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Pre-Conference Workshops
*Tentative schedule is listed below.  Workshop registration now available!
Monday Workshops
Monday, September 16

This beginners level, Infraslow Fluctuation Training will demonstrate this unique neurofeedback process in clinical practice in a three day workshop. The method pivots on the determination of an optimum frequency (OF) that is discovered for each client. Day one is the didactic portion of the workshop that includes basic software instruction, experiential training in a clinical decision tree for defining beginning placements, a demonstration of the OF determination process along with a discussion of the equipment and optimal signal processing requirements necessary to accomplish effective training. The value of QEEG in predicting treatment responders, treatment planning, and determining treatment outcomes will be established. Day two and three will be hands-on instruction in ISF training. Students will have several opportunities to implement and experience ISF training.Infraslow frequencies were first identified by Russian researchers in the 1950s (Aladjalova, 1957, 1964). These slow processes have been associated with the Hypothalmic Pituitary Adrenal Axis since that time when Aladjalova implanted electrodes in rabbit Hypothalamus. She described an increase in amplitude and a decrease in frequency in response to wounding that she theorized was a reparative, parasympathetic response. Infraslow frequencies, also corroborated by Joe Kamiya (Girton, Benson, & Kamiya, 1973), have become a signal of significant interest to researchers recently. Research suggests that the infraslow signal underlies the excitability dynamics of cortical networks (Vanhatalo et al., 2004). Vanhatalo, convinced of ISF's centrality in cortex, stated that any attempt to attenuate this slow signal eliminates the most salient features of the human EEG. Further, it appears to be a direct electrophysiological correlate for slow fluctuations in human psychophysical performance (Monto, Palva, Voipio, & Palva, 2008). Most recently research has suggested that very slow oscillations are associated with the Default Mode Network of the human cerebral cortex and appear to be related to ADHD symptom status (Broyd, Helps, & Sonuga-Barke, 2011 , Tye et al., 2012). Palva (Palva & Palva, 2012) describes the Infralsow frequencies as the думsuperstructureдуќ in cortex that regulates the activity within and between active neuronal networks. A recent software innovation has allowed this slow signal to be simultaneously rendered in a bipolar and referential montage. The advancement has made it possible to record in two channels while training on the bipolar montage. This allows for the monitoring of Zscores, slow cortical potentials, and raw amplitudes at each site during ISF training. This improvement makes for a safe, effective, and data rich method of slow wave training This workshop will be taught on the Brainmaster Avatar platform that utilizes the Atlantis or Discovery amplifier. Attendees with equipment should contact admin@neurofeeedbackservicesny.com to arrange for an ISF license before the workshop. Attendees do not need to have a Discovery, an Atlantis, the Avatar software, or an ISF License to attend. There will be enough equipment and software available for all attendees to use in the workshop. However, for the best learning experience it is recommended that attendees obtain either the Atlantis or the Discovery amplifier, and the Avatar Software with an ISF License.

Beginner Infraslow Neurofeedback (ISF) Workshop (Day 1 of 3)

Mark Smith, LCSW , Ray McGarty, MSW

Larkspur

This 3-day workshop provides a deeper learning opportunity for the LENS Provider, which includes concepts of the LENS and itsН application, supporting paradigms, advanced principles, and expanded areas of applicability to include complex patient presentations in the use of the Low Energy Neurofeedback System (LENS). How to more deeply integrate the concepts into the practitionerНs practice, with special emphasis on complex case presentations and symptom constellations. The workshop will offer hands-on training in the more advanced use and application of the LENS. Day 1: Review of concepts, paradigms, and areas of applicability as applied to clients with complex issues. Discussion of various clinical symptom presentations and their possible etiologies. Impact of environmental and nutritional issues on clientsН structural and functional impairments along with resistance to treatment will be discussed. Participants will bring clinical cases for discussion of treatment planning. Impact of the LENS Maps in treating complex clients. 10:00-11:00 (1 hour) Review of concepts, core paradigms, principles, and areas of applicability for clients with complex presentations. 11:00-11:30 (1/2 hour) Discussion of Variability, Map Interpretation and Suppression for complex cases. 11:30-11:45 (1/4 hour) Break 11:45-1:00 (1 _ hours) Discussion of Survivor Syndrome and the impact on treatment planning. Working with reactive clients and adjusting settings, including Duration, Duty Cycle, Band Filter Limits, Offset and Broad/Narrow Band options, to reflect client physiology.

LENS Intermediate course (Day 1 of 3)

Michael Beasley BS, MS, BCIA, CMT

Iris

This course satisfies 24 of the 36 didactic course requirements for QEEG Certification as arranged by the QEEG Certification Board. Attendees will earn up to 24 hours towards their QEEG certification requirements. This workshop has been approved by the QEEG Certification Board to provide didactic training which is recognized by the Board toward certification as a technician or a diplomate. This course is based upon the original 24-hour didactic blueprint, that has been in effect in the past. Beginning in 2019, the didactic requirement has increased to 36 hours, by the addition of 12 additional hours. This course remains as originally designed, with the original 24hour content. The following description includes material from the QEEG board certification requirements for the original 24-hour didactic program. Workshop topics will include Editing raw EEG and recognizing and removing or accounting for artifacts. Drug Effects including how drugs affect the EEG patterns, as well as how EEG can be used to predict and monitor drug response. Database Analysis Clinical and Cognitive Aspects , Montages and Spectral and Topographic Aspects of the EEG. Attendees will learn the subject inclusion and exclusion criteria for building a database .and fundamental statistical considerations within databases. Further detailed topics will include the effects of various drugs on the EEG/QEEG data and developmental changes in the EEG and knowledge. Brodmann area functions and network connections will provide an understanding of LORETA and sLORETA interpretation and training Practical information will include knowing which EEG signatures should be referred out to other professionals Be knowledgeable about general cognitive and clinical changes that take effect after neurofeedback training. The remaining required hours are 4 hours of Ethics, and 4 hours of QEEG and Neurofeedback. These can be earned through other classroom or online opportunities that are available and will be briefly described on the first day of this course.

QEEG Didactic Board Certification Course (Day 1 of 3)

Thomas Collura, PhD, MSMHC, David Cantor, PhD , Harry Kerasidis, MD

Aspen Amphitheater

This 3-day workshop is a learning arena for the practitioner, which includes essential concepts, core paradigms, principles, and areas of applicability of the Low Energy Neurofeedback System (LENS), and how to integrate the concepts into the practitionerНs practice. The workshop will offer hands-on training in the LENS in addition to a foundational knowledge in assessing the client, development of a treatment plan, using the concepts presented and how to reevaluate the effectiveness of the treatment plan. Day 1: Discussion of the core principles, paradigms, and areas of applicability related to the LENS approach. Entering a new patient into the database, and the steps to run a LENS session with the LENS software. Presentation of the 3 LENS Questionnaires (Intake, CNS and Sensitivity) and their central role in designing a treatment plan. Participants will assess one another, customize a treatment plan, and administer a LENS session.

Foundations of the LENS (Day 1 of 3)

Daphne Waldo BS, RN, MSN, CNL, PHN

Primrose

This course satisfies 24 of the 36 didactic course requirements for QEEG Certification as arranged by the QEEG Certification Board. Attendees will earn up to 24 hours towards their QEEG certification requirements. This workshop has been approved by the QEEG Certification Board to provide didactic training which is recognized by the Board toward certification as a technician or a diplomate. This course is based upon the original 24-hour didactic blueprint, that has been in effect in the past. Beginning in 2019, the didactic requirement has increased to 36 hours, by the addition of 12 additional hours. This course remains as originally designed, with the original 24hour content. The following description includes material from the QEEG board certification requirements for the original 24-hour didactic program. Workshop topics will include Editing raw EEG and recognizing and removing or accounting for artifacts. Drug Effects including how drugs affect the EEG patterns, as well as how EEG can be used to predict and monitor drug response. Database Analysis Clinical and Cognitive Aspects , Montages and Spectral and Topographic Aspects of the EEG. Attendees will learn the subject inclusion and exclusion criteria for building a database .and fundamental statistical considerations within databases. Further detailed topics will include the effects of various drugs on the EEG/QEEG data and developmental changes in the EEG and knowledge. Brodmann area functions and network connections will provide an understanding of LORETA and sLORETA interpretation and training Practical information will include knowing which EEG signatures should be referred out to other professionals Be knowledgeable about general cognitive and clinical changes that take effect after neurofeedback training. The remaining required hours are 4 hours of Ethics, and 4 hours of QEEG and Neurofeedback. These can be earned through other classroom or online opportunities that are available and will be briefly described on the first day of this course.

QEEG Didactic Board Certification Course (Day 1 of 3)

Thomas Collura, PhD, MSMHC, David Cantor, PhD , Harry Kerasidis, MD

Aspen Amphitheater

Tuesday Workshops
Tuesday, September 17

This beginners level, Infraslow Fluctuation Training will demonstrate this unique neurofeedback process in clinical practice in a three day workshop. The method pivots on the determination of an optimum frequency (OF) that is discovered for each client. Day one is the didactic portion of the workshop that includes basic software instruction, experiential training in a clinical decision tree for defining beginning placements, a demonstration of the OF determination process along with a discussion of the equipment and optimal signal processing requirements necessary to accomplish effective training. The value of QEEG in predicting treatment responders, treatment planning, and determining treatment outcomes will be established. Day two and three will be hands-on instruction in ISF training. Students will have several opportunities to implement and experience ISF training. Infraslow frequencies were first identified by Russian researchers in the 1950s (Aladjalova, 1957, 1964). These slow processes have been associated with the Hypothalmic Pituitary Adrenal Axis since that time when Aladjalova implanted electrodes in rabbit Hypothalamus. She described an increase in amplitude and a decrease in frequency in response to wounding that she theorized was a reparative, parasympathetic response. Infraslow frequencies, also corroborated by Joe Kamiya (Girton, Benson, & Kamiya, 1973), have become a signal of significant interest to researchers recently. Research suggests that the infraslow signal underlies the excitability dynamics of cortical networks (Vanhatalo et al., 2004). Vanhatalo, convinced of ISF's centrality in cortex, stated that any attempt to attenuate this slow signal eliminates the most salient features of the human EEG. Further, it appears to be a direct electrophysiological correlate for slow fluctuations in human psychophysical performance (Monto, Palva, Voipio, & Palva, 2008). Most recently research has suggested that very slow oscillations are associated with the Default Mode Network of the human cerebral cortex and appear to be related to ADHD symptom status (Broyd, Helps, & Sonuga-Barke, 2011 , Tye et al., 2012). Palva (Palva & Palva, 2012) describes the Infralsow frequencies as the думsuperstructureдуќ in cortex that regulates the activity within and between active neuronal networks. A recent software innovation has allowed this slow signal to be simultaneously rendered in a bipolar and referential montage. The advancement has made it possible to record in two channels while training on the bipolar montage. This allows for the monitoring of Zscores, slow cortical potentials, and raw amplitudes at each site during ISF training. This improvement makes for a safe, effective, and data rich method of slow wave training. This workshop will be taught on the Brainmaster Avatar platform that utilizes the Atlantis or Discovery amplifier. Attendees with equipment should contact admin@neurofeeedbackservicesny.com to arrange for an ISF license before the workshop. Attendees do not need to have a Discovery, an Atlantis, the Avatar software, or an ISF License to attend. There will be enough equipment and software available for all attendees to use in the workshop. However, for the best learning experience it is recommended that attendees obtain either the Atlantis or the Discovery amplifier, and the Avatar Software with an ISF License.

Beginner Infraslow Neurofeedback (ISF) Workshop (Day 2 of 3)

Mark Smith, LCSW Ray McGarty, MSW

Larkspur

This 3-day workshop provides a deeper learning opportunity for the LENS Provider, which includes concepts of the LENS and itsН application, supporting paradigms, advanced principles, and expanded areas of applicability to include complex patient presentations in the use of the Low Energy Neurofeedback System (LENS). How to more deeply integrate the concepts into the practitionerНs practice, with special emphasis on complex case presentations and symptom constellations. The workshop will offer hands-on training in the more advanced use and application of the LENS. Day 2: How to use the LENS Maps in directing treatment. Meaning of relative amplitudes, midline deviations, etc. will be discussed. What to do when a client isnНt improving. Trajectory of symptom improvement. Capabilities of the LENS in complex cases along with maximum use of the LENS. How to handle abreactions in clients including discussion with clients and families. Discussion of participants clients and development of treatment plans.

LENS Intermediate course (Day 2 of 3)

Michael Beasley BS, MS, BCIA, CMT

Iris

"For the past 30 years operant conditioning approaches have largely utilized EEG neurofeedback as a method for regulating the brain. The research shows that EEG neurofeedback has had a positive impact on multiple patient populations, but can take a long time in order to achieve a treatment effect. Neurostimulation approaches have been shown in the research to have a positive impact on multiple patient populations, but the long term effects have not been consistent or enduring. In this workshop Dr. Dogris & Dr. Thompson will demonstrate how to use QEEG data to generate treatment plans and strategies for using pEMF, tDCS, tACS and tRNS stimulation modalities for the treatment of ADHD, Depression, Anxiety, TBI and other clinical diagnosis. Furthermore, a discussion about how pEMF, tDCS, tRNS and tACS can be utilized to address power, coherence and phase dynamics in the EEG. QEEG data will be presented along with clinical outcome data.

The use of Neurostimulation in Clinical Practice (Day 1 of 2)

Nicholas Dogris, PhD

Bluebell

This 3-day workshop is a learning arena for the practitioner, which includes essential concepts, core paradigms, principles, and areas of applicability of the Low Energy Neurofeedback System (LENS), and how to integrate the concepts into the practitionerНs practice. The workshop will offer hands-on training in the LENS in addition to a foundational knowledge in assessing the client, development of a treatment plan, using the concepts presented and how to reevaluate the effectiveness of the treatment plan. Day 2: Discussion of the principles of Dominant Frequency, Offset, Duty Cycle, Duration, Band Filter Limits and Carrier Wave parameters and their relationship to the clinical information derived from the 3 patient questionnaires in customizing a treatment plan. Creating reports from the collected EEG, and interpreting the topographic maps. Discussion of the concept of Suppression and itНs impact on the course of treatment.

Foundations of the LENS (Day 2 of 3)

Daphne Waldo BS, RN, MSN, CNL, PHN

Primrose

This course satisfies 24 of the 36 didactic course requirements for QEEG Certification as arranged by the QEEG Certification Board. Attendees will earn up to 24 hours towards their QEEG certification requirements. This workshop has been approved by the QEEG Certification Board to provide didactic training which is recognized by the Board toward certification as a technician or a diplomate. This course is based upon the original 24-hour didactic blueprint, that has been in effect in the past. Beginning in 2019, the didactic requirement has increased to 36 hours, by the addition of 12 additional hours. This course remains as originally designed, with the original 24hour content. The following description includes material from the QEEG board certification requirements for the original 24-hour didactic program. Workshop topics will include Editing raw EEG and recognizing and removing or accounting for artifacts. Drug Effects including how drugs affect the EEG patterns, as well as how EEG can be used to predict and monitor drug response. Database Analysis Clinical and Cognitive Aspects , Montages and Spectral and Topographic Aspects of the EEG. Attendees will learn the subject inclusion and exclusion criteria for building a database .and fundamental statistical considerations within databases. Further detailed topics will include the effects of various drugs on the EEG/QEEG data and developmental changes in the EEG and knowledge. Brodmann area functions and network connections will provide an understanding of LORETA and sLORETA interpretation and training Practical information will include knowing which EEG signatures should be referred out to other professionals Be knowledgeable about general cognitive and clinical changes that take effect after neurofeedback training. The remaining required hours are 4 hours of Ethics, and 4 hours of QEEG and Neurofeedback. These can be earned through other classroom or online opportunities that are available and will be briefly described on the first day of this course.

QEEG Didactic Board Certification Course (Day 2 of 3)

Thomas Collura, PhD, MSMHC , David Cantor, PhD , Harry Kerasidis, MD

Aspen Amphitheater

Over 99% of American businesses are categorized as small businesses дус those employing less than 100 persons дус and small businesses employ 48% of working Americans (McIntyre, 2018 , Desjardins, 2017). Although there is dispute of exactly how many small businesses fail дус between 33% and 46% in the first 5 years, and nearly 80% failing by year 10 дус there is general consensus as to why they fail (McIntyre, 2018 , Desjardins, 2017 , Waring, 2017). Reasons for failure range from no market for the service, poor cash flow, poor team chemistry/bad hires, being out-competed, pricing/cost concerns, loss of focus, burnout, and poor marketing, among others (Wagner, 2012 , Gerber, 1995, 2005). These areas of failure are attributable to what Gerber (1995, 2005) says are the failures in, and competing requirements of, the three roles the small business owner fills: the entrepreneur, the technician, and the manager. For neurofeedback professionals, and others in the brain/mental health care space, nothing in the formal curriculum of licensure track graduate schools prepares them for building and growing a practice that will survive long term. Many of the obstacles to growth faced by neurofeedback professionals are common to all small business owners and are the result of limiting beliefs, faulty assumptions (Hyatt, 2018), and failing to work on the business due to the time demands of working in the business (Gerber, 2005 , Pagan, 2018). Others make the mistake of engaging in "hope marketing" (Walker, 2014), the idea that "if you build it, they will come." Neurofeeback practices, like other small businesses, have basic business activities (marketing, sales, delivery) and disciplines (brand, finance, management) that require the entrepreneur's disciplined leadership if the business is to succeed (Gerber, 1995, 2005). The nature of neurofeedback encourages the neurofeedback professional to cling to the technician role, often to the neglect of the entrepreneur role. The technician is the worst marketer, often focusing on the technology and not the transformation that neurofeedback offers to clients. The entrepreneur however, can tell a compelling story, the hero's journey, that connects with their vision and passion that will resonate with prospective clients. Neurofeedback professionals, as other entrepreneurs, struggle with identifying ideal clients (avatars) and appropriate marketing tools and strategies, and using social media as a means of engaging existing and potential clients (Brunson, 2017 , Walker, 2014). However, growth opportunities afforded by mastermind communities, referral source connection events, technology, customer relations management (CRM) tools, and social media marketing abound for entrepreneurs willing to be stretched personally and professionally (Brunson, 2017 , Patel, 2017 , Pagan, 2018).

Why Neurofeedback Practices Fail and How Not To (Day 1 of 2)

Wes Center, PhD

Lupine

Wednesday Workshops
Wednesday, September 18

Developmental Trauma (DT) or complex childhood trauma is arguably one of the most important public health challenges in the United States. It has a negative impact on the mental, physiological and neurobiological functioning, leads to a lower quality of life, early death and creates a substantial financial burden for the individuals affected, their families, and the healthcare system as a whole. Moreover, people with DT are often more resistant to traditional therapy. Research have shown that neurofeedback and biofeedback effectively treat people with DT. The purpose of this workshop is to deepen the participantsду» understanding of DT and ways to effectively incorporate neurofeedback and biofeedback to treat individuals with DT. The workshop will address an integrative approach to Treat Developmental Trauma Using Neurofeedback and Biofeedback. It will begin by ways to detect DT and how it differs from PTSD. After providing an overview of the impact of DT on health and well-being it will focus on the brain development and functioning. Next, the workshop will review research on the effectiveness of neurofeedback and biofeedback on individuals with DT. Finally, it will focus on the challenges therapists may encounter when working with individuals with DT, and ways to integrate traditional therapy with neurofeedback and biofeedback in overcoming those challenges. Case presentation will be used to highlight these points. The second part of the workshop will focus on the importance of incorporating neurological and physiological assessments. i.e. neuromarkers and physiomarkers, in addition to the traditional subjective assessments (e.g. questionnaires). At the individual level, we will discuss ways of assessing clientsду» baseline functioning, providing guidance for treatment, and tracking progress. To further the use and improve the outcome of these techniques, the benefits and challenges of identifying patterns of brain and physiological activities will be discussed. Overall, this workshop will provide its participants with a more complete understanding of DT and ways to improve treatment outcomes through at integrative approach. The workshop will be concluded with future directions and challenges.

An integrative Approach To Treat Developmental Trauma Using Neurofeedback And Biofeedback

Ainat Rogel, PhD, MSW , Diana Martinez, MD, PhD , Basel van der Kolk, MD

Cottonwood 1

Neurotherapy is rapidly evolving into a primary care option for many disorders. Problems with mood, anxiety, sleep quality, learning, cognitive processing, pain, addictions, anger management, and age-related memory are all amenable to rapid assessment and treatment. The assessment procedures are simple and straight forward involving assessment of a limited number of brain sites. Treatment options other than neurofeedback have been developed to markedly accelerate neurotherapy. Primary among these treatment options is the braindriving procedure. These complementary techniques markedly facilitate neurotherapy as a viable primary care alternative to dangerous and often ineffective pharmaceuticals. The workshop starts with the precise ClinicalQ assessment procedure that determines treatment strategies. The ClinicalQ data base contains over 1500 clinical patients and has proven to be far more accurate as compared with data bases based on presumptively думnormalдуќ subjects. Emphasis is on Braindriving treatment procedures, including review of major unconditioned stimuli required for treatment. Other treatment options including neurofeedback, AVS, CES, energy psychology methods, craniosacral manipulations, harmonic sounds, electrostimulation, and behavior therapies appropriate for a wide range of disorders are presented. Practitioners will be able to immediately apply these efficient techniques. Conditions that require full QEEG and normative data base procedures will be identified, as will conditions in which the more aggressive treatments are contraindicated. Materials provided will include detailed procedures for the rapid assessment protocol, including the listing of therapeutic probes associated with irregular activity at all recording sites. Also included in the provided materials include site location forms for acupuncture meridians, parameters associated with developing unconditioned stimuli for the Braindriving (classical conditioning) paradigms and procedure sheets for energy routines. Hands-on training for some craniosacral manipulations, acustimulation and energy routines is provided. This workshop is presented in response to many requests from previous participants in shorter workshops for one full day of training in these effective neurotherapeutic techniques.

ClinicalQ and Braindriving

Paul Swingle, PhD

Cottonwood 2

This 3-day workshop provides a deeper learning opportunity for the LENS Provider, which includes concepts of the LENS and itsН application, supporting paradigms, advanced principles, and expanded areas of applicability to include complex patient presentations in the use of the Low Energy Neurofeedback System (LENS). How to more deeply integrate the concepts into the practitionerНs practice, with special emphasis on complex case presentations and symptom constellations. The workshop will offer hands-on training in the more advanced use and application of the LENS. Day 3: Concepts, principles, and areas of applicability for BodyLENSTM. Maximization of BodyLENSTM effects. Participants will be introduced to the BodyLENSTM software. Features of the BodyLENSTM software will be covered: electrode placement, dosage, 2 Channel use. A first session will be practiced by participants on each other. 2 Channel LENS concepts will be presented. Maximizing the effect of 2 Channel LENS with complex clients will be discussed.

LENS Intermediate course (Day 3 of 3)

Michael Beasley BS, MS, BCIA, CMT

Iris

The 3-dimensional evaluation of the sources of non-ictal discharges and focal gross pathologies has recently been enhanced using advanced technology called swLORETA (weighted sLORETA (Palmero-Soler et al, 2007). swLORETA uses Single-Value-Decomposition (SVD) to weight the lead field in order to increase lead field homogeneity and hence improved localization of deep sources. This allows for estimates of EEG sources in different layers of the cortex. Also, swLORETA uses a real MRI and not an average MRI with 12,270 voxels and a Boundary-Element-Method (BEM) of source localization (Wroel and Aliahadi, 2002). Non-ictal events and gross pathologies are localized inside of 3дуђdimensional volumes with the aid of slice and volume cutting tools to allow one to navigate through the brain and identify dysregulated brain network hubs (Brodmann areas) and connections. Computations include Functional Connectivity (Coherence, Lagged Coherence and Phase Difference) and Effective Connectivity (Phase Slope Index) of the magnitude and direction of information flow between network hubs as well as integration with Diffusion Tensor Imaging (DTI). A useful method is to also view the EEG potentials on a transparent scalp while simultaneously viewing the deeper sources of the EEG from inside the brain. Both raw scores and Z scores are used as well as the Laplacian transform of the scalp EEG. Examples of source localization in patients with gross pathologies such as epileptic foci, TBI and stroke will be presented. Also, how to create a Neurofeedback protocol designed to target dysregulated brain networks linked to symptoms will be demonstrated. Understanding cross-frequency coupling from brainstem to limbic system to cortex including Neurofeedback protocol generation. Cross-frequency measures such as cross-frequency phase-amplitude coupling, cross-frequency coherence, cross-frequency power and cross-frequency phase reset will be demonstrated. Advanced Neuroimaging topics will be covered including the potential to resolve sources in the Thalamus, Sub-Thalamus, Habenua and Cerebellum. Implications and future applications of Neurofeedback including Cerebellar Neurofeedback will be discussed.

New Advances in Electrical NeuroImaging to Evaluate EEG Sources, Brain Networks, Cross-Frequency Coupling and Neurofeedback Protocols

Robert Thatcher, PhD

Evergreen E

The brain responds extremely well to stimulation. Since the discovery of photic driving by Adrian and Matthews in 1934, much has been discovered about the benefits of brainwave entrainment (BWE) or audio-visual entrainment (AVE), as it is commonly known today. AVE increases cerebral blood flow, beneficial neurotransmitters, has profound calming effects, induces a meditative mind state, increases brain lactate, triggers heat-shock protective protein and excites micro-glia. Research on the effectiveness of AVE in promoting relaxation, cognition and hypnotic induction, treating ADD, PMS, SAD, PTSD, migraine headache, chronic pain, anxiety, depression and episodic memory is now available. Recent discoveries have shown AVE to be a powerful means of recovery from traumatic brain injuries of a newly discovered type, termed thalamocortical disconnect. Cranio-electro stimulation (CES) is the application of a small current across the cranium. CES has been used over several regions of the brain, but itду»s primary focus is for stimulation of the brain stem. CES was initiated by Robinovitch, who, in 1914, made the first claim for electrical treatment of insomnia. In 1958, the book Electro-Sleep inspired research in Europe and in Eastern Block countries, as well as in South America, Asia and finally the US. Most of the roughly 200 studies have shown CES as a reliable method for drug rehab, for reducing anxiety, depression, pain, improving sleep, plus improve cognition and IQ. Roughly 1/3 of people donду»t respond to CES, while another third show mild to moderate improvement. However, some people respond exceptionally well. I have been recording EEG and processing the qEEGs of my best CES responders. These data will be presented. Transcranial DC Stimulation (tDCS) has been extensively studied since the 1980s, totalling roughly 1200 studies to date. A major advantage of tDCS is that it may be applied directly over an area of concern where the cortical activity over a specific site on the brain may be enhanced or suppressed, much like neurofeedback. Pretty much every possible aspect of human function has been studied with tDCS. tDCS works well for boosting peak mental performance in a wide variety of areas, the treatment of depression and a myriad of cognitive concerns, especially challenges resulting from stroke. Over 300 studies using tDCS for stroke rehabilitation (ataxia, apraxias and aphasias) have been published to date. The physiological principles of tDCS will be explained as well as clinical outcomes.

Stimulation Technologies (Audio-visual Entrainment, Cranio-electro Stimulation & transcranial DC Stimulation): Physiological Mechanisms and Clinical Outcomes

Dave Siever, CET , Elise Jones, MA

Ponderosa

Over 99% of American businesses are categorized as small businesses дус those employing less than 100 persons дус and small businesses employ 48% of working Americans (McIntyre, 2018 , Desjardins, 2017). Although there is dispute of exactly how many small businesses fail дус between 33% and 46% in the first 5 years, and nearly 80% failing by year 10 дус there is general consensus as to why they fail (McIntyre, 2018 , Desjardins, 2017 , Waring, 2017). Reasons for failure range from no market for the service, poor cash flow, poor team chemistry/bad hires, being out-competed, pricing/cost concerns, loss of focus, burnout, and poor marketing, among others (Wagner, 2012 , Gerber, 1995, 2005). These areas of failure are attributable to what Gerber (1995, 2005) says are the failures in, and competing requirements of, the three roles the small business owner fills: the entrepreneur, the technician, and the manager. For neurofeedback professionals, and others in the brain/mental health care space, nothing in the formal curriculum of licensure track graduate schools prepares them for building and growing a practice that will survive long term. Many of the obstacles to growth faced by neurofeedback professionals are common to all small business owners and are the result of limiting beliefs, faulty assumptions (Hyatt, 2018), and failing to work on the business due to the time demands of working in the business (Gerber, 2005 , Pagan, 2018). Others make the mistake of engaging in "hope marketing" (Walker, 2014), the idea that "if you build it, they will come." Neurofeeback practices, like other small businesses, have basic business activities (marketing, sales, delivery) and disciplines (brand, finance, management) that require the entrepreneur's disciplined leadership if the business is to succeed (Gerber, 1995, 2005). The nature of neurofeedback encourages the neurofeedback professional to cling to the technician role, often to the neglect of the entrepreneur role. The technician is the worst marketer, often focusing on the technology and not the transformation that neurofeedback offers to clients. The entrepreneur however, can tell a compelling story, the hero's journey, that connects with their vision and passion that will resonate with prospective clients. Neurofeedback professionals, as other entrepreneurs, struggle with identifying ideal clients (avatars) and appropriate marketing tools and strategies, and using social media as a means of engaging existing and potential clients (Brunson, 2017 , Walker, 2014). However, growth opportunities afforded by mastermind communities, referral source connection events, technology, customer relations management (CRM) tools, and social media marketing abound for entrepreneurs willing to be stretched personally and professionally (Brunson, 2017 , Patel, 2017 , Pagan, 2018).

Why Neurofeedback Practices Fail and How Not To (Day 2 of 2)

Wes Center, PhD

Lupine

This beginners level, Infraslow Fluctuation Training will demonstrate this unique neurofeedback process in clinical practice in a three day workshop. The method pivots on the determination of an optimum frequency (OF) that is discovered for each client. Day one is the didactic portion of the workshop that includes basic software instruction, experiential training in a clinical decision tree for defining beginning placements, a demonstration of the OF determination process along with a discussion of the equipment and optimal signal processing requirements necessary to accomplish effective training. The value of QEEG in predicting treatment responders, treatment planning, and determining treatment outcomes will be established. Day two and three will be hands-on instruction in ISF training. Students will have several opportunities to implement and experience ISF training. Infraslow frequencies were first identified by Russian researchers in the 1950s (Aladjalova, 1957, 1964). These slow processes have been associated with the Hypothalmic Pituitary Adrenal Axis since that time when Aladjalova implanted electrodes in rabbit Hypothalamus. She described an increase in amplitude and a decrease in frequency in response to wounding that she theorized was a reparative, parasympathetic response. Infraslow frequencies, also corroborated by Joe Kamiya (Girton, Benson, & Kamiya, 1973), have become a signal of significant interest to researchers recently. Research suggests that the infraslow signal underlies the excitability dynamics of cortical networks (Vanhatalo et al., 2004). Vanhatalo, convinced of ISF's centrality in cortex, stated that any attempt to attenuate this slow signal eliminates the most salient features of the human EEG. Further, it appears to be a direct electrophysiological correlate for slow fluctuations in human psychophysical performance (Monto, Palva, Voipio, & Palva, 2008). Most recently research has suggested that very slow oscillations are associated with the Default Mode Network of the human cerebral cortex and appear to be related to ADHD symptom status (Broyd, Helps, & Sonuga-Barke, 2011 , Tye et al., 2012). Palva (Palva & Palva, 2012) describes the Infralsow frequencies as the думsuperstructureдуќ in cortex that regulates the activity within and between active neuronal networks. A recent software innovation has allowed this slow signal to be simultaneously rendered in a bipolar and referential montage. The advancement has made it possible to record in two channels while training on the bipolar montage. This allows for the monitoring of Zscores, slow cortical potentials, and raw amplitudes at each site during ISF training. This improvement makes for a safe, effective, and data rich method of slow wave training. This workshop will be taught on the Brainmaster Avatar platform that utilizes the Atlantis or Discovery amplifier. Attendees with equipment should contact admin@neurofeeedbackservicesny.com to arrange for an ISF license before the workshop. Attendees do not need to have a Discovery, an Atlantis, the Avatar software, or an ISF License to attend. There will be enough equipment and software available for all attendees to use in the workshop. However, for the best learning experience it is recommended that attendees obtain either the Atlantis or the Discovery amplifier, and the Avatar Software with an ISF License.

Beginner Infraslow Neurofeedback (ISF) Workshop (Day 3 of 3)

Mark Smith, LCSW , Ray McGarty, MSW

Larkspur

This 3-day workshop is a learning arena for the practitioner, which includes essential concepts, core paradigms, principles, and areas of applicability of the Low Energy Neurofeedback System (LENS), and how to integrate the concepts into the practitionerНs practice. The workshop will offer hands-on training in the LENS in addition to a foundational knowledge in assessing the client, development of a treatment plan, using the concepts presented and how to reevaluate the effectiveness of the treatment plan. Day 3: Discussion of when, why and how to adjust the treatment plan based upon patient response to the previous session. Presentation of how altering the various application settings impact the course of treatment. Discussion of medication effects on client symptom profile, what to monitor and when adjustment might be necessary. ______________

Foundations of the LENS (Day 3 of 3)

Daphne Waldo BS, RN, MSN, CNL, PHN

Primrose

The neurotherapist is first a neuroscientist, a neurophysiologist, a neuroanatomist. Mastering these areas is a necessity before applying modalities such as neurofeedback, magnetic stimulation and electrical stimulation. Furthermore, the neurotherapist increasingly has the opportunity to interact and share clients with neurologists. The goal of this workshop is to provide the framework of clinical neurophysiology and functional neuroanatomy for a spectrum of the more common disorders that affect the nervous system. Presented by a neurologist/clinical neurophysiologist, and his chief EEG/neurotherapy technologist, this workshop will build a common bridge for communication between the fields of neurotherapy and neurology. The workshop begins with a review of functional neuroanatomy. Structural and physiologic correlates to brain, spinal cord, and peripheral nervous system function will be reviewed. Fundamentals of the tools that have been historically used to define these functions, such as EEG, QEEG, MRI, PET, SPECT, cognitive and event related evoked potentials will be discussed. The workshop will then review a variety of common disorders that affect the nervous system including QEEG findings and neurotherapy strategies for each: Seizure disorders are common disorders which affect the brain and often present with abnormalities of the EEG/QEEG. The current nomenclature and organizational understanding of the various seizure types will be reviewed. Appearance of various paroxysmal disturbances seen on EEG will be presented. Standard medication and non-medication therapies, including neurofeedback will be discussed. Concussion/Traumatic Brain Injury are perhaps one of the most common presenting disorders affecting brain function. A review of the acute and chronic pathophysiology along with neuroimaging, EEG and QEEG findings commonly associated with these injuries, epidemiology, and clinical management will be presented. Sleep disorders are common confounding variables to neurotherapy. Often treatment of the underlying sleep problems will affect the QEEG appearance. Similarly, neurotherapy often will result in improved sleep quality. The workshop will review common sleep disorders including insomnia, sleep apnea, restless legs and periodic limb movements, shift work and other circadian disorders, and narcolepsy. Migraine is another common physiologic disorder affecting 1 out every 5 women. The neurovascular theory of migraine pathophysiology will be presented. Migraine may have a complex presentation including complicated aura, and associated symptoms such as sensory sensitivity, nausea and pain. Pharmacologic, nutritional supplement, and neurotherapy strategies will be reviewed. Stroke and Neurodegenerative disorders. These are the common disorders of the elderly. The anatomy of the vascular supply to the brain will be reviewed. Common and rare causes of stroke will be presented. Prevention and treatment strategies will be discussed. A review of the neurodegenerative disorders including Alzheimerду»s, Parkinsonду»s, Lewey Body Disease, Multiple System Atrophy, and others will be presented as well. Toxic/Metabolic Encephalopathies. The common causes for toxic and metabolic encephalopathies including thyroid disease, hypoxia, hypercarbia, hepatic and renal failure and others and their effects on the QEEG will be presented. Attention Deficit Disorder. A neurological historical perspective of the disorder will be presented. Current concepts, epidemiology, natural longitudinal progression, and treatments will be reviewed. The workshop will end with a Q&A discussion to review the days topics.

Neurology for the Neurotherapist

Harry Kerasidis, MD , David Ims, MA

Evergreen F

This course satisfies 24 of the 36 didactic course requirements for QEEG Certification as arranged by the QEEG Certification Board. Attendees will earn up to 24 hours towards their QEEG certification requirements. This workshop has been approved by the QEEG Certification Board to provide didactic training which is recognized by the Board toward certification as a technician or a diplomate. This course is based upon the original 24-hour didactic blueprint, that has been in effect in the past. Beginning in 2019, the didactic requirement has increased to 36 hours, by the addition of 12 additional hours. This course remains as originally designed, with the original 24hour content. The following description includes material from the QEEG board certification requirements for the original 24-hour didactic program. Workshop topics will include Editing raw EEG and recognizing and removing or accounting for artifacts. Drug Effects including how drugs affect the EEG patterns, as well as how EEG can be used to predict and monitor drug response. Database Analysis Clinical and Cognitive Aspects , Montages and Spectral and Topographic Aspects of the EEG. Attendees will learn the subject inclusion and exclusion criteria for building a database .and fundamental statistical considerations within databases. Further detailed topics will include the effects of various drugs on the EEG/QEEG data and developmental changes in the EEG and knowledge. Brodmann area functions and network connections will provide an understanding of LORETA and sLORETA interpretation and training Practical information will include knowing which EEG signatures should be referred out to other professionals Be knowledgeable about general cognitive and clinical changes that take effect after neurofeedback training. The remaining required hours are 4 hours of Ethics, and 4 hours of QEEG and Neurofeedback. These can be earned through other classroom or online opportunities that are available and will be briefly described on the first day of this course.

QEEG Didactic Board Certification Course (Day 3 of 3)

Thomas Collura, PhD, MSMHC , David Cantor, PhD , Harry Kerasidis, MD

Aspen Amphitheater

For the past 30 years operant conditioning approaches have largely utilized EEG neurofeedback as a method for regulating the brain. The research shows that EEG neurofeedback has had a positive impact on multiple patient populations, but can take a long time in order to achieve a treatment effect. Neurostimulation approaches have been shown in the research to have a positive impact on multiple patient populations, but the long term effects have not been consistent or enduring. In this workshop Dr. Dogris & Dr. Thompson will demonstrate how to use QEEG data to generate treatment plans and strategies for using pEMF, tDCS, tACS and tRNS stimulation modalities for the treatment of ADHD, Depression, Anxiety, TBI and other clinical diagnosis. Furthermore, a discussion about how pEMF, tDCS, tRNS and tACS can be utilized to address power, coherence and phase dynamics in the EEG. QEEG data will be presented along with clinical outcome data. . . . . . . . . . . ......................................................................... .......... . . . . . . . . . . . . . .. .......................................................................................... .. . . . . .c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ./ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The use of Neurostimulation in Clinical Practice (Day 2 of 2)

Nicholas Dogris, PhD

Bluebell

Thursday, September 19
Plenary Sessions 8am-9am

HYPOTHESIS Evidence support the efficacy of transcranial photobiomodulation (PBM) to affect a wide variety of brain conditions [Hamblin, 2016, Salehpour et al, 2018). It is therefore reasonable to expect that underlying the clinical outcomes, are changes in neural oscillations. Such changes would be measurable with EEG. We could potentially use such data to adjust PBM parameters to modulate the brain to address various brain conditions or even elevate normal brain performance. This would be a novel and useful brain stimulation method for neurofeedback (NFB) practitioners. SUPPORTING EVIDENCE TO DATE In PBM, near infrared (NIR) light directed to the default mode network (DMN) at selected pulses could produce large brain responses. This has been suggested in studies involving dementia (Lim, 2018, Saltmarche et al, 2017, Zomorrodi et al, 2017) and acute cognitive processing (Heinrich et al, 2019). In a controlled study that specifically explored neural response to 40 Hz directed to the DMN of healthy subjects (the Gamma EEG study), it was found that the power spectrum and connectivity of alpha, beta and gamma increased significantly. Surprisingly, the opposite was found for the slower delta and theta bands where the power spectrum decreased with no significant change in connectivity. In the meantime, there was a global increase in inhibition which is often desirable (Zomorrodi et al, 2019). The changes are observable in QEEG maps, producible with commonly used 19-channel practitioner systems. These information gives a good basis to explore another popular pulse frequency with PBM to determine how much of the effect of the previous study with 40 Hz can be replicated, and what else can be learned with pulsed PBM. METHODS In a new study, we induce a different pulse frequency - of 10 Hz. The protocol of this new study is similar to the above study except that a frequency of 10 Hz is used instead of 40 Hz. It will also be a randomized double-blind study involving 20 healthy participants. In addition, a task stimulus is added to study event-related potential (ERP). Participants crossover to a different device (either from active to sham or vise versa) after a washout period of 2 weeks. RESULTS At the time of writing, the study has started but not completed. The results and analysis will focus on the similarity and differences with the Gamma EEG study so that we have new data on the effect of a different set of parameters, plus ERP. It leads to further investigations for personalized treatments. CONCLUSIONS Although this new study is yet to complete, the data from the Gamma EEG study has already given us considerable bases to make the following conclusions from pulsed PBM: 1. We can produce significant brain modulation that is frequency-dependent 2. It shows the potential for PBM to be an important partner to NFB practice 3. It will create clearer opportunities for personalized treatments. Findings in this new study inducing the alpha frequency of 10 Hz and a task, could give us new data to help improve future transcranial PBM treatments.

Neural Oscillations Induced with Photobiomodulation Could Improve Neurofeedback Outcomes

Lew Lim, PhD, MBA

Aspen Amphitheater

Violent offenders often present with Attention-Deficit/Hyperactivity Disorder (ADHD). Additionally, violent behaviour is associated with frontal lobe damage and, in some cases, with undiagnosed seizure disorders. Neurofeedback has established efficacy for treating both ADHD and Epilepsy, so logic supports using neurofeedback in a population prone to committing violent acts. Following that logic, Douglas Quirk treated violent offenders at the Ontario Correctional Institute, eventually publishing some initial findings in 1995. He documented a dose-response curve: the greater the number of neurofeedback plus biofeedback training sessions, the less likely the individual was to reoffend. Documenting that recidivism dropped from 65% to 20%, he estimated that neurofeedback training prevented more than 100 murders. Quirk died shortly after publication of those findings. This presentation seeks to renew interest in working with this population by reviewing both his work and other research findings that support applying neurofeedback and biofeedback to treat people who display violent behaviour. This presentation will review the rationale for applying neurofeedback , namely, that there is frontal lobe dysfunction, including high rates of ADHD, in the population of incarcerated people. This will be followed by a description of the intervention method of neurofeedback combined with appropriate biofeedback. The neurofeedback can be single or two channel but how to assess using 19 channels and treat with LORETA NFB will also be described. The biofeedback modalities are chosen following a stress test that identifies how a client responds to and recovers from mild stressors. The BFB modalities include peripheral skin temperature, skin conduction (electrodermal дус EDR), electromyogram, heart rate, and respiration. There will be an overview of relevant research papers that support major sections of material. The talk will finish with recommendations regarding not only how further applied research might be done in correctional facilities but also with how the neurofeedback practitioner can identify and treat potentially aggressive patients.

Preventing Murder: Treating Violent Behavior with NFB + BFB

Michael Thompson, MD, BSc , Lynda Thompson, PhD

Evergreen A-C

Plenary Sessions 9:10am-10:00am

Brain functions have been proved to be affected by external stimuli. Photobiomodulation (PBM) using near-infrared is one of the effective ways to modulate the hemodynamic activities in the brain and to activate the key enzyme cytochrome c oxidase (CCO) in electron transport chain (ETC) (Anders, Lanzafame, & Arany, 2015 , Anders et al., 2014 , Barrett & Gonzalez-Lima, 2013 , Blanco, Saucedo, & Gonzalez-Lima, 2017 , Rojas & Gonzalez-Lima, 2017 , Tian, Hase, Gonzalez-Lima, & Liu, 2016 , Vargas et al., 2017 , Wang, Tian, Soni, Gonzalez-Lima, & Liu, 2016). However, the effective dosage, or the right recipe for the power density as well as treatment time, is still not clear. To answer these questions, it is necessary to have a detailed optical model to describe the penetration rate and how photons propagate transcranially, particularly to reach the prefrontal lobe that dominates the cognitive functions. In this research, we used five layers of tissues including skin, skull, cerebrospinal fluid (CSF), gray matter, and white matter, each of which is represented by a set of wavelength-dependent Scattering coefficients ‘_s (‘й) and Absorption coefficients ‘_a (‘й). The anisotropy factor g is needed to run Monte Carlo simulations and predict the reflectance (fraction of light returning to tissue surface) (Sung, Kao, Zhan, & Lin, 2019). A broadband Near-Infrared light source emits photons through the prefrontal area, and a linear array with 10 sensors spacing 10 mm from each other collects the photons scattering back from the superficial and deep tissues. Based on these collected data, the Monte Carlo model is built and simulations are executed in high speed parallel computers. The thickness of each layer of the model is from the MRI result of participants. Through the Monte Carlo simulation results, we identified that penetration rate for the skull is about 3.5% and the photons could reach as deep as 4 cm to the grey matter, with about 2% of photons. In addition, we also noticed that photons have the longest path distance horizontally in the skull layer. This indicates that photons travel longer than expected as in previous studies. Therefore, the short-channel effect completely cannot be ignored when using Near-Infrared Spectroscopy (NIRS) techniques (Wang et al., 2016) to measure the activities of the CCO at the prefrontal lobe after the PBM treatment.

Optical Model of Transcranial Infrared Light and the Penetration Rate to Prefrontal Lobe

Kailin Wang, PhD , Lida Huang, PhD , Kung-Bin Sung, PhD

Aspen Amphitheater

Objectives and Hypotheses: The purpose of this study was to explore the feasibility and validity of Cerebellar EEG Biofeedback. Cerebellar EEG sources have been published using swLORETA with 128 channel EEG recordings (1,2). The question at hand is can cerebellar sources also be recorded using only 19 channels and can changes in limb position result in changes in cerebellar sources and can cerebellar sources be modified using standard EEG biofeedback methods. The null-hypotheses were: 1- It is not possible to measure cerebellar current sources using 19 channel EEG, 2- It is not possible to measure cerebellar functional connectivity to other brain regions, 3- It is not possible to change cerebellar EEG sources and/or connectivity by experimental manipulation and, 4- It is not possible to change cerebellar current sources using EEG biofeedback. Methods: The electroencephalogram (EEG) was recorded from 19 scalp locations referenced to linked ears from 10 normal controls and 10 TBI patients (age 18 to 23 years). The standard MNI-Colin27 MRI (3,4) with 12,056 voxels was used to compute the inverse solution using swLORETA (5). The Hilbert transform was used to compute the real-time auto and the cross-spectrum. Current sources from the 10 major cerebellum regions were computed off-line and in real-time (Vermis, lobules IV-VI, VIIB дус VIIIB and flocculus (6)). The measures of functional connectivity were coherence and phase differences between the 10 left hemisphere and the 10 right hemisphere cerebellar center voxels and the center voxels of 44 left hemisphere and 44 right hemisphere Brodmann areas. Results: All 20 subjects demonstrated cerebellar current sources in all 10 cerebellar regions in both off-line analyses and in real-time via playback of the recorded EEG. Similarly, functional and effective connectivity were successfully computed between the cerebellar center voxels and various neocortical center voxels, including Brodmann areas 3, 4, 5 and 7 which are known cerebellar projection areas. Conclusions: The results of the analyses rejected hypotheses #1 and #2 and successfully established the feasibility of measuring cerebellar current sources and functional and effective cerebellar connectivity using 19 EEG channels. Testing of the validity hypotheses #3 and #4 are awaiting the development of the necessary software for left vs right finger-to-nose and point-to-point cerebellar testing and neurofeedback software. We expect to complete the software development and the testing of these two hypotheses around July 2019 in advance of the ISNR conference.

The Feasibility and Validity of Cerebellar EEG Biofeedback

Robert Thatcher, PhD , Ernesto Palmero-Solert, PhD , Carl Biver, PhD

Evergreen A-C

Since the development of the Yerkes-Dodson curve of 1908, much has been learned about arousal and its relation to peak performance. Different activities require different levels arousal for top-notch performance. For instance, the arousal necessary to play a good game of golf is very different than required for a good game of hockey. Fear from self-criticism, stereotype threat, fear of losing a competition, excitement over the cameras, media and new adventures often adversely affect performance. Those with the calmest level of disposition often win the competition, even if rated as the underdog prior to competition. However, some athletes start a competition with too low an arousal and do poorly in the beginnings of a competition. Also, many athletes struggle with sleep and often have their worst sleep the night prior to competition. Audio-visual Entrainment (AVE) is a technique employing light & sound stimulation at various frequencies, which in turn can dramatically affect arousal. A peak-performance AVE protocol in combination with the EX-RAY visualization along with heart rate variability, enhances peak performance, and improves sleep, resulting in first-place finishes. Many Olympic and professional athletes have used AVE over the years to gain the mental edge over their opponents. The concepts and techniques surrounding peak-performance will be reviewed and demonstrated. Jeff Simonson, a competitive and winning racquetball player will explain how AVE has helped him achieve his 1st place finishes. Jeff has been playing tournament racquetball for the past 7 years. Until last year he never finished higher than 3rd place. In 2018 he started using the AVE on a regular basis and specifically a couple hours before a tournament. Last year he started winning tournaments. Heду»s been named to the Oregon All State Racquetball team in 2018 and 2019. Earlier this year he won the Oregon Championships for his division. He is also an avid golfer and has seen his game improve through use of the AVE.

Peak Performance in Sports: Factors that Impair Performance and Means of Improving It

Dave Siever, CET , Jeff Simonson, BA

Evergreen D-E-F

Plenary Sessions 10:10am-11:00am

This presentation will discuss the dynamics involved when directly integrating pulsed near-infrared light into neurofeedback designs which modulate the delivery of the pulsed NIR based on changes in selected EEG metrics. Used as an adjunctive intervention, the photobiomodulation devices have historically been standalone methods, delivering pre-set pulses for selected amounts of time in a separate context from neurofeedback. One example of this technology is the Vielight Neuro. The first instrument of its kind, the VieLight is a transcranial-intranasal near infrared light (NIR) photobiomodulation device, delivering pulsed NIR with light emitting diodes (LEDs) at a wavelength of 810 nm, which has been documented as the infrared wavelength with the highest skin penetration profile (Rojas, 2013). Delivering the near-infrared light in pulses, instead of as a continuous exposure, addresses concerns regarding thermal effects on biological tissue (Ando, 2011). Making the Vielight stimulation contingent on EEG behavior creates a framework in which the pulsed light becomes an explicit feedback element, an entirely novel application pairing its documented enhancement of BDNF and synaptogenesis (Hennessy, 2017) with unique patented live Z-score neurofeedback designs focusing heavily on supporting neural connectivity (Collura, 2008). These feedback designs incorporate the Vielight device to deliver NIR at 810 nm, pulsed at rates determined by the clinical analysis of individual qEEG results of each subject within the context of current literature on photobiomodulation. The exposure to these pulses are directly modified by shifts in pre-selected EEG metrics, with paradigms based on changes in power and connectivity in monitored neurophysiological locations compared to a set of database norms. Early findings in the literature indicate photobiomodulation has significant clinical potential in the treatment of a number of brain based disorders, including, but not limited to, traumatic brain injury (Henderson, 2016), Alzheimer's and Parkinson's (Johnstone, 2015), improving executive function (Barrett, 2013), memory (Rojas, 2012), stroke and developmental disorders (Hamblin, 2016), and depression (Cassano, 2015). A meta-analysis of articles examining the link between photobiomodulation and biological processes such as metabolism, inflammation, oxidative stress and neurogenesis suggest these processes are potentially effective targets for photobiomodulation to treat depression and brain injury. It also suggests there is preliminary clinical evidence suggesting the efficacy of photobiomodulation in treating major depressive disorder, comorbid anxiety disorders, and suicidal ideation (Cassano, 2016). Case studies with pre and post qEEG findings will be presented, and the practical significance of including photobiomodulation as an element of feedback within the neurofeedback paradigm itself will be discussed, as well as design principles underlying its integration with visual and auditory feedback.

Clinical Considerations of EEG-Guided Pulsed Near-Infrared Light as Feedback

Penijean Gracefire, LMHC, BCN, qEEG-D

Aspen Amphitheater

This course is for anyone who has wondered: " is that real or fake?" Artifacts in EEG can seriously hinder an accurate interpretation of the QEEG, altering neurotherapeutic protocol choices and potentially threatening the patientду»s clinical outcome. Muscle tension can look like anxiety, lateral eye movements and pulse artifacts can create delta and the mis-interpretation of head injury, a contaminated ear electrode can create hypercoherence! This presentation will demonstrate how artifacts appear not only in the raw EEG data, but also in the QEEG data. Tiff hopes to spare you and your patients this dilemma in the future, as well as provide tips on how to avoid any mis-read of quantitative and raw EEG data. While some artifact can be prevented or omitted, other artifact must be read around. The skilled clinician needs the ability to explain these findings to their patients when asked думwhatду»s that?дуќ Through exploring the more and less insidious forms of artifact, this lecture will guide the clinician through some of the more advanced ways of interpreting EEG so that the QEEG does not mislead one into misdiagnosis. Some of the artifacts covered will include channel noise, 60Hz/50Hz, blinks, chewing, EKG (various presentations), electrode pops, eye rolling, sweat, lateral eye movements, medication, mixed metals, muscle tension, shared variance, as well as easily confused real conditions. This presentation will be simple enough for the novice neurotherapist, but rich enough that even the most seasoned clinician should be able to glean something new.

All Artifacts

Tiff Thompson, PhD, R.EEG.T, BCN, MFT

Evergreen A-C

The objective of this investigation is to explore the relationship between symptoms and cognitive performance and volumetric QEEG analysis after sport concussion injury in high school athletes. Methods: Standard electroencephalograms (EEGs) were recorded in 70 high school athletes (31 males) shortly after concussion injury using sLORETA imaging compared to a normative database (NYU/BrainDx). Peak Z-score variation (PZV), and %volume of grey matter activity that fell outside Z= -2.5 to 2.5 (PIGMV for increased activity, PRGMV for reduced) were calculated for each of 5 EEG frequency bands. These data were compared for correlations to computerized neurocognitive and symptom assessment (XLNTbrain) also performed shortly after concussion injury. Results: Statistically significant Pearson r correlations were found with XLNTbrain Composite scores. For PZV: Negative correlations between Delta band PZV MIN values and non-verbal processing/memory scores (r=-.334, p=.005, r=-.339 p=.004 respectively). Positive correlations were found with Alpha band PZV MAX and verbal memory score (r=.319, p=.007). For PIGMV: Positive correlations were found between alpha band PIGMV and verbal processing, verbal memory, attention, and emotional reactivity (r=.341 p=.004, r=.351 p=.003, r=.244 p=.042, and r=.254 p=.034 respectively). Taking reaction time into account with Throughput measures: For PZV: Negative correlation was found between delta band PZV MIN and non-verbal memory. Positive correlations were found between alpha band PZV MAX and verbal memory. For PIGMV: Positive correlations were found between alpha band PIGMV and verbal processing and verbal memory (r=.28 =.019, r=.314 p=.008 respectively) and the beta-gamma band and nonverbal processing and non-verbal memory (r=.281 p=.019, r=.3 p=.012 respectively). Conclusions: This study demonstrates correlations between performance on computerized neurocognitive tasks and changes in quantitative sLORETA EEG analysis shortly after concussion injury in high school athletes. The data suggest that different cognitive processes may be supported by different frequency band activity. Further research including region specific EEG analysis and gender differences is needed.

Correlations between quantitative EEG volumetric analysis and computerized cognitive testing shortly after sport concussion injury in high school athletes

Harry Kerasidis, MD , David Ims, MA Stacie Rector, MS, LAT, ATC , Stephanie Guzzo, MS, LAT, ATC , Andrew Ims, BS , Annastassia Kerasidis, BA

Evergreen D-E-F

Thursday Plenary
Thursday Workshops
Thursday, September 19
Conference Workshops

This workshop covers areas from the BCIA blueprint of knowledge and skills, information relevant to all neurofeedback practitioners. Basic definitions and descriptions will be discussed. It will cover the highlights concerning the history of neurofeedback, research criteria for determining efficacy, efficacy levels of various disorders treated with NFB, basic neurophysiology & neuroanatomy (very brief) as these apply to assessment for biofeedback interventions, source of the electroencephalogram (EEG), instrumentation, procedures for assessment and intervention. It additionally comments on adjunctive techniques, including biofeedback and relaxation. Method This course is a didactic presentation that provides a very brief review of basic knowledge and will cover selected topics from the areas that comprise the Blueprint of Knowledge for specialty certification in EEG biofeedback developed by the BCIA. Goals are that participants will be able to answer questions on material that could legitimately be covered in a BCIA examination on EEG Biofeedback (that is, material that has been published, as contrasted to ideas based on clinical impressions). For example, they will be able to answer questions regarding EEG data collection and instrumentation including: impedance versus resistance, differential amplifier, sampling rates, filters and so on and understand EEG assessment (one, two and 19 channels, brain maps, LORETA, data bases, EEG artifacts, normal and abnormal waveforms, common findings in disorders where neurofeedback is used). Methods for obtaining accurate data and interpreting this information will be briefly covered. Additionally, they will be able to demonstrate an understanding of how learning theory (especially operant conditioning) applies to EEG biofeedback, discuss basic neurophysiology relevant to interventions that use the EEG (including Loreta z-score NFB) and briefly relate basic information on other related topics including: HRV, ERPs, ethics, statistics, and so on. Blueprint areas include: Section I Orientation: Overview of Biofeedback, Neurofeedback and Learning Section II Basic Neurophysiology and Neuroanatomy: Section III Instrumentation & Electronics: Section IV Research: Research Design with an emphasis on criteria for evaluating efficacy Section V Psychopharmacological Considerations: Overview as it relates to assessment and training. Section VI Patient/Client Assessment Section VII Developing Treatment Protocols: Fundamentals of Intervention: Choice of Electrode Placement, Channels, Bandwidths, and Adjunctive Techniques Section VIII Treatment Implementation Section IX Current Trends in Neurofeedback Section X Ethics and Professional Conduct: very brief review Results & Conclusions These headings do not have equal emphasis in this workshop. Feedback concerning the workshop has been that it increases the confidence level and successful outcomes for people taking the BCIA examination.

BCIA Review Course

Lynda Thompson, PhD , Michael Thompson, MD

Maroon Peak

JUSTIFICATION An increasing number of neurofeedback practitioners are enjoying the benefits of incorporating photobiomodulation (PBM) into their practice. To them, the reality of brain response to near infrared light (NIR) is no longer questioned. While often the immediate brain response is a cause for joy, inadequate understanding of the principles of PBM compromises on the attainment of optimal results. In addition, when we fine-tune the parameters further for neurofeedback (NFB) supported by EEG and QEEG, the results can be extraordinary. SUPPORT At this moment, investigations into the application of PBM for the brain is rapidly growing, having advanced from animal studies just a few years ago. We have seen some strong evidence from early controlled studies to treat a difficult disease like Alzheimerду»s and dementia (Lim, 2018), and major investigations into Parkinsonду»s are starting (Laakso et al, 2018). There have been published clinical reports for traumatic brain injury and stroke (Hamblin, 2018) and depression (Caldieraro et al, 2019). There is also evidence for cognitive enhancement (Henrich et al, 2019) and advanced meditation (Manchanda, 2018). Researchers and collaborators are continuously discovering new data that are yet unpublished but would be valuable for improving PBM outcomes. These data are obtained from clinical assessments, EEG, MRI and fMRI imaging. METHOD The half-day workshop will be compact and covers the principles of PBM, evidence on its effect on the brain, how PBM is applied to various brain conditions, how it can be applied as an adjunct to NFB practice and what to look forward to in the near future. It will include powerpoint presentations, discussions, hands-on guidance, sharing of experience by practitioners, and questions and answers sessions. EXPECTED RESULTS AND CONCLUSION Since much of the information shared here are unpublished nor openly revealed for various reasons, attendees will be treated to inside knowledge of the reasons and best practice behind PBM. Existing users will benefit from how to improve outcomes and newcomers will be surprised with the possibilities of PBM. The workshop will discuss various clinical conditions commonly treated in NFB practice on an experimental basis. It will also cover chronic pain, addiction, cognitive performance, sports performance and meditation. In addition, it will explore the exciting prospect of personalized treatments.

The Principles and Practice of Photobiomodulation Relevant to Neurofeedback

Lew Lim, PhD, MBA

Blanca Peak

The workshop will demonstrate how to read the plain EEG visually, and how to quantitate the abnormal findings. The emphasis will be on how to recognize focal abnormalities including phase reversals, sharp waves, paroxysmal beta bursting, sharp waves, spikes, spike/wave, spike/near wave, and other generalized abnormalities. It will also emphasize the marking of the various abnormalities on the tracing during the visual interpretation using the neuroguide format. A live demonstration of reading an actual EEG will be conducted so that the participants will learn first hand how to perform this type of analysis. Participants will be encouraged to submit a case of their own to the presenter to read spontaneously during the presentation, demonstrate the findings, and reach a conclusion, and compare findings to the corresponding QEEG findings that they have beforehand and should be available at the time of the interpretation of the raw EEG. The case to be submitted should, of course, be a case of traumtic brain injury and/or concussion/post-concussion syndrome. If there is suffient time during the presentation, then more than one EEG will be reviewed, although a thorough discussion of the first EEG shall be conducted. The workshop will also teach how to apply the focal findings seen during the visual interpretation of the raw EEG onto a topographic model of the brain. It will also teach how to organize and how to apply the focal findings onto a topographic model of the brain. The workshop will also teach how to recognize a trauma pattern, especially the coup-contrecoup classic finding. It will also demonstrate the positive correlation with the neurological examination, the QEEG, and the SPECT scan findings. The positive agreement between the localization of the various diagnostic tests is high, and one diagnostic test cross confirms the other. An example of how the EEG report is written up will be shown as an example, and how the reader may want to present their findings.

How to read an EEG quantitatively

Paul Wand, MD

Longs Peak

Live Complexity Training (LCT) (Dailey, 2018) is based upon an emerging EEG paradigm known as thalamocortical dysrthymia (TCD). It was originally proposed by Llinas et al (1999) and Llinas et al (2005) and more recently studied by Shulman et al (2011), Ros (2016), Vanneste et al (2016) and Vanneste et al (2018). Of particular note is further work by De Ridder and Gunkelman (2018) who described TCD and cross-frequency coupling (CFC) as думa unifying pathophysiological explanation for brain disorders.дуќ The following is a brief review of TCD and CFC as it relates to LCT neurofeedback training. Definitions Thalamocortical Dysrthymia (TCD) Thalamocortical dysrthymia is an emerging explanation for divergent neurological disorders or думsickness behavior.дуќ It occurs when resting state alpha is replaced with cross frequency coupling (CFC) of low and high frequency electroencephalagram (EEG) oscillations (theta to beta or gamma). More specifically, energy leaves 10 Hz peak alpha and appears in the lower (5-10 Hz) or upper (10-15) alpha skirts. See the spectral display below. This causes думredundancyдуќ in the EEG characterized by excessive theta and low oxygen intake, typically present in such disorders as ADHD, learning problems, head injuries and brain lesions and beta spindling (causing separation from oneду»s own sensory and kinesthetic cues (Shin et al, 2018)) as often occurs in PTSD. Sickness in the EEG Sickness in the EEG involves inefficient production of low and high frequencies plus a distorted peak 10 Hz alpha control in the form of a lowered alpha frequency (ex. depression), two discrete alpha peak frequencies (ex. schizophrenia, Shulman et al, 2011) or little to no established control frequency (ex. OCD). During this workshop, participants will discuss LCT and its main tenets, and then have the opportunity to view and practice theta/alpha/gamma (TAG) , delta/alpha/gamma(DAG) and Cross Frequency Coupling (CFC)with other workshop participants, if desired.

Understanding and Practicing 2XTAG Live Complexity Training (LCT) and Thalamocortical Dysrhythmia (TCD)

Lori Russel-Chapin, PhD , Theodore Chapin, PhD , Nicole Pacheco, PsyD

Humboldt Peak

To ICA or not to ICA? Independent Components Analysis is an EEG assessment tool that has become a recent point of controversy in the field of neurotherapy, however it stands as a widely accepted tool in academic neuroscience. This method of assessment is a signal processing that allows the separation of independent sources that are linearly mixed together. This allows for the separation of artifactual data from real brain data. Components in EEG data are spectrally and spatially independent patterns. Whereas analyses of the past have favored rhythm and frequency (two dimensional), the spectral rhythm is another lens, and can been seen in 3D with the use of the spatial dimension, providing for a more localized understanding of EEG phenomena. The non-invasive, whole brain imaging techniques available to neurotherapists are limited. EEG is known for its superior temporal assessment capability, relative to fMRI, MRI, and SPECT scans, however EEG has a limited spatial resolution. The scalp's smooth surface is used to pick up far-field potentials generated in cortical areas on the highly folded brain surface. This constraint makes estimation of the locations of neurophysiological current sources difficult. "Independent component analysis (ICA) is a signal decomposition technique that finds a set of maximally independent signals that mix linearly to produce the recorded data" (Bell and Sejnowski, 1995). This procedure allows for a more focused spatial assessment of brain activity, which increases in sensitivity according to the number of electrodes used. In this training, Tiff Thompson, PhD, R.EEG.T., MFT, QEEG-D, BCN will be demonstrating to participants how to use WinEEG, including importing data, raw wave form recognition, data cleaning (ICA-R), epoch selection and rejection, spectral analysis, and component generation. Coherence, asymmetry, and power will be examined as additional clinical tools useful in assessing the data. Dr. Thompson will be demonstrating the correct and incorrect ways to use the software and the basics of understanding differences between components vs. frequencies.

ICA101

Tiff Thompson, PhD, R.EEG.T, BCN, MFT

Pikes Peak

Friday Plenary
Friday, September 20
Plenary Sessions 8am-9am

Post-traumatic Stress is distinct from Moral Injury. The former is natural, automatic response to defend against danger, whereas the later is the interpretation of such an event, in light of an individualду»s values, beliefs, and world view. Moral injury, unlike post-traumatic stress, occurs when a person is able to reflect upon a traumatic experience after the immediate danger has passed (i.e., interpretation) (Ames, Erickson, Youssef, Arnold, Adamson, Sones, ду_ Koenig, 2019). PTSD is a fear reaction to danger and has identifiable trauma symptoms such as flashbacks, nightmares, hyper-vigilance, and dissociation. On the other hand, moral injury is an inner conflict based on a moral evaluation of having inflicted harm, a judgment grounded in a sense of personal agency. Moral injury is strongly related to negative consequences associated with war-zone stressors that transgress military veteransду» deeply held values and beliefs (Currier, Holland, Drescher, Lisman, & Foy, 2016). Currier, Holland and Malott (2014) hypothesized that lack of meaning increase the risk for adjustment problems after warzone service. Moral injury describes the effects of acts of commission or omission in war that result in mental, emotional, and spiritual struggle (Currier et al., 2016). In the past 15 years, the literature on disasters and mental health has shifted from a focus on psychopathology, to an interest in documenting manifestations of resilience in the face of mass trauma (Cerdнз, 2014). Positive psychology has provided a new forum for discussion about how we construe mental health issues. Each generation and each culture faces basic questions about the meaning of birth, suffering, and dying. Each has its own social constructions and ways of managing these very basic human experiences (Joseph, 2009). Post-traumatic Growth is the positive psychological change experienced as a result of a struggle with challenging life circumstances that represent significant challenges to the adaptive resources of the individual and an individualду»s way of understanding the world and his place in it. This positive change depends on an individualду»s perceived control that he has over a stressor, which in turn determines the stressorду»s impact. From a neurophysiological perspective, and individualду»s perceived control over a stressful situation suggests that the Dorsal Raphe Nucleus (DRN) in the brainstem and the ventral medial prefrontal cortex (mPFCv) (i.e., Brodmann areas 24, 25, and 32) are key in this process. Indeed, the prelimbic and infralimbic areas of the mPFCv ascertain whether a stress inducing stimulus is under an individualду»s control. Therefore, when an individual perceives that such a stimulus is under his control, the stress-induced activation of the DRN is mediated or inhibited by the mPFCv, and the effects of the думuncontrollableдуќ stressor are thereby blocked. This process implies that the perceived manifestation of control mediates the stress response that is triggered in the brainstem. Thus, as a practical matter the negative impact of stressors that cause dysregulation of the autonomic nervous system can be mitigated via entraining the functional neural networks that involve the mPFCv and DRN via biofeedback and neurofeedback protocols.

Understanding the Neurophysiology of PTSD, Moral Injury, and Post-traumatic Growth: How It Can Guide Training Protocols

Manuel Halter, PhD, JD

Aspen

INTRODUCTION In their landmark 1989 paper, Peniston & Kulkosky used alpha theta neurofeedback to promote alpha and theta wave production in alcoholics and improve treatment results. The EEG profiles of alcoholics often demonstrated reductions in alpha activity and alpha reactively increased in these individuals when alcohol was consumed (Pollack, Valavka, Goodwin, et al., 1983). Results from Peniston and Kulkoskyду»s original methodology indicated increased alpha and theta brainwave production, normalized personality measures, and prolonged prevention of relapse for the neurofeedback group (Peniston, 1998). Research has suggested that the application of alpha-theta neurofeedback is beneficial in promoting long term abstinence (Fisher, 2009). Independent studies with minor variations to the neurofeedback protocol have achieved similar success (Scott, Kaiser, Othmer, & Sideroff, 2005). Since 1989, drug court programs have integrated the leverage of the criminal justice system to addiction treatment services (Ritvo, Martin, & Fehling, 2015). The current study sought to apply neurofeedback within the context of a drug court program. The study participants were female members of an internal family systems (IFS) therapy group which had met for sixteen weeks as required by drug court. METHODS Pre-treatment baseline and post-treatment QEEG data, cognitive testing data and subjective symptom scores were acquired before and after treatment. Twice weekly, single channel electrode neurofeedback training was performed on a BrainMaster Atlantis amplifier in BrainMaster 3.7i software. Twenty sessions were planned but nineteen were performed due to inclement weather. Each client first completed five sessions of beta-type training. Alpha theta training was applied during the remaining sessions. RESULTS The subjective experiences of all three study participants improved with the neurofeedback sessions. QEEG analysis used ANI and BrainDx databases. Each participant in the study demonstrated changes in QEEG profiles over the course treatment. Alpha and beta bands demonstrated the most remarkable changes. Symptom scores reduced and trended towards improvement in two of three cases, while the last case remained elevated at a near constant level. Cognitive testing measures were varied and unreliable due to testing error. DISCUSSION While changes in the objective measures was mixed, making it difficult to draw concrete conclusions from this case series, dramatic changes were noted on some QEEG maps. No subjects relapsed during the neurofeedback program. In follow-up discussions all subjects reported improved self-regulation, emotional regulation, executive functioning. Group therapy facilitators and drug court council personnel noted changes in the participantsду» demeanor, mood, and personality. Follow up with the drug court council two months later revealed all three study participants were doing well and were on track to graduate from the drug court program within three months. CONCLUSION Study limitations and variance of objective results in the present study prevent clear conclusions about the efficacy of neurofeedback in this model, but interviews with the study participants, group therapy facilitators, and drug court council suggest neurofeedback had a positive effect. Future research is needed and currently a second study to use neurofeedback with individuals recovering in the drug court program is in development.

Integration of Neurofeedback in the Drug Court Treatment Model: A Pilot Study

David Ims, M.A. - Clinical Psychology , Harry Kerasidis, MD

Evergreen A-C

Plenary Sessions 9:10am-10:00am

Recent advances in computer technology have made QEEG testing relatively inexpensive and precise in identifying brain areas with electrical dysfunction related to either traumatic injury or neurodegenerative process. In this presentation, author presents two cases which can be frequently encountered in every neurological practice: case of early dementia and traumatic brain injury. QEEG may be used in clinical practice as an objective finding confirming diagnosis of early dementia. One case illustrates 62-year old patient who presented with gradual deterioration of memory and executive functions resulting in markedly reduced professional performance and income. This patient was seen initially by another neurologist who requested full neuropsychological evaluation which was not conclusive. MRI of the brain was reported as normal, however QEEG was completed which showed an increase in frontal and temporal delta and theta power. In addition, The executive network connectivity demonstrated hyper-coherence and reduced information flow between Brodmann areas-especially in the frontal regions. Further testing included glucose PET imaging which showed evidence of decreased metabolism in frontal and temporal regions in a pattern indicating diagnosis of Alzheimerду»s dementia. Subsequent computerized neuro-cognitive testing showed decline in his cognitive performance confirming clinical diagnosis of progressive neurodegenerative process. Second case demonstrates usefulness of QEEG as a marker of TBI and correlation with diffusion tensor imaging (DTI) modality of MRI. This patient was a 34-year old male who was hit by a drunken driver as a pedestrian and sustain brain injury which required hospitalization and prolonged rehabilitation. Subsequently patient complained of cognitive problems and speech dysfunction described as dysarthria as well as problems with ambulation difficulties due to weakness and balance problems. His cognitive complaints included short-term memory problems and low information processing speed. In addition, he reported behavioral problems including depression, anxiety associated with anger control. MRI of brain showed chronic changes of post-traumatic encephalomalacia, gliosis and axonal injury involving bilateral frontal lobes and right temporal lobe. DTI imaging showed statistically significant deviations of fractional anisotropy of the rostrum, genu and splenium of the corpus callosum and the right uncinate fasciculus and right inferior fronto-occipital fasciculus consistent with traumatic white matter injury. QEEG analysis of the surface EEG showed evidence of increased frontal and temporal theta power as well as reduction of frontal and central alpha and beta powers. SwLORETA imaging showed evidence of increased power in bilateral frontal and temporal lobes at 7 Hz with maximum Z score was located in the left anterior cingulate gyrus. SwLORETA imaging of functional connectivity and effective connectivity demonstrated both hyper-coherence and reduced coherence and reduced information flow between Brodmann areas especially in the frontal regions as well as in phase differences in parts of the corpus callosum. The clinical usefulness of QEEG will be demonstrated showing evidence of electrical abnormalities and networks dysfunctions including an elevation of frontal and temporal delta and theta powers as well as abnormalities in functional connectivity. In addition, the correlation of QEEG and findings from structural imaging technique-MRI diffusion tensor imaging (DTI) and another functional imaging-positron emission tomography will be presented.

QEEG as a useful tool for Evaluation of Early Cognitive Changes in Dementia and Traumatic Brain Injury (TBI) and other Neuro-psychiatric conditions-correlation with MRI, PET and Diffusion Tensor Imaging (DTI).

J. Lucas Koberda, MD, PhD

Aspen

Social Science literature offers many models of human emotions. Each model provides descriptive terminology but for the most part fail to identify the neuro-networks that are activated when elicited by external emotionally laden stimuli. Historically, science has viewed emotions as primitive and instinctive responses that were not associate with complex intellectual or cognitive functions. However, cognitive-emotional interactions are extremely important in every day decision-making and represents a significant area of study at present. In addition, the brain has a striking capacity to learn and remember the emotional significance of diverse stimuli and memorial events. Furthermore, the thought process allows humans to assign emotional valence to stimuli, and as a result can change the value that was previously assigned to a stimulus. Studies of brain functions reveal that neural pathways exist for these important cognitive-emotional interactions, but cross walking these cognitive-emotional interactions to widely used behavioral assessments is missing from the literature. Electroencephalographic (EEG) electromagnetic tomographic analysis (ETA) imaging techniques provide a mechanism for exposing neurological pathways of the emotional spectrum, while an individual is reliving emotional loaded past experiences. This presentation will focus on frontal EEG gamma band asymmetry, at the precognitive level and then will expand this examination to include other frequencies as well as other key subcortical structures. During the presentation, a number of experimental findings will be shared, including brain imaging of emotional triggers using the categories of fear, joy, anger and love. Experimental protocols require that each participant complete a behavioral insights assessment survey prior to coming to the lab for an EEG session. Participants are asked to write down three to five stimuli (single words or short phrases) for each of the four categories. The stimuli represent events that they believe will invoke feelings that fall into one of these categories. Next, they are asked to rate how strong they believe the emotion response will be on a likert scale. While connected for EEG data collection, each stimulus is presented [on screen] for a period of 2 seconds and are spaced with a [blank screen] with a randomized time between 3 to 5 seconds before a new stimuli is presented. The EEG process is followed by a post process interview. Participants are asked to review each of the stimuli they provided and reflect on their experience. The debrief includes asking if any particular stimuli stood out to them as being stronger or weaker than they originally thought, as well as exploring if any stimuli seemed to provoke additional thought or reflection when presented. All feedback is recorded and cross referenced to EEG output as well as a comparison to their behavioral style as identified in their behavioral assessment profile. Documenting the pathways exposed for each of these four emotional categories and then cross-referencing findings to a populate behavioral assessment is intended to provide new insights into the emotional tendencies of various behavioral styles and expose how different behavioral styles may process emotional stimuli differently.

Emotions: Exposing the neurological pathways that far too often controls our behaviors

Ronald Bonnstetter, PhD , Thomas Collura, PhD, MSMHC

Evergreen A-C

Developmental Trauma (DT) or complex childhood trauma is arguably one of the most important public health challenges in the United States. It has a negative impact on the mental, physiological and neurobiological functioning, leads to a lower quality of life, early death and creates a substantial financial burden for the individuals affected, their families, and the healthcare system as a whole. Moreover, people with DT are often more resistant to traditional therapy. Research have shown that neurofeedback and biofeedback effectively treat people with DT. While most of the outcome of the research and of clinical treatment is based on subjective measurements, such as questionnaires, less is known about objective measurements, i.e. neuromarkers and biomarkers in predicting and quantitatively measuring outcome improvement due to the treatment. The goal of this presentation is to deepen the participantsду» understanding of DT and to address the ways to effectively collect and identify neuromarkers and biomarkers This presentation will highlight the importance of conducting neurological and physiological assessments. i.e. neuromarkers and physiomarkers, in addition to using traditional subjective assessments (e.g. questionnaires). At the individual level, we will explore ways of assessing clientsду» baseline functioning, providing guidance for treatment, and tracking progress. To further the use and improve the outcome of these techniques, we will discuss the benefits and challenges of identifying patterns of brain and physiological activities. This presentation will begin by ways to detect DT and how it differs from PTSD. After providing an overview of the impact of DT on health and well-being, it will focus on the brain development and functioning. Next, the presentation will identify several markers such as quantitative EE (qEEG), Event Related Potential (ERP) and Heart Rate Variability (HRV). We will continue by using these markers to track progress and measure the impact of the treatment at the individual level. Case presentations and clinical examples will be used to demonstrate these points. We will talk about implementation of the individual data to identify patterns of activities. These patterns, can be used to predict the effectiveness of the treatment and to improve the outcome. Overall, this workshop will provide participants with a more complete understanding of DT and ways to use neuromarkers and biomarkers to predict effectiveness of treatment and to improve treatment outcomes. We will finish with future directions and challenges to collect and identify these markers and what we can do as a community to collect and analyze this valuable data in order to understand DT and improve outcome of treatment.

To Neuromarkers And Beyond: Importance Of Identifying Neuromarkers And Biomarkers To Predict And Improve Treatment Outcome For People With Developmental Trauma

Ainat Rogel, PhD, MSW , Diana Martin, MD, PhD

Evergreen D-E-F

Plenary Sessions 10:10am-11:00am

Barriers to the acceptance of a medical device innovation, electroencephalogram neurofeedback (EEG-NFB) for the treatment of ADHD in children, were investigated with a mixed-method embedded design utilizing the theoretical frameworks of Latour and Rogers. Within Latourду»s framework EEG-NFB is a technological innovation that is part of a larger paradigm shift going on in medical healthcare treatment. Healthcare professionals act as думgatekeepersдуќ to medical innovation within Rogerду»s framework. Eighteen U.S. and Dutch healthcare professionals, who commonly diagnose and treat children with ADHD, participated in the study. The mixed methods design involved a semi-structured interview embedded with quantitative assessments. The assessments included a self-monitoring questionnaire, selection and ranking of recommended treatments for for a child with ADHD from a vignette, and identification and ranking of factors that influence the healthcare professional's decision making process. Quantitative analyses were conducted with tukey-duckworth tests and a spearman correlation. Qualitative analysis was conducted by word analysis with Leximancer. No significant differences were present between the U.S. and Dutch healthcare professionals. The sample were all highly aware of EEG-NFB with half being EEG-NFB practitioners, some who refer for EEG-NFB, and a some who were aware of EEG-NFB but did not refer patients for treatment or practice it themselves. EEG-NFB was one of the most commonly recommended treatments, and the highest ranked treatment, for the child with ADHD from the vignette. The main barrier identified was awareness about EEG-NFB as a treatment for ADHD in children. Technical knowledge about how to actually conduct, refer for, and evaluate progress in EEG-NFB was another major barrier. One of the recommendations to increase adoption is to initiate marketing campaigns focused on increasing awareness among healthcare professionals. Another recommendation is affordable or free continuing education courses for healthcare professionals targeted toward how to speak to a patient about the proposed mechanism of action for EEG-NFB, find a provider to refer to, and evaluate a patientду»s progress during a course of EEG-NFB treatments.

The Psychology of Adopting Medical Device Innovations in Mental Healthcare: The Case of Neurofeedback in the United States and the Netherlands

Mark Trullinger

Aspen

Opiate addiction has been defined as a national epidemic in the United States according to a 2017 report from the Centers of Disease Control and Prevention (CDCP). The rise of opioid deaths can be traced to three waves with the first occurring in the 1990ду»s when there was a significant increase in opioid prescriptions. The second wave occurred in 2010 when there was a spike in heroin deaths. The third wave occurred in 2013 when there was a significant increase in synthetic opioid deaths. According to the CDCP over 350,000 people have died from opioid overdoses from 1999-2017. The common method for medical detoxification from opioids is a six day taper in where the patient is given suboxone to reduce pain and cravings. tDCS, tACS and tRNS cranial stimulation was used during the six day taper and was hypothesized to reduce cravings, anxiety, depression and to improve sleep. The Opioid group consisted of 53 patients. Pre and post EEGду»s were taken and analyzed showing significant changes in absolute power, coherence and phase as compared to controls and neurofeedback only conditions. Furthermore, patient symptom ratings and PHQ9 and GAD7 surveys showed significant reduction in cravings, depression and anxiety symptoms. No serious adverse side effects were reported in the stim only condition. In this session, data will be presented showing the outcomes of this study. xxxxxxx x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x xx x x x x x x x x x x x x x x x x x x x x x x

The Effect of NeuroField Neurostimulation and Neuromdulation on Acute Opiate Detoxification

Nicholas Dogris, PhD

Evergreen A-C

Hypnosis and neurofeedback each provide unique therapeutic strengths and opportunities. This presentation will explain the unique phenomena associated with hypnosis and naturalistic trances. An overview of research on hypnosis will precede the presentation of recommendations about the relative clinical utility of using either neurofeedback or hypnosis as the initial treatment of choice with various clinical conditions. Discussion will follow on how both modalities may be integrated into treatment and examples provided of how hypnotic suggestions may be used informally in neurofeedback sessions.

Integrating Clinical Hypnosis and Neurofeedback

D. Corydon Hammond, PhD, ECNS, BCN, QEEG-D

Evergreen D-E-F

Friday Workshops
Friday, September 20
Conference Workshops

Our professional organizations such as A the Association for Applied Psychophysiology and Biofeedback (AAPB), the Biofeedback Certification Alliance International (BCIA) and specifically the International Society for Neurofeedback Research (ISNR), can provide practitioners and professionals offering Quantitative electroencephalography (qEEG) and neurofeedback services opportunities to create and participate in ongoing forums for discussion of peripheral biofeedback and EEG biofeedback and the standards of care, ethical practices, challenges to our profession, and the rights and responsibilities of those persons seeking our services. Many clinicians and practitioners of qEEG and Neurofeedback are board certified in Neurofeedback by BCIA and must attend training in ethics and standards of practice for renewal of their BCIA certification as well as individual license requirements per state regulations. This workshop is designed to fulfill those requirements and will address scope of practice concerns that face neurofeedback service providers. The focus of this workshop is to provide attendees with an overview of professional ethics and standards of practice as they apply to the helping professions and specifically those providing peripheral biofeedback and EEG biofeedback/neurofeedback and qEEG services. In addition this workshop will address challenges peripheral biofeedback and EEG biofeedback/neurofeedback practitioners face in our organizations, clinics, and practices , including scope of practice concerns. Neurofeedback is becoming a думHolisticдуќ form of treatment/intervention for clients and patients with a variety of disorders. Neurofeedback practitioners come from a variety of backgrounds and professional training, (i.e., medical, mental health, education, to name just a few) and are often asked to help clients/patients with various disorders that may fall within or outside of their professional training , (nurses working with patients having mental health issues, counselor and educators working with clients /patients with headaches, TBI related symptoms). As healthcare becomes more complex ad integrated, those practicing peripheral biofeedback and EEG biofeedback/neurofeedback need to consistently keep ethics and standards of care in check.

Ethics in qEEG and Neuromodulation

Robert Longo, MRC , Leslie Sherlin, PhD

Crestone Peak

Epilepsy affects an estimated 2.2 million people in the United States alone and is the nationду»s fourth most common neurological disorder, after migraine, stroke, and Alzheimerду»s disease (IOM, 2012). Seizures are caused by aberrant connections within the brain that result in hyperexcitable networks. Neurofeedback training is designed to collect, analyze and думfeedbackдуќ information about an individualду»s EEG signals so that the individual can learn to modify their brain activity. By stimulating synaptic and network plasticity, neuroeedback training can modify hyperexcitable networks within the epileptic brain, offering the possibility of reduction in the number of clinical seizures. Published studies suggest that augmentation of the sensorimotor rhythm (SMR), a commonly-used neurofeedback protocol for patients with epilepsy, can be an effective means of reducing seizure frequency in patients with drug-refractory seizures (Sterman & Egner, 2006 , Tan et al., 2009). In addition, newer neurofeedback technology allows for the selection of multiple frequency bands in multiple head regions for training purposes, often based upon significant abnormalities in a baseline quantitative EEG (QEEG). This workshop will provide an introduction to seizures, epilepsy and EEG and QEEG findings in patients with epilepsy from a neurologistду»s point of view. The workshop will also provide an up-to-date review of the multiple types of neurofeedback training that have been used in patients with epilepsy and give practical pointers on using these techniques in this patient population. The specific topics that will be covered include: 1. An introduction to seizures and epilepsy 2. An introduction to EEG and QEEG in patients with epilepsy 3. A review of training protocols that have been used in patients with epilepsy 4. Is there data to predict which patients will do better with neurofeedback training? 5. What changes can you expect clinically from neurofeedback training in patients with epilepsy? 6. Are there specific findings in baseline QEEGs in patients with epilepsy? 7. What changes should you aim for/expect on the QEEG from neurofeedback training in patients with epilepsy? 8. Specific case studies 9. Question and answer period

QEEG and Neurofeedback in Patients with Epilepsy

Lauren Frey, MD

Humboldt Peak

Epilepsy was the first condition treated with neurofeedback almost 50 years ago and there is established efficacy (Level 4) for its treatment. Looking forward, post-concussion syndrome is an increasingly common condition and neurofeedback is looking highly promising as an intervention. Both epilepsy and post-concussion syndrome are brain-based conditions that are not always well managed with standard medical treatments , indeed, about a third of people with epilepsy do not have their seizures well controlled with medications and up to 30% of people who suffer a concussion do not fully recover and instead suffer from post-concussion syndrome. With approximately 1% of the population suffering from epilepsy and 500 out of 100,000 people suffering a concussion annually, both conditions represent good opportunities for neurofeedback practitioners. This presentation will (1) provide the rationale for neurofeedback training , (2) give an overview of research , (3) describe appropriate assessment , (4) outline the training procedures for these two conditions , and (5) provide case examples. Candidates for neurofeedback who have epilepsy are usually the third of patients who do not have their seizures well controlled with medications. Clients with post-concussion syndrome (PCS) typically present at least two years after suffering traumatic brain injuries, so any spontaneous recovery has already taken place. Our experience is that clients with PCS can recover within a year of starting neurofeedback combined with heart rate variability training. The comprehensive assessment that will be described utilizes not only EEG measures (both single channel and 19-channel data collection) but also measures of heart rate variability (HRV), balance, and event related potentials (ERPs). The ERPs (also called evoked potentials) are a particularly important measure because they reflect brain speed and, though they are not directly trained, processing speed does improve with neurofeedback training. ERPs provide a very objective measure of those changes and strengthens research findings. Of course, the greatest satisfaction in this work is in giving people their lives back , that is, returning them to their pre-concussion level of functioning. Regarding intervention, we will describe the direct training that brings about changes in EEG parameters, giving examples from single channel training as well as from the newer LORETA z-score training. We will also provide guidelines concerning when it is appropriate to alternate single channel neurofeedback and LORETA neurofeedback. Methods for combining HRV training with neurofeedback in the same session will be explained. Results of balance assessments will be delineated and some screens used for training balance will be shown. Finally, we will hypothesize about why neurofeedback for both epilepsy and post-concussion syndrome may eventually attain Level 5 efficacy , that is, not only equal to the current standard of care but superior in terms of outcomes that can be achieved.

Improving functioning in Epilepsy & Post-concussion Syndrome

Michael Thompson, MD, B.Sc , Lynda Thompson, PhD

Maroon Peak

Neurofeedback paradigms based on real-time references to EEG database ranges have been evolving rapidly since their arrival on the scene in 2006. Initially only capable of providing feedback from four surface channels of EEG, within a few years software capabilities expanded to nineteen channel feedback, which ushered in an entirely new model: EEG feedback based on real-time sLORETA readings compared to a set of database norms. This changed the way clinicians were able to conceptualize constructing protocols, leading to even more creativity and complexity to the ways brain areas were recruited into a feedback task designed to encourage cognitive flexibility and better neurophysiological integration. With the recent availability of software comparing sLORETA EEG connectivity metrics to database norms in real-time, clinical models for protocol design and selection are once again going through a series of updates, and beginning to reflect the ways in which providers are increasingly able to observe and interact with complex neural dynamics during a live feedback session. This workshop will present entirely new neurofeedback designs based on emerging sLORETA imaging technology which allows the clinician to base feedback on real-time communication and activity between estimated sLORETA voxels. This level of resolution has promising implications for taking source localization feedback to a different level of sensitivity and nuance. To best grasp the clinical practicalities of how to evaluate the dynamics of this new paradigm, it will be presented within the context of an allostatic model, in which the stability of a system is achieved by adaptive physiological and behavioral changes based predictive regulation of available resources in response to shifts in environmental demand. To support this approach, research on both the principles on allostasis and their applicability to neural dynamics will be reviewed, and pre and post qEEG maps of clinical case studies will be presented and discussed.

The Allostatic Dynamics of sLORETA Z-Scored Connectivity

Penijean Gracefire, LMHC,BCN,qEEG-D

Longs Peak

People seeking help from clinical providers are often experiencing a variety of symptoms which have their root cause in lifestyle factors. Neuroscience evidence increasingly documents the health hazards caused by insufficient exercise, suboptimal nutrition, overuse of iTech and overexposure to EMF (electromagnetic frequencies), and inadequate sleep. Likewise, health science research documents improvements in - and often amelioration of - clinical symptoms (such as headaches, insomnia, poor attention, anxiety, depression, etc.) when lifestyle changes are consistently implemented. We have been "prescribing" these lifestyle changes for the past several years to patients of all ages, and tracking their clinical course with symptom check lists, along with EEG and QEEG functional neuroimaging studies. In this practice paradigm, QEEG serves as an extremely valuable clinical tool to demonstrate the neurophysiologic underpinnings of a personду»s symptoms. QEEG also works to easily document changes in power spectral and coherence measures which correlate with their improved clinical symptoms while they are implementing lifestyle improvements. We call this "prescribing brain health" and find almost most patients and families highly receptive to this holistic approach to their neurological and/or neuropsychological symptoms. Most people seeking consultation in our neuroscience practice have already been previously prescribed one - or often many - medications, often with little benefit and/or troublesome side effects. So, they are receptive to hear a physician "prescribing" something other than just more pharmaceutical substances. "Seeing" the symptoms they are experiencing demonstrated in QEEG functional neuroimaging mappings also shows how these symptoms, if not properly addressed at a root-cause level, will have increasing adverse effects - influencing brain and body physiological functioning. Our experience has also demonstrated that some of those initially seeking neurofeedback in our practice will experience such health improvements after implementing these lifestyle changes, that neurofeedback is no longer deemed necessary. More commonly, those persons making healthy lifestyle changes will experience faster and more long-lasting benefits from neurofeedback, often resulting in less number of total training sessions than initially prescribed. Finally, we have had individuals in our practice who do not seem to benefit from neurofeedback training as would have been hoped. Almost invariably, we discover they have lifestyle factors (insufficient exercise, suboptimal nutrition/hydration, overuse of iTech and overexposure to EMF/electromagnetic radiation frequencies, and inadequate sleep) which hinder or delay onset of benefits from such neuromodulation. Thus, as true health-care providers, we seek to думfirst do no harmдуќ and help people take ownership of their own health care by думprescribingдуќ brain health and lifestyle medicine.

Prescribing Brain Health as a Prelude to Neurofeedback

Robert Turner, MD, MSCR, QEEGD, BSN

Blanca Peak

Saturday, September 21
Plenary Sessions 8am-9am

Brain functions have been proved to be affected by external stimuli. Photobiomodulation (PBM) using near-infrared is one of the effective ways to modulate the hemodynamic activities in the brain and to activate the key enzyme cytochrome c oxidase (CCO) in electron transport chain (ETC) (Anders, Lanzafame, & Arany, 2015 , Anders et al., 2014 , Barrett & Gonzalez-Lima, 2013 , Blanco, Saucedo, & Gonzalez-Lima, 2017 , Rojas & Gonzalez-Lima, 2017 , Tian, Hase, Gonzalez-Lima, & Liu, 2016 , Vargas et al., 2017 , Wang, Tian, Soni, Gonzalez-Lima, & Liu, 2016). A 808 nm LED system with 250 mW/cm2 power density, 10 min treatment on prefrontal area is adopted in this research. We investigated the cognitive effects of PBM using prefrontal cortex measures of attention, Psychomotor Vigilance Task (PVT), and memory, Delayed Match to Sample (DMS), to show the cognitive function enhancement. In addition, the primary brain activities as electroencephalography (EEG) is investigated to establish the link between the PBM and the EEG. In our preliminary results (n=12), the EEG related to the PBM on the subjects of various ages shows different responses in spectral and time domains, especially during the resting states. After PBM treatment, the peak-valley ratio of the waves in EEG has stronger contrast, and the effect lasts even the PBM has been stopped. This shows the PBM is not a short-term effect and could be observed in EEG. Our research indicates that the aging process and the brain function deterioration could be observed through the peak-valley ratio of the spectral-time measurements. Baseline vs. chronic (10 daily sessions, 10 min each) comparisons of mean cognitive scores all showed improvements, significant for PVT reaction time (p < 0.001), PVT lapses (p < 0.001), and DMS correct responses (p < 0.05). The peak-valley ratio is enhanced about 3 dB. This finding opens a window to investigate how the brain function enhancement is achieved at the system level and how the signaling enhancement are propagated.

Cognitive Function Enhancement through Photobiomodulation on Prefrontal Lobe and the EEG measurements

Kailin Wang, PhD , Lida Huang, PhD

Evergreen A-C

Many neurofeedback practitioners are interested in finding and incorporating novel modalities that can work to enhance their effectiveness with a wide range of clients both in and out of the office. However, incorporating new technology or additive treatments can be cumbersome to implement and it can be overwhelming to make changes. In this informative and engaging lecture, Dr. Amy Serin will review research and give concrete how-to steps from experience in her integrative care clinics in Arizona. She will review the latest research on bi-lateral alternating stimulation including double-blind placebo controlled research showing cortisol stability after a stressful task, a controlled study showing a 72% reduction in self harming behaviors in children with developmental disabilities, and review the salience networkду»s hypothesized role in short-circuiting the stress response in real time. A summary of the efficacy of cranial electric stimulation including outcome studies in post-traumatic stress disorder will be reviewed along with recommendations for when to use cranial electric stimulation in conjunction with neurofeedback. An update on why it may be helpful to incorporate EMDR therapy into neurofeedback practice or add other therapies with extracts from EMDR will be presented with case studies. She will also present concrete ways to incorporate these modalities into practice and present cases where the results of neurofeedback was insufficient for clients to be considered within normal limits and how adding these modalities either reduced the duration of treatment and improved efficacy for obsessive-compulsive disorder, addiction, post-traumatic stress disorder, depression, and anxiety in both children and adults. Participants will leave with a helpful blueprint and a list of concrete steps and helpful strategies to be able to return home and implement these modalities into their clinics. They will also gain a greater understanding of the additive benefits of the integrative care model and tips on how to avoid mistakes in implementation for the best outcomes.

Applied Innovation in Clinical Practice- Let's Go Beyond Neurofeedback

Amy Serin, PhD

Evergreen E-F

Plenary Sessions 9:10am-10:00am

The first part of the presentation covers the history of CPT coding and the former neurofeedback, biofeedback, and QEEG codes. This includes a history of the AMA CPT editorial panel and provides an understanding of how the CPT codes for the field have progressed through the system. This will also cover the history of insurance reimbursement for these codes. This will lead up to the current codes for practicing QEEG, neurofeedback, and biofeedback. The current codes will be reviewed in detail, discussing the requirements necessary for billing these codes as well as what types of neurofeedback, biofeedback, and QEEG would fall outside of the scope of these codes. It will intricately discuss this delicate separation. IT will also go over the current status of insurance reimbursement and its rapid growth in the past few years. This section will cover the value of the mental health parity act and its implementation team, which provided a technology review specifically for neurofeedback. After completing the current status of the codes, the third phase of the presentation will move toward the future. The future portion will share what information is publicly available regarding proposed changes to the CPT codes for biofeedback, neurofeedback, and QEEG. This section will be the opportunity for attendees to express any goals they may have for the codes that are not currently represented. This part will be interactive and everyone is encouraged to participate. A discussion will ensue regarding what is needed for future code change proposals to meet the goals of the field. It will also discuss practical applications of the current information available to fight for insurance reimbursement. Finally, this presentation will serve as a preparation for a workshop next year that will be focused on specific situations that people will bring in to give practical hands on experience at pushing for insurance reimbursement.

Update on CPT coding and Insurance reimbursement

Mark Trullinger, MSc , Joy Lunt, RN

Evergreen A-C

Recent research within the fields of medicine, neuroscience, psychiatry, and microbiology has revealed a complex, remarkably interconnected relationship between the brain and gastrointestinal system. The gut-brain axis involves a number of complex feedback loops between the microbiome, intestinal barrier, mucosal immune system, neuroendocrine system, and hypothalamic-pituitary-adrenal (HPA) axis, as well as the enteric, autonomic, and central nervous systems (De Palma, Collins, Bercik, & Verdu, 2014 , Mayer, 2011). Through these communication channels, signals from the brain can modulate motor, sensory, and secretory functions of the gut, and signals from the gut can influence various aspects of psychological and cognitive function (De Palma et al., 2014 , Grenham, Clarke, Cryan, & Dinan, 2011 , Mayer, Knight, Mazmanian, Cryan, & Tillisch, 2014). As such, alterations in one component can trigger a cascade of effects throughout the axis. Exposure to prolonged or excessive stressдуоwhether emotional trauma or pathogenic invasionдуоcan produce especially detrimental effects on this axis, leading to chronic physical and psychological disorders (Bell & Ross, 2014 , Mayer et al., 2014). In fact, gut-brain imbalances have been implicated in a myriad of ailments, including anxiety, depression, PTSD, autism, attention deficits, eating disorders, irritable bowel syndrome, inflammatory bowel disease, Chronду»s disease, and ulcerative colitis, among others (Bischoff et al., 2014 , Cryan & Dinan, 2012 , Mayer, 2011). Consequently, a failure to adequately address imbalances throughout this axis might inhibit clientsду» progress in neurotherapy. This presentation will provide an overview of research on the gut-brain axis as it relates to the fields of neurofeedback and mental health. We will especially examine the impact of stress on the gut-brain axis, as well as the role of this axis in stress-related disorders. We will then discuss practical recommendations for an integrative neurotherapy approach to help clients effectively balance this axis, thus maximizing their physical, cognitive, and emotional wellbeing. This will include methods for reducing the brainду»s stress reactivity, balancing the neuroendocrine system, optimizing microbiota compositions, repairing the gut lining, restoring tight junctions in the blood-brain barrier, ensuring adequate nourishment, and reducing inflammation.

An Integrative Neurotherapy Approach to Balancing the Gut-Brain Axis

Ashlie Bell, PhD, LCSW, BCN

Evergreen D-E-F

Plenary Sessions 10:10am-11:00am
Plenary Sessions 9:10am-10:00am

As the field of neurofeedback grows, a few novel neurofeedback approaches have emerged. While the use of functional magnetic resonance imaging (fMRI) based neuromodulation has shown efficacy as a form of treatment, fMRI is not cost effective or practical and yields low temporal resolution. (Frey et al., 2013). However, electroencephalography (EEG) is relatively inexpensive, practical, and yields high temporal resolution (Frey et al., 2013). Successful EEG based neurofeedback therapy has been demonstrated in the treatment of clinical conditions and symptoms including decreasing symptoms related to seizure disorders (Sterman & Egner, 2006) and learning disabilities (Coben et al., 2015 , Fernandez et al., 2003). Additional findings have shown that EEG based neurofeedback can reduce symptoms associated with Autism Spectrum Disorder (Coben, 2013 , Kouijzer, et al., 2009). Furthermore, a study by Wang et al. (2016) found that EEG characteristics associated with Autism were reduced using prefrontal neurofeedback treatment. There is also evidence that the effects of these interventions last beyond the initial training period (Coben, 2013 , Gevensleben et al., 2009). Some researchers have found success using 2-channel coherence training. However, the growing body of research concerning coherence assessment suggests that using a greater number of electrodes relative to the standard 2-channel approach increases spatial acuity (Blinowska, 2011). Research has shown the use of 4-channel multivariate coherence training is associated with significantly greater changes in power and coherence as compared to 2-channel coherence training (Coben et al., 2018). Advancing to 4 channels and calculating coherence metrics in a multivariate fashion led to greater changes in power, by more than 50%, and coherence, by more than 400% (Coben et al. 2018). This presentation will focus on the results of a meta-analysis on previous research conducted on several disorders whose subjects have received 4-channel multivariate coherence training and were compared to an alternate treatment or comparison group. These include a mixed diagnosis study (n = 174), symptoms of autism (n = 110), Mu suppression in autism (n = 78), depression (n = 54), developmental trauma (n = 40), learning disabilities (n = 63), epilepsy, (n = 52), and traumatic brain injuries (n = 20) with a total sample size of N = 591. We plan to conduct this meta-analysis to help us understand the general impact of this form of neurofeedback which then may be compared to other types. Such a statistical approach will also help us understand if this for of neurofeedback has greater efficacy for certain conditions over others. We will also seek to understand if there are any mitigating factors such as medications, age, gender or others. This findings will be presented and their implications discussed.

Meta-Analysis of Mulitvariate Coherence Neurofeedback research

Robert Coben, PhD , Carl Armes, BS

Evergreen A-C

Reading the raw EEG is an artform that is essential knowledge-base of any practitioner using EEG to assess and diagnose their patientsду» conditions. Spindles, triangular shapes, sinusoidal, monomorphic, and archiform waveforms are just a few telling morphological signs that are imperative in understanding what is really going on. Does the waveform wax and wane? Does it travel in spindles or bursts? Does it appear only a few times in the record? What if it is rhythmic? These temporal dynamics are also imperative in a proper assessment of the person. When looking at the raw waveform, you will learn more than what any QEEG, alone, can tell you. Through exploring the more insidious forms of artifact (i.e. electricity, channel noise, mixed metals, etc.) to detecting less commonly seen morphological forms in the EEG (i.e. lambda, mu, OIRDA, beta spindles, etc.), this lecture will guide the clinician through some of the more advanced ways of interpreting EEG so that the QEEG does not mislead one into misdiagnosis. We are privileged to have many analysis and diagnostic tools to help us dissect, spatially and temporally analyze, condense and summate the EEG into neat and tidy diagrams, but we fail our patients and our profession if we miss the devils in the details. Finally, montages are necessary to understand the many ways in which we can assess and view the EEG. There is no best montage for all purposes. While linked ears can provide a global view, it is prone to contamination if there is a strong temporal finding or if there is contamination otherwise in the ear electrodes. Average and weighted average montages (such as the Laplacian and Hjorth montages), will highlight any local phenomena, and will uncover any significant temporal component, but will fail us to see global information. Bi-polar montages are excellent for displaying phase reversals, which are indispensable in issues of head injury and seizure focus.

The Wisdom of Morphology

Tiff Thompson, PhD, R.EEG.T, BCN, MFT

Evergreen D-E-F

Saturday Plenary
SaturdayWorkshops
Saturday, September 21
Conference Workshops

Thalamocortical Disconnect Type of TBI, and How to Treat It with Audio-visual Entrainment Brain injuries, whether physical traumas or viral infections, trigger reactive gliosis and inflammation in the brain. During this process, the thalamocortical loop where alpha rhythms originate, shuts down or disconnects (TCD). This loss of alpha brain wave production manifests as anxiety, sleep disorders, emotional instability and cognitive losses. Behaviors range from anorexia to substance abuse, ritualistic obsessions to violence. Electroencephalography (EEG) tracings and quantified EEG (qEEG) easily detect a TCD in which low voltage, loss of alpha and poor phase are specific markers. Audio-visual Entrainment (AVE) involves the presentation of auditory and photic stimuli at brain wave frequencies. Modern research continues to show the benefits of AVE through non-frequency mechanisms such as , increased cerebral flow, hypnosis and deep meditation, increasing neurotransmitters such as serotonin and endorphins, providing autonomic calming, jumpstarting the brain (as is seen with thalamocortical TBI), generating lactate & ATP and for activating microglia to clean up amyloid deposits in Alzheimerду»s and the release of heat-shock protein-70. Research on the effectiveness of AVE in promoting relaxation, cognition and hypnotic induction, treating ADD, PMS, SAD, PTSD, migraine headache, chronic pain, anxiety, depression, TBI, PTSD, Alzheimerду»s and memory is now available. AVE used in a surprising and counter-intuitive way has given brain-injured people a second chance at regaining their lives, occupations, social life and good mental health. A counter-intuitive approach using AVE to думjumpstartдуќ the brain is proving to be highly successful. Physiology of Audio-visual Entrainment (AVE). Modern research continues to show the benefits of AVE through non-frequency mechanisms such as , increased cerebral flow, hypnosis and deep meditation, increasing neurotransmitters such as serotonin and endorphins, providing autonomic calming, jumpstarting the brain (as is seen with thalamocortical TBI), generating lactate & ATP and for activating microglia to clean up amyloid deposits in Alzheimerду»s and the release of heat-shock protein-70. Research on the effectiveness of AVE in promoting relaxation, cognition and hypnotic induction, treating ADD, PMS, SAD, PTSD, migraine headache, chronic pain, anxiety, depression, TBI, PTSD, Alzheimerду»s and memory is now available. Use of AVE in Residential Treatment for Addictions and TBI At our residential treatment center for addictions and TBI recovery, AVE has become the #1 go-to triage device to help give clients rapid relief from the symptoms of medication withdrawal, pain, anxiety, insomnia, headaches, and думbrain fog.дуќ Many of our clients (many football players) present one or more of the following profiles: addictions, anxiety, depression, PTSD, and traumatic brain injury (TBI). AVE has given us significant improvement in self-reported ratings of focus, relaxation, grounded (FRG), as well as reduction in pain and cravings. With its convenience, portability, ease of administration, and freedom from reliance on patient cooperation in our particularly volatile population, AVE is often the first thing we turn to in the first few days of admission. AVE also offers an affordable option for home-based aftercare upon release from our program. We will review EEG and subjective outcomes in cases of addictions and TBI.

Concussion/Traumatic Brain Injury: Its EEG & Behavioral Signature, Its relation to Alzheimers Disease and How to Treat It with Audio Visual Entrainment Technology

Dave Siever, CET , Becky Bassham, MSc

Pikes Peak

The Nature of Forgetting: Neurofeedback and psychotherapy in the treatment of dissociative disorders Since the time of Freud or even Janet before him, we have considered dissociation a psychological defense against remembering early childhood horrors, or in the corrupted and damaging rewrite, an indication of early forbidden childhood fantasies. But there are questions. What part of the babyду»s psyche figures out what is too terrible to remember? How would that help him? What is the nature of infantile memory? Does a child encode neglect as a memory or as absence of memory? Neuroscience is finally, if not exactly shedding light, bringing these questions into the light. Recent findings show that when a child suffers дуЦbad enoughду» neglect and abuse, she will not develop the brain structures and networks needed to support a sense of self and other. The cerebellum is not rocked into functionality, the right temporal lobe does not gather the resources needed to soothe itself and the parents have sparse pre-frontal cortices to loan to their children. The central networks, the default mode, the salience and the executive are poorly established. The neglected and abused child is at the mercy of his feral instincts , by her need to survive. These instincts correlate with structures deep in the midbrain that detect threat and pain, the periaqueductal gray and the superior colliculus that rapidly give rise to amygdala reactivity felt (or worse unfelt) as unbearable terror, rage and shame. Not only do those who suffer dissociation show this hyper connectivity between these reptilian structures and the amygdala, they lack connectivity between the pre-frontal cortex and the amygdala. Further, people suffering dissociative disorders process information in the partial areas which are non-verbal, sensory and which house implicit memory as distinct from those who have suffered trauma but not dissociation who process information frontally, that is verbally and explicitly. Where in this new story is there room or need for a psychological defense? There is no self, there is no other, different parts of the brain process memory and there are discreet pathways of hyper connectivity that foster reptilian modes. Reptiles freeze as their defense , mammals who are trapped and can neither fight or run employ death-feigning or freezing. So do babies and young children left essentially to fend for themselves or die. In this sense dissociation is clearly a defense. It is death-feigning. It encodes the reality of history rather than defending against it.

The Nature of Forgetting

Sebern Fisher, MA

Longs Peak

Improving focus and the ability to sustain attention is fundamental to dealing with problems such as Attention-Deficit/Hyperactivity Disorder (ADHD). But not all people with ADHD are devil-may-care: many, perhaps a majority, also suffer anxiety, especially as adults. Neurofeedback is established as efficacious in helping those with ADHD and there is clinical support for neurofeedback helping with symptoms of anxiety. Indicators of anxiety as seen in the EEG can include: excess beta activity, especially in frequencies above 20 Hz and very high amplitude high frequency alpha. Biofeedback has established efficacy for decreasing anxiety. Thus adding biofeedback to neurofeedback additionally helps reduce anxiety. The combination of ADHD symptoms plus anxiety is found in those with diverse diagnoses, including Learning Disabilities, Aspergerду»s Syndrome, Autism Spectrum Disorders, Post-concussion syndrome, Post-Traumatic Stress Disorder, Affect Disorders, and movement disorders, (Touretteду»s syndrome and Parkinsonду»s Disease). Assessment, which is crucial to getting the intervention right, will vary depending on the presenting symptoms. Neurofeedback treatment is based on QEEG assessment and understanding the neural net-works that underly the symptoms. Participants will learn the principles for doing efficient and accurate assessments, either single channel or 19-channel EEG. Assessments include history taking and information concerning the family, social functioning, school and/or work performance, medical factors (allergies, sleep apnea, head injuries, etc.) and extracurricular interests. There are also questionnaires and, for more objective test data, continuous performance tests (T.O.V.A., IVA). Computerized neurocognitive testing is added at baseline and upon completion of 40 sessions of training. With complex patients who may have comorbidity, testing can include some or all of the following: 19 channel quantitative electroencephalogram (QEEG), event related potentials (ERPs), heart rate variability (HRV), The assessment guides effective intervention for children, adolescents and adults for those with ADHD, those with attentional issues and co-morbidities, and athletes wishing to optimize performance. The intervention is multimodal and combines neurofeedback (NFB) with biofeedback, especially heart rate variability training (HRV). Clients can range from children who underachieve in school through to university students, executives, and athletes. Clients can also be entrepreneurs who are successful but frustrated by never getting their paperwork done and having difficulty listening in meetings. The neurofeedback can be single or two channel but how to assess using 19 channels and treat with LORETA NFB will also be described. The biofeedback modalities are chosen following a stress test that identifies how a client responds to and recovers from mild stressors. The BFB modalities include peripheral skin temperature, skin conduction (electrodermal дус EDR), electromyogram, heart rate, and respiration. We will share the successful approaches developed at the ADD Centre & Biofeedback Institute of Toronto over the last 26 years. Patients rarely come in to a clinical centre with just ADHD symptoms. More often they present with other disorders and the ADHD symptoms are just one factor. This workshop will focus on working effectively with this reality of everyday clinical practice.

Improving Self Regulation of Attention and Emotions: Combining NFB with BFB Effectively Modifies Neural Networks to Improve Performance

Lynda Thompson, PhD , Michael Thompson, MD, BSc

Maroon Peak

Clinical Applications of The New Neuronavigator-SW LORETA This one-day workshop will concentrate upon three paradigms for protocol development to obtain excellent training outcomes. The seminar presenters will focus on methodologies for developing database, fusion, and symptom checklist-based protocols for Neuronavigator SW LORETA Protocol development, and advanced analysis of the data will be illustrated through the current software. We will explore the dynamics of metric analysis, including coherence, lagged coherence and phase, utilizing Z scores for plotting graphs to track session progress automatically through graphical and statistical analysis. Participants will learn how to determine what the metrics are presenting when assessing the effectiveness of a training protocol designed for SW LORETA. Kevin Uzriду»s LAST Programs have advanced the clinicianду»s ability to monitor progress automatically and efficiently each training session. Furthermore, all the LAST programs are now capable of importing protocols directly into Neuroguide for training. Kevin will present each of his LAST programs to illustrate how to precisely track how each protocol is impacting the client from session to session, and when to determine the development of a new protocol. Dr. Lubar will also cover advanced artifacting methods and the use of the Neuronavigator LORETA TIME DOMAIN CAPTURE for localizing focal activity and possible seizure related paroxysmal discharges. Another important feature of Neuroguide which is its utilization of the phase slope index or effective connectivity which allows one to determine the direction of flow between different nodes and to be able to map out circuits. This can be especially important in determining whether there are QEEG based abnormalities underlying for example specific learning disabilities involving reading or other language-based problems. There is now a DTI (Diffuse Tensor Imaging) program within Neuronavigator. The DTI feature is a new development from Applied Neuroscience Inc. Dr. Lubar will discuss the importance of using the Diffusion Tensor Imaging when assessing the EEG. Another component in an advanced workshop has been to analyze complex cases especially where progress has been limited in order to determine how to develop more powerful protocols. Sal Barba will present clinical cases to illustrate how progress of each client developed from the use of the three methodologies for protocol development. Participants are encouraged to bring unusual cases to discuss.

The New Neuronavigator-LORETA in Clinical Applications

Joel Lubar, PhD, BCN Senior Fellow, QEEG Diplomate , Salvatore Barba, PhD, BCIA-BCN , Kevin Uzri, MA, LPC

Humboldt Peak

This first time workshop will synthesize the work of a Neurologist and Neuropsychologist to help participants understand the complexities of EEG analyses. These two professionals work together as a team and run their own separate practices focused on EEG analysis and neurofeedback/neuromodulation interventions. The workshop will focus on these multifacted issues by discussing both raw EEG and Quantitative analysis of such data. The history of EEG interpretation will be reviewed briefly with a focus on the utility of the EEG to medicine and therapeutics. We will begin with a focus on raw EEG interpretation as this should be part of any QEEG analysis. There will be information provided to clarify raw EEG interpretation of normal and abnormal profiles. The raw EEG will also be reviewed for guides towards seizure detection. Various aspects of seizures and subclinical seizure presentations will be presented. This will be followed by more advanced quantitative analysis methods that assist with source localization and intricate measures of neural connectivity. These will go beyond what is done in most typical QEEG analyses. The foci here will be on data cleaning and analysis based on independent components analysis. This will lead in to dicussions on the difference between time series and frequency based analyses which will both be presented. ICA analyses will then lead in to source localization techniques such as dipole localizaton and sLoreta. Data is then transferred to more typical databases for norm referenced comparisons of absolute and relative power and source localization of these findings. Lastly, there will be an extensive discussion on measure of neural connectivity including granger causality and reciprocal causality. From this, we will discuss how such data can and does impact treatment planning for neurofeedback and neuromodulation interventions. Case examples and vignettes will be used to demonstrate these approaches and their interpretation.

Interpretation of Raw and Complex Quantitative EEG Analyses

Robert Coben, PhD , Robert Turner, MD

Blanca Peak

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