Hybridizing 3-dimensional multiple object tracking with neurofeedback to enhance preparation, performance, and learning

Le vaste domaine de l’amélioration cognitive traverse les applications comportementales, biochimiques et physiques. Aussi nombreuses sont les techniques que les limites de ces premières : des études de pauvre méthodologie, des pratiques éthiquement ambiguës, de faibles effets positifs, des effets secondaires significatifs, des couts financiers importants, un investissement de temps significatif, une accessibilité inégale, et encore un manque de transfert. L’objectif de cette thèse est de proposer une méthode novatrice d’intégration de l’une de ces techniques, le neurofeedback, directement dans un paradigme d’apprentissage afin d’améliorer la performance cognitive et l’apprentissage. Cette thèse propose les modalités, les fondements empiriques et des données à l’appui de ce paradigme efficace d’apprentissage ‘bouclé’. En manipulant la difficulté dans une tâche en fonction de l’activité cérébrale en temps réel, il est démontré que dans un paradigme d’apprentissage traditionnel (3-dimentional multiple object tracking), la vitesse et le degré d’apprentissage peuvent être améliorés de manière significative lorsque comparés au paradigme traditionnel ou encore à un groupe de contrôle actif. La performance améliorée demeure observée même avec un retrait du signal de rétroaction, ce qui suggère que les effets de l’entrainement amélioré sont consolidés et ne dépendent pas d’une rétroaction continue. Ensuite, cette thèse révèle comment de tels effets se produisent, en examinant les corrélés neuronaux des états de préparation et de performance à travers les conditions d’état de base et pendant la tâche, de plus qu’en fonction du résultat (réussite/échec) et de la difficulté (basse/moyenne/haute vitesse). La préparation, la performance et la charge cognitive sont mesurées via des liens robustement établis dans un contexte d’activité cérébrale fonctionnelle mesurée par l’électroencéphalographie quantitative. Il est démontré que l’ajout d’une assistance- à-la-tâche apportée par la fréquence alpha dominante est non seulement appropriée aux conditions de ce paradigme, mais influence la charge cognitive afin de favoriser un maintien du sujet dans sa zone de développement proximale, ce qui facilite l’apprentissage et améliore la performance. Ce type de paradigme d’apprentissage peut contribuer à surmonter, au minimum, un des limites fondamentales du neurofeedback et des autres techniques d’amélioration cognitive : le manque de transfert, en utilisant une méthode pouvant être intégrée directement dans le contexte dans lequel l’amélioration de la performance est souhaitée.The domain of cognitive enhancement is vast, spanning behavioral, biochemical and physical applications. The techniques are as numerous as are the limitations: poorly conducted studies, ethically ambiguous practices, limited positive effects, significant side-effects, high financial costs, significant time investment, unequal accessibility, and lack of transfer. The purpose of this thesis is to propose a novel way of integrating one of these techniques, neurofeedback, directly into a learning context in order to enhance cognitive performance and learning. This thesis provides the framework, empirical foundations, and supporting evidence for a highly efficient ‘closed-loop’ learning paradigm. By manipulating task difficulty based on a measure of cognitive load within a classic learning scenario (3-dimentional multiple object tracking) using real-time brain activity, results demonstrate that over 10 sessions, speed and degree of learning can be substantially improved compared with a classic learning system or an active sham-control group. Superior performance persists even once the feedback signal is removed, which suggests that the effects of enhanced training are consolidated and do not rely on continued feedback. Next, this thesis examines how these effects occur, exploring the neural correlates of the states of preparedness and performance across baseline and task conditions, further examining correlates related to trial results (correct/incorrect) and task difficulty (slow/medium/fast speeds). Cognitive preparedness, performance and load are measured using well-established relationships between real-time quantified brain activity as measured by quantitative electroencephalography. It is shown that the addition of neurofeedback-based task assistance based on peak alpha frequency is appropriate to task conditions and manages to influence cognitive load, keeping the subject in the zone of proximal development more often, facilitating learning and improving performance. This type of learning paradigm could contribute to overcoming at least one of the fundamental limitations of neurofeedback and other cognitive enhancement techniques : a lack of observable transfer effects, by utilizing a method that can be directly integrated into the context in which improved performance is sought

A review and framework for designing interactive technologies for emotion regulation training

Emotion regulation is foundational to mental health and well-being. In the last ten years there has been an increasing focus on the use of interactive technologies to support emotion regulation training in a variety of contexts. However, research has been done in diverse fields, and no cohesive framework exists that explicates what features of such system are important to consider, guidance on how to design these features, and what remains unknown, which should be explored in future design research. To address this gap, this thesis presents the results of a descriptive review of 54 peer-reviewed papers. Through qualitative and frequency analysis I analyzed previous technologies, reviewed their theoretical foundations, the opportunities where they appear to provide unique benefits, and their conceptual and usability challenges. Based on the findings I synthesized a design framework that presents the main concepts and design considerations that researchers and designers may find useful in designing future technologies in the context of emotion regulation training

Rewiring the impulsive brain:Neurofeedback treatment in forensic psychiatric patients with substance use disorder

Mensen met een psychiatrische stoornis vertonen vaak inadequate copingsmechanismen als reactie op stressvolle situaties of gebeurtenissen. Hun gedrag is vaak onbezonnen en overhaast, waarbij er niet wordt nagedacht over de mogelijke (negatieve) consequenties. Soms kan dit gedrag leiden tot het plegen van een misdrijf. Patiënten binnen een Tbs-kliniek lijden doorgaans aan een combinatie van meerdere psychiatrische stoornissen, die gekenmerkt worden door een hoge mate van impulsiviteit. Impulsiviteit speelt ook een grote rol bij het ontstaan en in stand houden van middelenafhankelijkheid. Er is hierbij vaak sprake van een wisselwerking tussen een verhoogde mate van impulsiviteit die al aanwezig was voordat deze mensen afhankelijk zijn geworden van verslavende middelen, en de ontremmende werking van verslavende middelen. Op het moment dat deze patiënten behandeling zoeken voor hun middelenafhankelijkheid wordt ook de verdere de behandeling belemmerd door een hoge mate van impulsiviteit, omdat dit de kans op het voortijdig afbreken van de behandeling vergroot. Omdat verslaving de kans op terugval in delictgedrag verhoogd is het niet afronden van een verslavingsbehandeling vooral voor forensisch psychiatrische patiënten zeer risicovol. Daarom zijn behandelmethoden die de kans op een succesvolle vermindering van impulsiviteit en middelenafhankelijkheid vergroten van groot belang. Verslavende middelen kunnen leiden tot structurele neurofysiologische en neurocognitieve veranderingen, die de impulscontrole nog verder negatief beïnvloeden. Neurofeedback-training is gericht op het corrigeren van afwijkende hersenfrequenties, waarbij er verondersteld wordt dat deze afwijkende hersenfrequenties psychische stoornissen weerspiegelen. Door het verhogen of verlagen van bepaalde hersenfrequenties kunnen symptomen van psychische stoornissen verminderen. Tot op heden wordt neurofeedback-training echter nog niet vaak ingezet in de behandeling van forensisch psychiatrische patiënten, zowel in Nederland als ook internationaal. Dit proefschrift onderzocht of een theta/sensorimotor rhythm (SMR) neurofeedback training een geschikte behandelmethode is om een hoge mate van impulsiviteit en daarmee de bijkomende verslavingsproblematiek te verminderen. De studies in dit proefschrift laten zien dat forensische patiënten moeite hebben om de principes van neurofeedback training te kunnen leren, en hun hersenfrequenties door middel van de behandeling succesvol te trainen. Interpersoonlijke verschillen tussen patiënten lijken hierbij te bepalen in hoeverre patiënten van deze interventie kunnen profiteren. Slechts een gering aantal patiënten in deze studie is het gelukt om door middel van de neurofeedback training hun hersenfrequenties te reguleren. Daarnaast was neurofeedback training niet beter dan de reguliere behandeling om klinische symptomen, zoals hoge mate van impulsiviteit en zucht naar middelen te verminderen. Dit is een van de eerste studies die een neurofeedback-interventie heeft toegepast in een forensisch psychiatrische doelgroep met diverse stoornissen en comorbide middelenafhankelijkheid. Dit proefschrift geeft een eerste aanzet voor het toepassen van de training in deze populatie, en we hopen dan ook dat toekomstig onderzoek kan voortbouwen op de uitkomsten in dit proefschrift. Toekomstig onderzoek zou zich daarom moeten focussen op het identificeren van factoren die bepalen welke patiënten in staat zullen zijn om van de interventie te profiteren. Dit proefschrift geeft een eerste aanzet voor het toepassen van de training in dit populatie, waarbij toekomstig onderzoek kan voortbouwen op de uitkomsten in dit proefschrift

Recreation Embedded State Tuning for Optimal Readiness and Effectiveness (RESTORE)

Physiological self-regulation training is a behavioral medicine intervention that has demonstrated capability to improve psychophysiological coping responses to stressful experiences and to foster optimal behavioral and cognitive performance. Once developed, these psychophysiological skills require regular practice for maintenance. A concomitant benefit of these physiologically monitored practice sessions is the opportunity to track crew psychophysiological responses to the challenges of the practice task in order to detect shifts in adaptability that may foretell performance degradation. Long-duration missions will include crew recreation periods that will afford physiological self-regulation training opportunities. However, to promote adherence to the regimen, the practice experience that occupies their recreation time must be perceived by the crew as engaging and entertaining throughout repeated reinforcement sessions on long-duration missions. NASA biocybernetic technologies and publications have developed a closed-loop concept that involves adjusting or modulating (cybernetic, for governing) a person's task environment based upon a comparison of that person's physiological responses (bio-) with a training or performance criterion. This approach affords the opportunity to deliver physiological self-regulation training in an entertaining and motivating fashion and can also be employed to create a conditioned association between effective performance state and task execution behaviors, while enabling tracking of individuals psychophysiological status over time in the context of an interactive task challenge. This paper describes the aerospace spin-off technologies in this training application area as well as the current spin-back application of the technologies to long-duration missions - the Recreation Embedded State Tuning for Optimal Readiness and Effectiveness (RESTORE) concept. The RESTORE technology is designed to provide a physiological self-regulation training countermeasure for maintaining and reinforcing cognitive readiness, resilience under psychological stress, and effective mood states in long-duration crews. The technology consists of a system for delivering physiological self-regulation training and for tracking crew central and autonomic nervous system function; the system interface is designed to be experienced as engaging and entertaining throughout repeated training sessions on long-duration missions. Consequently, this self-management technology has threefold capability for recreation, behavioral health problem prophylaxis and remediation, and psychophysiological assay. The RESTORE concept aims to reduce the risk of future manned exploration missions by enhancing the capability of individual crewmembers to self-regulate cognitive states through recreation-embedded training protocols to effectively deal with the psychological toll of long-duration space flight

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

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

Development and gamification of a neurofeedback application to support anxiety treatment

Anxiety disorder is one of the most common mental illness, affecting 264 million people worldwide. Current treatments are limited because they cause side effects and/or require long therapeutic periods. Neurofeedback (NFB) has been associated with the reduction of anxious symptomatology but typically uses unappealing therapeutic interventions. In this work a game was developed, Anxiety Destroyer, using procedures of gamification adapted to the NFB, with the goal of providing a guided, immerse and efficient treatment, to be used at home. The lean method was applied to the development process by construction-measurement-learning of value propositions. Thirty people were studied, which performed up to 8 NFB sessions for 35 minutes, totalling 185 sessions, 108 hours. Three groups of 10 individuals were created, one group with frontal alpha asymmetry (Alpha Asymmetry (ALAY)) protocol (F4-F3), another with asymmetry between AF4 and AF3 channels (AF) for hairless skin usage and another control group, with increased alpha in F4 and F3 (F+). The Beck Anxiety Inventory (BAI) was applied to assess anxiety. The Game Experience Questionnaire (GEQ) was used to evaluate game experience in different versions, which were adapted to the needs of the user. The ALAY group significantly increased the asymmetry (p <0.05) (reduction of the anxiety biomarker), with a corresponding significant reduction (p <0.01) in the anxiety reported by BAI after NFB training. The AF group showed a decrease in the frontal alpha asymmetry, and the F+ a slight increase, respectively confirmed by the increase and decrease of the BAI. The GEQ did not show better gaming experience throughout sessions. An increase of the sample size is required to confirm these results, inclusively since some individuals in the AF and F+ groups abandoned treatment because of no perceived effects. However, this study suggests the effectiveness of the gamified application in the treatment of anxiety

Computer games for user engagement in attention deficit hyperactivity disorder (ADHD) monitoring and therapy

State-of-the-art computer games and psychological tests for symptom monitoring and therapy in Attention Deficit Hyperactivity Disorder (ADHD) are explored and reviewed. Three foci for research studies are identified: task (human performance) focus; educational focus; medical/clinical focus. It is found that game designs in the literature include a variety of tests of cognition mostly dependent on attention and executive functions (inhibitory motor control, working memory, interference suppression) which involve reactions to stimuli on computer (or mobile phone) screens. In addition, based on the measurement of neural pathways that can be accessed by Brain Computer Interfaces, there are several applications of games that employ biofeedback and demand the user to control aspects of their brain activity to play them, with the aim of improving function. A number of games have been used in clinical studies for self-monitoring and therapy, some of these controlled with comparators such as treatment as usual or cognitive therapies, or with the individual as their own control, where efficacy is evaluated by measuring behavioural and functional outcomes on measurement instruments such as ADHD or behavioural trait questionnaires or other cognitive tests. Other applications of games include education and raising awareness of mental health conditions to reduce stigma. The paper then presents and proposes designs of new games that are based on psychological tests or tasks that aim to monitor or improve attention, inhibitory and/or motor activity including Continuous Performance Tests, Go/No-go and Stop-signal tasks

Computer games for user engagement in attention deficit hyperactivity disorder (ADHD) monitoring and therapy

State-of-the-art computer games and psychological tests for symptom monitoring and therapy in Attention Deficit Hyperactivity Disorder (ADHD) are explored and reviewed. Three foci for research studies are identified: task (human performance) focus; educational focus; medical/clinical focus. It is found that game designs in the literature include a variety of tests of cognition mostly dependent on attention and executive functions (inhibitory motor control, working memory, interference suppression) which involve reactions to stimuli on computer (or mobile phone) screens. In addition, based on the measurement of neural pathways that can be accessed by Brain Computer Interfaces, there are several applications of games that employ biofeedback and demand the user to control aspects of their brain activity to play them, with the aim of improving function. A number of games have been used in clinical studies for self-monitoring and therapy, some of these controlled with comparators such as treatment as usual or cognitive therapies, or with the individual as their own control, where efficacy is evaluated by measuring behavioural and functional outcomes on measurement instruments such as ADHD or behavioural trait questionnaires or other cognitive tests. Other applications of games include education and raising awareness of mental health conditions to reduce stigma. The paper then presents and proposes designs of new games that are based on psychological tests or tasks that aim to monitor or improve attention, inhibitory and/or motor activity including Continuous Performance Tests, Go/No-go and Stop-signal tasks