This is the first contact with our professionals for all patients. During this 1 hour and a half session, our clinical neuropsychologists will determine if you are a viable candidate for neurofeedback therapy. They can also suggest other possible treatments, or even a combination of several treatments. If neurofeedback is not the best-suited approach for you, a report describing your clinical profile, as well as personalized recommendations, will be provided for you. If we believe that neurofeedback should be considered, no report will be given at this stage. The professional will discuss with you the details of the therapy that you will undergo, and will hand you a consent form that will state those details, as well as all the other administrative information (i.e. fees, the number of sessions, patient’s rights) related to the whole therapy process. In addition, an appointment for a complete evaluation will be scheduled. Keep in mind that during this session, you will also have the opportunity to ask the neuropsychologist any additional questions you may have concerning your disorder, or the suggested therapies.
2. Full evaluation: Testing and Brainmapping
When neurofeedback is considered appropriate for you, a complete evaluation will be scheduled. It will last approximately 2 hours and it will include neuropsychological testing, as well as brain mapping using a quantitative electroencephalogram (QEEG). It must take place in the morning and is preferably done without any stimulants. Accordingly, any substance with stimulating effect (such as caffeine or energy drinks) is better discontinued 5 days prior to testing. If you, or your child, are taking psychostimulants (such as Ritalin, Concerta, Dexedrine, or Adderal), testing can be done in the morning before the first dose is taken. Also, in order to get a better electrode adherence, we strongly recommend washing and drying the hair less than 12 hours before the evaluation (please refer to our downloadable documents for more information). After this session, another one-hour session will be scheduled, during which a detailed written report will be provided for you. All results, as well as a personalized therapy plan, will be discussed at this stage.
3. Neuropsychological Assessment
Neuropsychological assessment involves the investigation of various aspects of function, including intellectual, emotional, perceptual, sensory, strength, and coordination, with consideration towards the integrity of brain function. A detailed interview, review of medical and educational records, and the use of published standardized psychological tests are the most commonly used methods used in this type of assessment.
Neuropsychological assessment is used for diagnostic purposes (learning disabilities, concussions and more severe brain injury, developmental disabilities, loss of mental efficiency with aging, dementia, post-traumatic stress disorder, and emotional problems), to characterize change following the compromise of brain function and to determine return to play in sports, as well as mental efficiency in relation to careers.
4. Psychophysiological Stress Profiling (PSP)
Biofeedback assessment is used worldwide to quantify the working relationship between the body and the brain at rest, under stress and during recovery. Reacting to events in a stressful manner, or failing to return to baseline after the event, is associated with medical and psychological disorders, as well as decreased performance in personal and professional activities. When stressed, the body is pre-programmed to fight, flee, or freeze. The heart races, blood is sent to important areas of the body to help mobilize energy for movement and the brain becomes busy. Stress can be positive (win an award, enjoy another person, etc.) or it can be negative. These responses are adaptive, unless it is severe shock, or cumulative, some small stress factors across time (e.g. often with work-related irritability, arguments with others or anxiety over upcoming events, etc.) can become both
By looking at the physiological activity at rest, in response to stress inducers, and in recovery, in addition to clients’ comments about their past and current functioning, this type of assessment allows us to:
• Compare clients with a database of profiles of individuals in good psychophysiological health;
• Find atypical patterns that may cause problems;
• Compare client’s perceptions of themselves with their actual physiological and mental activity to see how well they know themselves;
• Identify strengths and weaknesses and develop a training program to optimize health.
5. Neuropsychological Screening for ADHD and attention difficulties.
The aim of this evaluation is to confirm the diagnosis of ADHD and to specify as well as quantify the different subtypes of this disorder. It can also be used as a baseline before therapy is started. To do so, a combination of questionnaires and standardized tools is used to gather the required information, including:
Detailed developmental history;
Behavioral symptoms in different environments (e.g., at school, with friends or with family);
Life stress inducers or recent changes;
A neuropsychological and psychological profile, using different tools (e.g., CBT, Conners-3, Ruff 2&7);
Brain function mapping, using quantitative electroencephalography (qEEG).
6. Quantitative Electroencephalographic Assessment of Brain Function (qEEG)
A QEEG is an assessment tool to evaluate a person’s brainwaves and determines to what extent the brainwave patterns differ from normal.
Recent research shows that certain dysfunctions, such as ADHD, schizophrenia, OCD, depression, specific learning disabilities, and others are associated with specific patterns in spontaneous, and evoked, electrical potentials, recorded from the head by multiple surface electrodes, and that these spontaneous potentials, and especially the evoked electric potentials, provide reliable brain markers of the brain function and dysfunction.
Measured data of spontaneous and evoked electrical potentials can be compared with data from a normative database, thus helping the clinicians confirm the diagnosis and establish a personalized treatment plan.
To perform a QEEG mapping procedure, electrodes, also known as sensors, are typically positioned on the client’s scalp at 32 standardized locations designated by the International 10-20 System (see below). This is usually accomplished by placing a special, tight lycra cap, much like a bathing cap, on the client’s head. This cap has all the electrodes already attached in their proper position and is then connected to a differential amplifier and computer with a special cable. The electrodes in the cap make contact with the skin of the scalp by means of a special gel that reduces the resistance between the electrode and the skin. The electrodes pick up the very faint electrical signals of the brain that pass through the skull and scalp and pass these on to a differential amplifier that may amplify the signal a million times or more and convert the analog signal to a digital signal before passing it on to the computer.
Understanding the numbers and graphics
The numbers generated are Z-scores, which is a metric which represents how normal or abnormal a score is in comparison to the Neuroguide Database. A Z score of +1 represents a score exceeding 84% of individuals that age; +1.25 exceeds 89%; +1.5 exceeds 93%; +2.0 exceeds 98%.
A combination of tables and graphics of Z scores appears below for either the traditional EEG bands (e.g. Delta 1-4 Hz.; Theta 4-7 Hz.; Alpha 8-12 Hz., Beta 12-25 Hz, etc.) or for specific single Hz. bins to enable increased precision.
The heads use colors to represent the Z scores at the 19 sites, with the nose on the top. Grey represents scores that are normal (+/- 1 Z score). The dots on the head are electrode sites (e.g. the top two being prefrontal sites)
Here is an example of three seconds of EEG recorded at 19 sites which show the brain making normal brainwaves to start but then shifts into a dysregulated state, where it makes the larger, slower brainwaves (theta). This dysregulated state is likely to occur when the ADHD child is inattentive.
ADHD Child’s EEG (8yrs old)
When this child’s recorded brainwaves are averaged and compared to a database, we find that he is making more theta activity in the frontal and prefrontal sites, which is greater than 97% of children his age. This information can be represented in graphs, as seen below.
The same ADHD child’s EEG is represented graphically.
We can see his excessive theta activity in the graph below:
An adult with Generalized Anxiety Disorder and an acquired brain injury
An overanxious woman who banged the back of her head has a different looking brain map, showing the excessive delta and theta in the back of her head, in addition to the excessive alpha everywhere.
Adult with Obsessive Compulsive Disorder
An adult suffering with severe Obsessive Compulsive Disorder has a QEEG which shows very excessive fast wave activity, a common pattern in OCD:
Adolescent with Seizure Disorder
An adolescent with a severe seizure disorder (5x/week) had this QEEG before and after treatment:
After a course of neurofeedback, you can see he had a much-improved QEEG (and only one seizure in 3 months). Notice the significant reduction of Delta and Theta activity.
Connectivity: a measure of how the various parts of the brain communicate with each other
Brainmaps provide a great deal of additional information in a variety of tables and graphs. In addition to measures of the power of the EEG at various speeds, the Connectivity measures give information about how well one part of the brain is communicating with another part of the brain. This adolescent with ADHD and Obsessive Compulsive Disorder has difficulties with effective communication between various prefrontal and frontal lobe sites.
The QEEG human brain mapping procedure is very relevant because it provides more information than the typical electroencephalogram (EEG). By having a QEEG done, the brain activity can be compared to a wide database of other “normal brains,” helping to determine which, if any, of the brain functions, is actually abnormal. QEEG can be helpful in determining whether a person’s symptoms are associated with specific brain dysfunctions.This valuable information can guide treatment planning. Repeated QEEG assessments can also be used to monitor treatment progress by showing changes in brain functioning as treatment progress and symptoms change.
EEG recording is non-noninvasive and a safe procedure.
7. Mini qEEG 10 site Brain Map
The Mini quantitative EEG assessment is a short alternative for the full qEEG. Though it provides less information, it is conducted in 2 – 6-minute sessions set in 1-minute epochs. The Mini qEEG assessment shows the clinician exactly if the client’s brain is over or underactive on certain points which cause symptoms like attention deficit, depression, anxiety, concentration problems etc.
8. Live Z Score training in Functional Connectivity
The concept of Z scores biofeedback (also known as Z-Score neurofeedback) is in order to identify brain regions that are de-regulated and depart from expected values in real-time.
9. Neurofeedback Training
EEG Neurofeedback is a form of biofeedback that uses real-time digital technology to measure the electrical activity of the brain (EEG) and present this information in a form that enables the individual to perceive changes in the state of the brain and learn to modify abnormal EEG patterns. To rewire the brain, we make use of neurofeedback therapy. This treatment stimulates metabolism and blood flow strengthens dendritic connections, as well as the functioning of neurotransmitters, which accounts for the improvement in the patient’s ability to carry out cognitive tasks successfully.
Treatment with EEG neurofeedback is based on the theory that once individuals understand their brain activity and learn to manipulate their own brain waves, they will be able to continue to do so, long after the therapy has ended. Some studies have followed patients for as long as 10 years after being treated with EEG neurofeedback and have shown no significant loss of treatment gains.
We apply electrodes to the scalp to listen in on brainwave activity. We process the signal by a computer, and we extract information about certain key brainwave frequencies. (All brainwave frequencies are equal, but some are
10. Cognitive-Behavioural Therapy (CBT)
The CBT is related to the theories of learning, behavior and conditioning. These therapies are called “cognitive” and are interested in the progressive modification of the mental plans of interpretation of reality, to eliminate the disorders, annoyance and unsuitable behavior.
11. Enhancement of performance in athletic, artistic, academic and occupational pursuits
.Executives, Students, Athletes
Peak performance training using EEG biofeedback can be likened to training in a gym. With repeated exercise, just as muscles respond and gain strength, the brain similarly learns to self-regulate more and more optimally through Neurofeedback.
Neurofeedback has been used for optimizing performance by athletes in world class football, basketball and hockey teams. It has been researched for golf performance enhancement and by racquetball players
The Canadian governing body for tennis and McGill University in Montreal have committed to a five year study to put 80 of the region’s top athletes through Neurofeedback training.
Studies at Imperial College London have shown that Neurofeedback enhances the performance of musicians and dancers.
Opera singers, musicians, and students have benefitted from Neurofeedback training to improve their performance, creativity and memory. Research has shown it to improve microsurgical skills and reduce time on tasks by 26%.
Alpha-theta training is a specialized form of Neurofeedback training which is offered without the visual stimulus. Instead, the clients relax on a recliner or in a chair with headphones that send auditory stimuli to the brain. These auditory signals alter in response to the brain states.
Awake state, as well as alpha-theta training, is used according to particular performance needs of the individual looking for Neurofeedback training for peak performance.
The Reaction Time Suite —> (http://www.thoughttechnology.com/reactiontime.htm) includes both continuous performance testing (CPT) and real sports reaction time training
We teach athletes the ability to be in control under pressure
We coach consistency and the ability to refocus
We provide goal setting skills
We track and decrease negative self-talk
We create a pre-competition game plan
We discuss strategies for energy management and self-confidence
We improve self-regulations of different physiologies: Peripheral skin temperature, electrodermal response (sweating), muscle tension (EMG), heart rate and the synchrony of heart rate with respiration (RSA)
Improvements in training can be seen within 10-20 training sessions. Training can improve both physical and mental skills. Physical skill enhancement can come from improving muscle training (relaxation and correct muscle coordination), sweat response (emotional control), heart rate variability (calmness and efficiency) and temperature (recovery from training). Mental training includes Neurofeedback for improving focus, lessening stress, enhancing imagery effectiveness, eliminating or lessening negative self talk, and recovery from fatigue. In short, it allows athletes to be more consistently ‘in the zone’. The BF/NF programs are also designed to match the nature of each sport; the type of skill needed, the time period, and the changes necessary within the actual sport’s performance. Being calm in one part of a skill may be important, but being highly energized in another part may lead to better performance. The brain and body should be trained to be flexible to match the sequence of the mental and physical states needed
Neurofeedback and sports in the news
Many Business executives, managers, sales associates, nurses, doctors, lawyers and other professionals have used Neurofeedback services to give them a competitive edge. Musicians, writers, singers, computer programmers and other performing artists have used Neurofeedback to enhance their creativity and skills, to refine their skills and performance, while being able to access and stay in “The Zone”
Neurofeedback or EEG Biofeedback helps the brain regulate itself and self regulation is key to optimal brain functioning. It is best considered as mental fitness training that over time teaches the individual’s brain improved skills of managing attention, arousal (level of excitability), and affective or emotional states.
Here are some examples of optimal frequencies for different tasks;
– to concentrate, read and memorize effectively, your brain requires unique states which are SMR, alpha and theta.
– to engage in a high level of mental activity often associated with decision making, logic and problem solving, requires a beta frequency(14-24 hz).
– a quiet body active mind for attention, information storage and retrieval, sequencing and for optimal performance sports and high performance tasks such as race car drivers, requires an smr (12-14 hz) frequency.
– relaxed but alert state of mind, resting wakefulness and the relaxed state after the execution of a task, such as the “pause” that the brain takes before executing the next task. for example the ability for a race car driver to execute the next required task at 200 mph requires very specific and efficient cycling of the brain and the ability of the brain to switch into alpha (8-12 hz) briefly before the next task is required to be executed.
– optimal state of mind for heightened creativity, sustained inspiration requires a theta frequency (4-8 hz); this is an optimal frequency for artists, musicians, composers and many other individuals.
– deep physical and mental relaxation, this is a delta frequency (less than 4 hz); this is important for restorative sleep as well.
At the Think Hub Center, we offer an extensive array of assessments and therapies including neurofeedback and traditional psychotherapy with personalized solutions for ADHD, insomnia, depression and OCD. In these areas, Think Hub Center only employs state-of-the-art and evidence-based techniques, integrated and embedded in a clinical-psychological setting. Personalized Neurofeedback is used in the treatment of ADHD, and brain stimulation (rTMS) for the treatment of depression, using only evidence-based protocols.