z-score NF
Research Papers
Semi-Automated Neurofeedback Therapy for Persistent Postconcussive Symptoms in a Military Clinical Setting: A Feasibility Study
INTRODUCTION: Neurofeedback therapy (NFT) has demonstrated effectiveness for reducing persistent symptoms following traumatic brain injury (TBI); however, its reliance on NFT experts for administration and high number of treatment sessions limits its use in military medicine. Here, we assess the feasibility of live Z-score training (LZT)-a variant of NFT that requires fewer treatment sessions and can be administered by nonexperts-for use in a military clinical setting. MATERIALS AND METHODS: A single group design feasibility study was conducted to assess acceptability, tolerance, treatment satisfaction, and change in symptoms after a 6-week LZT intervention in 38 Service Members (SMs) with persistent symptoms comorbid with or secondary to mild TBI. Acceptance and feasibility were assessed using treatment completion and patients' satisfaction with treatment. To evaluate changes in symptom status, a battery of self-report questionnaires was administered at baseline, posttreatment, and 3-month follow-up to evaluate changes in psychological, neurobehavioral, sleep, pain, and headache symptoms, as well as self-efficacy in symptom management and life satisfaction. RESULTS: Participants tolerated the treatment well and reported a positive experience. Symptom improvement was observed, including depressive, neurobehavioral, and pain-related symptoms, with effects sustained at 3-month follow-up. CONCLUSION: LZT treatment appears to be a feasible, non-pharmacological therapy amenable to SMs. Results from this pilot study promote further investigation of LZT as an intervention for SMs with persistent symptoms following TBI.
View Full Paper →A Methodology of Analysis for Monitoring Treatment Progression with 19-Channel Z-Score Neurofeedback (19ZNF) in a Single-Subject Design
19-Channel Z-Score Neurofeedback (19ZNF) is a modality using 19-electrodes with real-time normative database z-scores, suggesting effective clinical outcomes in fewer sessions than traditional neurofeedback. Thus, monitoring treatment progression and clinical outcome is necessary. The area of focus in this study was a methodology of quantitative analysis for monitoring treatment progression and clinical outcome with 19ZNF. This methodology is noted as the Sites-of-Interest, which included repeated measures analyses of variance (rANOVA) and t-tests for z-scores; it was conducted on 10 cases in a single subject design. To avoid selection bias, the 10 sample cases were randomly selected from a pool of 17 cases that met the inclusion criteria. Available client outcome measures (including self-report) are briefly discussed. The results showed 90 % of the pre-post comparisons moved in the targeted direction (z = 0) and of those, 96 % (80 % Bonferroni corrected) of the t-tests and 96 % (91 % Bonferroni corrected) of the rANOVAs were statistically significant; thus indicating a progression towards the mean in 15 or fewer 19ZNF sessions. All cases showed and reported improvement in all outcome measures (including quantitative electroencephalography assessment) at case termination
View Full Paper →Using Neurofeedback to Lower Anxiety Symptoms Using Individualized qEEG Protocols: A Pilot Study
Introduction: Anxiety disorders affect approximately 40 million Americans ages 18 and over (NIMH, 2015). Although qualitative and small-scale quantitative neurofeedback (NF) studies show reduction in anxiety symptoms, large-scale studies and quantitative electroencephalogram (qEEG) driven protocols are non-existent. This retrospective pilot study intended to assess whether qEEG guided amplitude NF is viable in symptom reduction of anxiety. Methods: Nineteen clients were assessed for anxiety, 14 were included in the data. Demographics include age ranges from 11-61 (M = 31.71, SD = 16.33), 9 male and 5 female, six identified as Caucasian, five as Hispanic/Latino, and three Caucasian/Hispanic ethnicity. Pre- and post-assessments included the Zung Self-Rating Anxiety Scale, Screen for Child Anxiety Related Disorders (SCARED), and the Achenbach System of Empirically Based Assessment (ASEBA). Clients received 30-min qEEG guided NF treatment sessions, twice a week. The range of attended session was 7-28 (M = 12.93, SD = 6.32). Results: Enhancement in clients' well-being was evidenced by statistically significant improvement in symptom measures scores. Although improvements for the two most anxiety-related categories on the ASEBA were not significant, other anxiety-related categories did show significant improvement. Yet, qEEG findings were not statistically significant. Directions for future research are discussed
View Full Paper →Z-score LORETA Neurofeedback as a Potential Therapy for Patients with Seizures and Refractory Epilepsy
Approximately 30 % of epilepsy patients are resistant to conventional medical therapy. Therefore, alternative forms of treatment are needed to improve efficiency of these therapeutic regimens. Neurofeedback (NFB) has been becoming recognized as one of the promising therapies improving control of medically refractory epilepsy cases. This multi-case paper describes our experience with LORETA Z-score NFB as a tool for control of patients with seizures.
View Full Paper →Z-score LORETA Neurofeedback as a Potential Therapy in Depression/Anxiety and Cognitive Dysfunction1www.TallahasseeNeuroBalanceCenter.com
Introduction of quantitative electroencephalogram low-resolution electromagnetic tomography (QEEG/LORETA) electrical brain imaging has improved our diagnostic ability in neuropsychiatric practice by enhancing identification of dysregulated (defined as two standard deviations above or below the norm) cortical areas implicated in patient symptoms. Additional use of LORETA Z-score neurofeedback (NFB) enables us to directly target these areas of dysregulation in order to improve associated symptoms. Out of 235 neuropsychiatric patients treated in our clinic with Z-score LORETA NFB, a detailed analysis of 35 cases of depression, anxiety, and cognitive dysfunction is presented. Specific areas of dysregulation attributed to particular conditions identified by LORETA are discussed. Follow-up findings of QEEG/LORETA electrical imaging after NFB therapy (including computerized cognitive testing results) are shown. This chapter summarizes our experience with LORETA Z-score NFB as a tool for therapy of depression and associated anxiety. In addition, this form of NFB is able to improve cognitive functions of individuals suffering from memory, information processing, and other cognitive dysfunctions. Extensive presentations of selected cases are used for demonstration of results from our practice. 25 out of 35 patients (71%) were identified as having an objective improvement (on average 10 points) through cognitive testing. In addition, with NFB subjective cognitive improvement and an objective reduction of QEEG abnormalities were also achieved in most of the patients. Detailed analysis of our patients diagnosed with depression and/or anxiety showed that out of 31 included in the study, 24 (77%) were found to have both subjective and objective (improvement of QEEG abnormalities) improvement of the symptoms within 10 sessions of LORETA Z-score NFB. These results are very promising and indicate good effectiveness of LORETA Z-score NFB in therapy of depression, anxiety, and cognitive enhancement.
Neurofeedback for Insomnia: A Pilot Study of Z-Score SMR and Individualized Protocols
Insomnia is an epidemic in the US. Neurofeedback (NFB) is a little used, psychophysiological treatment with demonstrated usefulness for treating insomnia. Our objective was to assess whether two distinct Z-Score NFB protocols, a modified sensorimotor (SMR) protocol and a sequential, quantitative EEG (sQEEG)-guided, individually designed (IND) protocol, would alleviate sleep and associated daytime dysfunctions of participants with insomnia. Both protocols used instantaneous Z scores to determine reward condition administered when awake. Twelve adults with insomnia, free of other mental and uncontrolled physical illnesses, were randomly assigned to the SMR or IND group. Eight completed this randomized, parallel group, single-blind study. Both groups received fifteen 20-min sessions of Z-Score NFB. Pre-post assessments included sQEEG, mental health, quality of life, and insomnia status. ANOVA yielded significant post-treatment improvement for the combined group on all primary insomnia scores: Insomnia Severity Index (ISI p < .005), Pittsburgh Sleep Quality Inventory (PSQI p < .0001), PSQI Sleep Efficiency (p < .007), and Quality of Life Inventory (p < .02). Binomial tests of baseline EEGs indicated a significant proportion of excessively high levels of Delta and Beta power (p < .001) which were lowered post-treatment (paired z-tests p < .001). Baseline EEGs showed excessive sleepiness and hyperarousal, which improved post-treatment. Both Z-Score NFB groups improved in sleep and daytime functioning. Post-treatment, all participants were normal sleepers. Because there were no significant differences in the findings between the two groups, our future large scale studies will utilize the less burdensome to administer Z-Score SMR protocol.
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