de Montijo Health Center, Granada Metropolitan District, Andalusian Health Service, Calle Virgen de la Consolación, 12, 18015 Granada, Spain;
| | - José Luis Romero-Bejar
- Department of Statistics and Operational Research, University of Granada. Av. Fuentenueva, 18071 Granada, Spain
- Correspondence:
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, University of Granada, Calle Cortadura del Valle S.N., 51001 Ceuta, Spain; (J.L.G.-U.); (N.S.-M.)
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18
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van Son D, van der Does W, Band GPH, Putman P. EEG Theta/Beta Ratio Neurofeedback Training in Healthy Females. Appl Psychophysiol Biofeedback 2021; 45:195-210. [PMID: 32458282 PMCID: PMC7391399 DOI: 10.1007/s10484-020-09472-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A growing number of studies suggest that EEG theta/beta ratio (TBR) is inversely related to executive cognitive control. Neurofeedback training aimed at reducing TBR (TBR NFT) might provide a tool to study causality in this relation and might enhance human performance. To investigate whether TBR NFT reduces TBR in healthy participants. Twelve healthy female participants were assigned (single blind) to one of three groups. Groups differed on baseline durations and one group received only sham NFT. TBR NFT consisted of eight or fourteen 25-min sessions. No evidence was found that TBR NFT had any effect on TBR. The current TBR NFT protocol is possibly ineffective. This is in line with a previous study with a different protocol.
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Affiliation(s)
- Dana van Son
- Institute of Psychology, Leiden University, Leiden, The Netherlands. .,Leiden Institute for Brain and Cognition, Leiden, The Netherlands.
| | - Willem van der Does
- Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Guido P H Band
- Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Peter Putman
- Institute of Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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19
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Esteves I, Nan W, Alves C, Calapez A, Melício F, Rosa A. An Exploratory Study of Training Intensity in EEG Neurofeedback. Neural Plast 2021; 2021:8881059. [PMID: 33777137 PMCID: PMC7979284 DOI: 10.1155/2021/8881059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/21/2021] [Accepted: 02/21/2021] [Indexed: 11/30/2022] Open
Abstract
Neurofeedback training has shown benefits in clinical treatment and behavioral performance enhancement. Despite the wide range of applications, no consensus has been reached about the optimal training schedule. In this work, an EEG neurofeedback practical experiment was conducted aimed at investigating the effects of training intensity on the enhancement of the amplitude in the individual upper alpha band. We designed INTENSIVE and SPARSE training modalities, which differed regarding three essential aspects of training intensity: the number of sessions, the duration of a session, and the interval between sessions. Nine participants in the INTENSIVE group completed 4 sessions with 37.5 minutes each during consecutive days, while nine participants in the SPARSE group performed 6 sessions of 25 minutes spread over approximately 3 weeks. As a result, regarding the short-term effects, the upper alpha band amplitude change within sessions did not significantly differ between the two groups. Nonetheless, only the INTENSIVE group showed a significant increase in the upper alpha band amplitude. However, for the sustained effects across sessions, none of the groups showed significant changes in the upper alpha band amplitude across the whole course of training. The findings suggest that the progression within session is favored by the intensive design. Therefore, based on these findings, it is proposed that training intensity influences EEG self-regulation within sessions. Further investigations are needed to isolate different aspects of training intensity and effectively confirm if one modality globally outperforms the other.
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Affiliation(s)
- Inês Esteves
- Evolutionary Systems and Biomedical Engineering Lab, Institute for Systems and Robotics, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisbon, Portugal
| | - Wenya Nan
- Department of Psychology, Shanghai Normal University, Shanghai 200234, China
| | - Cristiana Alves
- Evolutionary Systems and Biomedical Engineering Lab, Institute for Systems and Robotics, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisbon, Portugal
| | - Alexandre Calapez
- Evolutionary Systems and Biomedical Engineering Lab, Institute for Systems and Robotics, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisbon, Portugal
| | - Fernando Melício
- Evolutionary Systems and Biomedical Engineering Lab, Institute for Systems and Robotics, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisbon, Portugal
- Instituto Superior de Engenharia de Lisboa (ISEL), Instituto Politécnico de Lisboa, 1959-007 Lisbon, Portugal
| | - Agostinho Rosa
- Evolutionary Systems and Biomedical Engineering Lab, Institute for Systems and Robotics, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisbon, Portugal
- Department of Bioengineering, Instituto Superior Técnico, University of Lisbon, 1049-001 Lisbon, Portugal
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20
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Schönenberg M, Weingärtner AL, Weimer K, Scheeff J. Believing is achieving - On the role of treatment expectation in neurofeedback applications. Prog Neuropsychopharmacol Biol Psychiatry 2021; 105:110129. [PMID: 33031860 DOI: 10.1016/j.pnpbp.2020.110129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 11/16/2022]
Abstract
In neurofeedback applications, neural activity is recorded, processed in real-time and fed back to the user in order to facilitate self-regulation of the putative neural mechanisms that underlie cognition and behavior. Numerous studies suggest that neurofeedback interventions are an efficacious treatment particularly for patients with attention-deficit/hyperactivity disorder (ADHD). In recent years, however, findings of several well-controlled studies raised doubts concerning the proposed mechanism of action behind the behavioral effect of neurofeedback. This study investigated the impact of expectation on the efficacy of a sensorimotor rhythm (SMR) training. In a within-subjects design 30 blinded volunteers with ADHD symptoms received a standard SMR training session after inducing no (no-expectancy condition), positive (placebo condition), and negative (nocebo condition) expectations regarding the effectiveness of neurofeedback (by telling them that they would train a specific frequency band that was previously shown to be either unrelated to attention, should improve attention, or interfere with attentional processes). After each training, participants were presented with a cognitive test and subsequently requested to rate their performance on it. We could show that participants were able to successfully modify their EEG signal during training. Further, we found an effect over trainings on objective attentional performance. Most importantly, we found that the expectancy of positive or negative treatment effects considerably changed participants' perception of neurofeedback's efficacy even in the absence of any objective evidence. This study presents strong first evidence for a substantial effect of self-confirming response expectancies as one factor underlying the efficacy of neurofeedback. Future research has to carefully consider the impact of such psychosocial mechanisms when evaluating the (specific) efficacy of neuromodulatory treatments.
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Affiliation(s)
| | | | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Germany
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21
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Pigott HE, Cannon R, Trullinger M. The Fallacy of Sham-Controlled Neurofeedback Trials: A Reply to Thibault and Colleagues (2018). J Atten Disord 2021; 25:448-457. [PMID: 30078340 PMCID: PMC7783691 DOI: 10.1177/1087054718790802] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Sham-controlled neurofeedback (NFB) trials consistently find no separation on ADHD outcome measures leading many to conclude that NFB's beneficial effects are due to placebo. Method: We deconstruct the NFB training methodology and findings of six sham-controlled trials that assessed for evidence of learning. Results: All six studies found no evidence NFB subjects learned to self-modulate the targeted electroencephalogram (EEG). Careful analyses revealed these studies' training methodologies were antithetical to the established science of operant conditioning thereby preventing subjects from learning to self-modulate. These findings are in marked contrast to NFB studies whose methodology mirror the best practices of operant conditioning. Conclusion: The premise that NFB's beneficial effects are due to placebo phenomenon is unproven as these studies compared two forms of false-feedback, not operant conditioning of the EEG. Because these studies are highly cited and considered the gold standard in scientific rigor, a reappraisal of the evidence is urgently needed.
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Affiliation(s)
- H. Edmund Pigott
- NeuroThrive, LLC, Lutherville, MD, USA,Private Practice, Juno Beach, FL, USA,H. Edmund Pigott, Private Practice, 430 N. Lyra Circle, Juno Beach, FL 33408, USA.
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22
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Thibault RT, Veissière S, Olson JA, Raz A. EEG-Neurofeedback and the Correction of Misleading Information: A Reply to Pigott and Colleagues. J Atten Disord 2021; 25:458-459. [PMID: 30378452 DOI: 10.1177/1087054718808379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Amir Raz
- Chapman University, Irvine, CA, USA
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23
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Papanastasiou G, Drigas A, Skianis C, Lytras M. Brain computer interface based applications for training and rehabilitation of students with neurodevelopmental disorders. A literature review. Heliyon 2020; 6:e04250. [PMID: 32954024 PMCID: PMC7482019 DOI: 10.1016/j.heliyon.2020.e04250] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/23/2019] [Accepted: 06/15/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of this article is to explore a paradigm shift on Brain Computer Interface (BCI) research, as well as on intervention best practices for training and rehabilitation of students with neurodevelopmental disorders. Recent studies indicate that BCI devices have positive impact on students' attention skills and working memory as well as on other skills, such as visuospatial, social, imaginative and emotional abilities. BCI applications aim to emulate humans' brain and address the appropriate understanding for each student's neurodevelopmental disorders. Studies conducted to provide knowledge about BCI-based intervention applications regarding memory, attention, visuospatial, learning, collaboration, and communication, social, creative and emotional skills are highlighted. Only non-invasive BCI type of applications are being investigated based upon representative, non-exhaustive and state-of-the-art studies within the field. This article examines the progress of BCI research so far, while different BCI paradigms are investigated. BCI-based applications could successfully regulate students' cognitive abilities when used for their training and rehabilitation. Future directions to investigate BCI-based applications for training and rehabilitation of students with neurodevelopmental disorders concerning the different populations involved are discussed.
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Affiliation(s)
- George Papanastasiou
- NSCR Demokritos, Patr. Gregoriou E' & 27, Neapoleos str., 15341, Greece.,University of the Aegean Karlovassi Samos, 83200, Greece
| | - Athanasios Drigas
- NSCR Demokritos, Patr. Gregoriou E' & 27, Neapoleos str., 15341, Greece
| | | | - Miltiadis Lytras
- The American College of Greece, 6 Gravias str., 153 42, Greece.,King Abdulaziz University, Saudi Arabia
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24
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Khodakarami Z, Firoozabadi M. Psychological, Neurophysiological, and Mental Factors Associated With Gamma-Enhancing Neurofeedback Success. Basic Clin Neurosci 2020; 11:701-714. [PMID: 33643562 PMCID: PMC7878062 DOI: 10.32598/bcn.11.5.1878.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/10/2019] [Accepted: 10/02/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Regarding the neurofeedback training process, previous studies indicate that 10%-50% of subjects cannot gain control over their brain activity even after repeated training sessions. This study is conducted to overcome this problem by investigating inter-individual differences in neurofeedback learning to propose some predictors for the trainability of subjects. METHODS Eight healthy female students took part in 8 (electroencephalography) EEG neurofeedback training sessions for enhancing EEG gamma power at the Oz channel. We studied participants' preexisting fluid intelligence and EEG frequency sub-bands' power during 2-min eyes-closed rest and a cognitive task as psychological and neurophysiological factors, concerning neurofeedback learning performance. We also assessed the self-reports of participants about mental strategies used by them during neurofeedback to identify the most effective successful strategies. RESULTS The results revealed that a significant percentage of individuals (25% in this study) cannot learn how to control their brain gamma activity using neurofeedback. Our findings suggest that fluid intelligence, gamma power during a cognitive task, and alpha power at rest can predict gamma-enhancing neurofeedback performance of individuals. Based on our study, neurofeedback learning is a form of implicit learning. We also found that learning without a user's mental efforts to find out successful mental strategies, in other words, unconscious learning, lead to more success in gamma-enhancing neurofeedback. CONCLUSION Our results may improve gamma neurofeedback efficacy for further clinical usage and studies by giving insight about both non-trainable individuals and effective mental strategies.
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Affiliation(s)
- Zeynab Khodakarami
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Firoozabadi
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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25
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Blume F, Quixal M, Hudak J, Dresler T, Gawrilow C, Ehlis AC. Development of Reading Abilities in Children with ADHD Following fNIRS-Neurofeedback or EMG-Biofeedback. ACTA ACUST UNITED AC 2020. [DOI: 10.1024/2235-0977/a000302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Abstract. Children with attention deficit/hyperactivity disorder (ADHD) show deficient reading skills, which, like ADHD symptoms, are associated with limitations in neurocognitive abilities. Neurofeedback (NF) aims to improve the latter, to alleviate ADHD symptoms, and to promote school and reading performances. Whether frontal lobe-NF based on functional near-infrared spectroscopy (fNIRS) and electromyogram (EMG)-biofeedback (BF), however, improve reading abilities of children with ADHD and whether these changes are associated with changes in neurocognitive abilities, has not yet been clarified. It was also unclear whether embedding trainings in virtual reality (VR) could increase their effectiveness. These questions were examined using data of 35 children with ADHD (6–11 years) who participated in 15 sessions of fNIRS-NF in VR, fNIRS-NF in 2D, or EMG-BF in VR. On average, children's reading performance improved in all training groups. Stronger improvements were found after VR trainings. Improvements in reading natural words were, on a trend level, accompanied by decreasing attention, while improvements in reading pseudowords were accompanied by improved sustained attention and response inhibition. The results suggest that fNIRS-NF and EMG-BF effectively improve reading abilities of children with ADHD, especially when training in VR.
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Affiliation(s)
- Friederike Blume
- Department of Psychology, School Psychology, University of Tübingen, Germany
- LEAD Graduate School & Research Network, University of Tübingen, Germany
| | - Martí Quixal
- Department of Psychology, School Psychology, University of Tübingen, Germany
- LEAD Graduate School & Research Network, University of Tübingen, Germany
- Department of Linguistics, University of Tübingen, Germany
| | - Justin Hudak
- LEAD Graduate School & Research Network, University of Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - Thomas Dresler
- LEAD Graduate School & Research Network, University of Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - Caterina Gawrilow
- Department of Psychology, School Psychology, University of Tübingen, Germany
- LEAD Graduate School & Research Network, University of Tübingen, Germany
- enter for Individual Development and Adaptive Education of Children at Risk (IDeA), DIPF
- Leibniz Institute for Research and Information in Education, Frankfurt am Main, Germany
| | - Ann-Christine Ehlis
- LEAD Graduate School & Research Network, University of Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
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26
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Coben R, Hammond DC, Arns M. 19 Channel Z-Score and LORETA Neurofeedback: Does the Evidence Support the Hype? Appl Psychophysiol Biofeedback 2020; 44:1-8. [PMID: 30255461 PMCID: PMC6373269 DOI: 10.1007/s10484-018-9420-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Neurofeedback is a well-investigated treatment for ADHD and epilepsy, especially when restricted to standard protocols such as theta/beta, slow cortical potentials and sensori-motor rhythm neurofeedback. Advances in any field are welcome and other techniques are being pursued. Manufacturers and clinicians are marketing ‘superior’ neurofeedback approaches including 19 channel Z-score neurofeedback (ZNFB) and 3-D LORETA neurofeedback (with or without Z-scores; LNFB). We conducted a review of the empirical literature to determine if such claims were warranted. This review included the above search terms in Pubmed, Google scholar and any references that met our criteria from the ZNFB publication list and was restricted to group based studies examining improvement in a clinical population that underwent peer review (book chapters, magazine articles or conference presentations are not included since these are not peer reviewed). Fifteen relevant studies emerged with only six meeting our criterion. Based on review of these studies it was concluded that empirical validation of these approaches is sorely lacking. There is no empirical data that supports the notion that 19-channel z-score neurofeedback is effective or superior. The quality of studies for LNFB was better compared to ZNFB and some suggestion for efficacy was demonstrated for ADHD and Tinnitus distress. However, these findings need to be replicated, extended to other populations and have yet to show any “superiority.” Our conclusions continue to emphasize the pervasive lack of evidence supporting these approaches to neurofeedback and the implications of this are discussed.
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Affiliation(s)
- Robert Coben
- Integrated Neuroscience Services, 92 W. Sunbridge Drive, Fayetteville, AR, 72701, USA
| | | | - Martijn Arns
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands. .,Research Institute Brainclinics, Nijmegen, The Netherlands. .,neuroCare Group, Munich, Germany.
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Long-term effects of theta/beta neurofeedback on EEG power spectra in children with attention deficit hyperactivity disorder. Clin Neurophysiol 2020; 131:1332-1341. [PMID: 32304847 DOI: 10.1016/j.clinph.2020.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Neurofeedback has been proposed as an effective alternative for pharmacological treatment in children with attention-deficit/hyperactivity disorder (ADHD), with potentially long-term and delayed benefits. However, the specificity of such long-term behavioral improvements remains inconclusive and therefore additional research into the neurophysiological effects of neurofeedback is needed. We compared long-term effects of theta/beta neurofeedback (NFB) to methylphenidate (MPH) and physical activity (PA, semi-active control intervention) on electroencephalogram (EEG) power spectra. Based on the vigilance stabilization model, we hypothesized further reductions in theta and alpha power in the NFB compared to the control groups. METHOD EEG power spectra (theta, alpha and beta) during resting and task conditions were recorded at pre-, post-intervention and 6-months follow-up in 67 children, aged 7-13 (NFB: n = 24, MPH: n = 23, or PA: n = 20). RESULTS Analyses revealed no power spectra differences at follow-up between MPH and NFB (range p = .165-.905) and PA and NFB (range p = .172-.822). CONCLUSIONS No evidence was found for the specificity of theta/beta NFB at follow-up. SIGNIFICANCE This was the first study into long-term neurophysiological effects of theta/beta NFB. Future studies are encouraged to explore both specific and non-specific mechanisms of NFB. CLINICAL TRIALS REGISTRATION Train Your Brain? Exercise and neurofeedback intervention for ADHD, https://clinicaltrials.gov/show/NCT01363544, Ref. No. NCT01363544.
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Omejc N, Rojc B, Battaglini PP, Marusic U. Review of the therapeutic neurofeedback method using electroencephalography: EEG Neurofeedback. Bosn J Basic Med Sci 2019; 19:213-220. [PMID: 30465705 DOI: 10.17305/bjbms.2018.3785] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022] Open
Abstract
Electroencephalographic neurofeedback (EEG-NFB) represents a broadly used method that involves a real-time EEG signal measurement, immediate data processing with the extraction of the parameter(s) of interest, and feedback to the individual in a real-time. Using such a feedback loop, the individual may gain better control over the neurophysiological parameters, by inducing changes in brain functioning and, consequently, behavior. It is used as a complementary treatment for a variety of neuropsychological disorders and improvement of cognitive capabilities, creativity or relaxation in healthy subjects. In this review, various types of EEG-NFB training are described, including training of slow cortical potentials (SCPs) and frequency and coherence training, with their main results and potential limitations. Furthermore, some general concerns about EEG-NFB methodology are presented, which still need to be addressed by the NFB community. Due to the heterogeneity of research designs in EEG-NFB protocols, clear conclusions on the effectiveness of this method are difficult to draw. Despite that, there seems to be a well-defined path for the EEG-NFB research in the future, opening up possibilities for improvement.
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Affiliation(s)
- Nina Omejc
- Department of Psychology, Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia Graduate School of Neural and Behavioural Sciences, University of Tübingen, Germany.
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Shereena EA, Gupta RK, Bennett CN, Sagar KJV, Rajeswaran J. EEG Neurofeedback Training in Children With Attention Deficit/Hyperactivity Disorder: A Cognitive and Behavioral Outcome Study. Clin EEG Neurosci 2019; 50:242-255. [PMID: 30453757 DOI: 10.1177/1550059418813034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood disorder with symptoms of inattention, impulsivity, and hyperactivity. EEG neurofeedback training (NFT) is a new intervention modality based on operant conditioning of brain activity, which helps reduce symptoms of ADHD in children. METHODS AND PROCEDURES To examine the efficacy of NFT in children with ADHD, an experimental longitudinal design with pre-post comparison was adopted. A total of 30 children in the age range of 6 to 12 years diagnosed as ADHD with or without comorbid conditions were assigned to treatment group (TG; n = 15) and treatment as usual group (TAU; n = 15). TG received EEG-NFT along with routine clinical management and TAU received routine clinical management alone. Forty sessions of theta/beta NFT at the C3 scalp location, 3 to 4 sessions in a week for a period of 3.5 to 5 months were given to children in TG. Children were screened using sociodemographic data and Binet-Kamat test of intelligence. Pre-and postassessment tools were neuropsychological tests and behavioral scales. Follow-up was carried out on 8 children in TG using parent-rated behavioral measures. RESULTS Improvement was reported in TG on cognitive functions (sustained attention, verbal working memory, and response inhibition), parent- and teacher-rated behavior problems and on academic performance rated by teachers. Follow-up of children who received NFT showed sustained improvement in ADHD symptoms when assessed 6 months after receiving NFT. CONCLUSION The present study suggests that NFT is an effective method to enhance cognitive deficits and helps reduce ADHD symptoms and behavior problems. Consequently, academic performance was found to be improved in children with ADHD. Improvement in ADHD symptoms induced by NFT were maintained at 6-month follow-up in children with ADHD.
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Affiliation(s)
- E A Shereena
- 1 National Institute of Mental Health & Neuro Sciences, Bengaluru, Karnataka, India
| | - R K Gupta
- 1 National Institute of Mental Health & Neuro Sciences, Bengaluru, Karnataka, India
| | - C N Bennett
- 2 Department of Psychology, Christ (Deemed to be University), Bengaluru, Karnataka, India
| | - K J V Sagar
- 1 National Institute of Mental Health & Neuro Sciences, Bengaluru, Karnataka, India
| | - J Rajeswaran
- 1 National Institute of Mental Health & Neuro Sciences, Bengaluru, Karnataka, India
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Sibalis A, Milligan K, Pun C, McKeough T, Schmidt LA, Segalowitz SJ. An EEG Investigation of the Attention-Related Impact of Mindfulness Training in Youth With ADHD: Outcomes and Methodological Considerations. J Atten Disord 2019; 23:733-743. [PMID: 28748735 DOI: 10.1177/1087054717719535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The current study examined the impact of an activity-based mindfulness treatment on EEG indices of attention in youth with ADHD aged 11 to 17 years compared with a waitlist control group. METHOD Pre- and post-treatment, EEG was recorded as participants completed a single-point focus rest task and two active attention tasks. Theta power, beta power, and theta/beta ratio (TBR) were calculated during each task. RESULTS A significant group by time by task interaction was found that indicated significant improvement in attentional ability, indexed by decreased TBR, for the treatment group but not controls. CONCLUSION Findings support the benefit of mindfulness treatment for enhancing attentional control in youth with ADHD and extend the literature by providing evidence of these gains at a neural level. Findings also offer methodological support for the use of active attention tasks when examining mindfulness-related attentional gains in youth with ADHD. Directions for future research are discussed.
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Affiliation(s)
| | | | - Carson Pun
- 1 Ryerson University, Toronto, Ontario, Canada
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Harris S, Hundley G, Lambie G. The Effects of Neurofeedback on Depression, Anxiety, and Academic Self-Efficacy. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2019. [DOI: 10.1080/87568225.2019.1606689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Shaywanna Harris
- Department of Counselor Education & School Psychology, University of Central Florida, Orlando, USA
| | - Gulnora Hundley
- Department of Counselor Education & School Psychology, University of Central Florida, Orlando, USA
| | - Glenn Lambie
- Department of Counselor Education & School Psychology, University of Central Florida, Orlando, USA
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Hammond DC. Integrating Clinical Hypnosis and Neurofeedback. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2019; 61:302-321. [PMID: 31017552 DOI: 10.1080/00029157.2018.1501550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hypnosis and neurofeedback each provide unique therapeutic strengths and opportunities. This article provides an overview of some of the research on neurofeedback and hypnosis. The author's perspective and recommendations are provided on the relative clinical utility of using either neurofeedback or hypnosis as the initial treatment of choice with various clinical conditions.
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Milekovic T, Bacher D, Sarma AA, Simeral JD, Saab J, Pandarinath C, Yvert B, Sorice BL, Blabe C, Oakley EM, Tringale KR, Eskandar E, Cash SS, Shenoy KV, Henderson JM, Hochberg LR, Donoghue JP. Volitional control of single-electrode high gamma local field potentials by people with paralysis. J Neurophysiol 2019; 121:1428-1450. [PMID: 30785814 DOI: 10.1152/jn.00131.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Intracortical brain-computer interfaces (BCIs) can enable individuals to control effectors, such as a computer cursor, by directly decoding the user's movement intentions from action potentials and local field potentials (LFPs) recorded within the motor cortex. However, the accuracy and complexity of effector control achieved with such "biomimetic" BCIs will depend on the degree to which the intended movements used to elicit control modulate the neural activity. In particular, channels that do not record distinguishable action potentials and only record LFP modulations may be of limited use for BCI control. In contrast, a biofeedback approach may surpass these limitations by letting the participants generate new control signals and learn strategies that improve the volitional control of signals used for effector control. Here, we show that, by using a biofeedback paradigm, three individuals with tetraplegia achieved volitional control of gamma LFPs (40-400 Hz) recorded by a single microelectrode implanted in the precentral gyrus. Control was improved over a pair of consecutive sessions up to 3 days apart. In all but one session, the channel used to achieve control lacked distinguishable action potentials. Our results indicate that biofeedback LFP-based BCIs may potentially contribute to the neural modulation necessary to obtain reliable and useful control of effectors. NEW & NOTEWORTHY Our study demonstrates that people with tetraplegia can volitionally control individual high-gamma local-field potential (LFP) channels recorded from the motor cortex, and that this control can be improved using biofeedback. Motor cortical LFP signals are thought to be both informative and stable intracortical signals and, thus, of importance for future brain-computer interfaces.
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Affiliation(s)
- Tomislav Milekovic
- Department of Neuroscience, Brown University , Providence, Rhode Island.,Carney Institute for Brain Science, Brown University , Providence, Rhode Island.,Department of Fundamental Neuroscience, Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - Daniel Bacher
- Carney Institute for Brain Science, Brown University , Providence, Rhode Island.,School of Engineering, Brown University , Providence, Rhode Island
| | - Anish A Sarma
- Carney Institute for Brain Science, Brown University , Providence, Rhode Island.,School of Engineering, Brown University , Providence, Rhode Island.,Center for Neurorestoration and Neurotechnology, Rehabilitation Research & Development Service, Department of Veterans Affairs , Providence, Rhode Island
| | - John D Simeral
- Carney Institute for Brain Science, Brown University , Providence, Rhode Island.,School of Engineering, Brown University , Providence, Rhode Island.,Center for Neurorestoration and Neurotechnology, Rehabilitation Research & Development Service, Department of Veterans Affairs , Providence, Rhode Island
| | - Jad Saab
- Carney Institute for Brain Science, Brown University , Providence, Rhode Island.,School of Engineering, Brown University , Providence, Rhode Island
| | - Chethan Pandarinath
- Department of Neurosurgery, Stanford University , Stanford, California.,Department of Electrical Engineering, Stanford University , Stanford, California.,Stanford Neurosciences Institute, Stanford University , Stanford, California
| | - Blaise Yvert
- Department of Neuroscience, Brown University , Providence, Rhode Island.,Carney Institute for Brain Science, Brown University , Providence, Rhode Island.,Inserm, University of Grenoble, Clinatec-Lab U1205, Grenoble , France
| | - Brittany L Sorice
- Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts
| | - Christine Blabe
- Department of Neurosurgery, Stanford University , Stanford, California
| | - Erin M Oakley
- Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts
| | - Kathryn R Tringale
- Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts
| | - Emad Eskandar
- Department of Neurosurgery, Massachusetts General Hospital , Boston, Massachusetts.,Harvard Medical School , Boston, Massachusetts
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts.,Harvard Medical School , Boston, Massachusetts
| | - Krishna V Shenoy
- Department of Electrical Engineering, Stanford University , Stanford, California.,Stanford Neurosciences Institute, Stanford University , Stanford, California.,Neurosciences Program, Stanford University , Stanford, California.,Department of Neurobiology, Stanford University , Stanford, California.,Department of Bioengineering, Stanford University , Stanford, California
| | - Jaimie M Henderson
- Department of Neurosurgery, Stanford University , Stanford, California.,Stanford Neurosciences Institute, Stanford University , Stanford, California.,Department of Neurology and Neurological Sciences, Stanford University , Stanford, California
| | - Leigh R Hochberg
- Carney Institute for Brain Science, Brown University , Providence, Rhode Island.,School of Engineering, Brown University , Providence, Rhode Island.,Center for Neurorestoration and Neurotechnology, Rehabilitation Research & Development Service, Department of Veterans Affairs , Providence, Rhode Island.,Department of Neurology, Massachusetts General Hospital , Boston, Massachusetts.,Harvard Medical School , Boston, Massachusetts
| | - John P Donoghue
- Department of Neuroscience, Brown University , Providence, Rhode Island.,Carney Institute for Brain Science, Brown University , Providence, Rhode Island.,Center for Neurorestoration and Neurotechnology, Rehabilitation Research & Development Service, Department of Veterans Affairs , Providence, Rhode Island
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Moreno-García I, Meneres-Sancho S, Camacho-Vara de Rey C, Servera M. A Randomized Controlled Trial to Examine the Posttreatment Efficacy of Neurofeedback, Behavior Therapy, and Pharmacology on ADHD Measures. J Atten Disord 2019; 23:374-383. [PMID: 29254414 DOI: 10.1177/1087054717693371] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the efficacy of neurofeedback (NF), behavior therapy (BT), and pharmacology (PH) on the improvement of ADHD-related symptoms. METHOD Fifty-nine children with ADHD ( M = 8.80 years, SD = 1.92 years) were randomly assigned to one of the three treatments in a pre/post assessment design. Mother- and teacher-rated ADHD scales and children were assessed using The Integrated Visual and Auditory Continuous Performance Test (IVA/CPT). RESULTS The three treatments were effective on the IVA/CPT, but with different trends. BT and especially NF achieved improvement on response control and attention, and PH mainly in visual attention. On the rating scales, BT improved all measures, and NF and PH had a minor but interesting influence. CONCLUSION From a global perspective, behavior therapy had the most extensive results, but PH had the greatest capacity to improve overall attention. NF was able to improve both control response and inattention. Clinical implications are discussed.
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Okumura Y, Kita Y, Omori M, Suzuki K, Yasumura A, Fukuda A, Inagaki M. Predictive factors of success in neurofeedback training for children with ADHD. Dev Neurorehabil 2019; 22:3-12. [PMID: 28594254 DOI: 10.1080/17518423.2017.1326183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Neurofeedback (NF) training aims the enhancement of self-regulation over brain activities. While it is largely recognized as an effective treatment for attention deficit hyperactivity disorder (ADHD), the existence of non-learners has also been reported. The present study explored pre-training assessment indices that could predict learners prior to NF training. METHODS Twenty-two children with ADHD participated in slow cortical potential (SCP) NF training and completed pre- and post-training assessments. Participants were classified into learners or non-learners based on their progress in the SCP regulation, and pre-training indices that differentiate the two groups were examined by decision tree analysis. RESULTS AND DISCUSSION The learner rate in NF training was 45.5%. Learners were predicted by pre-training cognitive and neurophysiological measures regarding Stroop tasks, which suggested relatively intact executive function as their characteristics. Given that NF training is not universally effective for children with ADHD, further studies are necessary to establish application criteria.
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Affiliation(s)
- Yasuko Okumura
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Yosuke Kita
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Mikimasa Omori
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan.,b Department of Psychology, Faculty of Humanities and Social Sciences , Showa Women's University , Tokyo , Japan
| | - Kota Suzuki
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Akira Yasumura
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan.,c Department of Neuropsychiatry , The University of Tokyo Hospital , Tokyo , Japan
| | - Ayako Fukuda
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Masumi Inagaki
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan
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Bussalb A, Congedo M, Barthélemy Q, Ojeda D, Acquaviva E, Delorme R, Mayaud L. Clinical and Experimental Factors Influencing the Efficacy of Neurofeedback in ADHD: A Meta-Analysis. Front Psychiatry 2019; 10:35. [PMID: 30833909 PMCID: PMC6388544 DOI: 10.3389/fpsyt.2019.00035] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/21/2019] [Indexed: 11/13/2022] Open
Abstract
Meta-analyses have been extensively used to evaluate the efficacy of neurofeedback (NFB) treatment for Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. However, each meta-analysis published in the past decade has contradicted the methods and results from the previous one, thus making it difficult to determine a consensus of opinion on the effectiveness of NFB. This works brings continuity to the field by extending and discussing the last and much controversial meta-analysis by Cortese et al. (1). The extension comprises an update of that work including the latest control trials, which have since been published and, most importantly, offers a novel methodology. Specifically, NFB literature is characterized by a high technical and methodological heterogeneity, which partly explains the current lack of consensus on the efficacy of NFB. This work takes advantage of this by performing a Systematic Analysis of Biases (SAOB) in studies included in the previous meta-analysis. Our extended meta-analysis (k = 16 studies) confirmed the previously obtained results of effect sizes in favor of NFB efficacy as being significant when clinical scales of ADHD are rated by parents (non-blind, p-value = 0.0014), but not when they are rated by teachers (probably blind, p-value = 0.27). The effect size is significant according to both raters for the subset of studies meeting the definition of "standard NFB protocols" (parents' p-value = 0.0054; teachers' p-value = 0.043, k = 4). Following this, the SAOB performed on k = 33 trials identified three main factors that have an impact on NFB efficacy: first, a more intensive treatment, but not treatment duration, is associated with higher efficacy; second, teachers report a lower improvement compared to parents; third, using high-quality EEG equipment improves the effectiveness of the NFB treatment. The identification of biases relating to an appropriate technical implementation of NFB certainly supports the efficacy of NFB as an intervention. The data presented also suggest that the probably blind assessment of teachers may not be considered a good proxy for blind assessments, therefore stressing the need for studies with placebo-controlled intervention as well as carefully reported neuromarker changes in relation to clinical response.
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Affiliation(s)
- Aurore Bussalb
- Mensia Technologies SA, Paris, France.,Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Marco Congedo
- GIPSA-Lab, Université Grenoble Alpes, CNRS, Grenoble-INP, Grenoble, France
| | | | | | - Eric Acquaviva
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
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Sudnawa KK, Chirdkiatgumchai V, Ruangdaraganon N, Khongkhatithum C, Udomsubpayakul U, Jirayucharoensak S, Israsena P. Effectiveness of neurofeedback versus medication for attention-deficit/hyperactivity disorder. Pediatr Int 2018; 60:828-834. [PMID: 29931709 DOI: 10.1111/ped.13641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 05/27/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Neurofeedback (NF) is an operant conditioning procedure that trains participants to self-regulate brain activity. NF is a promising treatment for attention-deficit/hyperactivity disorder (ADHD), but there have been only a few randomized controlled trials comparing the effectiveness of NF with medication with various NF protocols. The aim of this study was therefore to evaluate the effectiveness of unipolar electrode NF using theta/beta protocol compared with methylphenidate (MPH) for ADHD. METHODS Children with newly diagnosed ADHD were randomly organized into NF and MPH groups. The NF group received 30 sessions of NF. Children in the MPH group were prescribed MPH for 12 weeks. Vanderbilt ADHD rating scales were completed by parents and teachers to evaluate ADHD symptoms before and after treatment. Student's t-test and Cohen's d were used to compare symptoms between groups and evaluate the effect size (ES) of each treatment, respectively. RESULTS Forty children participated in the study. No differences in ADHD baseline symptoms were found between groups. After treatment, teachers reported significantly lower ADHD symptoms in the MPH group (P = 0.01), but there were no differences between groups on parent report (P = 0.55). MPH had a large ES (Cohen's d, 1.30-1.69), while NF had a moderate ES (Cohen's d, 0.49-0.68) for treatment of ADHD symptoms. CONCLUSION Neurofeedback is a promising alternative treatment for ADHD in children who do not respond to or experience significant adverse effects from ADHD medication.
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Affiliation(s)
- Khemika Khemakanok Sudnawa
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vilawan Chirdkiatgumchai
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nichara Ruangdaraganon
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiyos Khongkhatithum
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Umaporn Udomsubpayakul
- Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Bangkok, Thailand
| | | | - Pasin Israsena
- National Electronics and Computer Technology Center, Pathumthani, Thailand
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Rosa So Q, Yang T, Phua KS, Yu J, Toh V, Ng WH, Ang KK. Increased Theta Oscillations During Motor Imagery in a Subject with Late-stage ALS. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:1078-1081. [PMID: 30440578 DOI: 10.1109/embc.2018.8512411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Non-invasive brain computer interface (BCI) has been successfully used to control cursors, helicopters and robotic arms. However, this technology is not widely adopted by people with late-stage amyotrophic lateral sclerosis (ALS) due to poor effectiveness. In this study, we attempt to assess the cognitive state of a completely locked-in ALS subject, and her ability to use motor imagery-based BCI for control. The subject achieves above chance level accuracies for both open loop (62.2%) and closed-loop (68.7%) 2-class movement vs. idle decoding. We also observe a prominent theta oscillation with peak frequency at 4.5 Hz during the experiments. Quantification shows that the theta oscillatory power increases during motor imagery tasks compared to idle tasks for both open-loop as well as closed-loop BCI tasks. Furthermore, for closed-loop sessions, theta oscillation power correlates positively with feedback accuracy during movement tasks, and negatively with feedback accuracy during idle tasks. Our study demonstrates the feasibility of motor imagery-based BCI for late-stage ALS subjects, and highlights the importance of feedback during BCI implementation.
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Alkoby O, Abu-Rmileh A, Shriki O, Todder D. Can We Predict Who Will Respond to Neurofeedback? A Review of the Inefficacy Problem and Existing Predictors for Successful EEG Neurofeedback Learning. Neuroscience 2018; 378:155-164. [DOI: 10.1016/j.neuroscience.2016.12.050] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/25/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
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Mixed-Effects Modeling of Neurofeedback Self-Regulation Performance: Moderators for Learning in Children with ADHD. Neural Plast 2018; 2018:2464310. [PMID: 29765401 PMCID: PMC5885491 DOI: 10.1155/2018/2464310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/21/2017] [Accepted: 11/28/2017] [Indexed: 12/01/2022] Open
Abstract
Introduction Neurofeedback (NF) has gained increasing popularity as a training method for children and adults with attention deficit hyperactivity disorder (ADHD). However, it is unclear to what extent children learn to regulate their brain activity and in what way NF learning may be affected by subject- and treatment-related factors. Methods In total, 48 subjects with ADHD (age 8.5–16.5 years; 16 subjects on methylphenidate (MPH)) underwent 15 double training sessions of NF in either a clinical or a school setting. Four mixed-effects models were employed to analyze learning: training within-sessions, across-sessions, with continuous feedback, and with transfer in which performance feedback is delayed. Results Age and MPH affected the NF performance in all models. Cross-session learning in the feedback condition was mainly moderated by age and MPH, whereas NF learning in the transfer condition was mainly boosted by MPH. Apart from IQ and task types, other subject-related or treatment-related effects were unrelated to NF learning. Conclusion This first study analyzing moderators of NF learning in ADHD with a mixed-effects modeling approach shows that NF performance is moderated differentially by effects of age and MPH depending on the training task and time window. Future studies may benefit from using this approach to analyze NF learning and NF specificity. The trial name Neurofeedback and Computerized Cognitive Training in Different Settings for Children and Adolescents With ADHD is registered with NCT02358941.
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Yaghoobi Karimui R, Azadi S, Keshavarzi P. The ADHD effect on the actions obtained from the EEG signals. Biocybern Biomed Eng 2018. [DOI: 10.1016/j.bbe.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Attention Deficit Disorder. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Duric NS, Assmus J, Gundersen D, Duric Golos A, Elgen IB. Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up. Nord J Psychiatry 2017; 71:386-394. [PMID: 28345387 DOI: 10.1080/08039488.2017.1305446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Different treatment approaches aimed at reducing attention-deficit/hyperactivity disorder (ADHD) core symptoms are available. However, factors such as intolerance, side-effects, lack of efficacy, high new technology costs, and placebo effect have spurred on an increasing interest in alternative or complementary treatment. AIM The aim of this study is to explore efficacy of multimodal treatment consisting of standard stimulant medication (methylphenidate) and neurofeedback (NF) in combination, and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents. METHODS This randomized controlled trial with 6-month follow-up comprised three treatment arms: multimodal treatment (NF + MED), MED alone, and NF alone. A total of 130 ADHD children/adolescents participated, and 62% completed the study. ADHD core symptoms were recorded pre-/post-treatment, using parents' and teachers' forms taken from Barkley's Defiant Children: A Clinician's Manual for Assessment and Parent Training, and a self-report questionnaire. RESULTS Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents, teachers, and participants in all three groups, with marked improvement in inattention in all groups. However, no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents, respectively, in the three groups. Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment, as reported by all participants. CONCLUSIONS Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment. More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment, and for those who want to reduce the use of stimulant medication.
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Affiliation(s)
- Nezla S Duric
- a Department of Child and Adolescent Psychiatry , Helse Fonna , Haugesund , Norway
| | - Jørg Assmus
- b Centre for Clinical Research, Helse Bergen , Norway
| | - Doris Gundersen
- c Department of Research and Innovation , Helse Fonna HF , Haugesund , Norway
| | - Alisa Duric Golos
- d Department of Clinical Medicine , University of Sarajevo , Bosnia & Herzegovina
| | - Irene B Elgen
- e Department of Child and Adolescent Psychiatry , Haukeland University Hospital , Bergen , Norway.,f Department of Clinical Medicine , University of Bergen , Norway
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Alegria AA, Wulff M, Brinson H, Barker GJ, Norman LJ, Brandeis D, Stahl D, David AS, Taylor E, Giampietro V, Rubia K. Real-time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder. Hum Brain Mapp 2017; 38:3190-3209. [PMID: 28342214 PMCID: PMC5434828 DOI: 10.1002/hbm.23584] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/06/2017] [Accepted: 03/13/2017] [Indexed: 02/05/2023] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self-control, underpinned by inferior fronto-striatal deficits. Real-time functional magnetic resonance neurofeedback (rtfMRI-NF) allows participants to gain self-control over dysregulated brain regions. Despite evidence for beneficial effects of electrophysiological-NF on ADHD symptoms, no study has applied the spatially superior rtfMRI-NF neurotherapy to ADHD. A randomized controlled trial tested the efficacy of rtfMRI-NF of right inferior prefrontal cortex (rIFG), a key region that is compromised in ADHD and upregulated with psychostimulants, on improvement of ADHD symptoms, cognition, and inhibitory fMRI activation. To control for region-specificity, an active control group received rtfMRI-NF of the left parahippocampal gyrus (lPHG). Thirty-one ADHD boys were randomly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI-NF runs over 2 weeks. Feedback was provided through a video-clip of a rocket that had to be moved up into space. A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life. Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11-month follow-up. Only the group targeting rIFG, however, showed a transfer effect, which correlated with ADHD symptom reductions, improved at trend level in sustained attention, and showed increased IFG activation during an inhibitory fMRI task. This proof-of-concept study demonstrates for the first time feasibility, safety, and shorter- and longer-term efficacy of rtfMRI-NF of rIFG in adolescents with ADHD. Hum Brain Mapp 38:3190-3209, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Analucia A. Alegria
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Melanie Wulff
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Helen Brinson
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Gareth J. Barker
- Centre for Neuroimaging Science, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Luke J. Norman
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and PsychotherapyCentral Institute of Mental Health, Medical Faculty Mannheim/Heidelberg UniversityMannheimGermany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric HospitalUniversity of ZurichZurichSwitzerland
- Center for Integrative Human Physiology, and Neuroscience Center Zurich, University of ZurichZurichSwitzerland
| | - Daniel Stahl
- Department of BiostatisticsKing's College LondonLondonUnited Kingdom
| | - Anthony S. David
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology and Neuroscience King's College LondonLondonUnited Kingdom
| | - Eric Taylor
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Vincent Giampietro
- Centre for Neuroimaging Science, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Katya Rubia
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
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Abstract
Brain-computer interface (BCI) technology can restore communication and control to people who are severely paralyzed. There has been speculation that this technology might also be useful for a variety of diverse therapeutic applications. This survey considers possible ways that BCI technology can be applied to motor rehabilitation following stroke, Parkinson's disease, and psychiatric disorders. We consider potential neural signals as well as the design and goals of BCI-based therapeutic applications. These diverse applications all share a reliance on neuroimaging and signal processing technologies. At the same time, each of these potential applications presents a series of unique challenges.
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Affiliation(s)
| | - Janis Daly
- Brain Rehabilitation Research Program, McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Chadwick Boulay
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Arns M, Batail JM, Bioulac S, Congedo M, Daudet C, Drapier D, Fovet T, Jardri R, Le-Van-Quyen M, Lotte F, Mehler D, Micoulaud-Franchi JA, Purper-Ouakil D, Vialatte F. Neurofeedback: One of today's techniques in psychiatry? Encephale 2017; 43:135-145. [DOI: 10.1016/j.encep.2016.11.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022]
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Geladé K, Bink M, Janssen TWP, van Mourik R, Maras A, Oosterlaan J. An RCT into the effects of neurofeedback on neurocognitive functioning compared to stimulant medication and physical activity in children with ADHD. Eur Child Adolesc Psychiatry 2017; 26:457-468. [PMID: 27665293 PMCID: PMC5364239 DOI: 10.1007/s00787-016-0902-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 08/31/2016] [Indexed: 02/02/2023]
Abstract
Neurofeedback (NFB) is a potential alternative treatment for children with ADHD that aims to optimize brain activity. Whereas most studies into NFB have investigated behavioral effects, less attention has been paid to the effects on neurocognitive functioning. The present randomized controlled trial (RCT) compared neurocognitive effects of NFB to (1) optimally titrated methylphenidate (MPH) and (2) a semi-active control intervention, physical activity (PA), to control for non-specific effects. Using a multicentre three-way parallel group RCT design, children with ADHD, aged 7-13, were randomly allocated to NFB (n = 39), MPH (n = 36) or PA (n = 37) over a period of 10-12 weeks. NFB comprised theta/beta training at CZ. The PA intervention was matched in frequency and duration to NFB. MPH was titrated using a double-blind placebo controlled procedure to determine the optimal dose. Neurocognitive functioning was assessed using parameters derived from the auditory oddball-, stop-signal- and visual spatial working memory task. Data collection took place between September 2010 and March 2014. Intention-to-treat analyses showed improved attention for MPH compared to NFB and PA, as reflected by decreased response speed during the oddball task [η p2 = 0.21, p < 0.001], as well as improved inhibition, impulsivity and attention, as reflected by faster stop signal reaction times, lower commission and omission error rates during the stop-signal task (range η p2 = 0.09-0.18, p values <0.008). Working memory improved over time, irrespective of received treatment (η p2 = 0.17, p < 0.001). Overall, stimulant medication showed superior effects over NFB to improve neurocognitive functioning. Hence, the findings do not support theta/beta training applied as a stand-alone treatment in children with ADHD.
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Affiliation(s)
- Katleen Geladé
- Yulius Academy, Yulius Mental Health Organization, Dennenhout 1, 2994 GC, Barendrecht, The Netherlands.
- Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Marleen Bink
- Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Tieme W P Janssen
- Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands
| | - Rosa van Mourik
- Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands
- Royal Dutch Kentalis, Utrecht, Pallas Athenedreef 10, 3561PE, Utrecht, The Netherlands
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, Dennenhout 1, 2994 GC, Barendrecht, The Netherlands
| | - Jaap Oosterlaan
- Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands
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Robineau F, Meskaldji DE, Koush Y, Rieger SW, Mermoud C, Morgenthaler S, Van De Ville D, Vuilleumier P, Scharnowski F. Maintenance of Voluntary Self-regulation Learned through Real-Time fMRI Neurofeedback. Front Hum Neurosci 2017; 11:131. [PMID: 28386224 PMCID: PMC5363181 DOI: 10.3389/fnhum.2017.00131] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/07/2017] [Indexed: 11/13/2022] Open
Abstract
Neurofeedback based on real-time functional magnetic resonance imaging (fMRI) is an emerging technique that allows for learning voluntary control over brain activity. Such brain training has been shown to cause specific behavioral or cognitive enhancements, and even therapeutic effects in neurological and psychiatric patient populations. However, for clinical applications it is important to know if learned self-regulation can be maintained over longer periods of time and whether it transfers to situations without neurofeedback. Here, we present preliminary results from five healthy participants who successfully learned to control their visual cortex activity and who we re-scanned 6 and 14 months after the initial neurofeedback training to perform learned self-regulation. We found that participants achieved levels of self-regulation that were similar to those achieved at the end of the successful initial training, and this without further neurofeedback information. Our results demonstrate that learned self-regulation can be maintained over longer periods of time and causes lasting transfer effects. They thus support the notion that neurofeedback is a promising therapeutic approach whose effects can last far beyond the actual training period.
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Affiliation(s)
- Fabien Robineau
- Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Neuroscience, University Medical CenterGeneva, Switzerland; Geneva Neuroscience CenterGeneva, Switzerland
| | - Djalel E Meskaldji
- Department of Radiology and Medical Informatics, CIBM, University of GenevaGeneva, Switzerland; Institute of Bioengineering, Ecole Polytechnique Fédérale de LausanneLausanne, Switzerland; Institute of Mathematics, Ecole Polytechnique Fédérale de LausanneLausanne, Switzerland
| | - Yury Koush
- Department of Radiology and Medical Informatics, CIBM, University of GenevaGeneva, Switzerland; Institute of Bioengineering, Ecole Polytechnique Fédérale de LausanneLausanne, Switzerland; Department of Radiology and Biomedical Imaging, Yale University, New HavenCT, USA
| | - Sebastian W Rieger
- Geneva Neuroscience CenterGeneva, Switzerland; Swiss Center for Affective SciencesGeneva, Switzerland
| | - Christophe Mermoud
- Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Neuroscience, University Medical Center Geneva, Switzerland
| | - Stephan Morgenthaler
- Institute of Mathematics, Ecole Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| | - Dimitri Van De Ville
- Geneva Neuroscience CenterGeneva, Switzerland; Department of Radiology and Medical Informatics, CIBM, University of GenevaGeneva, Switzerland; Institute of Bioengineering, Ecole Polytechnique Fédérale de LausanneLausanne, Switzerland
| | - Patrik Vuilleumier
- Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Neuroscience, University Medical CenterGeneva, Switzerland; Geneva Neuroscience CenterGeneva, Switzerland; Swiss Center for Affective SciencesGeneva, Switzerland
| | - Frank Scharnowski
- Psychiatric University Hospital, University of Zurich, ZürichSwitzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, ZürichSwitzerland; Zurich Center for Integrative Human Physiology, University of Zurich, ZürichSwitzerland
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Paluch K, Jurewicz K, Rogala J, Krauz R, Szczypińska M, Mikicin M, Wróbel A, Kublik E. Beware: Recruitment of Muscle Activity by the EEG-Neurofeedback Trainings of High Frequencies. Front Hum Neurosci 2017; 11:119. [PMID: 28373836 PMCID: PMC5357644 DOI: 10.3389/fnhum.2017.00119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/27/2017] [Indexed: 11/13/2022] Open
Abstract
EEG-neurofeedback (NFB) became a very popular method aimed at improving cognitive and behavioral performance. However, the EMG frequency spectrum overlies the higher EEG oscillations and the NFB trainings focusing on these frequencies is hindered by the problem of EMG load in the information fed back to the subjects. In such a complex signal, it is highly probable that the most controllable component will form the basis for operant conditioning. This might cause different effects in the case of various training protocols and therefore needs to be carefully assessed before designing training protocols and algorithms. In the current experiment a group of healthy adults (n = 14) was trained by professional trainers to up-regulate their beta1 (15-22 Hz) band for eight sessions. The control group (n = 18) underwent the same training regime but without rewards for increasing beta. In half of the participants trained to up-regulate beta1 band (n = 7) a systematic increase in tonic EMG activity was identified offline, implying that muscle activity became a foundation for reinforcement in the trainings. The remaining participants did not present any specific increase of the trained beta1 band amplitude. The training was perceived effective by both trainers and the trainees in all groups. These results indicate the necessity of proper control of muscle activity as a requirement for the genuine EEG-NFB training, especially in protocols that do not aim at the participants' relaxation. The specificity of the information fed back to the participants should be of highest interest to all therapists and researchers, as it might irreversibly alter the results of the training.
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Affiliation(s)
- Katarzyna Paluch
- Department of Neurophysiology, Nencki Institute of Experimental Biology of Polish Academy of Science Warsaw, Poland
| | - Katarzyna Jurewicz
- Department of Neurophysiology, Nencki Institute of Experimental Biology of Polish Academy of Science Warsaw, Poland
| | - Jacek Rogala
- Department of Neurophysiology, Nencki Institute of Experimental Biology of Polish Academy of Science Warsaw, Poland
| | - Rafał Krauz
- Centre for Physical Education and Sport, Military University of Technology Warsaw, Poland
| | - Marta Szczypińska
- Department of Physical Education, University of Physical Education Warsaw, Poland
| | - Mirosław Mikicin
- Department of Physical Education, University of Physical Education Warsaw, Poland
| | - Andrzej Wróbel
- Department of Neurophysiology, Nencki Institute of Experimental Biology of Polish Academy of Science Warsaw, Poland
| | - Ewa Kublik
- Department of Neurophysiology, Nencki Institute of Experimental Biology of Polish Academy of Science Warsaw, Poland
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A Randomized Trial of Comparing the Efficacy of Two Neurofeedback Protocols for Treatment of Clinical and Cognitive Symptoms of ADHD: Theta Suppression/Beta Enhancement and Theta Suppression/Alpha Enhancement. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3513281. [PMID: 28321406 PMCID: PMC5340952 DOI: 10.1155/2017/3513281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/18/2016] [Accepted: 01/19/2017] [Indexed: 11/17/2022]
Abstract
Introduction. Neurofeedback (NF) is an adjuvant or alternative therapy for children with Attention Deficit Hyperactivity Disorder (ADHD). This study intended to compare the efficacy of two different NF protocols on clinical and cognitive symptoms of ADHD. Materials and Methods. In this clinical trial, sixty children with ADHD aged 7 to 10 years old were randomly grouped to receive two different NF treatments (theta suppression/beta enhancement protocol and theta suppression/alpha enhancement protocol). Clinical and cognitive assessments were conducted prior to and following the treatment and also after an eight-week follow-up. Results. Both protocols alleviated the symptoms of ADHD in general (p < 0.001), hyperactivity (p < 0.001), inattention (p < 0.001), and omission errors (p < 0.001); however, they did not affect the oppositional and impulsive scales nor commission errors. These effects were maintained after an eight-week intervention-free period. The only significant difference between the two NF protocols was that high-frequency alpha enhancement protocol performed better in suppressing omission errors (p < 0.001). Conclusion. The two NF protocols with theta suppression/beta enhancement and theta suppression/alpha enhancement have considerable and comparable effect on clinical symptoms of ADHD. Alpha enhancement protocol was more effective in suppressing omission errors.
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