<p></p>
<p>Neurofeedback is based on the success of operant conditioning, the underlying thesis of which is the Law of Effect, which states, when you reward something, you reinforce that behavior. In the case of neurofedback, the patient is rewarded for making the
    appropriate (programmed) brain wave frequency or connectivity metrics, via either visual or auditory reinforcement.</p>

<p>Many neurofeedback modalities are preceded by an assessment of the brainwave activity, typically through a Quantitative EEG brainmap; there are schools of neurofeedback that do not do this, including the Othmer method and Valdeen Brown’s Neuroptimal.
    </p>

<p>There are many different modalities and ways to do neurofeedback. Some are single channel (one active electrode) some are two channels, some are four channels, and some use a 19-channel cap. Since neurofeedback is EEG biofeedback, using the brainwaves
    as the mechanism that is measured is brainwave activity. </p>
<p>Neurofeedback is based on the success of operant conditioning, the underlying thesis of which is the Law of Effect, which states, when you reward something, you reinforce that behavior. In the case of neurofedback, the patient is rewarded for making the
    appropriate (programmed) brain wave frequency or connectivity metrics, via either visual or auditory reinforcement.</p>

<p>Many neurofeedback modalities are preceded by an assessment of the brainwave activity, typically through a Quantitative EEG brainmap; there are schools of neurofeedback that do not do this, including the Othmer method and Valdeen Brown’s Neuroptimal.
    </p>

<p>There are many different modalities and ways to do neurofeedback. Some are single channel (one active electrode) some are two channels, some are four channels, and some use a 19-channel cap. Since neurofeedback is EEG biofeedback, using the brainwaves
    as the mechanism that is measured is brainwave activity. </p>
<p>During neurofeedback training, individual EEG electrodes or a full 19-channel cap are placed on the scalp and the EEG activity of the patient is monitored and fed back to them in real time. Based on the feedback and the practitioner’s guidance, changes
    in brainwave patterns occur and are associated with positive changes in physical, emotional, and psychological states of being. </p>

<p>Often a patient will ask: “how do I make this work?” or “what do I do?” and the answer is they “will” the screen (or tone) to respond positively to them. The answer that I always use is: “get out of your own way and let your brain do its thing, do not
    get too attached to doing better or doing worse, it will continue to ebb and flow.” </p>

<p>Neurofeedback is based on the principle that the brain responds to ‘information’ on a conscious and nonconscious manner, and typically without any assistance. We have the ability for complex processing. We find most tasks like breathing, eating and digestion
    are ultimately performed without our focused attention.</p>
<p><br></p>
<p><br></p>
<h2><a name="_Toc35418104">LENS and HPN</a></h2>
<p></p>
<div>
    <p>The LENS (<i>Low Energy Neurofeedback System)</i>&nbsp;technology leverages the neuroplasticity, innate within each and every individual, to help alleviate symptoms, optimize functioning, and reclaim lost neurological and physiological potential.
        This unique approach targets the central nervous system and helps to restore functioning that may have been compromised as a result of brain&nbsp;injury including stroke and concussions, trauma, PTSD, surgical procedures, anoxic events, medications,
        birth trauma, environmental influences, etc. These events often leave in their wake&nbsp;anxiety-depression spectrum issues, headaches, migraines, attention deficits, emotional disturbances, explosiveness, behavioral disorders, movement disorders,
        pain, range of motion issues, etc.&nbsp;</p>
    <p>There are four areas that distinguish the LENS from traditional neurofeedback:&nbsp;</p>
    <p>1.&nbsp;<i>Significantly fewer sessions</i>: rather than using operant conditioning to train the brain, the LENS technology utilizes the client’s unique real-time brain wave metrics (also known as EEG) to&nbsp;<i>interrupt the maladaptive mechanisms</i>&nbsp;that
        have been adapted by the CNS in response to head trauma and other events listed above. This produces measurable changes in brainwave activity and subsequent symptom reduction or elimination in significantly fewer sessions, with the number needed
        to improve/restore functioning for the majority of&nbsp;clients&nbsp;falling&nbsp;within the 2-15 session range.</p>
    <p>2.&nbsp;<i>Does not require conscious effort from the client:</i>&nbsp;the LENS has been used successfully with babies (as young as 3 months of age)/toddlers/children, clients on the autism spectrum, those with ADD/ADHD, and even animals (including
        racehorses, giraffes, gorillas&nbsp;and chimpanzees).</p>
</div>
<div>3.&nbsp;<i>Session Duration</i>: a typical LENS session lasts about 6 minutes, and this includes skin prep, sensor placement, running the software, sensor removal and post-session cleanup. For some clients, the&nbsp;actual duration of the LENS itself
    is as little as 1 second. &nbsp;Due to&nbsp;this short session duration, the LENS works well for those who are unable to pay attention to a computer screen for long periods of time, and/or who are not able to understand instructions such as is needed
    with traditional neurofeedback.<br></div>
<div><br></div>
<div>4.&nbsp;<i>Address pain issues</i>: the LENS technology has been applied to other areas of the body (limbs, torso, hands, etc.) to successfully address pain, discomfort, range of motion issues, and more.</div><br>
<p></p>
<h3><a name="_Toc35418105">A LENS Neurofeedback System</a></h3><img src="@@PLUGINFILE@@/LENS%20Neurofeedback%20System.png" alt="LENS Neurofeedback System" width="919" height="234" class="img-responsive atto_image_button_left"><br>
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<b>High
Performance Neurofeedback, </b>aka HPN Ultra Low Power Neurofeedback, was invented by Cory Snook and is thought to be another version of the LENS. HPN&nbsp;is a type of brainwave based&nbsp;<span style="font-size: 1rem;">biofeedback&nbsp;
that has shown promise of clinical efficacy in addressing the symptoms associated
with Traumatic Brain Injury (TBI), Post-Concussive Syndrome, Post-Traumatic
Stress Disorder (PTSD), Anxiety, Depression,&nbsp; “brain-fog,”&nbsp; and
attention deficit disorders.<br><br></span>
<p>HPN measures and tracks the electrical activity of the brain (brainwaves) and then sends directly back to the brain a very weak, imperceptible signal containing information based on the just preceding brainwave activity.&nbsp; The power in the signal
    is estimated to be about 3 p W (picowatts).&nbsp; Although the power in this signal is amazingly small, the brain appears to be able to adjust its own functioning based on this feedback.
</p>
<h3><a name="_Toc3535268"><br></a></h3>
<h3><a name="_Toc35418106"></a><a name="_Toc3535268">S</a>low Cortical Potential Neurofeedback and Infra Slow Fluctuation&nbsp; Neurofeedback</h3>

<p></p>
<p><span lang="DE">Slow Cortical Potential Neurofeedback and Infra-Slow
Neurofeedback involve dialing in the right slow cortical potential frequency
for the client. In a colloquial sense, these neurofeedback modalities are said
to coordinate electrical activity in the brain, controlling activation and
deactivation of those behavioral networks.</span></p>

<p><span lang="DE">Infra-slow Fluctuation (ISF) electroencephalogram (EEG)
biofeedback is focused on the lowest energy the brain produces (&lt; 0.1 Hz).
The intervention is performed with a Direct Current (DC) coupled neurofeedback
amplifier. It is distinct from Slow Cortical Potential (SCP) training and
Infra-Low Frequency (ILF) training. It shares a similar optimization process
with ILF that focuses on emergent state shifts within sessions.</span></p>

<h4><a name="_Toc35418107"><span lang="DE">What Are Slow Cortical Potentials and what are Infra Slow
Oscillations?</span></a><span lang="DE"></span></h4>

<p><span lang="DE">Slow Cortical Potentials are slow shifts in the EEG that last
from 0.3 seconds to several seconds, infra slow oscillations are typically
0.1Hz and lower. These shifts in the EEG reflect the depolarization of large
groups of pyramidal cells in the cortex. These slow shifts are caused by the
burning of blood glucose, that makes up the hemodynamics of the glial
cells.&nbsp;For two decades researchers have proposed that neurons, glial
cells, and blood may be regarded as compound generators of these infra-slow
bioelectrical phenomena (Hughes, Lőrincz, Parri, &amp; Crunelli, 2011; Zschocke
&amp; Speckmann, 1993). Thalamocortical neurons have been observed to exhibit
robust infra-slow oscillations (ISOs), in vitro, at approximately 0.005–0.1 Hz
(Lőrincz, Geall, Bao, Crunelli, &amp; Hughes, 2009). After a reappraisal of in
vivo and in vitro evidence, Crunelli and Hughes (2010) have proposed a three
cardinal oscillator model that identifies one cortical and two thalamic sources
of infra-slow frequencies. Astrocytes have recently been identified by Hughes
et al. (2011) as a source of ISOs in the 0.003–0.1 frequency range. These researchers
observed neurons in cat Thalamus succumbing to a cyclic inhibitory influence
that they proposed was generated in the slow regime by Thalamocortical
astrocytes. These cells create large electro-negative swings when they
depolarize. Slow Cortical Potentials (SCP) are changes of cortical polarization
lasting several hundred milliseconds to several seconds. SCPs are related to
the excitability level of underlying cortical regions. Negative SCP shifts
reflect higher cortical excitability while positive shifts reflect reduced
excitability or even inhibition. Sheets of cortical neurons are depolarized in
the creation of SCPs. It has been hypothezised that in autism spectrum cases,
the threshold of depolarization is too high and in ADHD cases, the threshold of
depolarization is too low. Additionally, in patients with
seizure&nbsp;conditions, large negative potential shifts have been observed
moments before a seizure. (ADHD children are taught to increase the negativity
of the SCP, while autistic and seizure cases are taught to decrease the
negativity of the SCP).<br>
<br>
<!--[if !supportLineBreakNewLine]--><br>
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<p><span lang="DE">In Europe Slow Cortical Potential (SCP) neurofeedback is taught
by Ute Strehl , who uses a visual to reflect higher arousal (in
electro-negative potentials, that is, going up) and lower arousal (in electro-positive
potentials, going down). In clinical thresholding, it is important to verbally
encourage and reward the patient, especially if they are children.&nbsp;SCP
training is a “one size fits all protocol” with the majority of the training
done at the vertex. As first developed, the client attempted to produce
cortical excitation, a negative DC shift, in the case of ADHD; or cortical
inhibition, a positive DC shift, in the case of Epilepsy over the course of
many short trials (Birbaumer, 1999; Birbaumer et al., 1994, Kotchoubey et al.,2001
). More recently SCP training has evolved to train in both negative and
positive cortical shifts in the same session with proportions of negative and
positive trials dependent on client presentation (Strehl et al., 2006). In
clinical interventions, such as epilepsy or ADHD Ute Strehl always implements
SCP feedback as a technique in the framework of behavior therapy which is being
enumerated by the German statutory health insurance.</span></p>

<p><span lang="DE">Ute Strehl and colleagues have published extensively in RCT
(randomized controlled trials) studies on their work.They have used a slow-wave
filter and a 500-millisecond interval moving window. This methodology is
available using thought technology equipment and screens (</span><span lang="DE"><a href="http://www.thoughttechnology.com/">www.thoughttechnology.com</a></span><span lang="DE">; <a href="https://www.neurocaregroup.com/neuroconn-technologie.html">https://www.neurocaregroup.com/neuroconn-technologie.html</a>;
<a href="https://www.mindmedia.com/">https://www.mindmedia.com/</a>). An
important, mandatory feature of SCP feedback is the online artifact control as eye
movements and huge EMG actitivty may interfere with EEG activity. </span></p>

<p><span lang="DE">In America, Infra Slow Neurofeedback is being taught by Siegfried
and Sue Othmer. ISF training owes its lineage to the early Beta/SMR training of
Susan Othmer and EEG Spectrum (Kaiser &amp; Othmer, 2000). That intervention
was done with a single channel of EEG and an intra-hemispheric bipolar montage
on the motor strip and temporal lobes. The starting frequency was in the 12–18
Hz range depending on the targeted hemisphere. The Othmers and others (Putman,
Othmer, Othmer, &amp; Pollock, 2005; Stokes &amp; Lappin, 2010), modified this
technique to include inter-hemispheric placements beginning on the temporal
lobes. Instead of set reward bands, a 3 Hz window was shifted up or down
contingent upon client response. The intervention produced immediate state
shifts in the client. The trainer targeted state regulation in real time by
discovering an optimum frequency through trial and error for each client.
Success was defined by the immediate improvement in affect and arousal
regulation in session and ultimately by generalized improvements in behavioral
and&nbsp;state regulation in life. Over time, it became apparent that the vast
majority of clients were finding an optimum clinical response at lower and
lower frequencies until 2007, when the beginning frequency was established at
0–3 Hz.</span></p>

<p><span lang="DE">Infra Low neurofeedback is being taught by Mark
Smith.&nbsp;Smith has reported clinical results including increased relaxation,
better sleep, profound changes in physiology, and a renewed sense of well-being
in daily life. ISF neurofeedback was put to the test by using Biofeedback
equipment that measured a subject’s physiological response to the training.
What was found during that training was blood pressure normalized, heart rate
slowed, hands became warm and dry, breathing became deeper and slower and the
big muscles in the shoulders (trapezius) relaxed. All direct indications of the
relaxation response.</span></p><br>
<p></p>
<h3><a name="_Toc35418108"></a><a name="_Toc3535269">Alpha-Theta</a></h3>

<p>Alpha/theta&nbsp;training,&nbsp;in&nbsp;which&nbsp;the&nbsp;goal&nbsp;is&nbsp;to&nbsp;achieve&nbsp;an&nbsp;altered,&nbsp;hypnogogic&nbsp;state&nbsp;of&nbsp;<span style="font-size: 1rem;">consciousness,&nbsp;useful&nbsp;for&nbsp;therapeutic&nbsp;purposes.&nbsp;
During alpha theta training, the participant is typically reclined or laying
supine, in a comfortable room in a comfortable position, with their eyes shut,
They are listening to auditory feedback (one popular set of sounds is the
sounds of ocean waves and the sound of waves upon the shore). The individual in
alpha theta training is trained to increased the amplitude of their theta
frequencies so that they surpass their alpha frequencies, inducing what is
considered a deep state. This increase of theta and decrease of alpha is called
a cross-over and is the clinical goal of alpha-theta neurofeedback.</span></p>

<p>&nbsp;Some clinicians use Alpha-Theta neurofeedback only as polish at the end of many neurofeedback sessions, as the accessing of theta while conscious can create abreactions in individuals who are not ready to access the deeper realms where suppressions
    and repressions reside. On the flip side, this can be a hugely healing protocol for individuals who need to integrate and incorporate the activation behind stress responses. </p>
<h3><a name="_Toc35418109">A diagram showing the concept of an alpha
theta crossover, the y-axis related to amplitude</a></h3>
<p><a name="_Toc35418109"><img src="@@PLUGINFILE@@/Crossover.png" alt="crossover" width="868" height="476" class="img-responsive atto_image_button_left"><br></a></p><br>
<p></p>
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<p>Many of the great minds of our times—artists, musicians, scientists, and geniuses of all sorts—have described arriving at their discoveries and innovations often when in a deep dream-like reverie. The alpha-theta brain wave state that reflects this level
    of trance teeters on the borderline between consciousness and unconsciousness and is the threshold between alpha and theta—a soft, awake brain wave state. This altered state of consciousness has been called different things by different researchers.
    Maury (1848) called it “hypnogogia,” Green, Green, &amp; Walters (1970) called it “the reverie state,” and Budzynski (1977) dubbed it “the twilight state.”</p>
<p>Individuals will often enter this state when daydreaming, resting, meditating, engaging in “mindless” activity (i.e. running, driving long distances), or entering sleep. This state is a calm, relaxed, and unattached presence wherein people report receiving
    imagery, sounds/music, or thoughts of novelty. Einstein reported coming to the notion of this theory of relativity while daydreaming, observing sunbeams and imagining what it would be like to ride on them (Boyd, 1995). Thomas Edison used to intentionally
    induce this state to answer his pressing questions by falling asleep in a chair while holding a ball bearing, with a pie tin placed on the ground underneath his hand. Upon entering light sleep, he would drop the ball bearing onto the pie tin, waking
    him—at which point he would scribble the ideas that arrived in his mind (Robbins, 2000, p. 191). </p>

<p>In a letter published in 1912, Mozart wrote a colleague about his experience around creativity, music, and this light stage of reverie:</p>

<p><i>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; When I am . . . completely myself,
entirely alone, and of good cheer—say, traveling in a carriage or walking after
a good meal, or during the night when I cannot sleep, it is on such occasions
that my ideas flow best and most abundantly. Whence and how they come I know
not, I cannot force them. . . . All this fires my soul, and provided I am not
disturbed, my subject enlarges itself, becoming methodized and defined, and the
whole, though it be long, stands almost complete and finished in my mind, so I
can survey it, like a fine picture or a beautiful statue, at a glance. Nor do I
hear in my imagination the parts successively, but I hear them, as it were, all
at once. What a delight this is, I cannot tell! All this inventing, this
producing, takes place in a lively dream. (34)</i></p>

<p>This brain wave state Einstein, Mozart, Edison, and others created their masterpieces in is was likely composed of two frequencies: alpha, which is recorded on an electroencephalogram (EEG) as 9-12 oscillations per second (Hz), and theta, 5-8 oscillations
    per second (Hz).&nbsp; Alpha theta is used for many clientele populations, including &nbsp;peak performance neurofeedback training. This training is a means of inducing in the performer heightened amplitudes and presence of alpha and theta brain wave
    states, theorized to bring about “flow” states, or experiences of “being in the zone.” The goal of this type of neurotherapy is to increase the ratio of theta to alpha, encouraging a crossover, whereby the amplitude of theta brainwaves supersedes
    the amplitude of alpha being produced. In personal neurofeedback practice as clinician, I often incorporate alpha-theta training into neurotherapy sessions once an individual has worked through their major psychological or emotional problems via psychotherapy
    or other forms of neurofeedback, demonstrating self-regulation. Otherwise there is risk in accessing the unconscious memories residing in theta state and bringing them into conscious awareness while the individual is psychologically unprepared. Alpha-theta
    training is like a polish, used once a subject displays evidenced psychological readiness to fine-tune their higher-level functioning skills.</p>

<p>In Egner and Gruzelier’s 2003 study on the enhancement of musicianship in music conservatoires with the aid of neurofeedback, it was discovered that individuals training alpha-theta brainwave states had a positive trend in three criteria of instrumental
    competence (notably, “perceived instrumental competence, especially rhythmic accuracy”), musicality (notably “stylistic accuracy, interpretive imagination, and expressive range”), and communication (notably “emotional commitment and conviction, ability
    to cope with the stress of the situation and with deportment”), whereas the study’s control group (without any neurofeedback) evidenced no improvements (p. 3). In the conservatoires’ real-life quantification, the neurofeedback recipients also saw
    an average a jump of two class grades. </p>

<p>Another study testing novice singers’ singing abilities as a result of alpha-theta training found similar results in performance communication (specifically “scales of commitment, confidence, enjoyment, attention holding, and deportment”) as well as in
    the technical areas of “breathing, diction, and pitch.” Lastly, the individuals subject to alpha-theta neurofeedback experienced “increased expressiveness, confidence, and stage presence,” all of which positively corresponded with their respective
    alpha-theta learning indices (Leach et al., 2008). While these studies are exciting and noteworthy, they are the first of few and there remains to be a lack of science linking alpha-theta brainwave states and musical abilities.<i></i></p>

<p><b>&nbsp;

</b></p>
<h3><b><a name="_Toc35418110"></a><a name="_Toc3535270">Amplitude</a> Training</b></h3>
<p></p>
<p>Amplitude training was the first neurofeedback “protocol” to be developed, and is uptraining or downtraining the size (or amplitude) of an EEG frequency or range of frequencies. Peak to peak (P – P) and root mean squared (RMS) are measures of a frequency’s
    amplitude from peak to valley. Single channel EEG feedback is usually simple amplitude training, where the individual is suppressing or enhancing frequency bands of delta, theta, alpha, beta, or hight beta. The Neurofield amplitude training is currently
    the only modality that allows for the uptraining of gamma frequencies. In the use of single channel training, a clinician can use ear electrodes as references, or they can use bi-polar training, where one area of the head is trained relative to another
    area of the head. Amplitude training can also be undertaken using a full 19-channel EEG cap. </p>
<h3><a name="_Toc35418111"></a><a name="_Toc3535271">Single Channel  v 19-channel</a></h3>

<p>At one time in the history of the field, there was a debate as to whether single channel was better than full 19-channel, and vice versa. The difference is the difference in training one to four channel locations, as opposed to training with 19 active
    electrodes. One is not better than the other, and the question to ask is: is it preferable to train the entire brain (based on the client’s presentation and EEG brainmap) or is it preferable to train single channels? There are many single channel
    amplifiers&nbsp; on the market.&nbsp; </p>
<h3><a name="_Toc35418112"></a><a name="_Toc3535272">Z-score Neurofeedback</a></h3>
<p><a name="_Toc3535272"></a></p>
<p><a name="_Toc3535272">Z-score neurofeedeback is used to
train the individual towards the “Z of zero.” This means that the individual’s
EEG is bring driven towards the normal range. Z-score neurofeedback can be used
for measures of coherence, phase, and power differentials in the brain.&nbsp; Providers that offer Z-score training
softwares are Brainmaster, Neurofield, and Neuroguide.</a></p>
<p style="display: inline !important;"><a name="_Toc3535272">Live Z-scores can be used either for live assessment or for feedback training, depending on how the system is configured and used. When used for assessment, live Z-scores can be viewed during&nbsp;data&nbsp;acquisition,&nbsp;and&nbsp;can&nbsp;also&nbsp;be&nbsp;recorded&nbsp;and&nbsp;reviewed.
Z-score neurofeedback relies upon a database of neurotypical EEGs as a basis of
relatively. &nbsp;The z-scores are integrated into the feedback design and they
are used to control displays, sounds, and other information for the purpose of
opreant conditioning and other learning paradigms.<br></a></p>
<p><a name="_Toc3535272"></a></p>
<p><a name="_Toc3535272">In Neuroguide, for instance, the
live z-scores are monitored using a dynamic JTFA mode (joint time frequency
analysis), as opposed to a fast fourier transform (FFT), which is more commonly
used for QEEG results (an average of data over time). A Joint time frequency
analysis allows for instant z-score feedback, providing real-time information
about the state of the brain. </a></p>
<a name="_Toc3535272">

    <p>The&nbsp;rapid&nbsp;analysis&nbsp;and&nbsp;feedback&nbsp;of&nbsp;Z-scores is essential for timely feedback. Z-score training can be&nbsp;accomplished&nbsp;with&nbsp;2&nbsp;or&nbsp;4&nbsp;channels&nbsp;of&nbsp;EEG, or with 19 channels. However, the
        live feedback is not the same as those observed using the postprocessed QEEG results.</p>
</a>
<p style="display: inline !important;"><a name="_Toc3535272">When inspecting individual live Z-scores in Neuroguide,&nbsp;it&nbsp;is&nbsp;observed&nbsp;that&nbsp;their&nbsp;&nbsp; &nbsp;typical&nbsp;values&nbsp;are&nbsp;not&nbsp;the&nbsp;same&nbsp;as&nbsp;those&nbsp;observed&nbsp;when&nbsp;using&nbsp;postprocessed&nbsp;QEEG&nbsp;results. This&nbsp;is&nbsp;not&nbsp;a&nbsp;problem&nbsp;or&nbsp;defect&nbsp;in&nbsp;the&nbsp;system,&nbsp;it&nbsp;is&nbsp;a&nbsp;natural&nbsp;consequence&nbsp;of&nbsp;watching&nbsp;a&nbsp;live&nbsp;</a>statistic,&nbsp;versus&nbsp;a&nbsp;static&nbsp;statistic.&nbsp;Live&nbsp;zscores&nbsp;can&nbsp;be&nbsp;used&nbsp;to&nbsp;train&nbsp;a&nbsp;combination&nbsp;of&nbsp;variables&nbsp;including&nbsp;absolute&nbsp;and&nbsp;relative&nbsp;power,&nbsp;power&nbsp;ratios,&nbsp;coherence,&nbsp;phase,&nbsp;and&nbsp;asymmetry.&nbsp;&nbsp;When&nbsp;used&nbsp;in&nbsp;this&nbsp;manner,&nbsp;the
    EEG&nbsp;Biofeedback&nbsp;Training&nbsp;Using&nbsp;Live&nbsp;Z­Scores&nbsp;and&nbsp;a&nbsp;Normative&nbsp;Database system is no longer targeting just a single variable or attribute. Rather, the possibility arises of training the brain in a complex
    multi-dimensional manner, s that it learns a comprehensive brain state.&nbsp;</p>
<p style="display: inline !important;">WIth Z-score training, we can also choose to uptrain or downtrain any components we like, including&nbsp;combinations&nbsp;of&nbsp;components,&nbsp;or&nbsp;relationships&nbsp;between&nbsp;components.&nbsp; So&nbsp;we&nbsp;can&nbsp;train&nbsp;to&nbsp;a&nbsp;Z&nbsp;score&nbsp;of&nbsp;­2&nbsp;or&nbsp;­3,&nbsp;or&nbsp;+2&nbsp;or&nbsp;+3&nbsp;or&nbsp;even&nbsp;+6&nbsp;if&nbsp;we&nbsp;choose.&nbsp;
</p>
<p style="display: inline !important;">Real time Z-score neurofeedback uses instantaneous measures of the EEG data compared to a Gaussian&nbsp;distribution&nbsp;to&nbsp;averaged&nbsp;“instantaneous”&nbsp;time&nbsp;domain&nbsp;spectral&nbsp;measures&nbsp;from&nbsp;groups&nbsp;of&nbsp;normal&nbsp;subjects&nbsp;and&nbsp;then&nbsp;cross­&nbsp;validates&nbsp;the&nbsp;means&nbsp;and&nbsp;standard&nbsp;deviations&nbsp;for&nbsp;each&nbsp;subject&nbsp;for&nbsp;each&nbsp;instant&nbsp;of&nbsp;time.
    <br></p>
<h3><a name="_Toc35418113"></a><a name="_Toc3535273">Wide Band Inhibit (aka “squash”)&nbsp;</a>&amp; Neuroptimal</h3>
<p>Little is known about the mechanism of action in Valdeen Brown’s Neuroptimal. This program is a simple set up, where the active electrodes are placed at C3 and C4 and the references are place on the upper ear cartilage and the ground electrode is placed
    on the ear lobe. The activity of the EEG is measured and displayed (using&nbsp; feedback visual called a “mind mirror”) . The slowest activity measured is 0.1Hz and the fastest is 64 HZ. The frequencies are squashed, overall, and this is thought of
    as a squash protocol to many in the field. As stated on the Neuroptimal website: “The differences in electrical signal are measured in terms of Duration, Intensity, Frequency and Shift and is unique to Neuroptimal. This information is offered back
    to the brain in real time via auditory and visual interruptions of the media.” The Neuroptimal approach involves training both sides of the brain at the same time, over the motor strip, using multiple frequencies and reinforcement tones. There are
    three basic stages of training, and the system alters training frequencies at each stage. The neuroptimal system is dedicated to reducing abnormal variability in the EEG to enhance system integration and functioning.</p>

<p>The system is described on the website as “a unique and highly expanded Neurofeedback process that is more sophisticated than the antiquated linear approaches that only include the 2-D model of frequency and amplitude as initially founded in the field
    of [NF. As a result, Neuroptimal is able to recognize the incredible natural potential of the brain and give information (or communication) that mirrors what the CNS just did. This information takes the form of mathematical interruptions in the auditory
    and visual fields that offers the individual a “mirror” into their own electrical activity. Thereby reminding the individual to move away from discomfort.” </p>

<p>The Neuroptimal system is marketed to non-clinical users, noting that brain maps and other means of clinical assessment are not necessary, since the device has not been termed a medical device by the FDA, but instead as a personal wellness device. They
    are explicit that the system does not diagnose, treat, mitigate, prevent, or cure any disease, disorder, or abnormal physical state.</p>
<h2><a name="_Toc35418114">Mind Mirror Neurofeedback, Displaying the
Amplitude on the Y-axis and the frequencies on the X-axis</a></h2><img src="@@PLUGINFILE@@/Mind%20Mirror.jpg" alt="Mind Mirror" width="865" height="503" class="img-responsive atto_image_button_left"><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br>
<h3><a name="_Toc35418115"></a><a name="_Toc3535274">Multi-Variate Training</a></h3>

<p>Four channel multi-variate training is a type of neurofeedback that Rob Coben invented, which measures and trains coherence between four electrodes. The protocol works when inputs from sensors are transformed into multivariate coherence values across
    all possible combinations of the four locations or sensors. This information makes up the reward band. Additionally, there are three user-defined inhibit hands that encourage a decrease in EEG frequencies, as a form of amplitude training.&nbsp; </p>

The multivariate nature of how coherence is calculated comes close to the brain’s noise, itself, and Coben theorizes this makes it easier for the client to train, as opposed to the typical coherence model, where cross correlations between pairs of electrodes
is used (bivariate coherence). The compromise to using pairwise coherence measures include inter-electrode&nbsp;
<p>distance, volume conduction of the brain, and the inability to capture three-dimensional brain activity (Nnez, 1994; Nunes and Srivinasan, 2006).</p>

<p>This method has been demonstrated on the EEGer Training system (developed by Ed Hamlin). Coben and Myers (2010) have shown that four channel multi-variate training has had greater efficacy than single or dual channel coherence training; they believe that
    one advantage to four-channel multi variate training is the number of electrodes used, as well as the statistical sophistication of what is actually fed back to the client.
</p>

<p>Coben intends to continue to refine his model of four channel multi-variate coherence training, foreshadowing future enhancements involving functional connectivity. </p>
<p><br></p>
<h3><a name="_Toc35418116"></a><a name="_Toc3535277">HEG</a></h3>

<p>Hemoencephalography (HEG) is a method of measuring brain function by measuring the brain blood flow. <a href="http://www.biocompresearch.org">Hershel Toomim</a> first coined the term hemoencephalography in 1997. Toomim discovered that the manipulation
    of brain blood flow is voluntary and can be trained using neurofeedback techniques. With the sensor giving feedback of increased blood flow, we can voluntarily increase brain blood flow at the location of the sensor. HEG trains the subject to increase
    blood ﬂow to a targeted area of the brain. Neurofeedback, as we have known it so far, measures the electrical activity of the brain, EEG, as a feedback signal to be controlled by the patient. Here EEG is substituted with blood oxygenation for the
    same purpose.</p>

There are two kinds of HEG, pIR and nIR (near infrared), the former is up training temperature and the latter is uptraining oxygen via interaction with an infrared light. Near-infrared HEG (nirHEG): uses a spectrophotometer to measure the oxygenated blood
flow inside&nbsp;<span style="font-size: 1rem;">the skull.
The bone is translucent and lets light in. The Instrument measures the amount
of blood that's carrying oxygen. This is similar to the
"pulse-oximeter" that is used as a finger clip in the hospital, and
that shines a red light through your skin to measure the blood oxygen level.&nbsp;</span><br>
<p>
    The advantage to using the nirHEG is that the elastic band on the head is easily moved to any location on the scalp to train the corresponding area of the brain. HEG is used on the frontal lobes and other areas where skin is showing. it will not work
    when placed on the hair, however. U<span style="font-size: 1rem;">nlike traditional neurofeedback, HEG is not affected by eye blinks
or facial movement which cause distortion when using EEG.</span></p>
<p><span style="font-size: 1rem;">Neurofeedback using this new technique provides
a means to exercise selected brain areas. Exercise increases blood ﬂ ow to the
chosen brain module.&nbsp; Capillaries and
dendrites grow with brain exercise (Kaiser 1997, Thompson et al. 1998, Joyce
and Seiver 1997, Rossiter 1996, 1996, Kaiser 1997). An audible tone was devised
that increased in pitch to signify increased blood oxygenation. To increase
oxygenation one would merely attend to the highest note in each trill and will
the next higher note to sound. Application of the headband and monitoring
patient progress is simple. The treatment process is divided into ten-minute
segments. Usually three to four such segments constitute a treatment session.<br>
<u>Why
is brain blood flow important?</u><br>
Active areas of the brain are marked by high oxygen density and higher than
normal temperature. The blood carries the fuel for the brain: oxygen and
glucose. When an area of the brain is more active, it has increased blood
supply. The brain dilates the capillaries of the area in use to bring more
blood supply. With continued use, more capillaries and more synaptic&nbsp;<span style="font-size: 1rem;">connections
between neurons are built in that area. When we increase blood flow, that area
of the brain is able to do it's job better and more efficiently.</span>

    </span>
</p>
<p>Sequential processing, including using language and executing tasks in proper order, takes place in the frontal lobes. Increased blood supply helps the brain accomplish these tasks. </p>

<p>The frontal cortex is in charge of inhibiting impulses, when appropriate. If the frontal cortex is not functioning well, a person will show a lot of impulsive behaviors. Also involved in this inhibition is control of migraines. <a href="http://www.stopmymigraine.com">Jeffrey
Carmen</a> has shown that when the frontal cortex has increased blood supply, migraine headaches are well controlled. The frontal lobes are important in the function of working memory. Working memory is important for reading comprehension and carrying
    out tasks.</p>
<p></p>
<h3><a name="_Toc35418117">Single Photon Emission Computerized
Tomography (SPECT Scan) demonstrating blood flow pre-and post-treatment</a></h3><img src="@@PLUGINFILE@@/HEG%20Image.png" alt="HEG Before and After Image" width="679" height="364" class="img-responsive atto_image_button_left"><br>
<p></p><br>
<p></p><br><br><br><br><br><br><br><br><br><br><br><br><br><br>
<h3><a name="_Toc35418118"></a><a name="_Toc3535278">Othmer Method</a></h3>

<p>The Othmer method (can be found at eeginfo.com) is recommended for intractable brain based disorders of childhood, such as seizures, conduct disorder, bipolar disorder, spectrum based disorders, pervasive developmental delays, cerebral palsy, birth trauma,
    and acquired birth injuries.&nbsp; Their device is an amplifier, and they rely exclusively on bipolar montages. </p>

<p>Building primarily on the work of Sterman, they developed a basic and reliable approach to neurofeedback that does not utilize brain mapping. Much of their early techniques involve balancing left and right hemispheres with respect to levels of arousal
    (1999).</p>

<p>The Othmers now largely proffer &nbsp;a new paradigm called Infra-low Frequency Training that involves training sub-delta frequencies that are actually slow shifts in dc brain potentials. This method involves training in frequency ranges of .0003 Hz or
    lower. Despite considerable controversy over whether present day amplifiers are actually capable of accurately providing data on such low frequencies, the Othmers claim that they have modified their amplifiers to achieve this feat. These slow frequencies
    are thought to be base frequencies of the EEG, also considered frequencies of hemodynamics—or the burning of blood glucose. A large number of clinicians have adopted this approach. It has gained recognition among clinicians for being very effective,
    especially in developmentally challenged children. Mark Smith has adopted a more conservative approach with this paradigm by building on more accepted frequency ranges of .001-.003 Hz or higher that can be easily measured with modern amplifiers. </p>
<p></p>
<h2><a name="_Toc35418119">How does It Work?</a></h2>

<p>Slow cortical potentials are slow event-related direct-current shifts of the electroencephalogram. Slow cortical potential shifts in the electrical negative direction reflect the depolarization of large cortical cell assemblies, reducing their excitation
    threshold. They change periodically from being electrically positive to electrically negative. They are described as a phasic tuning mechanism related to activities in the brain stem reticular process, the thalamus and the basal ganglia. These dc
    shifts are reflected in the superficial cortical layers and represent synaptic activities in the apical dendrites in those layers. Negative shifts represent increased probability of firing while positive shifts represent decreased probability or inhibition.
    Negative shifts are described as related to the utilization of resources for attention, memory, and other related cognitive mechanisms.</p>
<h3><a name="_Toc35418120"></a><a name="_Toc3535279">At Home Trainers</a></h3>

<p>There are at home trainers on the market currently, some offered through New Mind Academy (Richard Soutar’s work), others offered through a program called Myndlift, which uses a muse device to train the pre-frontal cortex of the brain. Through this program,
    people are directed through at home use with the assistance of a local clinician. </p>

<h3><a name="_Toc35418121">LORETA (Low Resolution Electromagnetic Tomographical
Analysis)</a></h3>
<iframe src="https://player.vimeo.com/video/443110917?h=bbd6d9f3ed&amp;color=13979b&amp;title=0&amp;portrait=0" width="640" height="360" frameborder="0" allow="autoplay; fullscreen; picture-in-picture" allowfullscreen=""></iframe>
<p><br></p>

When recording an EEG, 50% of the data arriving at the site of the electrode is from neurons directly underneath it, and 95% of the data comes from within 6 centimeters distance (that’s a circle with a diameter of 2 <sup>1/3</sup> inches—big) (Nunez,
1982; 1995, Cooper et al., 1965). This is one of the reasons that EEG is limited in terms of what it can determine spatially (i.e. where something lives in the brain). LORETA neurofeedback training is Z-score training that uses three dimensional source
localization so that the location within the interior of the brain can be&nbsp;&nbsp;<span style="font-size: 1rem;">pinpointed with accuracies of 1cm. LORETA
neurofeedback is thought to target subcortical structures that are showing
deviance in the amount of frequency generated.</span>
<p></p>
<p></p>
<h3><br>LORETA Z-score </h3>

<p>LORETA Z-Score neurofeedback is thought to regulate the deep structures of the brain and improve connectivity between the brain networks through targeting the central voxel within certain regions of the brain. In each session, a cap with 19 sensors is
    applied to your head. During training, your brainwaves learn to become balanced and normalized as they are rewarded.</p>

<p>The goal of LORETA is to reinforce stability of information processing in dysregulated networks and connections based on the client’s symptoms. It targets the specific areas of the brain and connections between nodes that are linked to the symptoms. In
    doing so it specifically targets deep brain structures that are out of balance. Similar to traditional Neurofeedback (single channel Neurofeedback) training it provides operant conditioning (rewards) based on your brainwaves compared to the brainwaves
    of a healthy population.</p>

<p>It is possible to train coherence, phase, and power from 88 Brodmann areas in LORETA Z-score neurofeedback. </p>
<p>There are a few ways to choose what regions of the brain to train using LORETA Z-score Neurofeedback. One means is using a symptom checklist, which is created from the patient’s EEG. Another method is using Neurodesigner.</p>
<h2><a name="_Toc35418122">Image from NeuroGuide Z-Score LORETA
Neurofeedback</a></h2><img src="@@PLUGINFILE@@/LORETA%20in%20Neuroguide.png" alt="LORETA in Neuroguide" width="762" height="1640" class="img-responsive atto_image_button_text-bottom"><br><br><br>
<p></p>
<p></p>
<h2><a name="_Toc35418123"></a><a name="_Toc3535280">Neuromodulation protocols</a></h2>

<p>Neuromodulation is also known as neurostimulation is different than neurofeedback, but fits under the umbrella of neurotherapy. Neurofield’s neurotherapy system is known for the blending of neurostimulation into neurofeedback training. Neuromodulation,
    at the clinical level, is comprised of transcranial alternating current stimulation (tACS), transcranial direct current stimulation (tDCS), transcranial random noise stimulation (tRNS), transcranial pink noise stimulation (tANS) and pulsed electro-magnetic
    field stimulation (PEMF).</p>
<h3><a name="_Toc35418124">Three Stimulation Modalities used in Neuromodulation</a></h3>
<p><a name="_Toc35418124"><img src="@@PLUGINFILE@@/Three%20Stimulation%20Modalities.png" alt="Three Stimulation Modalities" width="904" height="912" class="img-responsive atto_image_button_left"><br></a></p>
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<h3><a name="_Toc35418125">Transcranial Alternating Current Stimulation (tACS)</a></h3>

<p>tACS is a form of electrical stimulation that uses two electrodes (a positive electrode called an anode and a negative electrode, the cathode) to pass current back and forth through either the brain or the body. It is called alternating current because
    the side which is giving and receiving electrons (anode and cathode) continuously switches. Any frequency, or blend of frequencies, can be given with these devices. So, if a patient is in need of more delta, the clinician can stimulate them in the
    delta frequencies. This technology is engineered, developed, and sold through Neurofield, Inc, (founded by Nicholas Dogris and Brad Wiitala). Clinicians use stimulation devices to help their patients heal, recover, and change the behavior of the brain
    and their bodies. As opposed to neurofeedback, neurostimulation shows the brain how to behave and the brain, like a copy cat, mimics the stimulation frequency. </p>
<h3>The NeuroField System</h3>
<p><img src="@@PLUGINFILE@@/Neurofield%20System.jpg" alt="Neurofield System" width="700" height="426" class="img-responsive atto_image_button_left"><br></p>

In transcranial alternating current stimulation, one applies current and encourages neural synchronization. As electrons pass through the brain (from anode to cathode) the populations of neurons they go through become more likely to fire. This increased
likelihood of firing is generalized to the entire area where current is applied. This can cause neurons which were formerly out of phase with each other to align. This happens not just during treatment, but is hypothesized to cause lasting changes to
the brain. This is called Spike Timing Dependent Plasticity.<br>
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<h2><a name="_Toc35418126">The Mechanism of Transcranial Alternating
Current Stimulation</a></h2><img src="@@PLUGINFILE@@/tACS.png" alt="tACS" width="777" height="415" class="img-responsive atto_image_button_left"><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br><br>
<h3><a name="_Toc35418127">Transcranial Direct Current Stimulation (tDCS)</a></h3>

<p>tDCS is transcranial direct current stimulation. It is a form of electrical stimulation that is used to treat many conditions and pathologies, both in the brain and in the body. The technology uses a positive and a negative electrode (called the anode
    and the cathode, respectively). Direct current passes a one-way current through the brain or the body. In the brain, a surge in calcium ions and in sodium ions creates a condition of neuroplasticity, which makes the brain more susceptible to neurofeedback
    and pEMF conditioning. tDCS &nbsp;It increases the potential of the brain to change, learn and grow.</p>

tDCS 1) increases blood flow at the targeted areas and, thus, leads to vaso-profusion (which helps to heal wounds on the brain and the body and also encourages angiogenesis and neurogenesis), 2) causes large scale network organization, 3) stimulates/excites
the positive electrode site (anode) which increases glutamate and decreases GABA, and inhibits the negative&nbsp;electrode site (cathode) creating more GABA at the site of stimulation, and causes calcium and sodium surges in the glial cells, which leads
to flexibility in polarity shifting. TDCS does not force the brain to fire. Some of the symptoms and pathologies addressed by tDCS include migraines, age-related cognitive decline, and other disorders where the tissues of the brain agree damaged or compromised
(such as cerebro-vascular issues, stroke, and some epileptogenic profiles). tDCS protocols cause the underlying blood vessels to dilate, which allows oxygenation of the affected areas.&nbsp;A recent meta-analysis showed no serios adverse effets on over
1,000 people across 33,200 sessions (Bikson et al., 2016).<br>
<h3><a name="_Toc35418128">The application of transcranial direct
current</a></h3><img src="@@PLUGINFILE@@/tDCS.png" alt="tDCS" width="700" height="674" class="img-responsive atto_image_button_text-bottom"><br><br><br>
<h3><a name="_Toc35418129">Transcranial Random Noise Stimulation</a></h3>

<p>tRNS is a form of electrical stimulation that is used to pass noise (like the white noise of a television screen) through the brain and/or the body. One way to consider tRNS is as a “Wall of noise”. tRNS is different from tDCS because instead of giving
    steady current from anode to cathode, it is giving current at randomized frequencies and milliamperes between the two sites. This means that the region of the brain between the electrodes are stimulated, increasing neuroplasticity and reducing stuck
    patterns.&nbsp; This is one modality used to unlearn problematic fixed patterns. tRNS has also shown benefit for learning in people with developmental abnormalities. When tRNS stimulation is given during math lessons, it helps more than sham stimulation
    or behavioral therapy.&nbsp;&nbsp; Issues of hyper or hypo coherence and hyper or hypo phase lag are addressed by white noise, in addition, white noise is often used at the first layer of multi-layer protocols. </p>
<h3><a name="_Toc35418130">Different Forms of White Noise Stimulation</a></h3>
<p><a name="_Toc35418130"><img src="@@PLUGINFILE@@/Whit%20Noise%20Stim.png" alt="White Noise Stim" width="956" height="346" class="img-responsive atto_image_button_left"><br></a></p>
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<h3><a name="_Toc35418131">Pink Noise Stimulation</a></h3>

<p>Pink Noise is filtered white noise. This form of stimulation affects the restng membrane potneitl and has the same types of de-coupling properties as white noise. It also creates increased blood perfusion. Pink noise appears to have an effect on microstates,
    which are associated with the “on-off” switching of a neuon. In using pink noise, you can saturate a neuron with a failtered set of frequencies, that influence the switching of the neurons, effectively changing the ways that they fire. tRNS is one
    modality that can be used to address stuck patterns, such as thalamo-cortical dysrhythmias (which are found in many hearing disorders, form of mood and affect regulation disorders, some attention deficit disorders, and some movement disorders). Thalamo-cortical
    dysrhythmias are disorders where there is a persistent gamma waveform attached to&nbsp; a slower carrier wave (typically 8hz or less). Pink noise is typically one step in a multi-step protocol.
</p>
<h3><a name="_Toc35418132">The bell curve of pink noise</a></h3>
<p><a name="_Toc35418132"><img src="@@PLUGINFILE@@/Pink%20Noise.png" alt="pink noise in NF" width="686" height="426" class="img-responsive atto_image_button_left"><br></a></p><br>
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<h3><a name="_Toc35418133"></a><a name="_Toc3535282">pEMF (Pulsed Electro-Magnetic Frequency)</a></h3>
<p></p>
<p><a name="_Toc35418130"></a></p>
<p><a name="_Toc35418130">Pulsed Electromagnetic Field (pEMF)
stimulation is imperceptible, yet the effects are real. pEMF creates an
electromagnetic field, which allows cells and tissues in its wake to oscillate
at the same frequency. The frequency and duration of the pEMF are important
components of the effectiveness of the treatment. This modality is gentle
compared to other stimulation technologies. You can't feel it because an
electromagnetic field is generated through a wire coil that flows through the
air and passes through your body effortlessly. One of the happy benefits of
pEMF is the increase in blood flow at the site of the stimulation, which can
increase angiogenesis by way of allowing more oxygen rich blood to make its way
to the site. &nbsp;At low intensity pEMF is safe and has numerous clinical
benefits, including affecting the resting membrane potential (without the
forced depolarization of the membrane), inflammation reduction, nerve healing,
the healing of bones, the remediation of depression and other affective
disorders, and postoperative pain. </a></p>
<p><a name="_Toc35418130">Due to the low-level voltage output of pEMF, it is safe for
infants, the elderly, and animals. </a></p>
<h4><a name="_Toc35418130">pEMF devices are known for the
ability to help reduce pain</a></h4><a name="_Toc35418130"><img src="@@PLUGINFILE@@/pEMF%20for%20Pain.png" alt="pEMF for Pain" width="976" height="618" class="img-responsive atto_image_button_left"><br></a>
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<h3><a name="_Toc35418134"></a><a name="_Toc3535283">CES</a></h3>

<p><b>Cranial</b>&nbsp;electrotherapy&nbsp;<b>stimulation</b>&nbsp;(CES) is a form of neurostimulation that delivers a small, pulsed, alternating current via electrodes on the head. Recently, a systematic review (2018) found insufficient evidence that CES
    has clinically impactful effects on&nbsp;<a href="https://en.wikipedia.org/wiki/Fibromyalgia" title="Fibromyalgia">fibromyalgia</a>, headache, neuromusculoskeletal pain, degenerative joint pain, depression, or insomnia and there is low-strength evidence
    suggesting modest benefit in patients with anxiety and depression (Shekelle et al, 2018)</p>Dave Siever's company, Mind Alive creates cranial electric stimulators, that use photic stimulation, as well as ear clips that deliver small stimulation through
the ear lobes.&nbsp;<br><img src="@@PLUGINFILE@@/Mind%20Alive%20hardware.jpg" alt="Mind Alive Hardware" width="713" height="246" class="img-responsive atto_image_button_left"><br>
<p></p>
<p></p>