Virtual Reality and Neurofeedback for Management of Cancer Symptoms: A Feasibility Pilot.

Background: Evidence suggests the usefulness of complementary and alternative medicine approaches, like neurofeedback and virtual reality, for the management of cancer-related pain and mood. It is not well-understood whether neurofeedback delivered through virtual reality is feasible and acceptable to patients actively undergoing cancer treatment. Objective: The purpose of this study was to explore the feasibility and acceptability of a nature-based virtual reality combined with neurofeedback as a non-pharmacologic strategy for managing cancer-related pain and anxiety. Methods: This study utilized a mixed-methods approach. Participants included 15 cancer patients undergoing treatment. Patients engaged in a 22-minute nature-based virtual reality experience, wearing a virtual reality headset with a Brainlink headband measuring EEG activity. Participants were asked to complete the Edmonton Symptom Assessment System revised version (ESAS-r) before (T1) and after (T3) the experience to measure pain and anxiety. They were asked their level of pain midway through the experience (T2) and completed a follow-up interview afterward. Results: This study revealed feasible delivery of a virtual reality intervention combined with neurofeedback for patients seeking cancer treatment. All participants (100%) completed the intervention experience. Patients report this is an acceptable approach to managing cancer-related pain and anxiety. Comparisons between patients' pain scores at T1, T2, and T3 reveal statistically significant reductions in pain (p .001). Patients also report decreased depression and anxiety. Conclusion: This is the first study examining virtual reality combined with neurofeedback as a non-pharmacologic intervention for managing cancer symptoms during treatment. The study reveals it is a promising for managing cancer-symptoms.

A neurotherapy protocol to remediate cognitive deficits after adjuvant chemotherapy: a pilot study.

OBJECTIVES: Adjuvant chemotherapy for breast cancer is undeniably effective in increasing survival rates but many breast cancer survivors (BCS) exhibit side effects including nausea, fatigue, stress, and neurocognitive deficits, known as "chemobrain." This pilot study explored how neurotherapy, or EEG biofeedback, a non-pharmacological approach, improved neurocognitive, behavioral, and neurophysiological deficits associated with BCS who underwent chemotherapy. METHODS: Subjects underwent 18 sessions of EEG biofeedback training, in which audio and visual feedback occurred with successful shifting of EEG patterns. RESULTS: Quantitative EEG and assessment tests demonstrated neurophysiological, cognitive, and behavioral deficits in all nine subjects prior to training. EEG biofeedback resulted in significant improvements in neurophysiological, neurocognitive, and psychological functions in all nine subjects after training. CONCLUSIONS: We propose that this intervention and related forms of EEG biofeedback have the potential to significantly alleviate common side effects of chemotherapy in BCS and therefore merits additional research attention.

Correlations Between the DMN and the Smoking Cessation Outcome of a Real-Time fMRI Neurofeedback Supported Exploratory Therapy Approach: Descriptive Statistics on Tobacco-Dependent Patients.

The aim of this study was to explore the potential of default mode network (DMN) functional connectivity for predicting the success of smoking cessation in patients with tobacco dependence in the context of a real-time function al MRI (RT-fMRI) neurofeedback (NF) supported therapy.Fifty-four tobacco-dependent patients underwent three RT-fMRI-NF sessions including resting-state functional connectivity (RSFC) runs over a period of 4 weeks during professionally assisted smoking cessation. Patients were randomized into two groups that performed either active NF of an addiction-related brain region or sham NF. After preprocessing, the RSFC baseline data were statistically evaluated using seed-based ROI (SBA) approaches taking into account the smoking status of patients after 3 months (abstinence/relapse).The results of the real study group showed a widespread functional connectivity in the relapse subgroup (n = 10) exceeding the DMN template and mainly low correlations and anticorrelations in the within-seed analysis. In contrast, the connectivity pattern of the abstinence subgroup (n = 8) primarily contained the core DMN in the seed-to-whole-brain analysis and a left lateralized correlation pattern in the within-seed analysis. Calculated Multi-Subject Dictionary Learning (MSDL) matrices showed anticorrelations between DMN regions and salience regions in the abstinence group. Concerning the sham group, results of the relapse subgroup (n = 4) and the abstinence subgroup (n = 6) showed similar trends only in the within-seed analysis.In the setting of a RT-fMRI-NF-assisted therapy, a widespread intrinsic DMN connectivity and a low negative coupling between the DMN and the salience network (SN) in patients with tobacco dependency during early withdrawal may be useful as an early indicator of later therapy nonresponse.

EEG-heart rate connectivity changes after sensorimotor rhythm neurofeedback training: Ancillary study.

OBJECTIVES: Neurofeedback can induce long-term changes in brain functional connectivity, but its influence on the connectivity between different physiological systems is unknown. The present paper is an ancillary study of a previous paper that confirmed the effect of neurofeedback on brain connectivity associated with chronic pain. We analysed the influence of neurofeedback on the connectivity between the electroencephalograph (EEG) and heart rate (HR). METHODS: Seventeen patients diagnosed with fibromyalgia were divided into three groups: good sensorimotor rhythm (SMR) training responders (n = 4), bad SMR responders (n = 5) and fake training (SHAM, n = 8). Training consisted of six sessions in which participants learned to synchronize and desynchronize SMR power. Before the first training (pre-resting state) and sixth training (post-resting state) session, open-eye resting-state EEG and electrocardiograph signals were recorded. RESULTS: Good responders reduced pain ratings after SMR neurofeedback training. This improvement in fibromyalgia symptoms was associated with a reduction of the connectivity between the central area and HR, between central and frontal areas, within the central area itself, and between central and occipital areas. The sham group and poor responders experienced no changes in their fibromyalgia symptoms. CONCLUSIONS: Our results provide new evidence that neurofeedback is a promising tool that can be used to treat of chronic pain syndromes and to obtain a better understanding of the interactions between physiological networks. These findings are preliminary, but they may pave the way for future studies that are more methodologically robust. In addition, new research questions are raised: what is the role of the central-peripheral network in chronic pain and what is the effect of neurofeedback on this network.

Pilot Study Using Neurofeedback as a Tool to Reduce Surgical Resident Burnout.

BACKGROUND: Burnout is prevalent among surgical residents. Neurofeedback is a technique to train the brain in self-regulation skills. We aimed to assess the impact of neurofeedback on the cognitive workload and personal growth areas of surgery residents with burnout and depression. STUDY DESIGN: Fifteen surgical residents with burnout (Maslach Burnout Inventory [MBI] score > 27) and depression (Patient Health Questionnaire-9 Depression Screen [PHQ-9] score >10), from 1 academic institution, were enrolled and participated in this institutional review board-approved prospective study. Ten residents with more severe burnout and depression scores were assigned to receive 8 weeks of neurofeedback treatments, and 5 others with less severe symptoms were treated as controls. Each participant's cognitive workload (or mental effort) was assessed initially, and again after treatment via electroencephalogram (EEG) while the subjects performed n-back working memory tasks. Analysis of variance (ANOVA) tested for significance between the degree of change in the treatment and control groups. Each subject was also asked to rate changes in growth areas, such as sleep and stress. RESULTS: Both groups showed high cognitive workload in the pre-assessment. After the neurofeedback intervention, the treatment group showed a significant (p < 0.01) improvement in cognitive workload via EEG during the working memory task. These differences were not noted in the control group. There was significant correlation between time (NFB sessions) and average improvement in all growth areas (r = 0.98) CONCLUSIONS: Residents demonstrated high levels of burnout, correlating with EEG patterns indicative of post-traumatic stress disorder. There was a notable change in cognitive workload after the neurofeedback treatment, suggesting a return to a more efficient neural network.

Effect of the Neurofeedback-EEG Training During Physical Exercise on the Range of Mental Work Performance and Individual Physiological Parameters in Swimmers.

The aim of the study was to demonstrate the effects of the Neurofeedback-EEG training during physical exercise on the improvements in mental work performance and physiological parameters. The study examined seven swimmers based on the following anthropometric measurements: body height, body mass and body composition. The Kraepelin's work curve test, EEG and EMG during physical exercise were also performed. The athletes followed 20 Neurofeedback-EEG training sessions on the swimming ergometer for 4 months. Most mean indices of partial measures of the work curve were significantly modified (p < 0.05) following the Neurofeedback-EEG training. Mean level of maximal oxygen uptake in study participants was over 55 ml/kg/min, with statistically significant differences documented between the first and the second measurements. No significant differences were found in the fatigue rate between the measurements 1 and 2. The improved mental work performance following the Neurofeedback-EEG training facilitates optimization of psychomotor activities.

Treatment of Neurodegeneration: Integrating Photobiomodulation and Neurofeedback in Alzheimer's Dementia and Parkinson's: A Review.

Objective: A review of photobiomodulation (PBM) in Alzheimer's dementia is submitted. The addition of PBM in neurodegenerative diseases is a dual modality that is at present gaining traction as it is safe, antiviral, and anti-inflammatory for treating neurodegeneration with photons that stimulate mitochondria increasing adenosine triphosphate and proteasomes increasing misfolded protein removal. Neurofeedback provides neural plasticity with an increase in brain-derived nerve factor mRNA and an increase in dendrite production and density in the hippocampus coupled with overall growth in dendrites, density, and neuronal survival. Background: Alzheimer's disease pathophysiology is the accumulation of hyperphosphorylated tau protein neurofibrillary tangles and subsequently amyloid-beta (Aß) plaques. PBM and neurobiofeedback (NBF)address the multiple gene expression and upregulation of multiple pathogenic pathway inflammation, reactive oxidative stress, mitochondrial disorders, insulin resistance, methylation defects, regulation of neuroprotective factors, and regional hypoperfusion of the brain. There is no human evidence to suggest a clinical therapeutic benefit from using consistent light sources while significantly increasing safety concerns. Methods: A PBM test with early- to mid-Alzheimer's was reported in 2017, consisting of a double-blind, placebo-controlled trial in a small pilot group of early- to mid-dementia subjects under Institutional Review Board (IRB)-approved Food and Drug Administration (FDA) Clinical Trial. Results: PBM-treated subjects showed that active treatment subjects tended to show greater improvement in the functioning of the executive: clock drawing, immediate recall, practical memory, and visual attention and task switching (Trails A&B). A larger study using the CerebroLite helmet in Temple Texas again of subjects in a double-blind, placebo-controlled IRB-approved FDA Clinical Trial demonstrated gain in memory and cognition by increased clock drawing. Conclusions: Next-generation trials with the Cognitolite for Parkinson's disease subjects will incorporate the insights regarding significant bilateral occipital hypocoherence deficits gained from the quantitative EEG analyses. Future applications will integrate noninvasive stimulation delivery, including full-body and transcranial and infrared light with pulsed electromagnetic frequencies.

A software for testing and training visuo-motor coordination for upper limb control.

BACKGROUND: Developing methods to accelerate improvements in motor function are welcomed in clinical practice. Therefore, the aim of this study is to describe changes in brain activity related to the execution of motor tasks implemented on a software - the NeuroMaze - developed specifically to stimulate speed-accuracy tradeoff. NEW METHOD: The NeuroMaze was tested in eleven young and healthy individuals in a single experimental session. The tasks consisted in moving a square appearing on the monitor by holding and dragging it with a mouse across paths of different widths (wide [2 cm] vs intermediate [1.5 cm] vs narrow [1 cm] widths). The mouse cursor speed and scalp electroencephalography (EEG) from the frontal, somatosensory and motor areas were recorded. RESULTS: The mouse speed is reduced by 15 ±â€¯6% and 48 ±â€¯7% from the wide to the intermediate and narrow paths respectively (p < 0.005). Moreover, there was a greater beta EEG relative power in the narrow path in the frontal area of the brain when compared to the wide path (p < 0.05). Similarly, the narrow path reduced the gamma EEG relative power in motor/sensorimotor areas when compared to the wide path (p < 0.05). COMPARISON WITH EXISTING METHODS: The NeuroMaze is introduced as a method to elicit speed-accuracy tradeoff, and the authors are not aware of specific methods to establish fair comparisons. CONCLUSION: The NeuroMaze creates conditions to stimulate brain areas related to motor planning, sensory feedback and motor execution using speed-accuracy tradeoff contexts. Therefore, the NeuroMaze may induce adaptations in patients undergoing upper limb rehabilitation.

Alpha-phase synchrony EEG training for multi-resistant chronic low back pain patients: an open-label pilot study.

PURPOSE: Chronic low back pain (cLBP) affects a quarter of a population during its lifetime. The most severe cases include patients not responding to interventions such as 5-week-long in-hospital multi-disciplinary protocols. This document reports on a pilot study offering an alpha-phase synchronization (APS) brain rehabilitation intervention to a population of n = 16 multi-resistant cLBP patients. METHODS: The intervention consists of 20 sessions of highly controlled electroencephalography (EEG) APS operant conditioning (neurofeedback) paradigm delivered in the form of visual feedback. Visual analogue scale for pain, Dallas, Hamilton, and HAD were measured before, after, at 6-month and 12-month follow-up. Full-scalp EEG data were analyzed to study significant changes in the brain's electrical activity. RESULTS: The intervention showed a great and lasting response of most measured clinical scales. The clinical improvement was lasting beyond the 6-month follow-up endpoints. The EEG data confirm that patients did control (intra-session trends) and learned to better control (intersession trends) their APS neuromarker resulting in (nonsignificant) baseline changes in their resting state activity. Last and most significantly, the alpha-phase concentration (APC) neuromarker, specific to phase rather than amplitude, was found to correlate significantly with the reduction in clinical symptoms in a typical dose-response effect. CONCLUSION: This first experiment highlights the role of the APC neuromarker in relation to the nucleus accumbens activity and its role on nociception and the chronicity of pain. This study suggests APC rehabilitation could be used clinically for the most severe cases of cLBP. Its excellent safety profile and availability as a home-use intervention makes it a potentially disruptive tool in the context of nonsteroidal anti-inflammatory drugs and opioid abuses. These slides can be retrieved under Electronic Supplementary Material.

Effect of deactivation of activity patterns related to smoking cue reactivity on nicotine addiction.

With approximately 75% of smokers resuming cigarette smoking after using the Gold Standard Programme for smoking cessation, investigation into novel therapeutic approaches is warranted. Typically, smoking cue reactivity is crucial for smoking behaviour. Here we developed a novel closed-loop, smoking cue reactivity patterns EEG-based neurofeedback protocol and evaluated its therapeutic efficacy on nicotine addiction. During an evoked smoking cue reactivity task participants' brain activity patterns corresponding to smoking cues were obtained with multivariate pattern analysis of all EEG channels data, then during neurofeedback the EEG activity patterns of smoking cue reactivity were continuously deactivated with adaptive closed-loop training. In a double-blind, placebo-controlled, randomized clinical trial, 60 nicotine-dependent participants were assigned to receive two neurofeedback training sessions (∼1 h/session) either from their own brain (n = 30, real-feedback group) or from the brain activity pattern of a matched participant (n = 30, yoked-feedback group). Cigarette craving and craving-related P300 were assessed at pre-neurofeedback and post-neurofeedback. The number of cigarettes smoked per day was assessed at baseline, 1 week, 1 month, and 4 months following the final neurofeedback visit. In the real-feedback group, participants successfully deactivated EEG activity patterns of smoking cue reactivity. The real-feedback group showed significant decrease in cigarette craving and craving-related P300 amplitudes compared with the yoked-feedback group. The rates of cigarettes smoked per day at 1 week, 1 month and 4 months follow-up decreased 30.6%, 38.2%, and 27.4% relative to baseline in the real-feedback group, compared to decreases of 14.0%, 13.7%, and 5.9% in the yoked-feedback group. The neurofeedback effects on craving change and smoking amount at the 4-month follow-up were further predicted by neural markers at pre-neurofeedback. This novel neurofeedback training approach produced significant short-term and long-term effects on cigarette craving and smoking behaviour, suggesting the neurofeedback protocol described herein is a promising brain-based tool for treating addiction.

Volitional limbic neuromodulation exerts a beneficial clinical effect on Fibromyalgia.

Volitional neural modulation using neurofeedback has been indicated as a potential treatment for chronic conditions that involve peripheral and central neural dysregulation. Here we utilized neurofeedback in patients suffering from Fibromyalgia - a chronic pain syndrome that involves sleep disturbance and emotion dysregulation. These ancillary symptoms, which have an amplificating effect on pain, are known to be mediated by heightened limbic activity. In order to reliably probe limbic activity in a scalable manner fit for EEG-neurofeedback training, we utilized an Electrical Finger Print (EFP) model of amygdala-BOLD signal (termed Amyg-EFP), that has been successfully validated in our lab in the context of volitional neuromodulation. We anticipated that Amyg-EFP-neurofeedback training aimed at limbic down modulation would improve chronic pain in patients suffering from Fibromyalgia, by reducing sleep disorder improving emotion regulation. We further expected that improved clinical status would correspond with successful training as indicated by improved down modulation of the Amygdala-EFP signal. Thirty-Four Fibromyalgia patients (31F; age 35.6 ±â€¯11.82) participated in a randomized placebo-controlled trial with biweekly Amyg-EFP-neurofeedback sessions or sham neurofeedback (n = 9) for a total duration of five consecutive weeks. Following training, participants in the real-neurofeedback group were divided into good (n = 13) or poor (n = 12) modulators according to their success in the neurofeedback training. Before and after treatment, self-reports on pain, depression, anxiety, fatigue and sleep quality were obtained, as well as objective sleep indices. Long-term clinical follow-up was made available, within up to three years of the neurofeedback training completion. REM latency and objective sleep quality index were robustly improved following the treatment course only in the real-neurofeedback group (time × group p < 0.05) and to a greater extent among good modulators (time × sub-group p < 0.05). In contrast, self-report measures did not reveal a treatment-specific response at the end of the neurofeedback training. However, the follow-up assessment revealed a delayed improvement in chronic pain and subjective sleep experience, evident only in the real-neurofeedback group (time × group p < 0.05). Moderation analysis showed that the enduring clinical effects on pain evident in the follow-up assessment were predicted by the immediate improvements following training in objective sleep and subjective affect measures. Our findings suggest that Amyg-EFP-neurofeedback that specifically targets limbic activity down modulation offers a successful principled approach for volitional EEG based neuromodulation treatment in Fibromyalgia patients. Importantly, it seems that via its immediate sleep improving effect, the neurofeedback training induced a delayed reduction in the target subjective symptom of chronic pain, far and beyond the immediate placebo effect. This indirect approach to chronic pain management reflects the substantial link between somatic and affective dysregulation that can be successfully targeted using neurofeedback.

Design and Validation of an FPGA-Based Configurable Transcranial Doppler Neurofeedback System for Chronic Pain Patients.

Neurofeedback is a self-regulation technique that can be applied to learn to voluntarily control cerebral activity in specific brain regions. In this work, a Transcranial Doppler-based configurable neurofeedback system is proposed and described. The hardware configuration is based on the Red Pitaya board, which gives great flexibility and processing power to the system. The parameter to be trained can be selected between several temporal, spectral, or complexity features from the cerebral blood flow velocity signal in different vessels. As previous studies have found alterations in these parameters in chronic pain patients, the system could be applied to help them to voluntarily control these parameters. Two protocols based on different temporal lengths of the training periods have been proposed and tested with six healthy subjects that were randomly assigned to one of the protocols at the beginning of the procedure. For the purposes of the testing, the trained parameter was the mean cerebral blood flow velocity in the aggregated data from the two anterior cerebral arteries. Results show that, using the proposed neurofeedback system, the two groups of healthy volunteers can learn to self-regulate a parameter from their brain activity in a reduced number of training sessions.

Surface electromyographic biofeedback for behavioral dysphonia in adult people: a systematic review / Biofeedback eletromiográfico de superfície para disfonia comportamental em adultos: revisão sistemática

ABSTRACT Purpose To review systematically the literature and to analyze the effectiveness of surface electromyographic biofeedback in the rehabilitation of adults with behavioral dysphonia. Research strategies Two authors performed an independent search in the following databases: Clinical Trials, Cochrane Library, Embase, LILACS, PubMed, and Web of Science. A specific search strategy was developed for each database. Selection criteria The review included studies that examined the effectiveness of surface electromyographic biofeedback compared to other direct vocal therapy intervention in adults with behavioral dysphonia. There were no restrictions in regard to language or date of publication. Data analysis Analysis of the risk of bias, heterogeneity, quantitative and qualitative data, sensitivity, subgroups, and publication bias. Results 51 studies were identified, but only two cohort studies remained as prospects for analysis. The studies showed 100% uncertain risk of selection, performance, and detection bias. There was a high degree of clinical heterogeneity. The descriptive analysis showed a reduction in muscle electrical activity and improvement in vocal self-assessment using electromyographic biofeedback; however, it was not possible to calculate the effect size of the interventions. The present study was limited by the fact that it was unable to show a consensus for the majority of data analyzed. Conclusion The available literature does not support a conclusive finding about the effectiveness of surface electromyographic biofeedback compared to other direct interventions used in the rehabilitation of adults with behavioral dysphonia. The studies analyzed vary widely in their clinical procedures and methodology, making it impossible to determine the procedure's effectiveness.

RESUMO Objetivo Revisar sistematicamente a literatura e analisar a efetividade do biofeedback eletromiográfico de superfície na reabilitação de adultos com disfonia comportamental. Estratégia de pesquisa Dois autores realizaram uma busca independente nas bases de dados: Clinical Trials , Cochrane Library, Embase, LILACS, PUBMED e Web of Science. Elaborou-se uma estratégia de busca específica para cada base. Critérios de seleção Foram incluídos estudos que analisaram a efetividade do biofeedback eletromiográfico de superfície comparado com outras intervenções de terapia vocal direta em adultos com disfonia comportamental. Não houve restrição de idioma e data de publicação. Análise de dados Análise do risco de viés, heterogeneidade, dados quantitativos e qualitativos, sensibilidade, subgrupos e viés de publicação. Resultados foram identificados 51 estudos, sendo que apenas dois estudos coorte prospectivos foram analisados. Os estudos apresentaram 100% de risco incerto de viés de seleção, performance e detecção. Houve alta heterogeneidade clínica. A análise descritiva mostrou redução da atividade elétrica muscular e melhora da autoavaliação vocal com o uso do biofeedback eletromiográfico, porém, não foi possível calcular o tamanho do efeito das intervenções. O presente estudo apresentou limitações por não conseguir apresentar um consenso para a maioria dos dados analisados. Conclusão A literatura disponível não permite gerar uma evidência conclusiva acerca da efetividade do biofeedback eletromiográfico comparado a outras intervenções diretas na reabilitação de sujeitos adultos com disfonia comportamental.

Common Synaptic Input to Motor Neurons and Neural Drive to Targeted Reinnervated Muscles.

We compared the behavior of motor neurons innervating their physiological muscle targets with motor neurons from the same spinal segment whose axons were surgically redirected to remnant muscles (targeted muscle reinnervation). The objective was to assess whether motor neurons with nonphysiological innervation receive similar synaptic input and could be voluntary controlled as motor neurons with natural innervation. For this purpose, we acquired high-density EMG signals from the biceps brachii in 5 male transhumeral amputees who underwent targeted reinnervation of this muscle by the ulnar nerve and from the first dorsal interosseous muscle of 5 healthy individuals to investigate the natural innervation of the ulnar nerve. The same recordings were also performed from the biceps brachii muscle of additional 5 able-bodied individuals. The EMG signals were decomposed into discharges of motor unit action potentials. Motor neurons were progressively recruited for the full range of submaximal muscle activation in all conditions. Moreover, their discharge rate significantly increased from recruitment to target activation level in a similar way across the subject groups. Motor neurons across all subject groups received common synaptic input as identified by coherence analysis of their spike trains. However, the relative strength of common input in both the delta (0.5-5 Hz) and alpha (5-13 Hz) bands was significantly smaller for the surgically reinnervated motor neuron pool with respect to the corresponding physiologically innervated one. The results support the novel approach of motor neuron interfacing for prosthesis control and provide new insights into the role of afferent input on motor neuron activity.SIGNIFICANCE STATEMENT Targeted muscle reinnervation surgically redirects nerves that lost their target in the amputation into redundant muscles in the region of the stump. The study of the behavior of motor neurons following this surgery is needed for designing biologically inspired prosthetic control strategies. Moreover, targeted muscle reinnervation offers a human experimental framework for studying the control and behavior of motor neurons when changing their target innervated muscle fibers and sensory feedback. Here, we show that the control of motor neurons and their synaptic input, following reinnervation, was remarkably similar to that of the physiological innervation, although with reduced common drive at some frequencies. The results advance our knowledge on the role of sensory input in the generation of the neural drive to muscles and provide the basis for designing physiologically inspired methods for prosthesis control.

Randomized controlled trial of neurofeedback on chemotherapy-induced peripheral neuropathy: A pilot study.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a significant problem for cancer patients, and there are limited treatment options for this often debilitating condition. Neuromodulatory interventions could be a novel modality for patients trying to manage CIPN symptoms; however, they are not yet the standard of care. This study examined whether electroencephalogram (EEG) neurofeedback (NFB) could alleviate CIPN symptoms in survivors. METHODS: This was a randomized controlled trial with survivors assigned to an NFB group or a wait-list control (WLC) group. The NFB group underwent 20 sessions of NFB, in which visual and auditory rewards were given for voluntary changes in EEGs. The Brief Pain Inventory (BPI) worst-pain item was the primary outcome. The BPI, the Pain Quality Assessment Scale, and EEGs were collected before NFB and again after treatment. Outcomes were assessed with general linear modeling. RESULTS: Cancer survivors with CIPN (average duration of symptoms, 25.3 mo), who were mostly female and had a mean age of 62.5 years, were recruited between April 2011 and September 2014. One hundred percent of the participants starting the NFB program completed it (30 in the NFB group and 32 in the WLC group). The NFB group demonstrated greater improvement than the controls on the BPI worst-pain item (mean change score, -2.43 [95% confidence interval, -3.58 to -1.28] vs 0.09 [95% confidence interval, -0.72 to -0.90]; P =·.001; effect size, 0.83). CONCLUSIONS: NFB appears to be effective at reducing CIPN symptoms. There was evidence of neurological changes in the cortical location and in the bandwidth targeted by the intervention, and changes in EEG activity were predictive of symptom reduction. Cancer 2017;123:1989-1997. © 2017 American Cancer Society.

[Neurofeedback-based motor imagery training for rehabilitation after stroke]. / Neurofeedback-gestütztes Bewegungsvorstellungstraining zur Rehabilitation nach einem Schlaganfall.

Mental training, including motor observation and motor imagery, has awakened much academic interest. The presumed functional equivalence of motor imagery and motor execution has given hope that mental training could be used for motor rehabilitation after a stroke. Results obtained from randomized controlled trials have shown mixed results. Approximately half of the studies demonstrate positive effects of motor imagery training but the rest do not show an additional benefit. Possible reasons why motor imagery training has so far not become established as a robust therapeutic approach are discussed in detail. Moreover, more recent approaches, such as neurofeedback-based motor imagery or closed-loop systems are presented and the potential importance for motor learning and rehabilitation after a stroke is discussed.

Neurofeedback ineffective in paediatric brain tumour survivors: Results of a double-blind randomised placebo-controlled trial.

BACKGROUND: Many paediatric brain tumour survivors (PBTS) suffer from neurocognitive impairments. Promising effects of neurofeedback (NF) on neurocognitive functioning have been reported, however research into NF for PBTS has not been conducted. We investigated the effects of NF on neurocognitive functioning in PBTS using a double-blind randomised placebo-controlled trial with a parallel-group design (Pediatric Research on Improving Speed, Memory, and Attention; the PRISMA study). METHODS: Eligible for inclusion were PBTS with neurocognitive complaints, aged 8-18 years, >2 years post-treatment. They were recruited from five medical centres in the Netherlands. A randomisation table assigned participants to 30 sessions (two per week) of either NF or placebo feedback (PF) (ratio 1:1). Participants, parents, trainers, and researchers handling the data were blinded to group assignment. Participants were assessed pre-, post- and 6 months post-training to determine whether NF training would lead to improved functioning as compared with PF training. Primary outcome measures were attention, processing speed, memory, executive functioning, visuomotor integration, and intelligence. Linear mixed models analyses were used to test differences between NF and PF training over time. RESULTS: A total of 82 children were enrolled (mean age 13.9 years, standard deviation = 3.2, 49% males); 80 participants were randomised (NF: n = 40, PF n = 40); 71 participants completed the training (NF: n = 34, PF: n = 37); 68 participants completed training and 6 months post-training assessment (NF: n = 33, PF: n = 35). Similar improvements were found over time for the two treatment groups on the primary outcomes (all p's > 0.15). CONCLUSION: Results indicated no specific treatment-effects of NF on neurocognitive functioning of PBTS.

Effect of EEG Biofeedback on Cognitive Flexibility in Children with Attention Deficit Hyperactivity Disorder With and Without Epilepsy.

Attention deficit hyperactivity disorder (ADHD) is one of the most common developmental disorders in school-aged children. Symptoms consistent with ADHD have been observed in 8-77 % of children with epilepsy. Researchers have been motivated to search for alternative forms of treatment because 30 % of patients with ADHD cannot be treated by psychostimulants. Several studies support the use of a multimodal treatment approach that includes neurofeedback (NF) for the long-term management of ADHD. These studies have shown that NF provides a sustained effect, even without concurrent treatment with stimulants. We aimed to assess cognitive flexibility in ADHD children with and without temporal lobe epilepsy (TLE), and to evaluate the effects of NF on cognitive flexibility in these groups of children. We prospectively evaluated 69 patients with ADHD aged 9-12 years. The control group was 26 ADHD children without TLE who received no treatment. The first experimental group comprised 18 children with ADHD. The second experimental group comprised 25 age-matched ADHD children with TLE. This group was further divided in two subgroups. One subgroup comprised those with mesial temporal lobe epilepsy (16 patients, 9 with hippocampal sclerosis and 7 with hippocampal atrophy), and the other with lateral temporal lobe epilepsy (9 patients, 5 with temporal lobe dysplasia, 3 with temporal lobe cysts, and 1 with a temporal lobe cavernoma). We treated their ADHD by conducting 30 sessions of EEG NF. Reaction time and error rates on the Trail Making Test Part B were compared before and after treatment, and significant differences were found for all groups of patients except those who had mesial temporal lobe epilepsy with hippocampal atrophy. Our results demonstrate that in most cases, NF can be considered an alternative treatment option for ADHD children even if they have TLE. Additional studies are needed to confirm our results.