Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

The Psychology of Neurofeedback: Clinical Intervention Even if Applied Placebo

Advocates of neurofeedback make bold claims concerning brain regulation, treatment of disorders, and mental health. Decades of research and thousands of peer-reviewed publications support neurofeedback using electroencephalography (EEG-nf); yet, few experiments isolate the act of receiving feedback from a specific brain signal as a necessary precursor to obtain the purported benefits. Moreover, while psychosocial parameters including participant motivation and expectation, rather than neurobiological substrates, seem to fuel clinical improvement across a wide range of disorders, for-profit clinics continue to sprout across North America and Europe. Here, we highlight the tenuous evidence supporting EEG-nf and sketch out the weaknesses of this approach. We challenge classic arguments often articulated by proponents of EEG-nf and underscore how psychologists and mental health professionals stand to benefit from studying the ubiquitous placebo influences that likely drive these treatment outcomes

Non-pharmacological interventions for ADHD in school settings: an overarching synthesis of systematic reviews

OBJECTIVE: This overarching synthesis brings together the findings of four systematic reviews including 138 studies focused on non-pharmacological interventions for ADHD used in school settings. These reviews considered the effectiveness of school-based interventions for ADHD, attitudes toward and experience of school-based interventions for ADHD, and the experience of ADHD in school settings. METHOD: We developed novel methods to compare the findings across these reviews inductively and deductively. RESULTS: Key contextual issues that may influence the effectiveness and implementation of interventions include the relationships that pupils with ADHD have with their teachers and peers, the attributions individuals make about the etiology of ADHD, and stigma related to ADHD or intervention attendance. CONCLUSION: Although we found some positive effects for some outcomes and intervention categories, heterogeneity in effect size estimates and research evidence suggests a range of diverse contextual factors potentially moderate the implementation and effectiveness of school-based interventions for ADHD.National Institute for Health Research Health Technology Assessment (NIHR HTA) programNIHR Collaboration for Leadership in Applied HealthResearch and Care South West Peninsula (PenCLAHRC

Recovering Hidden Responder Groups in Individuals Receiving Neurofeedback for Tinnitus

The widespread understanding that chronic tinnitus is a heterogeneous phenomenon with various neural oscillatory profiles has spurred investigations into individualized approaches in its treatment. Neurofeedback, as a non-invasive tool for altering neural activity, has become increasingly popular in the personalized treatment of a wide range of neuropsychological disorders. Despite the success of neurofeedback on the group level, the variability in the treatment efficacy on the individual level is high, and evidence from recent studies shows that only a small number of people can effectively modulate the desired aspects of neural activity. To reveal who may be more suitable, and hence benefit most from neurofeedback treatment, we classified individuals into unobserved subgroups with similar oscillatory trajectories during the treatment and investigated how subgroup membership was predicted by a series of characteristics. Growth mixture modeling was used to identify distinct latent subgroups with similar oscillatory trajectories among 50 individuals suffering from chronic subjective tinnitus (38 male, 12 female, mean age = 47.1 ± 12.84) across 15 neurofeedback training sessions. Further, the impact of characteristics and how they predicted the affiliation in the identified subgroups was evaluated by including measures of demographics, tinnitus-specific (Tinnitus Handicap Inventory) and depression variables, as well as subjective quality of life subscales (World Health Organization—Quality of Life Questionnaire), and health-related quality of life subscales (Short Form-36) in a logistic regression analysis. A latent class model could be fitted to the longitudinal data with a high probability of correctly classifying distinct oscillatory patterns into 3 different groups: non-responder (80%), responder (16%), and decliner (4%). Further, our results show that the health-related wellbeing subscale of the Short Form-36 questionnaire was differentially associated with the groups. However, due to the small sample size in the Responder group, we are not able to provide sufficient evidence for a distinct responder profile. Nevertheless, the identification of oscillatory change-rate differences across distinct groups of individuals provides the groundwork from which to tease apart the complex and heterogeneous oscillatory processes underlying tinnitus and the attempts to modify these through neurofeedback. While more research is needed, our results and the analytical approach presented may bring clarity to contradictory past findings in the field of tinnitus research, and eventually influence clinical practice

Meta-Analysis of the Efficacy of Neurofeedback

Decreases in overall well-being and daily functioning result from unpleasant and uncomfortable symptoms associated with physical health and mental health disorders. Neurofeedback training, rooted in the theory of operant conditioning, presents the possibility of increasing brain wave regulation, decreasing symptoms experienced from abnormal brain wave activity, and increasing overall well-being and daily functioning. The efficacy of neurofeedback for physical and mental health outcomes is unclear, contributing to confusion about the treatment and any potential benefits. In order to assess the efficacy of neurofeedback in the alleviation of physical health and mental health symptoms, a systematic review and meta-analysis of neurofeedback using a random effects model to generate the effect sizes was conducted on 21 studies with 22 comparisons that used neurofeedback to treat patients. The results showed that neurofeedback can be effective for physical and mental health outcomes, including for autism with an effect size of 0.29, tinnitus with an effect size of 0.77, schizophrenia with an effect size of 0.76, depression with an effect size of 0.28, insomnia with an effect size of 0.52, obesity with an effect size of 0.40, intellectual disability with an effect size of 0.73, and pain with an effect size of 0.30. Well-being and daily functioning for those with physical and mental health disorders can be improved. These findings have implications for clinical practice to help patients in treatment for physical and mental health problems, and also for social change by providing evidence for alternative health care options

Real-time fMRI neurofeedback and smartphone-based interventions to modulate mental functions

Our brains are constantly changing on a molecular level depending on the demands thrown at them by our environments, behavior, and thoughts. This neuronal plasticity allows us to voluntarily influence mental functions. Taking conscious control over mental functions goes potentially back millenia, but it was psychotherapy since the early 20th century which moulded this concept into a concrete form to target specific mental disorders. Mental disorders constitute a large burden on modern societies. Stress-related disorders like anxiety and depression particularly make up a large part of this burden and new ways to treat or prevent them are highly desirable, since traditional approaches are not equally helpful to every person affected. This might be because the infrastructure is not available where the person lives, their schedules and obligations or financial means do not enable them to seek help or they simply do not respond to traditional forms of treatment. Technological advances bring forth new potential approaches to modulate mental functions and allow using additional information to tailor an intervention better to an individual patient. The focus of this dissertation lies on two promising approaches to cognitively intervene and modulate mental functions: real-time functional magnetic resonance imaging neurofeedback (rtfMRInf) on one hand and smartphone-based interventions (SBIs) on the other. To investigate various aspects of both these methods in the context of stress and in relation to personalized interventions, we designed and conducted two experiments with a main rtfMRInf intervention, and also with ambulatory training of mental strategies, which participants accessed on their mobile phones. The four publication this thesis entails, are related to this topic as follows: The first publication focuses on rtfMRInf effects on the physiological stress response, exploring whether neurofeedback could reduce stress-related changes in brain activity and blood pressure. The second publication focuses on rtfMRInf effects on psychological measures related to the stress response, namely on arousal and mood, based on data from self-report by the participants. The third publication focuses on rtfMRInf methodology itself, looking at complex connectivity data between major neural networks. Finally, the fourth publication focuses on personalized prediction of intervention success of an SBI using data from previous training days

Neurofeedback with fMRI: A Critical Systematic Review

Neurofeedback relying on functional magnetic resonance imaging (fMRI-nf) heralds new prospects for self-regulating brain and behavior. Here we provide the first comprehensive review of the fMRI-nf literature and the first systematic database of fMRI-nf findings. We synthesize information from 99 fMRI-nf experiments—the bulk of currently available data. The vast majority of fMRI-nf findings suggest that self-regulation of specific brain signatures seems viable; however, replication of concomitant behavioral outcomes remains sparse. To disentangle placebo influences and establish the specific effects of neurofeedback, we highlight the need for double-blind placebo-controlled studies alongside rigorous and standardized statistical analyses. Before fMRI-nf can join the clinical armamentarium, research must first confirm the sustainability, transferability, and feasibility of fMRI-nf in patients as well as in healthy individuals. Whereas modulating specific brain activity promises to mold cognition, emotion, thought, and action, reducing complex mental health issues to circumscribed brain regions may represent a tenuous goal. We can certainly change brain activity with fMRI-nf. However, it remains unclear whether such changes translate into meaningful behavioral improvements in the clinical domain

EEG neurofeedback for executive functions in children with neurodevelopmental challenges

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of EEG neurofeedback as treatment for inhibition and updating problems in children facing neurodevelopmental challenges