[PPT] - NEUROFEEDBACK THERAPY IN GROUP SETTING Ms Jerry Lee Association of PowerPoint Presentation

SLIDE 1

NEUROFEEDBACK THERAPY IN GROUP SETTING

Ms Jerry Lee Association of Resource & Education for Autistic Children (REACh)

SLIDE 2

I. INTRODUCTION
Ne

Neur urof

fee

eedb dbac ack th ther erapy y (NFT (NFT) ) is is a te techn hnique ique th that t pr pres esen ents ts rea eal-time time fee eedb dbac ack k on

n br

brainw ainwave e ac activity tivity as as me meas asur ured ed by by se sens nsor

rs

s on

n th

the e sc scalp alp th throu

ugh

gh th the e for

rm of

m of a a vide video

ga

game, me, mo movie vie

r
r music

music disp display lay. . (See, (See, 20 2010 10)

NFT

NFT is is use used d as as an an co compliment mplimentar ary y th ther erapy for

r sp

spec ecial ial ne need eds s childr hildren en an and d ha has s pr prod

duc

uced ed po positiv sitive e ef effec ects ts as as fou

und

nd i in n pr previou vious s res esea earch. h.

SLIDE 3

1) 1) Autism utism Spect Spectrum Disor um Disorder der (AS (ASD) D) Jar arusiewicz usiewicz (2002) (2002)

24 participants:
12 received NFT
12 acted as control group
36 sessions:
Inhibit theta, enhance low beta at C4 site

SLIDE 4

26% average reduction in total ATEC

rated autism symptoms versus 3% in comparison with control group.

Children in NFT group showed

Improvement in socialization, vocalization, anxiety, schoolwork, tantrums, and sleep, compared with control group.

SLIDE 5

Pined Pineda a et al. (20 et al. (2008) 08)

8 high-functioning ASD participants
Assigned to either placebo or

experimental groups

10 weeks training of the mu frequency

band (8–13 Hz).

Experimental participants showed

increased sustained attention ability, and improved scores on subscales of the ATEC compared to the placebo group.

SLIDE 6

Kouijz

uijzer

er, , de de Moor Moor, , Ger Gerrit rits, , Congedo Congedo, , & & van van Sc Schie hie (2009) (2009)

14 participants:
7 children received NFT
7 children acted as control group
40 sessions
Inhibit theta, enhance low beta at C4
Participants who received NFT showed

improvement in social interaction, communication and concept generation.

SLIDE 7

Impr

Improvements ements in cognitiv in cognitive function e functions s inc include: lude:

Sustained auditory selective attention
Inhibition of verbal responses
Inhibition of motor responses
Set shifting (switch between the

numerical and alphabetical mode)

Planning ability

SLIDE 8

Fauzan auzan & & Mahayud Mahayuddin din (2014) (2014)

34 participants (age 3 to 20)
36 training sessions
Inhibit theta, enhance beta at frontal

lobe

Participants were reported to show

improvement in their social behaviors, sleeping pattern and reduction in aggressiveness and tantrum.

SLIDE 9

2) 2) Att Attentiv entive e Deficit Deficit Hy Hyper peractivity activity Disor Disorder der (ADHD (ADHD) Kais Kaiser er & & Othme Othmer (2000 (2000)

1089 subjects
726 children
186 subjects with ADHD or ADD diagnoses
20 or more sessions
SMR-beta neurofeedback training

SLIDE 10

Neurofeedback training produced

significant improvement in attentiveness, impulse control, and response variability.

Significant clinical improvement in
ne or more measures was seen in

85% of those subjects with moderate pre-training deficits.

SLIDE 11

Fuc Fuchs, B hs, Birbau irbaumer mer, , Lutz Lutzenber enberger ger, , Gr Gruz uzelier elier, , & & Kaiser Kaiser (2003) (2003)

34 children (age 8 to 12)
22 in neurofeedback group
12 in methylphenidate group
Neurofeedback group: reinforcement
n the production of cortical SMR

and beta activity

SLIDE 12

Both neurofeedback and

methylphenidate groups reported:

Improvements on all subscales of the Test of

Variables of Attention.

Improvements on the speed and accuracy

measures of the d2 Attention Endurance Test.

Significant reduction in behaviors related to the

disorder as rated by teachers and parents on the IOWA-Conners Behavior Rating Scale.

These findings suggest that

neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children.

SLIDE 13

Mohammadi Mohammadi, , Malmi Malmir, , Khale Khaleghi ghi (2015) (2015)

16

16 childr hildren en (a (age ge 9-15) 15)

13

13 bo boys ys and and 3 3 gir girls ls

All

All childr hildren w en wer ere e dia diagno gnose sed d with with ADHD ADHD- comb combined ined type type

1st

st pha

phase (15 ses se (15 session sions): enh s): enhanc ance e SMR SMR and and redu educe ce the theta a ta at C4. t C4.

2nd

nd ph

phas ase (15 se e (15 sess ssion ions): e s): enh nhan ance ce beta beta and and redu educe theta ce theta at t C3. C3.

SLIDE 14

Assessm

Assessments ents con consisted of sisted of d2 d2 attention endur ttention endurance ance test, AD test, ADHD HD rating ting sca scale le (par (parent f ent for

rm) a

m) at thr t three ee time time periods periods: bef : befor

re,

e, mid middle dle and and the the end end of

f the tr

the training. aining.

Based

Based on parents’ reports, hyp hyper eractivity/impulsivity activity/impulsivity wer ere e impr improved after the ed after the 2nd

nd pha

phase of se of beta beta tr training aining. .

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II. OBJECTIVE OF STUDY

1.

1. To
explor

xplore the possibility e the possibility of

f

ha having par ving parents c ents conduct the N

nduct the NFT

FT in in group

up.

. 2.

2. To
explor

xplore the pos e the possibility sibility of

f using

using standar standardiz dized ed neur neurof

feedbac

eedback tr trea eatment tment pr protocol f

tocol for c
r childr

hildren en with autism. with autism.

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III. STUDY STATEMENT
Incr

Increase ease in in the po the power of er of SMR on SMR on C4 C4 is is associa associated with ted with the r the reduction of eduction of hype hyperactivity/im activity/impuls pulsivi ivity ty symptoms. symptoms.

Enhan

Enhancemen cement t of

f beta w

beta waves es and and decr decrease in ease in excessiv cessive e theta in the theta in the left hemispheric left hemispheric on C3

n C3 ar

are e recommended to impr ecommended to improve e att ttention. ention.

SLIDE 17

Alpha

Alpha activity activity is is tr trained ained most most fr frequentl equently y in in parietal parietal regions gions and and had sho had shown positiv wn positive e ef effects in ects in impr improvemen ement t of

f cogn

cognitiv itive e perf perfor

rmance and to ac

mance and to achie hieve e relax elaxed me ed mental ntal sta state. te.

SLIDE 18

IV. METHOD
Dur

Duration: tion: 6 w 6 weeks eeks

The study

he study was as car carried out ried out in a in a fr free ser ee service vice centr centre f e for c

r childr

hildren en with with autism autism in P in Penan enang, g, Malay Malaysia. sia.

SLIDE 19

Eight

Eight c childr hildren w en wer ere s e selected to elected to par parti ticipa cipate in t te in this his stu study dy.

They w

hey wer ere assi e assigned to 2 g gned to 2 groups

ups

(4 (4 per persons sons in in eac each h group

up).

).

Eac

Each g h group r

up receiv

eceived 10 session ed 10 sessions s

f
f NFT

NFT (2 (2 sess sessions ions per per week). eek).

SLIDE 20

GR GROUP OUP 1 1 GR GROUP OUP 2 2

Received standardized neurofeedback treatment protocols. Received individualized neurofeedback treatment protocols. Protocols:

1. C3 Beta - improve

attention

2. C4 SMR - reduce

impulsivity and restless behavior

3. Pz Alpha - improve

sensory regulation and cognition Protocols were based on participant’s critical

needs. (clinical symptoms)

SLIDE 21

V. SAMPLE

GR GROU OUP P 1

Four
ur childr

hildren en dia diagnosed with gnosed with autism autism spec spectr trum um disor disorder der (mode (moderate te le level el)

Age

Age 7 to 11 7 to 11

Selection criteri

Selection criteria: a:

Able to sit through a 45 minutes session
Children who can commit to 10 sessions
f NFT

SLIDE 22

GR GROUP OUP 2

Four c
ur childr

hildren en dia diagnos gnosed with ed with autism autism spectr spectrum um disor disorder der (3 moder (3 moderate, 1 te, 1 se sever ere) e)

Age

Age 5 to 20 5 to 20

Selection

Selection Crit Criteria: eria:

Children are able to sit through a 45

minutes session

Children who can commit to 10

sessions of NFT

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VI. PROTOCOLS

GR GROU OUP 1 P 1

Child Child Pr Protoco

tocol

Period eriod Frequ equenc ency A, B, C & D C3 Beta 6 All sessions C4 SMR 6 Sessions 1, 3, 5, 7 & 9 Pz Alpha 6 Sessions 2, 4, 6, 8 & 10

SLIDE 24

GR GROU OUP P 2

Child Child Pr Protoco

tocol

Period eriod Frequ equenc ency E

(moderate)

P3 Beta T4 Delta 4 4 All sessions F

(moderate)

C3 Beta F8 Delta 4 4 G

(severe)

P3 Beta T4-P4 Delta 4 4 H

(moderate)

C3 Beta T4-P4 Delta 4 4

Protocols are decided based on children’s

needs.

SLIDE 25

VII. TRAINING

GR GROU OUP 1 P 1 & 2 & 2

Par

arents ents wer ere e giv given en 3 hou 3 hours s of

f

tr training aining on placement of

n placement of electr

electrode,

de,

ho how to get good signal w to get good signal and and ho how w to to run un the the neur neurof

feedbac

eedback tr training. aining.

SLIDE 26

VIII. PROCEDURE

GR GROU OUP P 1 1 & 2 & 2

Par

arents ents of

f the

the selected selected childr hildren en wer ere giv e given en briefing on briefing on the the pur purpose pose and r and requir equirements of ements of the the study study. .

All

All par parents s ents signed igned consent f consent for

rms

ms to to allo allow their w their childr hildren to pa en to participa ticipate in te in the study the study.

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Childr

Children en in eac in each g h group s

up star

tarted ted the the session session together together.

Par

arents ents cond conducted t ucted the he sess sessions ions with minimal with minimal super supervision vision fr from

m

neur neurof

feedb

eedbac ack ther therapist. pist.

Childr

Children en play played games ed games as as feedbac eedback k for beta tr

r beta training

aining.

Childr

Children en watc tched hed video video as f as feedbac eedback k for SMR,

r SMR, alpha

alpha and d and delta elta tr training aining.

SLIDE 28

Training

aining dur duration and tion and thr thresholds esholds wer ere e adjusted adjusted if if necessar necessary y based based

n parent’s feedback on child’s

beha behavior vior.

Parents were asked to rate child’s

beha behavior vior with the individualiz with the individualized ed pr prog

gress

ess chec hecklist after eac klist after each h session. session.

SLIDE 29

Ther

herapist pist super supervised vised the NFT the NFT fr from

m

sess session ion 1 to 1 to 5.

5. Super

Supervision vision was as reduced and educed and faded aded of

ff fr

from 6

m 6th

th

session session onw

nwar

ards ds.

SLIDE 30

IX. RESULTS:

GROUP 1

SLIDE 31

Child

Child A A and D and D sho showed ne ed nega gativ tive e ef effect aft ect after t er the he 3rd

rd and 4

and 4th

th session:

session:

Uncontrollable laughing
Increased restless behavior
Unable to attend to task
Increased self talk
Sudden shouting without reason

SLIDE 32

Adjustment

Adjustment to the to the tr training aining dur duration tion wer ere e made made a at the t the 6th

th sess

session. ion.

4 periods for beta training
8 periods for SMR and alpha training
Aft

After adjus er adjustment tment, , child hild A an A and c d child hild D’s inappropriate beha behavior viors reduced. educed.

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Child

Child B an B and Child d Child C sh C showed positiv ed positive e ef effect fr ect from the

m the standar

standardiz dized ed neur neurof

feedbac

eedback pr protocols:

tocols:
Improvement in concentration and

attention

Faster response in answering

questions

Increased awareness to their

surroundings

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GROUP 1

CHIL CHILD A D A CHIL CHILD D D D

Uncontrollable laughing
Unable to sustain attention on school

work

Restless behavior increased (walked

in and out of classroom, running around)

Increased in making meaningless

sounds

Slow in response to instructions
Increased self talk
Increased hyperactivity
Increased impulsivity (Gets excited very

quickly and shouts)

Stiffen body and tense face muscle
Able to stay asleep better

After adjustment:

Uncontrollable laughing reduced
Restless behavior reduced
Increased attempt to communicate

with mother

Respond to instructions slightly faster
Able to make request more often but in

single word

Makes more meaningful communication

with mother

Attention and concentration improved
Memory improved

SLIDE 35

CHILD B CHILD B CHILD C CHILD C

Able to follow instructions promptly
Able to engage in sequential tasks

(origami) with minimal guidance

Improved understanding of context
Improved memory recall
Attention and concentration

improved

Able to answer questions correctly

and promptly

Increased awareness towards

surrounding

Showed more initiative to communicate

with mother though not in complete sentence

Comment on his surroundings to mother
Restless behavior reduced
Able to answer question correctly and

promptly

Attention and concentration improved
Self talk reduced

SLIDE 36

RESULTS: GROUP 2

SLIDE 37

Child Child Pr Prot

toco
cols

ls & Objectiv & Objective Changes Changes obs

bser

erved ed E P3 Beta

Improve speech processing

and learning T4 Delta

Moderate emotion
Increased in self talk, repeat sentences /

instructions that parents usually say (irrelevant to situation)

Increase of self stimulatory behavior
Increase in hyperactivity
Body coordination improved (able to pedal
n bicycle with training wheels, do cross

limb training in OT session) After protocol adjustment: P3-P4 Alpha

Improve sensory

processing C4 Delta

Reduce restless behavior
Self stimulatory behavior reduced
Increased awareness of surroundings
Improved in answering questions and

making request

Repeat phrases relevant to situation
Able to understand non verbal cues better
Response time is faster
Started to memorize and spell words

SLIDE 38

Child Child Pr Protocol

tocol & Obje

Objectiv ctive Chang Changes es obser

bserved

ed F C3 Beta

Increase awareness to

surrounding F8 Delta

Reduce anxiety
Self talk increased
Gets irritated easily
Snoring reduced

C3 Beta maintained 4 periods F8 Delta increased from 4 to 6 periods

Able to construct complete sentence

better and vocalize

Self talk and self singing decreased
Increased awareness of surrounding

(initiated to keep floor mats after activity, greet people without mother’s reminder)

Eye contact improved
Less anxious when she played with

dogs, able to feed, play and kiss the

dogs. (She was guided physically

previously)

SLIDE 39

Child Child Pr Protocols

tocols & Objectiv

& Objective Changes Changes obser

bserved

ed G (severe) P3 Beta

Improve speech

processing and learning T4-P4 Delta

Reduce impulsiveness

and emotional outburst

Responds faster when his name was

called.

Better in following instructions.
Attention and understanding of task

improved.

Able to listen to mother’s reasoning

when he is upset / frustrated.

Temper tantrum reduced. (He hits a

Barney soft toy at home when he’s

upset. The hitting behaviour

reduced) P3 Beta maintained 4 periods T4-P4 Delta increased from 4 to 6 periods

SLIDE 40

Child Child Pr Protocols

tocols & Objectiv

& Objective Changes Changes obser

bserved

ed H C3 Beta

Improve attention

T4-P4 Delta − Reduce impulsiveness and emotional outburst

Increased awareness of surrounding
Able to imitate teacher’s body

movements in class

Temper tantrum intensified
Impulsivity increased (shout without

reason)

Showed more aggressive and

destructive behaviours during temper tantrum (scratch and bite others, turn

ver table, threw things on floor)
No changes were reported after

changing bipolar (T4-P4) to monopolar (T4, P4). After 1st Adjustment: C3 Beta – 3 periods T4 Delta – 3 periods P4 Delta – 3 periods

SLIDE 41

Child Child Pr Protocols

tocols & Objectiv

& Objective Changes Changes obser

bserved

ed H After 2nd adjustment: T4 Delta

Moderate emotion

F4 Delta

Reduce strong emotion
No temper tantrum reported.
Mother reported child seemed calmer

and sleeps earlier than usual.

Able to understand better when parents

reason with him when he couldn’t get things that he wants.

SLIDE 42

X. CONCLUSION

Objectiv Objective e 1: 1:

Neur

Neurof

feedbac

eedback ther therapy y is is recommended to ecommended to be conducted in be conducted in individ individual ual setting setting. .

The child’s emotional state and

mo movements ements in in the r the room

om caused

caused distr distraction action to to other

ther childr

hildren en during N during NFT FT .

SLIDE 43

Childr

Children en who w ho wer ere e fr frustr ustrated ted or

r

agita gitated display ted displayed ed beha behavior viors suc such h as as sho shouting, cr uting, crying and ying and bod body r y roc

cking.

king. Thes hese e beh behavior viors cau caused sed distr distraction action to to

ther c
ther childr

hildren. en.

Duri

During ng session, f session, few c ew childr hildren ended en ended ear earlier lier and and left the r left the room.

om. The

he mo movemen ements in and out o ts in and out of the r the room

om also

also caused caused distr distraction f action for those w

r those who w

ho wer ere e still still doing doing the NFT the NFT. .

SLIDE 44

Objective 2:

Individualized neurofeedback

treatment protocols are recommended for children with autism.

Children who received individualized

neurofeedback treatment protocols (Group 2) showed positive and immediate effect from NFT .

SLIDE 45

Only 2 children who received

standardized neurofeedback treatment protocols (Group 1) showed positive effect from NFT . Adjustments to the standardized neurofeedback protocols were needed to suit the children’s needs.

SLIDE 46

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