The effectiveness of neurofeedback training on EEG coherence and neuropsychological functions in children with reading disability

Effects of neurofeedback on the self-concept of children with learning disorders

Children with learning disorders (LDs) often have a lower self-concept than their typically developing peers. Neurofeedback (NFB) treatments seem to improve the cognitive and academic performance of these children, but the effects on self-concept have not been studied. In this exploratory study, 34 right-handed children (8-11 y.o.) with LD and delayed electroencephalographic maturation responded to the Piers-Harris Children's Self-Concept Scale. One group received NFB (n = 20), and another group (n = 14) served as control, which included 9 children treated with sham-NFB and 5 on a waiting-list. A nonparametric permutation approach was used to compare the academic performance and self-concept difference (postscores - prescores) between the NFB and control groups. Given the smaller size of the control subgroups, a comparison of the percent changes between sham-NFB and the waiting-list was performed with the non-overlap of all pairs (NAP) technique. In the NFB group, the scores of reading, math, and global self-concept increased significantly, highlighting the self-concept subdomains of physical appearance, nonanxiety, popularity, and happiness. Additionally, the sham-NFB subgroup showed better outcomes than the waiting-list subgroup, perhaps due to noncontrolled factors. We found improved academic performance and self-concept in children with LDs who received NFB treatment. This study is an important exploratory step in studying a relevant treatment that seems to ameliorate symptoms of LDs such as anxiety and low self-concept.

Review of EEG-based neurofeedback as a therapeutic intervention to treat depression

Depression, or major depressive disorder, is a common mental disorder that affects individuals' behavior, mood, and physical health, and its prevalence has increased during the lockdowns implemented to curb the COVID-19 pandemic. There is an urgent need to update the treatment recommendations for mental disorders during such crises. Conventional interventions to treat depression include long-term pharmacotherapy and cognitive behavioral therapy. Electroencephalogram-neurofeedback (EEG-NF) training has been suggested as a non-invasive option to treat depression with minimal side effects. In this systematic review, we summarize the recent literature on EEG-NF training for treating depression. The 12 studies included in our final sample reported that despite several issues related to EEG-NF practices, patients with depression showed significant cognitive, clinical, and neural improvements following EEG-NF training. Given its low cost and the low risk of side effects due to its non-invasive nature, we suggest that EEG-NF is worth exploring as an augmented tool for patients who already receive standard medications but remain symptomatic, and that EEG-NF training may be an effective intervention tool that can be utilized as a supplementary treatment for depression. We conclude by providing some suggestions related to experimental designs and standards to improve current EEG-NF training practices for treating depression.

Neurofeedback for the Education of Children with ADHD and Specific Learning Disorders: A Review

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.

Training the brain to time: the effect of neurofeedback of SMR-Beta1 rhythm on time perception in healthy adults

The timing ability plays an important role in everyday activities and is influenced by several factors such as the attention and arousal levels of the individuals. The effects of these factors on time perception have been interpreted through psychological models of time, including Attentional Gate Model (AGM). On the other hand, research has indicated that neurofeedback (NFB) training improves attention and increases arousal levels in the clinical and healthy population. Regarding the link between attentional processing and arousal levels and NFB and their relation to time perception, this study is a pilot demonstration of the influence of SMR-Beta1 (12-18 Hz) NFB training on time production and reproduction performance in healthy adults. To this end, 12 (9 female and 3 males; M = 26.3, SD = 3.8) and 12 participants (7 female and 5 males; M = 26.9, SD = 3.1) were randomly assigned into the experimental (with SMR-Beta1 NFB) and control groups (without any NFB training), respectively. The experimental group underwent intensive 10 sessions (3 days a week) of the 12-18 Hz up-training. Time production and reproduction performance were assessed pre and post NFB training for all participants. Three-way mixed ANOVA was carried out on T-corrected scores of reproduction and production tasks. Correlation analysis was also performed between SMR-Beta1 and time perception. While NFB training significantly influenced time production (P < 0.01), no such effect was observed for the time reproduction task. The results of the study are finally discussed within the frameworks of AGM, dual-process and cognitive aspects of time perception. Overall, our results contribute to disentangling the underlying mechanisms of temporal performance in healthy individuals.

Improving Functional Connectivity in Developmental Dyslexia through Combined Neurofeedback and Visual Training

This study examined the effects of combined neurofeedback (NF) and visual training (VT) on children with developmental dyslexia (DD). Although NF is the first noninvasive approach to support neurological disorders, the mechanisms of its effects on the brain functional connectivity are still unclear. A key question is whether the functional connectivities of the EEG frequency networks change after the combined NF–VT training of DD children (postD). NF sessions of voluntary α/θ rhythm control were applied in a low-spatial-frequency (LSF) illusion contrast discrimination, which provides feedback with visual cues to improve the brain signals and cognitive abilities in DD children. The measures of connectivity, which are defined by small-world propensity, were sensitive to the properties of the brain electrical oscillations in the quantitative EEG-NF training. In the high-contrast LSF illusion, the z-NF reduced the α/θ scores in the frontal areas, and in the right ventral temporal, occipital–temporal, and middle occipital areas in the postD (vs. the preD) because of their suppression in the local hub θ-network and the altered global characteristics of the functional θ-frequency network. In the low-contrast condition, the z-NF stimulated increases in the α/θ scores, which induced hubs in the left-side α-frequency network of the postD, and changes in the global characteristics of the functional α-frequency network. Because of the anterior, superior, and middle temporal deficits affecting the ventral and occipital–temporal pathways, the z-NF–VT compensated for the more ventral brain regions, mainly in the left hemispheres of the postD group in the low-contrast LSF illusion. Compared to pretraining, the NF–VT increased the segregation of the α, β (low-contrast), and θ networks (high-contrast), as well as the γ2-network integration (both contrasts) after the termination of the training of the children with developmental dyslexia. The remediation compensated more for the dorsal (prefrontal, premotor, occipital–parietal connectivities) dysfunction of the θ network in the developmental dyslexia in the high-contrast LSF illusion. Our findings provide neurobehavioral evidence for the exquisite brain functional plasticity and direct effect of NF–VT on cognitive disabilities in DD children.

Closed-loop Modulation of the Self-regulating Brain: A Review on Approaches, Emerging Paradigms, and Experimental Designs

Closed-loop approaches, setups, and experimental designs have been applied within the field of neuroscience to enhance the understanding of basic neurophysiology principles (closed-loop neuroscience; CLNS) and to develop improved procedures for modulating brain circuits and networks for clinical purposes (closed-loop neuromodulation; CLNM). The contents of this review are thus arranged into the following sections. First, we describe basic research findings that have been made using CLNS. Next, we provide an overview of the application, rationale, and therapeutic aspects of CLNM for clinical purposes. Finally, we summarize methodological concerns and critics in clinical practice of neurofeedback and novel applications of closed-loop perspective and techniques to improve and optimize its experiments. Moreover, we outline the theoretical explanations and experimental ideas to test animal models of neurofeedback and discuss technical issues and challenges associated with implementing closed-loop systems. We hope this review is helpful for both basic neuroscientists and clinical/ translationally-oriented scientists interested in applying closed-loop methods to improve mental health and well-being.

Using Neurofeedback to Restore Inter-Hemispheric Imbalance: A Study Protocol for Adults With Dyslexia

Neurofunctional models of developmental dyslexia (DD) point out disruption of the left-lateralized reading network. In individuals with DD, the left temporo-parietal (TP) regions are underactivated during reading tasks and a dysfunctional activation of the contralateral regions is reported. After a successful reading intervention, left TP lateralization was found to be increased in children with DD. Previous studies measured the effect of modulating the excitability of the left TP cortex using non-invasive brain stimulation (NIBS) in individuals with reading difficulties, showing significant reading improvements. NIBS exclusion criteria and safety guidelines may limit its application in settings without medical supervision and in younger populations. Neurofeedback (NF) training could be an alternative intervention method for modulating the inter-hemispheric balance of the temporal–parietal regions in DD. To date, the effect of NF on reading has been scarcely investigated. Few protocols increasing beta activity in underactivated areas showed improved reading outcomes. However, none of the previous studies designed the NF intervention based on a neurofunctional model of DD. We aim to propose a study protocol for testing the efficacy of a NF training specifically designed for inducing a functional hemispheric imbalance of the tempo-parietal regions in adults with DD. A randomized clinical trial aimed at comparing two experimental conditions is described: (a) Enhancing left beta/theta power ratio NF training in combination with reducing right beta/theta power ratio NF training and (b) sham NF training.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier [NCT04989088].

Resting state EEG network modularity predicts literacy skills in L1 Chinese but not in L2 English

EEG network modularity, as a proxy for cognitive plasticity, has been proposed to be a more reliable neural marker than power and coherence in predicting learning outcomes. The present study examined the associations between resting state EEG network modularity and both L1 Chinese and L2 English literacy skills among 90 Hong Kong first to fifth graders. The modularity indices of different frequency bands were highly correlated with one another. An exploratory factor analysis, performed to extract a general modularity index, explained 77.1% of the total variance. The modularity index was positively associated with Chinese word reading, Chinese phonological awareness, Chinese morphological awareness, and Chinese reading comprehension but was not significantly correlated with English word reading or English morphological awareness. Findings suggest that resting state EEG network modularity is likely to serve as a reasonable, reliable, and cost-effective neural marker of the development of first language but not second language literacy skills.

Effects of Neurofeedback on the Working Memory of Children with Learning Disorders-An EEG Power-Spectrum Analysis

Learning disorders (LDs) are diagnosed in children impaired in the academic skills of reading, writing and/or mathematics. Children with LDs usually exhibit a slower resting-state electroencephalogram (EEG), corresponding to a neurodevelopmental lag. Frequently, children with LDs show working memory (WM) impairment, associated with an abnormal task-related EEG with overall slower EEG activity (more delta and theta power, and less gamma activity in posterior sites). These EEG patterns indicate inefficient neural resource management. Neurofeedback (NFB) treatments aimed at normalizing the resting-state EEG of LD children have shown improvements in cognitive-behavioral indices and diminished EEG abnormalities. Given the typical findings of WM impairment in children with LDs, we aimed to explore the effects of an NFB treatment on the WM of children with LDs by analyzing the WM-related EEG power spectrum. EEGs of 18 children (8–11 y.o.) with LDs were recorded, pre- and post-treatment, during performance of a Sternberg-type WM task. Thirty sessions of an NFB treatment (NFB-group, n = 10) or 30 sessions of a placebo-sham treatment (sham-group, n = 8) were administered. We analyzed the before and after treatment group differences for the behavioral performance and the WM-related EEG power spectrum. The NFB group showed faster response times in the WM task post-treatment. They also exhibited a decreased theta power and increased beta and gamma power at the frontal and posterior sites post-treatment. We explain these findings in terms of NFB improving the efficiency of neural resource management, maintenance of memory representations, and improved subvocal memory rehearsal.

A mobile app that uses neurofeedback and multi-sensory learning methods improves reading abilities in dyslexia: A pilot study

Reading comprehension is difficult to improve for children with dyslexia because of the continuing demands of orthographic decoding in combination with limited working memory capacity. Children with dyslexia get special education that improves spelling, phonemic and vocabulary awareness, however the latest research indicated that special education does not improve reading comprehension. With the aim of improving reading comprehension, reading speed and all other reading abilities of children with dyslexia, Auto Train Brain that is a novel mobile app using neurofeedback and multi-sensory learning methods was developed. With a clinical study, we wanted to demonstrate the effectiveness of Auto Train Brain on reading abilities. We compared the cognitive improvements obtained with Auto Train Brain with the improvements obtained with special dyslexia training. Auto Train Brain was applied to 16 children with dyslexia 60 times for 30 minutes. The control group consisted of 14 children with dyslexia who did not have remedial training with Auto Train Brain, but who did continue special education. The TILLS test was applied to both the experimental and the control group at the beginning of the experiment and after a 6-month duration from the first TILLS test. Comparison of the pre- and post- TILLS test results indicated that applying neurofeedback and multi-sensory learning method improved reading comprehension of the experimental group more than that of the control group statistically significantly. Both Auto Train Brain and special education improved phonemic awareness and nonword spelling.

EEG coherence during subjectively-rated psychological state variations

BACKGROUND

Neurofeedback training aims to develop awareness and control of psychological states in order to self-regulate brain activity and while used widely therapeutically, important questions remain unanswered. Central to these aims is an assumed association between the live EEG-based feedback and the subjective experience of a psychological state. To date, there is little evidence to support this relationship. Previous studies examining the association between an EEG index and subjective experience have explored only the presence or absence of the state, or merely assumed state variations. The current study aims to examine this association by considering how different levels of a psychological state (i.e., attention) are reflected in EEG coherence.

METHODS

Our approach aims to allow comparisons of EEG coherence between psychological states (attention vs. rest), and also within subjectively-rated levels of a psychological state (attention) through a purpose-designed questionnaire. Thirty healthy adult participants performed a resting eyes-open (REO) and attention modulation task, while 28 channels of EEG were recorded. Levels within the psychological state were subjectively-attested by participants on a trial-by-trial basis.

RESULTS

The main analyses examined the effect of subjectively-rated attention levels (SRALs) on EEG coherence, with results suggesting that high and low SRALs may be represented by: 1) different levels of alpha and theta coherence at anterior and posterior electrodes of the frontal lobe bilaterally, and 2) different levels of alpha coherence between central and parietal lobes, also bilaterally.

DISCUSSION

These findings provide partial, preliminary evidence for EEG correlates of SRALs. These findings may have implications for understanding underlying mechanisms of NFT, which is an underdeveloped area.

Random Feedback Makes Listeners Tone-Deaf

The mental representation of pitch structure (tonal knowledge) is a core component of musical experience and is learned implicitly through exposure to music. One theory of congenital amusia (tone deafness) posits that conscious access to tonal knowledge is disrupted, leading to a severe deficit of music cognition. We tested this idea by providing random performance feedback to neurotypical listeners while they listened to melodies for tonal incongruities and had their electrical brain activity monitored. The introduction of random feedback was associated with a reduction of accuracy and confidence, and a suppression of the late positive brain response usually elicited by conscious detection of a tonal violation. These effects mirror the behavioural and neurophysiological profile of amusia. In contrast, random feedback was associated with an increase in the amplitude of the early right anterior negativity, possibly due to heightened attention to the experimental task. This successful simulation of amusia in a normal brain highlights the key role of feedback in learning, and thereby provides a new avenue for the rehabilitation of learning disorders.

Altered patterns of directed connectivity within the reading network of dyslexic children and their relation to reading dysfluency

Reading is a complex cognitive skill subserved by a distributed network of visual and language-related regions. Disruptions of connectivity within this network have been associated with developmental dyslexia but their relation to individual differences in the severity of reading problems remains unclear. Here we investigate whether dysfunctional connectivity scales with the level of reading dysfluency by examining EEG recordings during visual word and false font processing in 9-year-old typically reading children (TR) and two groups of dyslexic children: severely dysfluent (SDD) and moderately dysfluent (MDD) dyslexics. Results indicated weaker occipital to inferior-temporal connectivity for words in both dyslexic groups relative to TRs. Furthermore, SDDs exhibited stronger connectivity from left central to right inferior-temporal and occipital sites for words relative to TRs, and for false fonts relative to both MDDs and TRs. Importantly, reading fluency was positively related with forward and negatively with backward connectivity. Our results suggest disrupted visual processing of words in both dyslexic groups, together with a compensatory recruitment of right posterior brain regions especially in the SDDs during word and false font processing. Functional connectivity in the brain's reading network may thus depend on the level of reading dysfluency beyond group differences between dyslexic and typical readers.

Neurofeedback in Learning Disabled Children: Visual versus Auditory Reinforcement

Children with learning disabilities (LD) frequently have an EEG characterized by an excess of theta and a deficit of alpha activities. NFB using an auditory stimulus as reinforcer has proven to be a useful tool to treat LD children by positively reinforcing decreases of the theta/alpha ratio. The aim of the present study was to optimize the NFB procedure by comparing the efficacy of visual (with eyes open) versus auditory (with eyes closed) reinforcers. Twenty LD children with an abnormally high theta/alpha ratio were randomly assigned to the Auditory or the Visual group, where a 500 Hz tone or a visual stimulus (a white square), respectively, was used as a positive reinforcer when the value of the theta/alpha ratio was reduced. Both groups had signs consistent with EEG maturation, but only the Auditory Group showed behavioral/cognitive improvements. In conclusion, the auditory reinforcer was more efficacious in reducing the theta/alpha ratio, and it improved the cognitive abilities more than the visual reinforcer.

New Approaches to the Diagnosis and Treatment of Learning Disabilities in an International Context

Abstract. Learning disability (LD) is a term frequently used to describe neurological disorders affecting academic and school performance. Although often applied, this term is not precisely defined. While the new DSM-V has substantially redefined LD, problems still remain, including the influence of different cultural experiences and the near absence of proposals for the application of biomarkers in LD diagnosis. This paper discusses these issues and calls for more emphasis to be placed on the identification and application of biomarkers for LD diagnosis. In addition, it proposes that these biomarkers should be incorporated into a more comprehensive bio-psycho-social diagnosis model of LD.

Modulation of Craving Related Brain Responses Using Real-Time fMRI in Patients with Alcohol Use Disorder

LITERATURE

One prominent symptom in addiction disorders is the strong desire to consume a particular substance or to display a certain behaviour (craving). Especially the strong association between craving and the probability of relapse emphasises the importance of craving in the therapeutic process. Neuroimaging studies have shown that craving is associated with increased responses, predominantly in fronto-striatal areas.

AIM AND METHODS

The aim of the present study is the modification of craving-related neuronal responses in patients with alcohol addiction using fMRI real-time neurofeedback. For that purpose, patients with alcohol use disorder and healthy controls participated once in neurofeedback training; during the sessions neuronal activity within an individualized cortical region of interest (ROI) (anterior cingulate cortex, insula, dorsolateral prefrontal cortex) was evaluated. In addition, variations regarding the connectivity between brain regions were assessed in the resting state.

RESULTS AND DISCUSSION

The results showed a significant reduction of neuronal activity in patients at the end of the training compared to the beginning, especially in the anterior cingulate cortex, the insula, the inferior temporal gyrus and the medial frontal gyrus. Furthermore, the results show that patients were able to regulate their neuronal activities in the ROI, whereas healthy subjects achieved no significant reduction. However, there was a wide variability regarding the effects of the training within the group of patients. After the neurofeedback-sessions, individual craving was slightly reduced compared to baseline. The results demonstrate that it seems feasible for patients with alcohol dependency to reduce their neuronal activity using rtfMRI neurofeedback. In addition, there is some evidence that craving can be influenced with the help of this technique.

FUTURE PROSPECTS

In future, real-time fMRI might be a complementary neurophysiological-based strategy for the psychotherapy of patients with psychiatric or psychosomatic diseases. For that purpose, the stability of this effect and the generalizability needs to be assessed.

Brain mechanisms and reading remediation: more questions than answers

Dyslexia is generally diagnosed in childhood and is characterised by poor literacy skills with associated phonological and perceptual problems. Compensated dyslexic readers are adult readers who have a documented history of childhood dyslexia but as adults can read and comprehend written text well. Uncompensated dyslexic readers are adults who similarly have a documented history of reading impairment but remain functionally reading-impaired all their lives. There is little understanding of the neurophysiological basis for how or why some children become compensated, while others do not, and there is little knowledge about neurophysiological changes that occur with remedial programs for reading disability. This paper will review research looking at reading remediation, particularly in the context of the underlying neurophysiology.