Hey group,

Please take a look at this case study that demonstrates the efficacy of neurofeedback for brain injury rehabilitation. This case is pretty severe, so the goal of neurofeedback for this individual is not to return him to normal functioning but rather, to increase the quality of his life. But if it can improve the situation for this person, think what it could do for someone with a mild traumatic brain injury.

http://www.peakac.com.au/resources/james%20page3.html

Interesting 'case study.' I would expect more information if this was a scientific case study. It is more like a blog.

What protocol/modality was used? They say reward/inhibit but little about the equipment and such.

This appears to be "neuro stimulation" more than neurofeedback. The vegetative patient does nothing to effect his brain' s responses.

I have read about a study being done using a TENS like system for brain stimulation. This sounds similar.

Mark,

When reading case studies, you have to consider who the case study is for. In this case study, the target audience is the layperson; therefore, it doesn't need to be in a 'scientific' format. It would actually be counterproductive if it would just confuse the reader.

The protocols used are mentioned in the 7th paragraph under the title of 'Therapists comments.' There is no need to mention the equipment because, again, this is not a scientific case study.

It appears that there was no stimulation involved at all, so this would not be similar to a TENS therapy. Your comment regarding about the vegetative patient not being able to respond to neurofeedback is incorrect. It has been shown that vegetative patients can respond to neurofeedback because the subconscious brain is always trying to self regulate itself without the need of the conscious mind.

I have tried to research this case study. This case study is the only report listing this patient. I would expect that if this therapy is generating notable improvement, it would be mentioned in other publications.

Even you said:
<It appears that there was no stimulation involved at all, so this would not be similar to a TENS therapy. Your comment regarding about the vegetative patient not being able to respond to neurofeedback is incorrect. It has been shown that vegetative patients can respond to neurofeedback because the subconscious brain is always trying to self regulate itself without the need of the conscious mind.>

If there was no stimulation involved, what was the therapy? No light stimulation, no electromagnetic stimulation, no electrical stimulation, no sound stimulation. How do they claim any change if there is no mechanism to promote such change?

Maybe you are confusing TENS with LENS therapy. TENS is Transcutaneous Electrical Nerve Stimulation. It sure sounds like James was treated with a TENS like system. They treated him at C-3, C-4 and C-5. This was not neurofeedback. It was nerve stimulation not brain stimulation unless you consider an EMG type of stimulation and graphing to be brain stimulation. The equipment used to perform an EMG can measure existing nerve signals and generate nerve signals to be tracked further up the nerve bundle.

I have had this done to diagnose nerve dysfunction in my left hand, wrist, arm, shoulder and neck.

Sounds like they stimulated specific spinal nerves at C-3, C-4, and C-5 to excite them into signaling or opening the signaling pathway to the brain. This has more to do with neural patterning. If the brain has lost its memory of the signal pathways, this stimulation starts the brain at recognizing an open pathway. This is why they do physical therapy with repeated limb movements.

The positional nerve signals are sent to the brain and it begins to open these signal pathways to better understand this movement information. As this happens, the blood flow to the positional nerves also benefits the other nerve fibers in the same nerve bundle.

At 22 years old, the brain would have long since minimized or stopped this 'learning' function. When the brain has been in an extended state of coma with associated neuronal damage, it can 'forget' how to recognize nerve signals sent through the spinal cord. These inactive bundles can get lethargic and sort of hybernate.

These TENS like stimulations push a signal along the nerve fiber and bundles. This stimulates the specific nerves to increase their metabolism thus increasing their call for blood flow. This blood flow can reinvigorate other nerve fibers in the same bundle.

These signals, when received by the brain, are compared to images in memory in the brain. If the brain does not have an image in memory to compare this nerve signal to, it has to establish a new "image file" to use to interpret future signals.

It is similar to when someone buys a new car. They see their new VW beetle so often that the VW Beetle's image is prevalent in their brain. Now, as they drive down the road and other VW Beetles drive by, their brain quickly identifies them with the many VW Beetle images stored in memory. This makes the drive-by VW Beetles stick out in their mind.

All of the sensory and cognitive systems work this way. Memory is a comparison and linking system, not an intuitive system that just figures things out from scratch.

Memory can develop these images in as little as three repetitions. It takes 7 or more failures or over-writes to unlink or delete a linked image. The comatose person's brain likely was unable to recognize or link these nerve signals during the coma to the point that it deleted or unlinked the images.

Now, this new pushing of nerve signals is starting a new learning process. There may be stored memory images still functional so the linking may be all that is required to re-establish this image as recognizable. It is like walking a trail in the late spring that has overgrown since last fall. It becomes recognizable very quickly.

James' recovery of some function is remarkable but appears to coincide with others who recover these basic functions. I am sure his family are delighted to have some of James back.

Mark,

I'm not sure what else to tell you at this point regarding this case study. I read the article again and found no mention of them using stimulation.

The mechanism for change in neurofeedback is just a simple feedback system. I won't go into the details here, but simply put, the client is fed back a real time picture of his/her brainwave functioning and is asked to either inhibit brainwaves or reward them. Again, no stimulation is introduced to the client at all.

I think you may not have a solid understanding of how biofeedback actually works. You can find loads of information on it on the web, and I would encourage you to look further into it.

Cheers

You said
<The mechanism for change in neurofeedback is just a simple feedback system. I won't go into the details here, but simply put, the client is fed back a real time picture of his/her brainwave functioning and is asked to either inhibit brainwaves or reward them. Again, no stimulation is introduced to the client at all.>

I agree. This is how neurofeedback works. The patient observes their eeg waveform (this is the feedback), makes changes in thought patterns until they find the though patterns that suppress the bad waveforms and improve the good waveforms. As they learn to do these beneficial thought patterns, they (the beneficial thought patterns) become more habituated.

This can be very effective in ADD/ADHD and sometimes OCD. It can improve performance in athletes and high stress professionals, etc. The thought is that the good waveforms are in areas of the brain that are underutilized. This 'brain training' increases blood flow to these areas and helps them to become more functional and dominant over the other areas that cause dysfunction, etc. This is sometimes called 'neuro-regulation.'

The system used with James does not appear to compare to the above described neurofeedback.

The problem is many are calling therapies neurofeedback when they are more properly defined as neurotherapy.

I agree than neurofeedback can be if great benefit when used properly. My concern is that many therapists use it as a shotgun term and approach to any condition. LENS, ROSHI, pROSHI and EMDR are neuro-therapies, not neurofeedback. The machine or therapist controls a stimulating system.

In neurofeedback, like mhr4 said in his above post, the patient initiates the response to the waveform information to cause it to reduce in the poor areas and increase in the good areas. It is like a very targeted form of Cognitive Behavioral Therapy (CBT) that uses the waveform to target the poor thought patterns. A good term would be 'Replacement Thought Therapy" as it help the patient replace poor thought patterns with beneficial thought patterns.

It is a very interesting science, especially when it gets to the EEG waveform level. It is based on the centuries old understanding of 'operant conditioning.' Infants learn most of their early behavior through operant conditioning.

I asked around regarding this case study and it was confirmed that James used traditional neurofeedback for his therapy. This is definitely a remarkable case and is a testament to the power of neurofeedback.


With neurofeedback, it isn't a case of the client 'changing their thought patterns' to initiate a change. If this were the case, then neurofeedback wouldn't be necessary and the client could just do cognitive behavioral therapy. Rather, a phsyiological/biochemical change takes place to maximize how the brain is functioning. For example, if you have ever been around a kid who suffers from ADHD, no amount of trying to change their thought patterns is going to get them to sit down and concentrate. Rather, either neurofeedback or ritalin is required for this.

Also, I contacted the company that makes the LENS neurofeedback system and they informed me that it is a biofeedback device, and not neuro-therapy. I'm making this distinction because it is important for anyone reading this to understand that any stimulus that is introduced into the clients brain via radio wave frequencies, comes from feedback from the clients own brain. So, the therapist isn't arbitrarily guessing what frequency to stimulate, it is empirically decided from the clients own eeg signal.