Biofeedback, Head Trauma, and Neuroplasticity

Four topics for today’s post, links to two videos, report of ground breaking research on neuroplasticity and EEG biofeedback, and a note on the limits of ADHD stimulant medication. The sources are far-flung, but they have in common support for the widely misunderstood value of Neurofeedback.

First, I am posting a link to a video that introduces the fundamentals of biofeedback, created by my colleague Michael Cohen in Jupiter, Florida. His four-minute animated presents the story of biofeedback (including neurofeedback) simply and clearly. I’d think it would be good for people over age 12. The message: if you can measure it you can change it. http://youtu.be/4Sin4QR4cwo

The second video is a “testimonial” I found when I viewed the above, also from Mike Cohen. As the YouTube commentary states, “April has suffered debilitating symptoms for over nine years since an illness left her with a severe traumatic brain injury (TBI). After just six weeks of neurofeedback, she has experienced significant improvement. This interview with April, her daughter, and Mike Cohen of the Center for Brain Training explores the power neurofeedback can have in people’s lives, even many years after a brain injury occurs.” http://youtu.be/gVUI3en9rJ4

Next is a report of the most significant new research to date on neuroplasticity in the brain resulting from EEG neurofeedback. The report, Neurofeedback Training Induces Changes in White and Gray Matter published online ahead of print in the prestigeous Clinical EEG & Neuroscience this past March 26, 2013, comes from the lab of Mario Beaurogard in Montreal. Beaurogard has a solid track record of brain research into the most philosophically interesting questions in neurofeedback (perhaps by this coming Fall, I will have had time to post a review his work over the past decade in more detail). Beaurogard and his group used MRI and white matter diffusion techniques (with SHAM neurofeedback comparisons) to study brain connectivity changes with attention training Neurofeedback (designed to increase beta activity in the right frontal and parietal areas) in university students with ADHD.

Their final paragraph heralds the significance of the research and is worth quoting in full: “In summary, our results show that a neurofeedback (NFT) protocol aimed at enhancing b1 activity can enhance visual and auditory sustained attention performance. Importantly, our results indicate that this protocol can induce modifications in white matter pathways implicated in sustained attention. Furthermore, such a protocol can produce grey matter volume alterations in brain regions involved in this kind of attention. After 50 years of research in the field of neurofeedback, our study constitutes the first empirical demonstration that NFT can lead to microstructural changes in white matter and grey matter (emphasis added)”. http://eeg.sagepub.com/content/early/2013/03/19/1550059413476031

Finally, a story in today’s Wall Street Journal reviews studies on the poor evidence for cognitive enhancement of stimulant drugs for kids with ADHD. The key point is that “millions of children and college students take medication to treat ADHD and to help them perform better in school. But there isn’t great evidence to suggest that these drugs actually improve academic outcomes.” Shirley S Wang’s story goes on:

“Stimulants used to treat ADHD like Ritalin and Adderall are sometimes called “cognitive enhancers” because they have been shown in a number of studies to improve attention, concentration and even certain types of memory in the short-term. Similar drugs were given to World War II soldiers to improve their ability to stay alert while scanning radars for enemy aircraft.

However, a growing body of research finds that in the long run, achievement scores, grade-point averages or the likelihood of repeating a grade generally aren’t any different in kids with ADHD who take medication compared with those who don’t. (Typically, studies take into account accommodations schools provide kids with ADHD, such as more time to take tests.)

A June study looked at medication usage and educational outcomes of nearly 4,000 students in Quebec over an average of 11 years and found that boys who took ADHD drugs actually performed worse in school than those with a similar number of symptoms who didn’t. Girls taking the medicine reported more emotional problems, according to a working paper published on the website of the National Bureau of Economic Research, a nonprofit economics research firm.”

These data are complex and, as usual, somewhat contradictory. We can say that stimulant medication can be a significant aid in concentration, focus, and attention, but other types of training are necessary to establish patterns of discipline and study habit formation. Our experience is that neurofeedback has some overlap with stimulant drugs in increasing attention, but by also reducing anxiety and, in essence, letting the brain work more smoothly in integrating modalities it makes studying more natural and allows students to establish discipline patterns.

It is also interesting that the same issue of WSJ had a story on long-term recovery from language difficulty from strokes (aphasia). With training, the article said, the brain can recover function well over a year after a stroke. For those of us in the neurofeedback field, this is well-established, having been reported at meetings for many years. I am not aware of any large studies of post-stroke EEG neurofeedback, but I know clinicians have demonstrated neuroplastic-type responses all through the thirty years I have been in the field. That is why the Beauregard study is so important because it demonstrates that the brain changes its connectivity (plasticity) at deeper levels than the feedback itself reaches–that is, by affecting the cerebral cortex grey matter, it is actually involving the deeper loops of nerve “wiring” that connect wide-spread areas of the brain.