[Mark in Idaho]

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.

[Mark in Idaho]

Neuro-stimulation, what is it, and is it the same as neurofeedback.

Again, the same disclaimer that started the previous post applies here.

The brain can be stimulated by a number of avenues.

CHEMICAL, as in drugs like Ritalin and other stimulants. These drugs speed up the way the brain processes information. The pharmacokinetics (the way the drugs are handled by or processed or metabolized by the body) and pharmacodynamics (the way the drug effects the body) are beyond the scope of this post. Most drugs that act on the brain are not FULLY understood. They are prescribed because they cause an effect that appears to improve a situation that is more valuable than the negative value of the side-effects.

NUTRITIONAL, caffeine, dense sugars and other food substances can cause the brain to be stimulated.

SENSORY, The visual, auditory, olfactory (smell), and tactile (touch) senses can be used to stimulate the brain into targeted responses.

ELECTRO-MAGNETIC, energy can be directed at the brain with electric currents and magnetic fields. The nervous system is a complex electro-chemical network. Altering this electro-chemical network can cause changes to how the nervous system processes information.

The last two are the focus of Neuro-stimulation as it relates to neurofeedback.

There are a variety of Neuro-stimulating therapies on the market. Their promoters use a variety of brand names to attempt to differentiate their system from the others. The two most common are LENS and ROSHI/pROSHI. There are others that appear to be a rebranding of LENS and ROSHI type systems. TMS and H-Coil are terms used to describe Transcranial Magnetic Stimulation.

They all have one thing in common. An energy force is applied to the brain as a stimulant. This can be electrical pulses to the scalp or skin, magnetic fields aimed at specific parts of the brain, visual stimulation inputted through the eyes/optic nerve, olfactory stimulation through the nose (aromatherapy is the common term) and tactile stimulation through the skin.

Each of these stimulates a specific part of the brain. They often start with a analysis of the brain with Electroencephalographic (EEG) equipment. This is done to find the area of the brain that is 'misbehaving.'
This misbehaving usually manifests outwardly as behavioral (psychological) symptoms. ADD/ADHD, anxiety, depression, anger, paranoia, etc. These psychological symptoms can exacerbate (make worse) physiological symptoms from an injury or disease process, such as concussion, dementia, stroke, etc.

The practitioner will analyze the EEG waveforms, choose the part of the brain to be targeted, and set the equipment to stimulate an associated part of the brain.

This can be done with flashing lights. The ROSHI and pROSHI system works on this principle. The flashing lights stimulate the optic nerve pathways with a flashing frequency that attempts to either disrupt the current nerve processing with a negative (uncomfortable) stimulation or enhance it with a positive (rewarding) stimulation. The desired goal it to train the brain to suppress the unwanted nerve processes and encourage the positive nerve processes.

It can be done with electromagnetic fields. This electromagnetic field is similar to the transmission from a cell phone. Instead of being received by a cell tower antenna, these electromagnetic fields are received by the brain cells.

These electromagnetic fields can disrupt the electro-chemical processes between brain cells. It may try to input a better timing frequency that is either faster, slower, stronger or weaker. It also may just try to get an area to have homogeneous frequencies. That is, most or all of the nerve pathways are working at the same speed.

One could think of this as telling parts of the brain to relax and telling other parts to work harder. In an ADD brain, it is telling the over attentive part of the brain to slow down and stop misbehaving and telling the inattentive part of the brain to speed up and pay attention.

These two parts of the brain are not necessarily in different physical locations. They are usually intertwined and may share common brain cells and pathways. Think of it as an ambulance with lights and siren needing to get past the traffic congestion on the road. Its lights and sirens are telling the cars to slowdown, pull to the side of the road and stop so the ambulance can go by. It is also the cop pulling the weaving drunk driver over so the other traffic can safely go on its way.

The brain wants to do this. It is called self-regulation or neuroregulation. If there is a malfunction in this self-regulation, the brain may need help to re-establish a proper self regulation.

These neuro-stimulation therapies are very short acting at first. Through repeated application of the neuro-stimulation therapies, the brain gets trained into a habit of proper self-regulation or neuro-regulation. These therapies are not a cure. Most of the manufacturers and practitioners will state this outright. Others will allude to the need for ongoing therapies at less frequent intervals.

Some therapies will effect lasting improvements in only 10 or 20 treatments. Others will require a hundred or so with sporadic booster therapies. The root value of these therapies is to create an cognitive environment where the patient can cognitively participate in this self-regulation.

A comparison would be a student pilot. His instructor will only let him take a flying lesson when there are no wind gusts at the airport. Once he has learned the basic flying skills, he can learn to land in gentle winds. As he improves, he can land the plane in gusting crosswinds.

The neuro-stimulation starts be stopping the wind gusts in the brain. As the brain establishes better neuro-regulation, it can properly function in light wind gusts and can slow the strong wind gusts. Occasionally it may need some remedial training to strengthen these skills.

These neuro-stimulations only effect the nerve processes. They do not cause a physiological repair of damaged brain cells. These re-regulated processes allow the brain to better tolerate the damaged brain malfunctions. For example, the frustration of a damaged memory can be made much worse by stress.

The stress hormones speed up brain processes. The damaged brain will likely be more dysfunctional at these higher processing speeds so the frustration of the memory dysfunction becomes worse. This leads to even more memory dysfunction and so on. Teaching the brain and the patient to regulate these stress reactions can drastically reduce symptoms.

The new process of Transcranial Magnetic Stimulation is being studied for it benefit to people with various thought dysfunctions. Hallucinations, paranoias, depression, etc. can be due to thought malfunctions or physiological damage that leads to thought malfunctions.

It tries to disrupt these nerve processes by inputting a magnetic field that alters the current faulty process. The early research shows promise but has not yet been able to chart long term results. It is expected that there will be a need for "booster" therapies in many cases.

Many will call Nuero-stimulation therapies neurofeedback. This is an inaccurate term. Yes, the neuro-stimulation is often directed after observing feedback from the brain by way of an EEG waveform. Some call the stimulation directed at the brain the feedback. This is an improper use of the term neurofeedback. As discussed in the previous post, the neurostimulation is a "response" to the "feedback."

Unfortunately, this field is unregulated by the FDA so consistent terminology is problematic. All of the neuro-feedback and neuro-stimulation therapies are only approved for treating the psychological/psychiatric symptoms. Even the best research has failed to show them to be effective at promoting physiological brain cell healing. The reduction of psychological symptoms creates a better environment for the physiological healing to take place, if it is possible.

The reduction of psychological symptoms can go a long way toward improving function across all areas of daily living.

I am not a strong proponent of these various neurotherapies because USED ALONE, they can become a horrible money drain and frustration to the patient. If the environment the patient has to live and work in is not improved, these therapies will likely need to be repeated. If the patient has not developed work-arounds and accommodations for their symptoms, these therapies will be much less effective.

It is like throwing water on a person standing in a burning building. It is better to help him out of the burning building first. Then you can work to help him heal. I am a proponent of the start local process. If the patient has things in their life and environment that can be changed to improve their functions, those things need to be done first. Save the neurofeedback and neurostimulation for what is left over.

There are some uses of neuro-stimulation that can be effective for serious nervous dysfunction. Research is being done regarding using neurostimulation to help a comatose person awaken or improve cognitive awareness, i.e. become more aware of surroundings.

My neurologist used some of these neurotherapies in his practice but did not suggest them for me. He agreed that I had been very effective at modifying my though patterns (CBT) and environment to reduce the psychological effects on my cognitive dysfunctions. These CBT and other skills had served me very well over the decades of Post Concussion Syndrome/Multiple Impact Syndrome symptoms.

Those of you who have read this far and understand what I am saying could help me by clicking on the "Thanks" button. If you have questions or comments , please post them as replies or Private messages.

[Hockey]

Dear Mark,

Thank you for going to the effort of posting all of this information - I know it wouldn't have been easy. It's too much for me in one go so I'm going to print it out and work my way through it.

Thanks Again

[Chemar]

just a gentle reminder that this is just one members opinion on these treatments and that members should investigate further and substantiate this information from other sources as well

[Mark in Idaho]

Hockey,

Thanks for your comments. Yes, it takes me hours to put these posts together.

I fully understand you difficulty understanding my posts. It has taken me years to put all of the information into perspective. For the first few years after my life changing concussion in 2001, I struggled to make sense of the reports from some of the most brilliant minds in the concussion/mTBI research and treatment industry.

My goal here is to help others understand sooner what took me years to begin to understand. Understanding the simple fact that most of our struggles result from the psychological manifestations that appear as we try to endure our physiological and cognitive injuries can be life changing.

Dr. Daniel Amen wrote "Change Your Brain, Change Your Life" for those seeking better mind function. His title could be easily be modified to "Change Your Thinking, Change Your Brain" since our thinking gets in the way of our brains functioning best.

It is like we are stuck in a catch-22. Our broken brains prevent us from discovering how we can improve our thinking to help our broken brains recover to the level possible.

We get stuck with two problems. There is a serious lack of easy to understand facts about PCS?mTBI and there are too many physicians who just tell us that we should take an antidepressant because we worry to much about our questionable problems.

In fact, in the process of typing and rereading these posts as I attempt to make them understandable, I learn new understandings.

For example, I have observed the limit the FDA puts on the promotion of neurofeedback/neurotherapy for some time but never noticed the reason for this. As I dig deeper, I have found that the studies have never found any link between the different therapies and physiological healing. It is like trying to prove a negative. If something is not there, you will likely not notice its absence until you look specifically to see why it is not there.

Claims regarding brain injury healing are not there because the data shows that only psychological symptoms are effected. I noticed this last week reading a published report. They mentioned the lack of effect on physiological damage as an aside at the end of the study report. They cautioned that only psychological improvement has any statistically significant data.

[roshidude]

HI Mark+

Just swerved into this report, but must point out that pROSHI 3D and LENS
are much different approaches to neurotherapy, in that pROSHI 3D does not
require any electrodes, to do its work. LENS is more akin to the original ROSHI(AVS) system.

/ChuckD....

Originally Posted by Mark in Idaho

Neuro-stimulation, what is it, and is it the same as neurofeedback.

Again, the same disclaimer that started the previous post applies here.

The brain can be stimulated by a number of avenues.

CHEMICAL, as in drugs like Ritalin and other stimulants. These drugs speed up the way the brain processes information. The pharmacokinetics (the way the drugs are handled by or processed or metabolized by the body) and pharmacodynamics (the way the drug effects the body) are beyond the scope of this post. Most drugs that act on the brain are not FULLY understood. They are prescribed because they cause an effect that appears to improve a situation that is more valuable than the negative value of the side-effects.

NUTRITIONAL, caffeine, dense sugars and other food substances can cause the brain to be stimulated.

SENSORY, The visual, auditory, olfactory (smell), and tactile (touch) senses can be used to stimulate the brain into targeted responses.

ELECTRO-MAGNETIC, energy can be directed at the brain with electric currents and magnetic fields. The nervous system is a complex electro-chemical network. Altering this electro-chemical network can cause changes to how the nervous system processes information.

The last two are the focus of Neuro-stimulation as it relates to neurofeedback.

There are a variety of Neuro-stimulating therapies on the market. Their promoters use a variety of brand names to attempt to differentiate their system from the others. The two most common are LENS and ROSHI/pROSHI. There are others that appear to be a rebranding of LENS and ROSHI type systems. TMS and H-Coil are terms used to describe Transcranial Magnetic Stimulation.

They all have one thing in common. An energy force is applied to the brain as a stimulant. This can be electrical pulses to the scalp or skin, magnetic fields aimed at specific parts of the brain, visual stimulation inputted through the eyes/optic nerve, olfactory stimulation through the nose (aromatherapy is the common term) and tactile stimulation through the skin.

Each of these stimulates a specific part of the brain. They often start with a analysis of the brain with Electroencephalographic (EEG) equipment. This is done to find the area of the brain that is 'misbehaving.'
This misbehaving usually manifests outwardly as behavioral (psychological) symptoms. ADD/ADHD, anxiety, depression, anger, paranoia, etc. These psychological symptoms can exacerbate (make worse) physiological symptoms from an injury or disease process, such as concussion, dementia, stroke, etc.

The practitioner will analyze the EEG waveforms, choose the part of the brain to be targeted, and set the equipment to stimulate an associated part of the brain.

This can be done with flashing lights. The ROSHI and pROSHI system works on this principle. The flashing lights stimulate the optic nerve pathways with a flashing frequency that attempts to either disrupt the current nerve processing with a negative (uncomfortable) stimulation or enhance it with a positive (rewarding) stimulation. The desired goal it to train the brain to suppress the unwanted nerve processes and encourage the positive nerve processes.

It can be done with electromagnetic fields. This electromagnetic field is similar to the transmission from a cell phone. Instead of being received by a cell tower antenna, these electromagnetic fields are received by the brain cells.

These electromagnetic fields can disrupt the electro-chemical processes between brain cells. It may try to input a better timing frequency that is either faster, slower, stronger or weaker. It also may just try to get an area to have homogeneous frequencies. That is, most or all of the nerve pathways are working at the same speed.

One could think of this as telling parts of the brain to relax and telling other parts to work harder. In an ADD brain, it is telling the over attentive part of the brain to slow down and stop misbehaving and telling the inattentive part of the brain to speed up and pay attention.

These two parts of the brain are not necessarily in different physical locations. They are usually intertwined and may share common brain cells and pathways. Think of it as an ambulance with lights and siren needing to get past the traffic congestion on the road. Its lights and sirens are telling the cars to slowdown, pull to the side of the road and stop so the ambulance can go by. It is also the cop pulling the weaving drunk driver over so the other traffic can safely go on its way.

The brain wants to do this. It is called self-regulation or neuroregulation. If there is a malfunction in this self-regulation, the brain may need help to re-establish a proper self regulation.

These neuro-stimulation therapies are very short acting at first. Through repeated application of the neuro-stimulation therapies, the brain gets trained into a habit of proper self-regulation or neuro-regulation. These therapies are not a cure. Most of the manufacturers and practitioners will state this outright. Others will allude to the need for ongoing therapies at less frequent intervals.

Some therapies will effect lasting improvements in only 10 or 20 treatments. Others will require a hundred or so with sporadic booster therapies. The root value of these therapies is to create an cognitive environment where the patient can cognitively participate in this self-regulation.

A comparison would be a student pilot. His instructor will only let him take a flying lesson when there are no wind gusts at the airport. Once he has learned the basic flying skills, he can learn to land in gentle winds. As he improves, he can land the plane in gusting crosswinds.

The neuro-stimulation starts be stopping the wind gusts in the brain. As the brain establishes better neuro-regulation, it can properly function in light wind gusts and can slow the strong wind gusts. Occasionally it may need some remedial training to strengthen these skills.

These neuro-stimulations only effect the nerve processes. They do not cause a physiological repair of damaged brain cells. These re-regulated processes allow the brain to better tolerate the damaged brain malfunctions. For example, the frustration of a damaged memory can be made much worse by stress.

The stress hormones speed up brain processes. The damaged brain will likely be more dysfunctional at these higher processing speeds so the frustration of the memory dysfunction becomes worse. This leads to even more memory dysfunction and so on. Teaching the brain and the patient to regulate these stress reactions can drastically reduce symptoms.

The new process of Transcranial Magnetic Stimulation is being studied for it benefit to people with various thought dysfunctions. Hallucinations, paranoias, depression, etc. can be due to thought malfunctions or physiological damage that leads to thought malfunctions.

It tries to disrupt these nerve processes by inputting a magnetic field that alters the current faulty process. The early research shows promise but has not yet been able to chart long term results. It is expected that there will be a need for "booster" therapies in many cases.

Many will call Nuero-stimulation therapies neurofeedback. This is an inaccurate term. Yes, the neuro-stimulation is often directed after observing feedback from the brain by way of an EEG waveform. Some call the stimulation directed at the brain the feedback. This is an improper use of the term neurofeedback. As discussed in the previous post, the neurostimulation is a "response" to the "feedback."

Unfortunately, this field is unregulated by the FDA so consistent terminology is problematic. All of the neuro-feedback and neuro-stimulation therapies are only approved for treating the psychological/psychiatric symptoms. Even the best research has failed to show them to be effective at promoting physiological brain cell healing. The reduction of psychological symptoms creates a better environment for the physiological healing to take place, if it is possible.

The reduction of psychological symptoms can go a long way toward improving function across all areas of daily living.

I am not a strong proponent of these various neurotherapies because USED ALONE, they can become a horrible money drain and frustration to the patient. If the environment the patient has to live and work in is not improved, these therapies will likely need to be repeated. If the patient has not developed work-arounds and accommodations for their symptoms, these therapies will be much less effective.

It is like throwing water on a person standing in a burning building. It is better to help him out of the burning building first. Then you can work to help him heal. I am a proponent of the start local process. If the patient has things in their life and environment that can be changed to improve their functions, those things need to be done first. Save the neurofeedback and neurostimulation for what is left over.

There are some uses of neuro-stimulation that can be effective for serious nervous dysfunction. Research is being done regarding using neurostimulation to help a comatose person awaken or improve cognitive awareness, i.e. become more aware of surroundings.

My neurologist used some of these neurotherapies in his practice but did not suggest them for me. He agreed that I had been very effective at modifying my though patterns (CBT) and environment to reduce the psychological effects on my cognitive dysfunctions. These CBT and other skills had served me very well over the decades of Post Concussion Syndrome/Multiple Impact Syndrome symptoms.

Those of you who have read this far and understand what I am saying could help me by clicking on the "Thanks" button. If you have questions or comments , please post them as replies or Private messages.

[Mark in Idaho]

I did state the ROSHI and pROSHI use light as the stimulation source. I actually talked directly to the developer of ROSHI.