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Gan H, Bu J, Zeng GQ, Gou H, Liu M, Cui G, Zhang X. Correlation between abnormal brain network activity and electroencephalogram microstates on exposure to smoking-related cues. BJPsych Open 2023; 9:e31. [PMID: 36718768 PMCID: PMC9970173 DOI: 10.1192/bjo.2022.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Research into neural mechanisms underlying cue-induced cigarette craving has attracted considerable attention for its significant role in treatments. However, there is little understanding about the effects of exposure to smoking-related cues on electroencephalogram (EEG) microstates of smokers, which can reflect abnormal brain network activity in several psychiatric disorders. AIMS To explore whether abnormal brain network activity in smokers on exposure to smoking-related cues would be captured by EEG microstates. METHOD Forty smokers were exposed to smoking and neutral imagery conditions (cues) during EEG recording. Behavioural data and parameters for microstate topographies associated with the auditory (A), visual (B), salience and memory (C) and dorsal attention networks (D) were compared between conditions. Correlations between microstate parameters and cigarette craving as well as nicotine addiction characteristics were also analysed. RESULTS The smoking condition elicited a significant increase in the duration of microstate classes B and C and in the duration and contribution of class D compared with the neutral condition. A significant positive correlation between the increased duration of class C (smoking minus neutral) and increased craving ratings was observed, which was fully mediated by increased posterior alpha power. The increased duration and contribution of class D were both positively correlated with years of smoking. CONCLUSIONS Our results indicate that smokers showed abnormal EEG microstates when exposed to smoking-related cues compared with neutral cues. Importantly, microstate class C (duration) might be a biomarker of cue-induced cigarette craving, and class D (duration and contribution) might reflect the relationship between cue-elicited activation of the dorsal attention network and years of smoking.
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Affiliation(s)
- Hefan Gan
- Department of Radiology, the First Affiliated Hospital of USTC, Hefei National Research Center for Physical Sciences at the Microscale and School of Life Science, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China
| | - Junjie Bu
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Ginger Qinghong Zeng
- Institute of Advanced Technology, University of Science and Technology of China, Hefei, China
| | - Huixing Gou
- Department of Radiology, the First Affiliated Hospital of USTC, Hefei National Research Center for Physical Sciences at the Microscale and School of Life Science, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China
| | - Mengyuan Liu
- Department of Psychology, School of Humanities and Social Science, University of Science and Technology of China, Hefei, China
| | - Guanbao Cui
- Application Technology Center of Physical Therapy to Brain Disorders, Institute of Advanced Technology, University of Science and Technology of China, Hefei, China
| | - Xiaochu Zhang
- Department of Radiology, the First Affiliated Hospital of USTC, Hefei National Research Center for Physical Sciences at the Microscale and School of Life Science, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China; Department of Psychology, School of Humanities and Social Science, University of Science and Technology of China, Hefei, China; Application Technology Center of Physical Therapy to Brain Disorders, Institute of Advanced Technology, University of Science and Technology of China, Hefei, China; Biomedical Sciences and Health Laboratory of Anhui Province, University of Science and Technology of China, Hefei, China
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Rosenthal A, Ebrahimi C, Wedemeyer F, Romanczuk-Seiferth N, Beck A. The Treatment of Substance Use Disorders: Recent Developments and New Perspectives. Neuropsychobiology 2022; 81:451-472. [PMID: 35724634 DOI: 10.1159/000525268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
Substance-related disorders are complex psychiatric disorders that are characterized by continued consumption in spite of harmful consequences. Addiction affects various brain networks critically involved in learning, reward, and motivation, as well as inhibitory control. Currently applied therapeutic approaches aim at modification of behavior that ultimately leads to decrease of consumption or abstinence in individuals with substance use disorders. However, traditional treatment methods might benefit from recent neurobiological and cognitive neuroscientific research findings. Novel cognitive-behavioral approaches in the treatment of addictive behavior aim at enhancement of strategies to cope with stressful conditions as well as craving-inducing cues and target erroneous learning mechanisms, including cognitive bias modification, reconsolidation-based interventions, mindfulness-based interventions, virtual-reality-based cue exposure therapy as well as pharmacological augmentation strategies. This review discusses therapeutic strategies that target dysregulated neurocognitive processes associated with the development and maintenance of disordered substance use and may hold promise as effective treatments for substance-related disorders.
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Affiliation(s)
- Annika Rosenthal
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Ebrahimi
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friederike Wedemeyer
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nina Romanczuk-Seiferth
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne Beck
- Department of Psychiatry and Neurosciences
- CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Health and Medical University, Campus Potsdam, Faculty of Health, Potsdam, Germany
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Rempala HA, Barterian JA. Neurofeedback for opioid dependent patients in an outpatient setting: a pilot feasibility study. Subst Abuse Treat Prev Policy 2022; 17:28. [PMID: 35428348 PMCID: PMC9013036 DOI: 10.1186/s13011-022-00458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neurofeedback (NF) has been described as “probably efficacious” when used in conjunction with other interventions for substance use disorders, including the recent studies in the population of individuals with opioid use disorder. Despite these promising outcomes, the seriousness of the opioid epidemic, and the high rate of relapse even with the most effective medication-assisted maintenance treatments NF continues to be an under-researched treatment modality. This article explores factors that affected the feasibility of adding Alpha/Theta Neurofeedback to treatment as usual for opioid dependence in an outpatient urban treatment center. The study strived to replicate previous research completed in Iran that found benefits of NF for opioid dependence. Methods Out of approximately two dozen patients eligible for Alpha/Theta NF, about 60% (n = 15) agreed to participate; however, only 2 participants completed treatment. The rates of enrollment in response to active treatment were monitored. Results The 4 factors affecting feasibility were: (1) the time commitment required of participants and providers, (2) ineffectiveness of standard incentives to promote participation, (3) delayed effects of training, and (4) the challenges of researching treatment options not reimbursed by the insurance companies. Conclusions The findings indicate that a large-scale study examining the use of NF for the treatment of opioid use disorder in the United States will likely be difficult to accomplish without modification to the traditional randomized control study approach and suggests challenges to the implementation of this treatment in an outpatient setting. A single-case methodology is proposed as a viable alternative.
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Stewart JL, May AC, Paulus MP. Bouncing back: Brain rehabilitation amid opioid and stimulant epidemics. NEUROIMAGE-CLINICAL 2019; 24:102068. [PMID: 31795056 PMCID: PMC6978215 DOI: 10.1016/j.nicl.2019.102068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/20/2019] [Accepted: 11/03/2019] [Indexed: 12/18/2022]
Abstract
Frontoparietal event related potentials predict/track recovery. Frontostriatal functional magnetic resonance imaging signals predict/track recovery. Transcranial magnetic left prefrontal stimulation reduces craving and drug use.
Recent methamphetamine and opioid use epidemics are a major public health concern. Chronic stimulant and opioid use are characterized by significant psychosocial, physical and mental health costs, repeated relapse, and heightened risk of early death. Neuroimaging research highlights deficits in brain processes and circuitry that are linked to responsivity to drug cues over natural rewards as well as suboptimal goal-directed decision-making. Despite the need for interventions, little is known about (1) how the brain changes with prolonged abstinence or as a function of various treatments; and (2) how symptoms change as a result of neuromodulation. This review focuses on the question: What do we know about changes in brain function during recovery from opioids and stimulants such as methamphetamine and cocaine? We provide a detailed overview and critique of published research employing a wide array of neuroimaging methods – functional and structural magnetic resonance imaging, electroencephalography, event-related potentials, diffusion tensor imaging, and multiple brain stimulation technologies along with neurofeedback – to track or induce changes in drug craving, abstinence, and treatment success in stimulant and opioid users. Despite the surge of methamphetamine and opioid use in recent years, most of the research on neuroimaging techniques for recovery focuses on cocaine use. This review highlights two main findings: (1) interventions can lead to improvements in brain function, particularly in frontal regions implicated in goal-directed behavior and cognitive control, paired with reduced drug urges/craving; and (2) the targeting of striatal mechanisms implicated in drug reward may not be as cost-effective as prefrontal mechanisms, given that deep brain stimulation methods require surgery and months of intervention to produce effects. Overall, more studies are needed to replicate and confirm findings, particularly for individuals with opioid and methamphetamine use disorders.
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Affiliation(s)
- Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, United States.
| | - April C May
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, United States; Department of Community Medicine, University of Tulsa, Tulsa, OK, United States
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Gouzoulis-Mayfrank E, Härtel-Petri R, Hamdorf W, Havemann-Reinecke U, Mühlig S, Wodarz N. Methamphetamine-Related Disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:455-461. [PMID: 28705298 DOI: 10.3238/arztebl.2017.0455] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/14/2017] [Accepted: 04/07/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Methamphetamine is considered more dangerous than other stimulants because of its acute complications, long-term neurotoxicity, and potential for drug dependence. Until now, there have been no evidence-based guidelines for the treatment of methamphetamine-related disorders, either in Germany or abroad. METHODS A systematic literature search was performed on the treatment of methamphetamine-related disorders. Based on this literature review, a multidisciplinary expert panel developed recommendations using the nominal group technique. RESULTS The evidence base for the treatment of methamphetamine-related disorders is sparse. The efficacy of psychotherapeutic techniques such as cognitive behavioral therapy and contingency management and the efficacy of complex, disorder-specific treatment programs have been proven in ran - domized controlled trials, but it remains unclear which method is best. Persons carrying a diagnosis of substance abuse should be offered psychotherapy. Structured exercise programs, whether self-directed or professionally led, can improve addiction-specific endpoints as well as comorbid disorders and should, therefore, be offered as well. Pharmacotherapy has shown little to no effect in relatively low-quality clinical trials with low case numbers and high dropout rates, and therefore only a few weak recommendations were made. These include tranquilizers for the short-term treatment of agitation and atypical antipsychotics if necessary. Attempts to substitute other substances, such as methylphenidate or dexamphetamine, for methamphetamine have not yielded any robust evidence to date. Sertraline should not be administered due to serious adverse events. CONCLUSION Many of the recommendations in the guideline are made with a weak grade of recommendation because of the poor evidence base and the modest size of the reported therapeutic effects. In acute situations, symptomoriented treatment is recommended. Psychotherapy and exercise should be offered as well.
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Affiliation(s)
- Euphrosyne Gouzoulis-Mayfrank
- *All of the authors of the S3 guideline are listed in eTable1. They contributed equally to this article; Landschaftsverband Rheinland (Rhineland Regional Council, LVR)-Klinik Köln; Psychotherapeutic Practice Bayreuth; Allgemeine Hospitalgesellschaft (AHG) Klinik Mecklenburg; University Medical Center Göttingen; Technische Universität Chemnitz; Department of Psychiatry and Psychotherapy, University Hospital of Regensburg
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Efficacy of Invasive and Non-Invasive Brain Modulation Interventions for Addiction. Neuropsychol Rev 2018; 29:116-138. [PMID: 30536145 PMCID: PMC6499746 DOI: 10.1007/s11065-018-9393-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 11/08/2018] [Indexed: 12/14/2022]
Abstract
It is important to find new treatments for addiction due to high relapse rates despite current interventions and due to expansion of the field with non-substance related addictive behaviors. Neuromodulation may provide a new type of treatment for addiction since it can directly target abnormalities in neurocircuits. We review literature on five neuromodulation techniques investigated for efficacy in substance related and behavioral addictions: transcranial direct current stimulation (tDCS), (repetitive) transcranial magnetic stimulation (rTMS), EEG, fMRI neurofeedback and deep brain stimulation (DBS) and additionally report on effects of these interventions on addiction-related cognitive processes. While rTMS and tDCS, mostly applied at the dorsolateral prefrontal cortex, show reductions in immediate craving for various addictive substances, placebo-responses are high and long-term outcomes are understudied. The lack in well-designed EEG-neurofeedback studies despite decades of investigation impedes conclusions about its efficacy. Studies investigating fMRI neurofeedback are new and show initial promising effects on craving, but future trials are needed to investigate long-term and behavioral effects. Case studies report prolonged abstinence of opioids or alcohol with ventral striatal DBS but difficulties with patient inclusion may hinder larger, controlled trials. DBS in neuropsychiatric patients modulates brain circuits involved in reward processing, extinction and negative-reinforcement that are also relevant for addiction. To establish the potential of neuromodulation for addiction, more randomized controlled trials are needed that also investigate treatment duration required for long-term abstinence and potential synergy with other addiction interventions. Finally, future advancement may be expected from tailoring neuromodulation techniques to specific patient (neurocognitive) profiles.
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Imperatori C, Della Marca G, Amoroso N, Maestoso G, Valenti EM, Massullo C, Carbone GA, Contardi A, Farina B. Alpha/Theta Neurofeedback Increases Mentalization and Default Mode Network Connectivity in a Non-Clinical Sample. Brain Topogr 2017; 30:822-831. [PMID: 28936792 DOI: 10.1007/s10548-017-0593-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
Several studies showed the effectiveness of alpha/theta (A/T) neurofeedback training in treating some psychiatric conditions. Despite the evidence of A/T effectiveness, the psychological and neurobiological bases of its effects is still unclear. The aim of the present study was to explore the usefulness of the A/T training in increasing mentalization in a non-clinical sample. The modifications of electroencephalographic (EEG) functional connectivity in Default Mode Network (DMN) associated with A/T training were also investigated. Forty-four subjects were enrolled in the study and randomly assigned to receive ten sessions of A/T training [neurofeedback group (NFG) = 22], or to act as controls [waiting list group (WLG) = 22]. All participants were administered the mentalization questionnaire (MZQ) and the Symptom Checklist-90-Revised (SCL-90-R). In the post training assessment, compared to WLG, NFG showed a significant increase of MZQ total scores (3.94 ± 0.73 vs. 3.53 ± 0.77; F1;43 = 8.19; p = 0.007; d = 0.863). Furthermore, A/T training was also associated with a significant increase of EEG functional connectivity in several DMN brain areas (e.g. Posterior Cingulate Cortex). Taken together our results support the usefulness of the A/T training in enhancing mentalization and DMN connectivity.
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Affiliation(s)
- Claudio Imperatori
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy.
| | - Giacomo Della Marca
- Sleep Disorders Unit, Institute of Neurology, Catholic University, Rome, Italy
| | - Noemi Amoroso
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Giulia Maestoso
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Enrico Maria Valenti
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Chiara Massullo
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Giuseppe Alessio Carbone
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Anna Contardi
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Benedetto Farina
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
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Orndorff-Plunkett F, Singh F, Aragón OR, Pineda JA. Assessing the Effectiveness of Neurofeedback Training in the Context of Clinical and Social Neuroscience. Brain Sci 2017; 7:E95. [PMID: 28783134 PMCID: PMC5575615 DOI: 10.3390/brainsci7080095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/16/2017] [Accepted: 08/04/2017] [Indexed: 12/25/2022] Open
Abstract
Social neuroscience benefits from the experimental manipulation of neuronal activity. One possible manipulation, neurofeedback, is an operant conditioning-based technique in which individuals sense, interact with, and manage their own physiological and mental states. Neurofeedback has been applied to a wide variety of psychiatric illnesses, as well as to treat sub-clinical symptoms, and even to enhance performance in healthy populations. Despite growing interest, there persists a level of distrust and/or bias in the medical and research communities in the USA toward neurofeedback and other functional interventions. As a result, neurofeedback has been largely ignored, or disregarded within social neuroscience. We propose a systematic, empirically-based approach for assessing the effectiveness, and utility of neurofeedback. To that end, we use the term perturbative physiologic plasticity to suggest that biological systems function as an integrated whole that can be perturbed and guided, either directly or indirectly, into different physiological states. When the intention is to normalize the system, e.g., via neurofeedback, we describe it as self-directed neuroplasticity, whose outcome is persistent functional, structural, and behavioral changes. We argue that changes in physiological, neuropsychological, behavioral, interpersonal, and societal functioning following neurofeedback can serve as objective indices and as the metrics necessary for assessing levels of efficacy. In this chapter, we examine the effects of neurofeedback on functional connectivity in a few clinical disorders as case studies for this approach. We believe this broader perspective will open new avenues of investigation, especially within social neuroscience, to further elucidate the mechanisms and effectiveness of these types of interventions, and their relevance to basic research.
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Affiliation(s)
| | - Fiza Singh
- Departments of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA.
| | - Oriana R Aragón
- Marketing Department, Clemson University College of Business, Clemson, SC 29634, USA.
| | - Jaime A Pineda
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA 92093, USA.
- Neurosciences Group, University of California, San Diego, La Jolla, CA 92093, USA.
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Abstract
PURPOSE OF REVIEW Stimulant use disorders are significant contributors to the global burden of disease, with a growing impact on women. Psychosocial interventions are the gold standard for treating this condition, but several barriers may prevent women from accessing appropriate treatment. Therefore, we systematically reviewed the most recent findings about psychosocial interventions for stimulant use disorders, focussing on results relevant to women. RECENT FINDINGS Twenty-two eligible studies were identified. Psychosocial interventions in stimulant use disorders were examined in 17 recent studies, but no analyses for sex-related differences were performed. These aspects were investigated in further five studies, either through secondary analyses on the female subgroup or specifically examining a female-only sample. Contingency management, either alone or in combination with other interventions, provided the most positive results on several outcome measures. Only one pilot study showed good potential for an alternative approach of systemic family therapy, warranting further research in this direction. SUMMARY Research in stimulant use disorders shows an increasing interest in exploring interventions capable of addressing sex-specific issues. Combined therapy including contingency management and other treatments appears the most promising option, but larger secondary studies are needed to rank the efficacy of different psychosocial interventions while considering their feasibility and acceptability in specific subpopulations, including women.
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Neurofeedback in Substance Use and Overeating: Current Applications and Future Directions. CURRENT ADDICTION REPORTS 2017. [DOI: 10.1007/s40429-017-0137-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
Brain-computer interface (BCI) technology can restore communication and control to people who are severely paralyzed. There has been speculation that this technology might also be useful for a variety of diverse therapeutic applications. This survey considers possible ways that BCI technology can be applied to motor rehabilitation following stroke, Parkinson's disease, and psychiatric disorders. We consider potential neural signals as well as the design and goals of BCI-based therapeutic applications. These diverse applications all share a reliance on neuroimaging and signal processing technologies. At the same time, each of these potential applications presents a series of unique challenges.
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Affiliation(s)
| | - Janis Daly
- Brain Rehabilitation Research Program, McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Chadwick Boulay
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Imperatori C, Valenti EM, Della Marca G, Amoroso N, Massullo C, Carbone GA, Maestoso G, Quintiliani MI, Contardi A, Farina B. Coping food craving with neurofeedback. Evaluation of the usefulness of alpha/theta training in a non-clinical sample. Int J Psychophysiol 2017; 112:89-97. [DOI: 10.1016/j.ijpsycho.2016.11.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/08/2016] [Accepted: 11/11/2016] [Indexed: 11/25/2022]
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