Networks of Neuropsychological Functions in the Clinical Evaluation of Adult ADHD

This study applied network analysis to explore the relations between neuropsychological functions of individuals in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. A total of 319 participants from an outpatient referral context, that is, 173 individuals with ADHD (ADHD group) and 146 individuals without ADHD (n-ADHD group), took part in this study and completed a comprehensive neuropsychological assessment. A denser network with stronger global connectivity was observed in the ADHD group compared to the n-ADHD group. The strongest connections were consistent in both networks, that is, the connections between selective attention and vigilance, and connections between processing speed, fluency, and flexibility. Further centrality estimation revealed attention-related variables to have the highest expected influence in both networks. The observed relationships between neuropsychological functions, and the high centrality of attention, may help identify neuropsychological profiles that are specific to ADHD and optimize neuropsychological assessment and treatment planning of individuals with cognitive impairment.

A Biofeedback Enhanced Adaptive Virtual Reality Environment for Managing Surgical Pain and Anxiety

Pain and anxiety are common accompaniments of surgery, and opioids have been the mainstay of pain management for decades, with about 80% of the surgical population leaving the hospital with an opioid prescription. Moreover, patients receiving an opioid prescription after short-stay surgeries have a 44% increased risk of long-term opioid use, and about one in 16 surgical patients becomes a long-term user. Current opioid abuse and addiction now place the US in an “opioid epidemic,” and calls for alternative pain management mechanisms. To mitigate the preoperative anxiety and postoperative pain, we developed a virtual reality (VR) experience based on Attention Restoration Theory (ART) and integrated the user’s heart rate variability (HRV) biofeedback to create an adaptive environment. A randomized control trial among 16 Total Knee Arthroplasty (TKA) patients undergoing surgery at Patewood Memorial Hospital, Greenville, SC demonstrated that patients experiencing the adaptive VR environment reported a significant decrease in preoperative anxiety ([Formula: see text]) and postoperative pain ([Formula: see text]) after the VR intervention. These results were also supported by the physiological measures where there was a significant increase in RR Interval (RRI) ([Formula: see text]) and a significant decrease in the low frequency (LF)/high frequency (HF) ratio ([Formula: see text]) and respiration rate (RR) ([Formula: see text]).

Brain computer interface based applications for training and rehabilitation of students with neurodevelopmental disorders. A literature review

The aim of this article is to explore a paradigm shift on Brain Computer Interface (BCI) research, as well as on intervention best practices for training and rehabilitation of students with neurodevelopmental disorders. Recent studies indicate that BCI devices have positive impact on students' attention skills and working memory as well as on other skills, such as visuospatial, social, imaginative and emotional abilities. BCI applications aim to emulate humans' brain and address the appropriate understanding for each student's neurodevelopmental disorders. Studies conducted to provide knowledge about BCI-based intervention applications regarding memory, attention, visuospatial, learning, collaboration, and communication, social, creative and emotional skills are highlighted. Only non-invasive BCI type of applications are being investigated based upon representative, non-exhaustive and state-of-the-art studies within the field. This article examines the progress of BCI research so far, while different BCI paradigms are investigated. BCI-based applications could successfully regulate students' cognitive abilities when used for their training and rehabilitation. Future directions to investigate BCI-based applications for training and rehabilitation of students with neurodevelopmental disorders concerning the different populations involved are discussed.

In-Ear EEG Based Attention State Classification Using Echo State Network

It is important to maintain attention when carrying out significant daily-life tasks that require high levels of safety and efficiency. Since degradation of attention can sometimes have dire consequences, various brain activity measurement devices such as electroencephalography (EEG) systems have been used to monitor attention states in individuals. However, conventional EEG instruments have limited utility in daily life because they are uncomfortable to wear. Thus, this study was designed to investigate the possibility of discriminating between the attentive and resting states using in-ear EEG signals for potential application via portable, convenient earphone-shaped EEG instruments. We recorded both on-scalp and in-ear EEG signals from 6 subjects in a state of attentiveness during the performance of a visual vigilance task. We have designed and developed in-ear EEG electrodes customized by modelling both the left and right ear canals of the subjects. We use an echo state network (ESN), a powerful type of machine learning algorithm, to discriminate attention states on the basis of in-ear EEGs. We have found that the maximum average accuracy of the ESN method in discriminating between attentive and resting states is approximately 81.16% with optimal network parameters. This study suggests that portable in-ear EEG devices and an ESN can be used to monitor attention states during significant tasks to enhance safety and efficiency.

The Effect of an Integrated Neurofeedback and Biofeedback Training Intervention on Ice Hockey Shooting Performance

The purpose of this study was to investigate the effectiveness of a sensorimotor rhythm (SMR) neurofeedback training (NFT) and biofeedback training (BFT) intervention on ice hockey shooting performance. Specifically, the purpose was to examine (a) whether an NFT/BFT program could improve ice hockey shooting performance, (b) whether the implementation of an SMR-NFT intervention leads to neurological adaptations during performance, and (c) whether such neurological changes account for improvement in shooting performance. Using a longitudinal stratified random control design, results demonstrated that while both SMR-NFT/BFT and control groups improved performance, the rate of improvement for the SMR-NFT/BFT group was significantly higher than the control. Participants in the SMR-NFT/BFT group demonstrated the ability to significantly increase SMR power from pre- to postintervention in the lab. However, no significant changes in SMR power were found during shooting performance. This result may be suggestive of differing cortical activity present during motor-skill preparation.

A Pilot Study of Neurofeedback for Chronic PTSD

EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well over 30 years; however, it has made very little impact on clinical care. One reason for this has been the difficulty in designing research to measure clinical change in the real world. While substantial evidence exists for its efficacy in treating attention deficit/hyperactivity disorder, relatively little evidence exists for its utility in other disorders including posttraumatic stress disorder (PTSD). The current study represents a "proof-of-concept" pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. Participants completed 40 sessions of neurofeedback training two times per week with sensors randomly assigned (by the study coordinator, who was not blind to condition) to sensor placements of either T4-P4 or T3-T4. We found that neurofeedback significantly reduced PTSD symptoms (Davidson Trauma Scale scores averaged 69.14 at baseline to 49.26 at termination), and preceded gains in affect regulation (Inventory of Altered Self-Capacities-Affect Dysregulation scores averaged 23.63 at baseline to 17.20 at termination). We discuss a roadmap for future research.

Brain-computer interfaces for communication and rehabilitation

Brain-computer interfaces (BCIs) use brain activity to control external devices, thereby enabling severely disabled patients to interact with the environment. A variety of invasive and noninvasive techniques for controlling BCIs have been explored, most notably EEG, and more recently, near-infrared spectroscopy. Assistive BCIs are designed to enable paralyzed patients to communicate or control external robotic devices, such as prosthetics; rehabilitative BCIs are designed to facilitate recovery of neural function. In this Review, we provide an overview of the development of BCIs and the current technology available before discussing experimental and clinical studies of BCIs. We first consider the use of BCIs for communication in patients who are paralyzed, particularly those with locked-in syndrome or complete locked-in syndrome as a result of amyotrophic lateral sclerosis. We then discuss the use of BCIs for motor rehabilitation after severe stroke and spinal cord injury. We also describe the possible neurophysiological and learning mechanisms that underlie the clinical efficacy of BCIs.

Brain-computer interfaces in the completely locked-in state and chronic stroke

Brain-computer interfaces (BCIs) use brain activity to control external devices, facilitating paralyzed patients to interact with the environment. In this chapter, we discuss the historical perspective of development of BCIs and the current advances of noninvasive BCIs for communication in patients with amyotrophic lateral sclerosis and for restoration of motor impairment after severe stroke. Distinct techniques have been explored to control a BCI in patient population especially electroencephalography (EEG) and more recently near-infrared spectroscopy (NIRS) because of their noninvasive nature and low cost. Previous studies demonstrated successful communication of patients with locked-in state (LIS) using EEG- and invasive electrocorticography-BCI and intracortical recordings when patients still showed residual eye control, but not with patients with complete LIS (ie, complete paralysis). Recently, a NIRS-BCI and classical conditioning procedure was introduced, allowing communication in patients in the complete locked-in state (CLIS). In severe chronic stroke without residual hand function first results indicate a possible superior motor rehabilitation to available treatment using BCI training. Here we present an overview of the available studies and recent results, which open new doors for communication, in the completely paralyzed and rehabilitation in severely affected stroke patients. We also reflect on and describe possible neuronal and learning mechanisms responsible for BCI control and perspective for future BMI research for communication in CLIS and stroke motor recovery.

The effects of individual upper alpha neurofeedback in ADHD: an open-label pilot study

Standardized neurofeedback (NF) protocols have been extensively evaluated in attention-deficit/hyperactivity disorder (ADHD). However, such protocols do not account for the large EEG heterogeneity in ADHD. Thus, individualized approaches have been suggested to improve the clinical outcome. In this direction, an open-label pilot study was designed to evaluate a NF protocol of relative upper alpha power enhancement in fronto-central sites. Upper alpha band was individually determined using the alpha peak frequency as an anchor point. 20 ADHD children underwent 18 training sessions. Clinical and neurophysiological variables were measured pre- and post-training. EEG was recorded pre- and post-training, and pre- and post-training trials within each session, in both eyes closed resting state and eyes open task-related activity. A power EEG analysis assessed long-term and within-session effects, in the trained parameter and in all the sensors in the (1-30) Hz spectral range. Learning curves over sessions were assessed as well. Parents rated a clinical improvement in children regarding inattention and hyperactivity/impulsivity. Neurophysiological tests showed an improvement in working memory, concentration and impulsivity (decreased number of commission errors in a continuous performance test). Relative and absolute upper alpha power showed long-term enhancement in task-related activity, and a positive learning curve over sessions. The analysis of within-session effects showed a power decrease ("rebound" effect) in task-related activity, with no significant effects during training trials. We conclude that the enhancement of the individual upper alpha power is effective in improving several measures of clinical outcome and cognitive performance in ADHD. This is the first NF study evaluating such a protocol in ADHD. A controlled evaluation seems warranted due to the positive results obtained in the current study.

In-school neurofeedback training for ADHD: sustained improvements from a randomized control trial

OBJECTIVE

To evaluate sustained improvements 6 months after a 40-session, in-school computer attention training intervention using neurofeedback or cognitive training (CT) administered to 7- to 11-year-olds with attention-deficit/hyperactivity disorder (ADHD).

METHODS

One hundred four children were randomly assigned to receive neurofeedback, CT, or a control condition and were evaluated 6 months postintervention. A 3-point growth model assessed change over time across the conditions on the Conners 3-Parent Assessment Report (Conners 3-P), the Behavior Rating Inventory of Executive Function Parent Form (BRIEF), and a systematic double-blinded classroom observation (Behavioral Observation of Students in Schools). Analysis of variance assessed community-initiated changes in stimulant medication.

RESULTS

Parent response rates were 90% at the 6-month follow-up. Six months postintervention, neurofeedback participants maintained significant gains on Conners 3-P (Inattention effect size [ES] = 0.34, Executive Functioning ES = 0.25, Hyperactivity/Impulsivity ES = 0.23) and BRIEF subscales including the Global Executive Composite (ES = 0.31), which remained significantly greater than gains found among children in CT and control conditions. Children in the CT condition showed delayed improvement over immediate postintervention ratings only on Conners 3-P Executive Functioning (ES = 0.18) and 2 BRIEF subscales. At the 6-month follow-up, neurofeedback participants maintained the same stimulant medication dosage, whereas participants in both CT and control conditions showed statistically and clinically significant increases (9 mg [P = .002] and 13 mg [P < .001], respectively).

CONCLUSIONS

Neurofeedback participants made more prompt and greater improvements in ADHD symptoms, which were sustained at the 6-month follow-up, than did CT participants or those in the control group. This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD.