What's New in Neurofeedback

• Stimulant therapy, EEG biofeedback, and parenting style on ADHD

• EEG signature and phenomenology of alpha/theta neurofeedback training versus mock feedback

• Biofeedback Enhances ADHD Treatments - Therapy Helps Some Patients Reduce or Eliminate Medication

  Search Medline for keywords "EEG Biofeedback" for these and related papers, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

• Scientists Pinpoint Brain's 'Ick' Factor

• Program Boosts Brain Activity in Dyslexic Kids

• All Addictive Drugs Tweak the Brain the Same, Study Finds

• Eat less to stay sharp

• Mental Function in Middle Age Linked to Death Risk

  All links at: http://news.yahoo.com/fc?tmpl=fc&cid=34&in=science&cat=brain_research

As a psychology professor, a parade of textbook representatives flows through my office each month, hawking wares. Mostly 2003 editions of 2001 publications, if you want to know, but they give it an old college try anyway. "What research methods book do I use?" they ask. "What intro psych text have I assigned?" "Do I know about the upcoming 2004 edition of Kosslyn, now refreshingly focused on the brain, or on evolutionary processes, or gender issues, or cultural relativism...." Out of habit, I eventually get around to asking whether they -- Houghton Mifflin, or Worth, or Norton, or Allyn & Bacon or whoever is standing in my office -- whether their company has in its possession an introductory textbook on EEG... Quantitative EEG, to be specific.

You can see it in their eyes: "Wow, a request? Finally something we can sell to this man!" The stronger of the two (reps typically wander corridors in pairs) breaks open the awkwardly large binder he carries, seeking the proper section of his company's burgeoning catalog. After a moment the woman points over her partner's shoulder to a listing in the catalog and pipes up, "Would Fundamentals of Neuropsychology work for your course?"

No, of course not. That one spends only five pages on EEG ....

It's a minor exercise in futility because there is no introductory book to Quantitative EEG.

Twenty psychology and computer science students at the Rochester Institute of Technology (New York) recently completed an undergraduate course on QEEG, if not the first in the world, the first in Western New York. The title of the class was the title of this piece. (I wanted Functional Neuroimaging; the dean thought 19 year olds would be put off by such terminology.) Well, I thought it would be useful to relate the experience of teaching this course, including the syllabus and texts read by the students, as a starting point for others interested in teaching such a course or individuals learning more about this topic on their own.

First, I shouldn't make it sound like there are no introductory books on QEEG. There are a few, even sparkling examples of basic texts -- if you're getting board certified as a neurologist, or starting your residency in sleep medicine, or completing graduate work in electrophysiology. The most comprehensive textbook on EEG is Niedermeyer, of course. Electroencephalography: Basic Principles, Clinical Applications, and Related Fields edited by Ernst Niedermeyer and Fernando Lopes Da Silva. Weighing in at 1,258 pages, and with its share of dry boring chapters to boot, it's not what I would call undergraduate reading. I could have assigned three or perhaps even four chapters from Neidermeyer, handholding my students as we read each page together. But lugging around an 18-pound treekiller which cost $250 is not what most undergraduates are prepared to do in this century.

The next likeliest choice was Fisch and Spehlmann's EEG Primer by Bruce J. Fisch, but its layout is for committed readers, people who are sure they want to get at the meat of the matter. Undergraduates needs catchy figures, bold text, normal textbook dimensions, and as few charts of squiggly lines as possible. Fisch is probably a great book for graduate work, but I suspect every one of my group of 20 year olds would sell it off to the used book dealers. Failure to retain a text for later reference (e.g., selling it after the Final) usually implies poor information transfer.

Finally, I considered EEG in Clinical Practice by John R. Hughes and Hans Lüders translated opus, Atlas and classification of electroencephalography. Both are good, but not assignable to psychology undergrads.

So that left me with the next best thing. A book that sounds perfectly titled for my course: The Academic Press book Introduction to Quantitative EEG and Neurofeedback edited by Evans & Abarbanel. Although its title may make it sound like an introductory textbook to QEEG, it isn't. I should know, I co-authored a chapter in it, and very little about the basics of QEEG was said in that chapter. The book should be (re)titled an Introduction to Neurofeedback, as it contains a mere two chapters on the fundamentals of EEG analysis, and even that's stretching the truth. But it would do -- along with supplemental readings. What I had hoped to find in an introductory text is outlined in my syllabus below. (Neurofeedback should be included in any introduction to QEEG, but as one of a handful of promising practical applications of QEEG, not as a centerpiece.... In fact I do teach about neurofeedback to my students, my introductory Brain course students. That way all the psych students get exposed to neurofeedback. Who's to stop me? The brain, as I reveal to them, is nothing more than a few sensors sticking out of a highly flexible and interdependent feedback machine.)

Evans & Abarbanel was supplemented by papers that the students accessed online. Two of the papers were chapters from my 1994 dissertation where I review some of the history and methodology of QEEG, Kaiser (1994a). http://www.skiltopo.com/papers/applied/articles/dakdiss3.htm; and Kaiser (1994b). http://www.skiltopo.com/papers/applied/articles/dakdiss2.htm. Three other articles were online, belonging to journals that RIT has subscriptions to:

• Wallace et al (2001) Journal of Head Trauma & Rehabilitation 16(2): 165-190.
• Sterman & Mann (1995). Biological Psychology, 40 (1-2), 115-130.
• Kubler et al (2001). Psychological Bulletin, 127 (3), 358-375.

I would have preferred to include some if not all of the readings below to introduce this field but alas, none of these were available online, at least not at RIT.

1. Quantitative Electroencephalography, by DP Holschneider & AF Leuchter (2002), in C. Edward Coffey, Jeffrey L. Cummings (Eds), The American Psychiatric Press Textbook of Geriatric Neuropsychiatry
2. Human electroencephalography by RJ Davidson, D Jackson and C Larson (2000), in JT Cacioppo, LG Tassinary, G Berntson (Eds), "Handbook of Psychophysiology", 2nd Edition, July 2000.
3. Pfurtscheller G, & Lopes da Silva FH. (1999). Event-related EEG/MEG synchronization and desynchronization: basic principles. Clinical Neurophysiology, 110, 1842-57.
4. Zappulla RA. (1991). Fundamentals and applications of quantified electrophysiology. Annals of the New York Academy of Science, 620, 1-21.
5. Steriade M, Gloor P, Llinas RR, Lopes de Silva FH, Mesulam MM. (1990). Report of IFCN Committee on Basic Mechanisms. Basic mechanisms of cerebral rhythmic activities. Electroencephalography and Clinical Neurophysiology, 76, 481-508. (A classic neuroscience paper that only a foolish person would assign to a psychology student.)
6. Gevins AS. (1984). Analysis of the electromagnetic signals of the human brain: milestones, obstacles, and goals. IEEE Transactions in Biomedical Engineering, 31, 833-50.
7. Brazier MAB (1980). The early development of quantitative EEG analysis: The roots of modern methods. In Sinz & Rosenzweig (Eds), Psycholophysiology.

This course is part of our 4-course biopsychology track so students were to design and administer experiments in this course and thus the prerequisite was either Experimental Psychology or my other course, Brain & Behavior.

Course Objectives: At the end of study (10 week quarter), students should be able to:
1. Describe the strengths and weaknesses of each functional neuroimaging method.
2. Discuss current theories and methods associated with EEG analysis including event-related techniques and operant conditioning.
3. Exhibit critical thinking and writing skills in the context of cognitive neuroscience.

Topics (chapters to read from Intro to QEEG and Neurofeedback [IQN])
1. Neuroimaging techniques, neuroanatomy
2. Introduction to EEG IQN 1, Kaiser 1994a
3. Fourier analysis; transformations Wallace et al, 2001
4. Methodological choices, artifact Kaiser 1994b
5. Synchrony measures, databases IQN 2
6. Neurofeedback, dysrhythmias IQN 3, 4, 11
7. Alpha-theta training IQN 7, 13
8. Alpha asymmetry IQN 8
9. Other applications Sterman & Mann, 1995
10. Event-related paradigm Kubler et al, 2001

Some chose the Stroop task, where one level was naming inks of congruent words (color words like red appearing in red ink) and the other level was naming inks of incongruent words (red in blue ink). Other tasks were eyes closed mathematical processing compared to eyes closed room visualization, or viewing famous faces compared to unknown faces, or performing a right-brained task of identifying emotional expression (whether two faces exhibit the same emotion) compared to a verbal task (whether a written word and numeral referred to the same number). The most interesting design was an audio-visual emotional Stroop task. The students recorded video and audio while an actor relayed happy and sad stories. Then they matched or mismatched the emotional valence conveyed in the audio and video of different stories. So the actor describes in one story how his cat died of a heart attack in front of him while his face lights up as he relays a different funny tale. Or he tells about this great date he had while the video shows a man about to cry. Watching this stimuli nearly sprained the subjects' brains.

The system provided only four spectral bands for analysis. We chose ~theta (2-6 Hz) for artifact control, alpha (8-12), SMR (12-15), and high beta (21-38 Hz). Data was mostly de-artifacted in the spectral domain -- not the best, but the system couldn't provide review of the temporal data stream. Deartifacting was done by removing epochs that were noted as bad during the recording (which were few, as I had to keep track of the signals, stimuli, and subjects all at once) and by applying robust analysis to the theta band: epochs containing the top and bottom 5% amounts of theta were eliminated. I pushed the macrostate assumption -- we're trying to get at the homogeneous brain state elicited by the task; high and low outliers do not represent this brain state well. Nothing I would publish, but the goal here was not divining empirical truths from EEG; it was more in providing students experience with the techniques and the technology, to let them apply what knowledge they acquired during the course to actual series of microvolt values.

In Part 2 (next month) I'll provide some of the questions I used to test what knowledge these students acquired during these 10 quick weeks.

News & Reviews NEW BOOKS

Genetics and the Electroencephalogram
by Friedrich Vogel
Genetic studies of normal EEG findings in twin and family studies. -www.amazon.com/exec/obidos/ASIN/3540655735/top100

Children with Emerald Eyes: Histories of Extraordinary Boys and Girls
by Mira Rothenberg, Peter A. Levine
Case histories of deeply disturbed children, from incarcerated teenagers to profoundly autistic children. -www.amazon.com/exec/obidos/ASIN/1556434480/top100

Adolescent Substance Abuse Treatment in the United States: Exemplary Models
by Sally J. Stevens, Andrew R. Morral
Best practices described for treating substance abuse in teenagers. -www.amazon.com/exec/obidos/ASIN/0789016060/top100

Clinical Neuropsychology
by Kenneth Heilman, Edward Valenstein
A definitive text on all major neurobehavioral disorders of adults, including aphasia, alexia, agraphia, agnosia, apraxia, amnesic disorders, dementia, and others. A required reference. -www.amazon.com/exec/obidos/ASIN/0195133676/top100

Bipolar Disorders: A Guide to Helping Children & Adolescents
by Mitzi Waltz
Layperson guide for parents of children with bipolar disorders, explaining diagnosis and common misdiagnoses, medications and responses, therapeutic interventions, and alternative therapies. -www.amazon.com/exec/obidos/ASIN/1565926560/top100

The Addiction-Prone Personality (Longitudinal research)
by Gordon E. Barnes and others
Investigates to what extent there is a causal link between personality traits and the development of alcohol abuse. -www.amazon.com/exec/obidos/ASIN/0306462494/top100

SMR neurofeedback improves aspects of cognitive performance in healthy individuals. : Eight sessions of SMR neurofeedback improved healthy individuals on cued semantic recall performance and to a lesser extent accuracy of focused attentional processing. www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?form=6&db=m&uid=12543448

ADHD and conduct disorder: an MRI study in a community sample. : Smaller cerebellar volumes were found for both pure ADHD and co-morbid children compared to the controls. www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?form=6&db=m&uid=12516313

Stimulation of the nervous system for the management of seizures : Although vagal nerve stimulation for refractory epilepsy proved effective in many patients, the number of antiepileptic drugs they take is not significantly reduced. www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?form=6&db=m&uid=12521358

Prevalence of Autism in a US Metropolitan Area. : Prevalence for autism is 3.4 per 1000 (male-female ratio, 4:1), no differenced between black and white children. For those profoundly impairment, the male-female ratio decreased to 1.3. www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?form=6&db=m&uid=12503976

Ritalin revisited: does it really help in neurological injury? : Methylphenidate may augment activity of injured neuronal tissue in the comatose patient, with similar action in stroke and TBI. www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?form=6&db=m&uid=12506813

Transcranial magnetic stimulation for auditory hallucinations. : Auditory hallucinations were robustly improved with 9 days of 1-Hz rTMS relative to sham stimulation. Half maintained improvement for at least 15 weeks. www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?form=6&db=m&uid=12511172

Reduced thalamic volume in high-functioning individuals with autism. : Neuroimaging suggests underdeveloped connections between cortical and thalamic regions in autism. www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?form=6&db=m&uid=12547467

Executive dysfunction following TBI : Summarizes the nature of executive deficits following TBI, neuroanatomical substrates, selected assessment and treatment strategies, and recent research. www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?form=6&db=m&uid=12547981

Endogenous opiates and behavior: 2001. : An annual review of research on the opiate system, summarizing papers on behavioral effects of the opiate system, notably its role in pain, stress, learning, drug abuse, sexual activity, electrophysiology, and immunological responses. www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?form=6&db=m&uid=12535711

Last week, while watching my autistic son in the pool during his swim class, I noticed how his left and right feet worked in unison far better than his hands. It got me thinking how the body provides us so much information about our brains. It gives us the tools to assess how integrated our cerebral hemispheres are (at least motorically) as well as the means to increase this integration.

In my opinion, autism and many other psychiatric and neurological conditions reflect failures to integrate our two primary modes of thought. These modes are typically represented in the left and right hemispheres, respectively (especially in right-handed males). If failure to integrate these modes, or ultradominance of one mode over another, can lead to mental illness or neurodevelopmental disorders, then we should see this failing in the body as well as in the mind. And we do. Failure to lateralize in handedness is associated with schizophrenia. Other instances exist as well. I haven't the time to describe them now, but will try in at a latter time.

Ok, so let's stipulate the need for greater cerebral integration. Let's start with the motor system. Swimming is one task that requires bimanual (and bipedal) coordination. Computer games like Quake or Doom that required both hands on the keyboards (one navigating, one shooting) would be integrating. Of course I'd prefer to see non-violent games -- maybe dividing the function of the mouse into its two separate axes: one hand works a mouse that only provides north/south axis info, the other only east/west info. Together the hands must work to play any computer game (let's hope they're educational!).

I was talking to a friend who suffers from Asperger's syndrome and he recalled that his condition improved greatly during college, a time when he had to type a lot of papers. Typing is one of the best bimanual tasks. Both hands are essentially doing the same thing, pecking keys, with no hand dominately the workds... So I'm integrating my brain right now. At least motorically.

The best task to integrate the hemispheres cognitively is narrative processing. Watching or listening or reading stories. Narrative processing requires language processing subserving a unifying plot that is new and meaningful (if the story is good), a left brain task coordinating with a right brain task.

So now that I've finished integrating my hemispheres motorically with the typing of this newsletter, I'm off to watch ER on television so I can integrate them cognitively as well. Bye now.