Therapy Approaches

Z Score Neurofeedback

Z score Neurofeedback utilizes an evidenced based approach in the form of standard deviations or Z scores. It often leads to more rapid changes than traditional Neurofeedback based only on symptoms, limited training sites and canned protocols. We utilize two different approaches, depending upon the age of the client as well as the presenting concerns.




4-19 Channel Z score Neurofeedback

This approach computes EEG coherence, phase delay, amplitude and power asymmetry, phase reset, phase lock and phase shift duration. For children, we use a minimum of four channels for training. Training sites are determined by the results of the Quantitative EEG or Brain Map. Progress is typically much more rapid than when using traditional forms of Neurofeedback employing only amplitude training.




Z-Scored LORETA

LORETA (Low Resolution EEG Tomography) is based on the work of Robert Thatcher, PhD. This approach represents non-invasive brain imaging techniques, based on the data gathered from the 19 channel Quantitative EEG (qEEG) and Dr. Thatcher's qEEG database. It uses a mathematical process called the "inverse solution" to suggest what is happening in deep structures beneath the cortex. LORETA provides a 3-Dimensional source correlation of Brodman areas to a reference MRI. This allows the use of Neurofeedback directly on deep brain areas. The symptom checklist is combined with LORETA Z scores measured during a qEEG analysis to aid in linking a client's symptoms to functional networks within the brain. It is of particular use for Traumatic Brain Injury, Migraines and Autism or for those clients with multiple diagnoses. Progress is typically much more rapid than when using traditional forms of Neurofeedback employing only amplitude training.




Interactive Metronome (IM)

The Interactive Metronome* (IM) is a computer-based training program that has been shown to improve attention, coordination and timing for individuals with sensory processing difficulties.

People who may benefit from use of the IM include children and adults with attention deficit disorders, motor planning problems, poor coordination, post-stroke or traumatic brain injury issues, gross and fine-motor concerns, and some learning and language disorders. IM can also be used as a mechanism to enhance academic performance and aid in a wide range of cognitive difficulties. The IM combines principles of the music metronome with the power of a computer to precisely measure and improve human performance. It is the only research-based technology program that uses interactive exercises and a patented auditory guidance system to measure and improve one’s rhythm and timing. By improving this fundamental ability, the individual learns to plan, sequence and process information more effectively.

The IM works by using special head-phones and hand and foot sensors to measure how closely a participant responds to the computer generated beat. Participants are challenged to synchronize a hand and foot movements with a tone heard through headphones. Audio and visual feedback signals participants about their performance. IM provides a non-invasive way to stimulate learning and motor development.

Interactive Metronome training typically consists of 15 one-hour sessions, usually three-five times per week. We can assist with this frequency by providing home units for training. The trainee progresses through a series of exercises to systematically improve their timing, focus and concentration to lower their IM scores. The IM training can be adjusted and utilized with additional techniques to address concerns in individual therapy sessions. We are licensed IM-Home Providers.

* Interactive Metronome is a registered trademark.




Integrative Listening Systems

Neuro-plasticity is the brain's ability to reorganize itself by forming new neural connections throughout life. For example if one hemisphere of the brain is damaged either by injury or disease, the intact hemisphere may take over some of its functions. This is done by reorganizing and forming new neural pathways. The integrated listening program stimulates activity of the cerebellum to strengthen neural connections and in the process builds patterns for further development in learning and coordination.

Another important part of the listening program is the stimulation of the vestibular system. The vestibule, located in the inner ear, has 3 main functions: Balance, Posture and Eye Movement. These three functions play an important role in our sense of who we are and where we are in our environment, in our ability to move in a smooth and coordinated way, the tone and strength of our muscle development, and the eye tracking ability required for learning. The tone of all the muscles in our body is in a large part dependent on the vestibular system. It is this system that tells your body how much muscle tension is needed to perform a particular function.

Movement, listening and visual stimulation are vital to our ability to learn and process information. As these 3 systems are so interrelated, 'exercising' them simultaneously is a holistic approach which requires the brain to become better at integrating multi-sensory information. We are essentially re-training the brain to become more efficient and effective, and in the process strengthening neural connections to improve performance. When done in conjunction with specific Sensory Processing techniques, the results of therapy can be measurable.




Hemoencephalography (HEG)

Hemoencephalography (HEG) is a form of Neurofeedback that addresses intentionally increasing cerebral blood flow to the front of the brain. This area of the brain is known as the Prefrontal Cortex (PFC) and is referred to as the executive control center. By increasing blood flow to this area of the brain, we are helping it to function better. HEG has also been shown to provide impressive relief for Migraines and ADD / ADHD on its own. It is combined with our EEG Neurofeedback program to provide a more comprehensive approach to treatment for these specific diagnoses.

The front part of your brain or the prefrontal cortex is the area behind the forehead. It plays a critical role in making decisions, developing and carrying out plans and intentions and sticking to those plans despite distraction. For example, let’s assume it is time for you to study for a test. Your prefrontal cortex will formulate a plan for meeting that need. It accesses the knowledge you need such as your memory of where your books and assignment papers are located and the task you need to complete. Then a distraction occurs, a friend calls to talk on the phone and you answer it; your prefrontal cortex will keep you focused on completing your assignment after you have ended your phone conversation. The prefrontal cortex also has the ability to inhibit other areas of the brain connected to emotions, allowing you to, for example, over-ride a fear of heights when you need to climb a ladder and change a light bulb. The prefrontal cortex controls attention, blocks distractions in the environment, controls physical and emotional impulses and helps access your memory. However, in order for this region of the brain to function properly it requires blood flow to supply it with the nutrients necessary for metabolism. Studies have demonstrated that some individuals have limited blood flow to this area of the brain such as seen in children and adults with ADD/ADHD.

While the goal of Neurofeedback is to normalize brain wave patterns and improve the brain's resiliency to stressors, the goal of HEG is to increase blood flow to the prefrontal cortex. Increasing the amount of blood to this area will result in increased metabolism, allowing this area of the brain to function optimally. Like Neurofeedback, HEG is completely non-invasive and drugless. It involves monitoring one or more surface sensors on the forehead. This sensor will read the blood flow to the prefrontal cortex and display that signal on the computer screen. The software provides feedback to on an auditory basis in the form of music as well as in the form of a visual display. You must then keep the blood flow signal at a certain level or the music will diminish in intensity and the video will change in the quality of its graphics. When one obtains the predetermined signal level, then the visual and auditory reinforcement will remain constant. It is in this way that one is able to learn how to increase blood flow to the important center known as the prefrontal cortex.

We have available at our Clinic two different HEG (Hemoencephalographic) systems:

» The first is "nIR" HEG-neurofeedback. This tracks and trains according to the level of blood oxygenation and is best used when under-arousal is present. This would involve a condition of excessive slow wave activity (high amplitudes of theta/alpha). It is known to help with attention when it directly relates to prefrontal cortex abnormal EEG activity (EEG slowing or high theta-beta ratios).

» The second is "pIR" HEG-neurofeedback which also tracks and trains but according to cerebral temperature. It is used at our Clinic for help with Headaches and where there is excessive beta activity (high amplitudes) seen in over-arousal.

Dr. Jeffery Carmen developed Passive Infrared HEG specifically to treat migraine headaches because of the universal agreement that the vascular system in the brain is very much part of the migraine process. He treated 100 individuals with migraines using HEG over a period of four years. Over 90% of the subjects that completed at least 6 sessions reported significant improvement including substantially reduced pain levels. Typically both pain levels and frequency of migraine improved. Dr. Carmen's theory for the efficacy of HEG for migraines is that HEG training strengthens the prefrontal cortex and its ability to use inhibitory control over some part of the brain that is thought to generate Migraines. We have an excellent article written by Dr. Carmen that we would be happy to share with you that discusses this topic in more detail. Our use of pIR HEG is an integral part of our treatment protocol for Migraines and Tension Headaches.

ADD/ADHD is a neurological disorder that directly impacts on regulation of the prefrontal cortex. Brain imaging studies have shown different activity in the prefrontal cortex of children and adults with ADD/ADHD. These scans have demonstrated lack of activation during tasks requiring intense concentration where you would normally see an increase in prefrontal cortex activity. This lack of normal brain activation results in the symptoms commonly seen with this condition. For children ages 10 and above and for adults with ADD/HD this has been an added benefit to the traditional Neurofeedback program at our clinic.




Heart Rate Variability

Heart Rate Variability (HRV) is the beat-to-beat variations in heart rate or pulse which occur normally during all levels of activity, from sleeping to sitting still or moving. HRV is closely tied to a person's emotional state, and with biofeedback it can be used as a treatment option for a variety of emotional and cognitive conditions, including anxiety and depression.

HRV patterns are different from heart rate patterns, and are much more significant for emotional based therapy. When we are in a constant state of stress, anxiety, anger or sadness our heart rate tends to be lower and more disorganized. In contrast, when we are in an emotionally stable state our heart rate reflects this by being more rhythmical.

Using a computerized analysis of heart and respiratory rate information, it is possible to measure the rate of variability and to then use this information to create a more stable emotional state.

The conditions best addressed by HRV Biofeedback include:

» Anxiety
» Depression
» Stress
» Insomnia
» Fatigue




Galvanic Skin Response (GSR) Biofeedback

Galvanic Skin Response, also known as electrodermal response (EDR) or psychogalvanic reflex (PGR), is a method of measuring the electrical resistance of the skin and interpreting it as an image of activity in certain parts of the body. Changes in the electrical properties of the skin in response to stress or anxiety can be measured either by recording the electrical resistance of the skin or by recording weak currents generated by the body. Stress thermometers are a less sophisticated version to teach hand-warming techniques. All of these yield feedback or information and are used to teach individuals to better control stress. Basically, increased stress levels lessen the blood flow to the hands and feet. This causes a decrease in peripheral (hand/foot) temperatures. With the monitoring help of GSR, an individual can learn to control that temperature. What is happening is biofeedback or the ability to consciously control the dilation and constriction of blood vessels in the arms and legs.




Alpha-Theta

This is a specialized Neurofeedback process intended to address stress resulting from issues such as chronic trauma, pain and more. This process is used to increase the amount and amplitude of an individual's alpha and theta brain waves which can then impact on resolution of a number of issues that one can be conscious of and process without falling asleep. It is different from EEG Neurofeedback in that it is a closed eyes state training which is more of a psychotherapeutic process and should never be used in isolation without first preparing the individual's nervous system through awake-state training in the form of EEG Neurofeedback and Biofeedback training in the area of stress reduction and relaxation techniques.