Collura Validation SAN 2011 ppt - stresstherapysolutions.com Publications/Br… · (Guan) (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University Clinical Changes -Guan

Validation of a global live z-score protocol:

mechanism, within-subject results, and a randomized controlled study

Society for Applied Neuroscience

May 5, 2011 – Thessaloniki, Greece

Thomas F. Collura, Ph.D., QEEG-D

BrainMaster Technologies

The Brain Enrichment Center

Bedford, Ohio(C) 2011 Thomas F. Collura, (C) 2011 Thomas F. Collura,

Ph.D. &/or E. Festa, Brown Ph.D. &/or E. Festa, Brown

UniversityUniversity

AcknowledgementAcknowledgement

�� Elena Festa, Ph.D.Elena Festa, Ph.D.

�� William Heindel, Ph.D.William Heindel, Ph.D.

�� Department of Cognitive, Linguistic, and Department of Cognitive, Linguistic, and

Psychological SciencesPsychological Sciences

�� Brown University, Providence, Rhode Brown University, Providence, Rhode

IslandIsland

�� AlzheimerAlzheimer’’s Association, USAs Association, USA(C) 2011 Thomas F. Collura, (C) 2011 Thomas F. Collura,



Validation PrinciplesValidation Principles

�� Controlled ConditionsControlled Conditions

�� Record physiological & behavioral Record physiological & behavioral

variablesvariables

�� Demonstrate physiological changeDemonstrate physiological change

�� Demonstrate behavioral changeDemonstrate behavioral change

�� Confirm principles of operationConfirm principles of operation

(C) 2011 Thomas F. Collura, (C) 2011 Thomas F. Collura,



Validation SpecificsValidation Specifics

�� Metric based upon QEEG parametersMetric based upon QEEG parameters

�� Live feedback of derived computationsLive feedback of derived computations

�� Operant learning of brainOperant learning of brain

�� Demonstrable expected EEG changesDemonstrable expected EEG changes

�� Demonstrable clinical / behavioral changesDemonstrable clinical / behavioral changes




Live ZLive Z--Score PrinciplesScore Principles

�� Normalization of QEEGNormalization of QEEG--based parametersbased parameters

�� Resulting change in brain functionResulting change in brain function

�� ““NormalNormal”” reference databasereference database

�� Anatomy, Physiology, LogicAnatomy, Physiology, Logic

�� Activation AND Connectivity changesActivation AND Connectivity changes

�� ““First OrderFirst Order”” Changes Changes –– ““expectedexpected””

�� Secondary / Compensating ChangesSecondary / Compensating Changes




Possible Changes Possible Changes –– ““PhenotypesPhenotypes””

�� Normalize aberrant processNormalize aberrant process

�� Focal or Global abnormalitiesFocal or Global abnormalities

�� Depression , Anxiety, AttentionDepression , Anxiety, Attention

�� Normalize coping/compensating mech.Normalize coping/compensating mech.

�� Denial, Masking, Hyperconnection (injury)Denial, Masking, Hyperconnection (injury)

�� PTST, chronic pain, chronic anxietyPTST, chronic pain, chronic anxiety

�� Normalize Normalize ““Peak performancePeak performance”” mechanismmechanism

�� ““HighHigh”” SMR, SMR, ““FastFast”” AlphaAlpha

�� Hypercoherence, HypocoherenceHypercoherence, Hypocoherence(C) 2011 Thomas F. Collura, (C) 2011 Thomas F. Collura,



Validation StagesValidation Stages

�� Single subject Single subject –– Within SessionWithin Session

�� Single subject Single subject –– Across SessionsAcross Sessions

�� Across subjects Across subjects –– Within SessionWithin Session

�� Across subjects Across subjects –– Across SessionsAcross Sessions

�� Physiological AND Behavioral observationsPhysiological AND Behavioral observations




Single Subject Single Subject -- Within SessionWithin Session

Individual ZIndividual Z--ScoresScores




Single Subject Single Subject –– Within SessionWithin Session

Aggregate (All) ZAggregate (All) Z--ScoresScores




Subjective ChangeSubjective Change

�� ““More aware of my painMore aware of my pain””

�� (Chronic Pain)(Chronic Pain)

�� Normalization of abnormal alphaNormalization of abnormal alpha

�� Removal of coping mechanismRemoval of coping mechanism




Single Subject Single Subject –– Across SessionsAcross Sessions

(Guan)(Guan)




Clinical Changes Clinical Changes -- GuanGuan

�� Reduction of AnxietyReduction of Anxiety

�� Reduction of DepressionReduction of Depression

�� Improved ability to studyImproved ability to study

�� Improved ability to return to workImproved ability to return to work




Single Subject Single Subject –– Across SessionsAcross Sessions

(Lambos)(Lambos)




Clinical Changes Clinical Changes -- LambosLambos

�� ADHD / Defiant / ViolentADHD / Defiant / Violent

�� Reduction in violent outburstsReduction in violent outbursts

�� Improved ability to pay attentionImproved ability to pay attention

�� Increased compassion with othersIncreased compassion with others

�� Ability to transfer to regular class Ability to transfer to regular class




Controlled StudyControlled Study

�� Aging PopulationAging Population

�� Normal and Mild AlzheimerNormal and Mild Alzheimer’’ss

�� N=79N=79

�� Real NF: 4Real NF: 4--channels: Cz C4 P3 P4channels: Cz C4 P3 P4

�� Percent Z Scores (PZOK): 248 ZPercent Z Scores (PZOK): 248 Z--ScoresScores

�� Cognitive / Behavioral MeasuresCognitive / Behavioral Measures




NFT Study in AD and AgingNFT Study in AD and Aging

�� Train posterior sites to: Train posterior sites to: �� enhance cortical processing within posterior systems enhance cortical processing within posterior systems

�� relieve burden of anterior systems to moderate deteriorated relieve burden of anterior systems to moderate deteriorated posterior systemposterior system

�� Investigate the shortInvestigate the short--term effects of NFT on term effects of NFT on neurocognitive measures of attention and sensory neurocognitive measures of attention and sensory integration in healthy elderly and patients with early integration in healthy elderly and patients with early stage ADstage AD

�� Compare performance of trueCompare performance of true--NFT vs. mockNFT vs. mock--NFT NFT subjectssubjects




Experimental DesignExperimental Design

�� Healthy elderly and AD patients assigned to either mock Healthy elderly and AD patients assigned to either mock or trueor true--NFT groupNFT group�� Each mockEach mock--NFT subject demographically matched to a trueNFT subject demographically matched to a true--NFT NFT subjectsubject

�� 8 NFT sessions 8 NFT sessions �� 11--2 sessions/week over 42 sessions/week over 4--6 weeks6 weeks

�� Assessment battery pre & post NFTAssessment battery pre & post NFT�� Within 2 weeks of NFT sessionsWithin 2 weeks of NFT sessions




Healthy Elderly ParticipantsHealthy Elderly Participants

GROUPGROUP N (m,f)N (m,f) AGEAGE EDED MMSEMMSE RBANSRBANS

NFTNFT 20 (5,15)20 (5,15)71.671.6

(8.1)(8.1)

16.016.0

(3.3)(3.3)

28.828.8

(1.1)(1.1)

108.2108.2

(12.2)(12.2)

Mock NFTMock NFT 19 (3,16)19 (3,16)72.272.2

(8.3)(8.3)

16.016.0

(2.6)(2.6)

28.828.8

(1.2)(1.2)

108.5108.5

(13.1)(13.1)

MMSE: Mini-Mental State Examination

RBANS: Repeatable Battery for the Assessment of Neuropsychological Status




Mild AD ParticipantsMild AD Participants

GROUPGROUP N (m,f)N (m,f) AGEAGE EDED MMSEMMSE RBANSRBANS

NFTNFT 18 (8,10)18 (8,10)78.078.0

(5.0)(5.0)

14.014.0

(3.1)(3.1)

24.424.4

(1.1)(1.1)

74.774.7

(13.1)(13.1)

Mock NFTMock NFT 12 (6,6)12 (6,6)77.577.5

(6.4)(6.4)

14.014.0

(2.6)(2.6)

25.425.4

(1.2)(1.2)

79.379.3

(9.7)(9.7)

MMSE: Mini-Mental State Examination

RBANS: Repeatable Battery for the Assessment of Neuropsychological Status




�� NFT sessionsNFT sessions�� Electrode sites: C3, C4, P3, P4Electrode sites: C3, C4, P3, P4

�� 10 min. % z10 min. % z--score ok trainingscore ok training

�� 5 min. baseline (eyes closed) pre & post5 min. baseline (eyes closed) pre & post

�� Brainwave activity recorded with Atlantis I (4+4) system Brainwave activity recorded with Atlantis I (4+4) system ((BrainMaster Technologies, Inc.BrainMaster Technologies, Inc.))

�� RealReal--time ztime z--score neurofeedback training provided by score neurofeedback training provided by using the Z score DLL (using the Z score DLL (Applied Neuroscience, Inc.Applied Neuroscience, Inc.) in ) in conjunction with Brainmaster 3.21 software (conjunction with Brainmaster 3.21 software (BrainMaster BrainMaster Technologies, Inc.Technologies, Inc.) )

MethodsMethods




�� Training RegimenTraining Regimen

�� Sessions 1Sessions 1--44

�� 75% of z75% of z--scores within 1 STD of normative rangescores within 1 STD of normative range

�� Sessions 5Sessions 5--88

�� 80% of z80% of z--scores within 1 STD of normative rangescores within 1 STD of normative range

�� Audiovisual feedback provided through continuous Audiovisual feedback provided through continuous

modulation of the picture contrast of an IMAX nature modulation of the picture contrast of an IMAX nature

movie and organ tones when reward criterion sustained movie and organ tones when reward criterion sustained

for 500 msfor 500 ms

�� MockMock--NFT subjects received feedback in each NFT session NFT subjects received feedback in each NFT session

based on the recorded brainwave activity across each NFT based on the recorded brainwave activity across each NFT

session of the matched truesession of the matched true--NFT subjects NFT subjects

MethodsMethods




�� Assessment BatteryAssessment Battery

�� Several standardized neuropsychological tests of Several standardized neuropsychological tests of cognitive functions and emotional wellcognitive functions and emotional well--being (RBANS, being (RBANS, CAD, GDS)CAD, GDS)

�� Resting brainwave activity 64Resting brainwave activity 64--channel EEG recording channel EEG recording (eyes closed)(eyes closed)

�� Behavioral and EEG measures of neurocognitive tests Behavioral and EEG measures of neurocognitive tests assessing specific component attentional processesassessing specific component attentional processes

MethodsMethods




Neurocognitive MeasuresNeurocognitive Measures

�� Alerting, Orienting, & Executive ControlAlerting, Orienting, & Executive Control

�� Spatial Orienting/Simon Interference taskSpatial Orienting/Simon Interference task

�� Selective Attention & Sensory IntegrationSelective Attention & Sensory Integration

�� Visual Search taskVisual Search task




Visual Search:Visual Search:

Selective Attention and Sensory IntegrationSelective Attention and Sensory Integration

Set Size 1 Set Size 3 Set Size 5




Visual Search and Sensory Integration:Visual Search and Sensory Integration:

Healthy ElderlyHealthy Elderly




Visual Search and Sensory Integration:Visual Search and Sensory Integration:

Mild ADMild AD




Results: Visual SearchResults: Visual Search

�� Healthy ElderlyHealthy Elderly

�� Real NFT decreased RTs for both sensory binding conditionsReal NFT decreased RTs for both sensory binding conditions

�� Mock NFT had no effect on RTs for either binding conditionsMock NFT had no effect on RTs for either binding conditions

�� Mild ADMild AD

�� Real NFT had no effect on RTs for either binding conditionsReal NFT had no effect on RTs for either binding conditions

�� Mock NFT had no effect on RTs for either binding conditionsMock NFT had no effect on RTs for either binding conditions




Simon InterferenceSimon Interference

CongruentCongruent

Covert Orienting/Simon InterferenceCovert Orienting/Simon Interference

LEFT

LEFT IncongruentIncongruent




OrientingOrienting

AlertingAlerting

DoubleDouble

InvalidInvalid

LEFT

LEFT

LEFT

ValidValid

No CueNo Cue

LEFT




Effects of NFT on Simon InterferenceEffects of NFT on Simon Interference

Healthy Elderly Mild AD




Results: Simon InterferenceResults: Simon Interference


�� Real NFT had no effect on RTs for either Congruent or Real NFT had no effect on RTs for either Congruent or Incongruent trialsIncongruent trials

�� Mock NFT increased RTs for both Congruent and Incongruent Mock NFT increased RTs for both Congruent and Incongruent trials trials


�� Real NFT had no significant effect on RTs for either Congruent Real NFT had no significant effect on RTs for either Congruent or Incongruent trialsor Incongruent trials

�� Mock NFT had no significant effect on RTs for either Congruent Mock NFT had no significant effect on RTs for either Congruent or Incongruent trialsor Incongruent trials




Effects of NFT on Spatial OrientingEffects of NFT on Spatial Orienting





Results: Spatial OrientingResults: Spatial Orienting


�� Real NFT reduced RTs for both Valid and Invalid Cue trials Real NFT reduced RTs for both Valid and Invalid Cue trials

�� Mock NFT increased RTs for both Valid and Invalid Cue trialsMock NFT increased RTs for both Valid and Invalid Cue trials


�� Real NFT selectively reduced RTs for Invalid Cue trialsReal NFT selectively reduced RTs for Invalid Cue trials

�� Mock NFT had no effect on RTs for either Valid or Invalid Cue Mock NFT had no effect on RTs for either Valid or Invalid Cue trialstrials




Effects of NFT on AlertingEffects of NFT on Alerting





Results: AlertingResults: Alerting


�� Real NFT had no effect on RTs for either Double or No Cue trialsReal NFT had no effect on RTs for either Double or No Cue trials

�� Mock NFT selectively increased RTs for No Cue Cue trialsMock NFT selectively increased RTs for No Cue Cue trials


�� Real NFT reduced RTs for both Double and No Cue TrialsReal NFT reduced RTs for both Double and No Cue Trials

�� Mock NFT increased RTs for both Double and No Cue TrialsMock NFT increased RTs for both Double and No Cue Trials




Summary: Real NFTSummary: Real NFT

�� Healthy ElderlyHealthy Elderly�� No effect on crossNo effect on cross--cortical sensory integration, but enhanced cortical sensory integration, but enhanced selective attention in the visual search taskselective attention in the visual search task

�� Generalized enhancement of response times in spatial orientingGeneralized enhancement of response times in spatial orienting

�� No effect on either alerting measures or response inhibition in No effect on either alerting measures or response inhibition in Simon interferenceSimon interference

�� Mild ADMild AD�� No effect on either crossNo effect on either cross--cortical sensory integration or selective cortical sensory integration or selective attention measures in the visual search taskattention measures in the visual search task

�� Selective improvement in disengagement in spatial orientingSelective improvement in disengagement in spatial orienting

�� Enhanced phasic and tonic alerting Enhanced phasic and tonic alerting

�� No effect on response inhibition in Simon interferenceNo effect on response inhibition in Simon interference




Summary: Mock NFTSummary: Mock NFT

�� Healthy ElderlyHealthy Elderly�� No effect on crossNo effect on cross--cortical sensory integration or selective cortical sensory integration or selective attention in the visual search taskattention in the visual search task

�� Generalized slowing of response times for spatial orienting, Generalized slowing of response times for spatial orienting, alerting and Simon interference measuresalerting and Simon interference measures

�� Mild ADMild AD�� No effect on crossNo effect on cross--cortical sensory integration or selective cortical sensory integration or selective attention in the visual search taskattention in the visual search task

�� No effect on response times for spatial orienting or Simon No effect on response times for spatial orienting or Simon interference measuresinterference measures

�� Generalized slowing of response times for the alerting measuresGeneralized slowing of response times for the alerting measures




NonNon--Memory Impairments in ADMemory Impairments in AD

�� AttentionAttention

�� Cognitive operations involved in the detection and selection Cognitive operations involved in the detection and selection of sensory informationof sensory information

�� Automatic (stimulusAutomatic (stimulus--driven)driven)�� Voluntary (controlled, goalVoluntary (controlled, goal--directed)directed)

�� Different attentional processes mediated by distinct neural Different attentional processes mediated by distinct neural subsystemssubsystems

�� Sensory IntegrationSensory Integration

�� The The ““Binding ProblemBinding Problem””

�� MomentMoment--byby--moment ability to combine distinct sensory inputs moment ability to combine distinct sensory inputs related to a single object into a coherent, unified related to a single object into a coherent, unified representationrepresentation

�� Dependent upon effective interactions across cortical areas Dependent upon effective interactions across cortical areas (C) 2011 Thomas F. Collura, (C) 2011 Thomas F. Collura,



NonNon--Memory Impairments in AD (and Aging)Memory Impairments in AD (and Aging)

�� Posterior Cortical Processing SystemsPosterior Cortical Processing Systems�� Alerting (cortical tonus)Alerting (cortical tonus)

�� OrientingOrienting

�� Sensory IntegrationSensory Integration�� Inefficient cortical processing in AgingInefficient cortical processing in Aging

�� Corticocortical disconnectivity in ADCorticocortical disconnectivity in AD

�� Anterior Executive Control ProcessesAnterior Executive Control Processes�� Changes in frontal cortex with age and AD results in less Changes in frontal cortex with age and AD results in less efficient controlled attentional processesefficient controlled attentional processes

�� Greater demands placed on anterior executive processes to Greater demands placed on anterior executive processes to moderate deterioration in posterior attentional and sensory moderate deterioration in posterior attentional and sensory systemssystems




Documents

Collura Validation SAN 2011 ppt - stresstherapysolutions.com Publications/Br… · (Guan) (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University Clinical Changes -Guan