Neurofeedback, neurostimulation and neurotherapy, is there a difference?

This post is a personal compilation from the results of years of research. I have gleaned this information from published reports of scientific studies, equipment manufacturers' and software publishers' descriptions of their products and personal experience with various equipment and protocols.

Any appearance of copying others' works is purely coincidental and unintended. Since some of the sources are unverified online sources, I have tried to verify as much as possible but this . It is common for online sources to be biased in an attempt to sell a product or service. I have done my best to sort through these biases, but this is just my understanding based on these other sources.

I'll start with neuro-feedback in this post. Neuro-stimulation will be in a following post.

Neurofeedback is the process, like biofeedback, where a device measures specific physiological parameters of the patient. In this case, those parameters are brain waveforms taken with Electro-Encephalo-Graphic equipment attached to electrodes on the scalp, ears and face.

Currently, these devices use a PC computer with specialized signal amplifiers with software to decode the analog signal to a digital signal that can be displayed on a computer screen and/or analyzed by other computer software. The computer is "feeding back" to the patient information about how his brain is "performing."

The image on the screen can be either a number/graph value or an icon/avatar that moves with the wave form.

The patient is shown the poor waveforms and offered suggestions to modify them. Some waveforms are too weak or slow, others are too strong or fast.

The practitioner has usually set the software parameters to focus on a specific wave form for targeted training. The patient watches the screen and tries to get the icon/avatar to perform a task or be in the acceptable range.

Sometimes, they are responding to beeps and other tones to their ears. Either way, the goal is to either move the icon/avatar in the appropriate way or to cause the sound to be a pleasant sound.

This might be done by suppressing thoughts or increasing thoughts. It is not a direct cause and effect procedure. Through experimenting with different thought relaxation and stimulation techniques, the patient will discover what efforts cause the desired change/improvement. The patient's efforts are the "Response" to the feedback.

It can be compared to trying to relax. One might think they are relaxed but a physical therapist can touch a muscle and show how tense it is. She may be able to help the patient relax that specific muscle with pressure points/myofacial release techniques that help the patient focus on just that muscle.

This is what the feedback is for. It helps identify the spasming 'brain muscle.' As the patient develops more skill at relaxing or activating the specific 'brain muscle,' these skills become easier, sometimes even normal or unconscious.

This kind of therapy can be valuable to those with ADD/ADHD, OCD, anxiety, addiction, etc. These prior conditions are rarely cured. More likely, the patient has learned how to quickly identify the onset of symptoms and then quickly respond and reduce or end the onset of negative symptoms. One could say they are 'in recovery' rather than recovered.

Some therapists will try to treat the above listed conditions with CBT, Cognitivre Behavior Therapy. Neurofeedback is a sort of CBT on steroids. The steroids is the EEG displaying the inner most workings of the brain as it thinks the negative cognitive thought or behavior.

A comparison would be an experience I once had. My body is extremely sensitive to bleeding and blood draws. I will faint out cold. I try using CBT by saying to myself, 'This is only a small blood draw or small cut with not much bleeding. I have no reason to feel faint.' These thoughts can completely end the faint feeling. This denial of the faint feeling is the CBT effect. No matter how hard I try to relax, distract myself with other thoughts, rationalize the lack of risk, etc. I still risk passing out. I have passed out FIVE times from these simple blood draw/bleeding events.

The problem is my conscious or cognitive thoughts (CBT) can't get to the root cause of the fainting, some kind of vagus or other neurological connected response. My conscious thought may no longer recognize the faint feeling but I faint anyway.
Neurofeedback shows the patient how to get to the root cause of the behavior/thought. Oddly, I am trained as an EMT, Emergency Medical Technician, and can respond to an accident with bleeding and open wounds without any risk of fainting.

btw, I am sure to tell the physician/phebotomist about this problem. Otherwise, I can put both of us at risk as I fall off of an exam table or chair. During the procedure, I usually will talk about something unrelated and the physician/phlebotamist can hear my voice trail off as I pass out. Before offering these warnings, I have found myself in the arms of an angry small statured doctor holding a scalpel and trying to keep me from landing on the floor. Where is the cute phlebotomist when you need someone to catch you? LOL Once, a PET scan tech thought she may have killed me by injecting the contrast agent into a vein. She was quite relieved when she finally revived me. She was about to call a "code."

As a brain injured person for many decades, I have learned how to 'listen' to my body and sense those minute sensations that tell me to change something. Often, the change is to a different environment. I may have to close my eyes to block out visual stimulation. I may need to put in ear plugs to block out background noise.

My neuro analyzed my EEG and could see how my brain almost instantly overloads with visual and auditory stimulation. He said that my dysfunction is so severe and organic based that the neurofeedback he offered in his office would be ineffective.

Some with a brain injury may be responsive to neurofeedback for these same symptoms IF:
The overstimulation is minor but leads to a psychological anxiety component that results in a headache or other symptomology.
The patient is young ( under 40 years old, the younger the better statistically) and the brain injury/concussion severity history is minimal with some other psychological component compounding the symptoms.

I have not found any research yet that suggests that neurofeedback can remedy purely organic brain dysfunctions. If such research is ever done to support the use of neurofeedback to treat PCS/mTBI brain injuries, it could lead to the FDA approving neurofeedback as a treatment for brain injuries.

There are a number of systems/software that fit this definition of neurofeedback. Most practitioners do not promote the system/software brand used with neurofeedback unless they also sell the equipment and offer training.

There are some researchers who report evidence that neurofeedback can remedy psychological symptoms thus improving the environment for organic healing, similar to using nutrition to help the brain heal.

It is very common for neurofeedback to be used as a catchall term for various neurotherapies. One web site even states that the 'feedback' is the stimulation from the computer/device back at/into the patients brain by visual stimuli, electromagnetic fields, sound, and even minute electrical shocks etc.

A simple comparison would be giving a speech in a speech class. You give the speech. That is your "performance." The teacher measures your performance and grades it. He gives you your grade and any comments as "feedback." Your "response" to the grade/feedback could be: high grade---thank you and appreciation for his praise, low grade--disagreement and defiance of his perspective, or accepting his criticism/feedback and working to improve your next performance.

The last 'response' above is the focus of neurofeedback.

The weakness CBT has with ADD/ADHD, OCD, anxiety, addiction and even PCS or mTBI, etc. is when the issue has a neurophysiological component, the cognitive thought may not effect that component. It would be like an addict saying, "No matter how hard I try to tell myself that I do not want the drugs, my body hurts unless I give it what it says it wants. Neurofeedback would be teaching or conditioning the body to not hurt and not want the drugs. btw. Neurofeedback can be very effective at addressing these problems with chemical addiction.

Neurofeedback is not currently FDA approved for the treatment of concussion/mTBI. There are various long term studies being done in this area. One that is in the end stages showed a mixed bag of long term benefit indicating another study with better procedures might be warranted.

Currently, neurofeedback appears to only help with the psychological components of PCS/mTBI. These psychological components are still worth addressing as they only complicate the recovery process.

Two very good online descriptions are:

http://www.odemagazine.com/doc/61/neurofeedback

The following report is highly technical but is representative of current research;

http://john.kounios.googlepages.com/...kisTCN2007.pdf

I have far more references on my computer at home. As I am currently traveling, I do not have access to them. I may post more references later.


Next, neuro-stimulation.