1. Validation of a global live z-score protocol: mechanism, within-subject results, and a randomized controlled study
Society for Applied Neuroscience
May 5, 2011 – Thessaloniki, Greece
Thomas F. Collura, Ph.D., QEEG-D
BrainMaster Technologies
The Brain Enrichment Center
Bedford, Ohio

2. Acknowledgement Elena Festa, Ph.D. William Heindel, Ph.D.
Department of Cognitive, Linguistic, and Psychological Sciences
Brown University, Providence, Rhode Island
Alzheimer’s Association, USA

3. Validation Principles
Controlled Conditions
Record physiological & behavioral variables
Demonstrate physiological change
Demonstrate behavioral change
Confirm principles of operation

4. Validation Specifics Metric based upon QEEG parameters
Live feedback of derived computations
Operant learning of brain
Demonstrable expected EEG changes
Demonstrable clinical / behavioral changes

5. Live Z-Score Principles
Normalization of QEEG-based parameters
Resulting change in brain function
“Normal” reference database
Anatomy, Physiology, Logic
Activation AND Connectivity changes
“First Order” Changes – “expected”
Secondary / Compensating Changes

6. Possible Changes – “Phenotypes”
Normalize aberrant process
Focal or Global abnormalities
Depression , Anxiety, Attention
Normalize coping/compensating mech.
Denial, Masking, Hyperconnection (injury)
PTST, chronic pain, chronic anxiety
Normalize “Peak performance” mechanism
“High” SMR, “Fast” Alpha
Hypercoherence, Hypocoherence

7. Validation Stages Single subject – Within Session
Single subject – Across Sessions
Across subjects – Within Session
Across subjects – Across Sessions
Physiological AND Behavioral observations

8. Single Subject - Within Session Individual Z-Scores

9. Single Subject – Within Session Aggregate (All) Z-Scores

10. Subjective Change “More aware of my pain” (Chronic Pain)
Normalization of abnormal alpha
Removal of coping mechanism

11. Single Subject – Across Sessions (Guan)

12. Clinical Changes - Guan
Reduction of Anxiety
Reduction of Depression
Improved ability to study
Improved ability to return to work

13. Single Subject – Across Sessions (Lambos)

14. Clinical Changes - Lambos
ADHD / Defiant / Violent
Reduction in violent outbursts
Improved ability to pay attention
Increased compassion with others
Ability to transfer to regular class

15. Controlled Study Aging Population Normal and Mild Alzheimer’s N=79
Real NF: 4-channels: Cz C4 P3 P4
Percent Z Scores (PZOK): 248 Z-Scores
Cognitive / Behavioral Measures

16. NFT Study in AD and Aging
Train posterior sites to:
enhance cortical processing within posterior systems
relieve burden of anterior systems to moderate deteriorated posterior system
Investigate the short-term effects of NFT on neurocognitive measures of attention and sensory integration in healthy elderly and patients with early stage AD
Compare performance of true-NFT vs. mock-NFT subjects

17. Experimental Design
Healthy elderly and AD patients assigned to either mock or true-NFT group
Each mock-NFT subject demographically matched to a true-NFT subject
8 NFT sessions
1-2 sessions/week over 4-6 weeks
Assessment battery pre & post NFT
Within 2 weeks of NFT sessions

18. Healthy Elderly Participants
GROUP
N (m,f)
AGE ED
MMSE
RBANS
NFT
20 (5,15)
71.6
(8.1)
16.0
(3.3)
28.8
(1.1)
108.2
(12.2)
Mock NFT
19 (3,16)
72.2
(8.3)
(2.6)
(1.2)
108.5
(13.1)
MMSE: Mini-Mental State Examination
RBANS: Repeatable Battery for the Assessment of Neuropsychological Status

19. Mild AD Participants GROUP N (m,f) AGE ED MMSE RBANS NFT 18 (8,10)
78.0
(5.0)
14.0
(3.1)
24.4
(1.1)
74.7
(13.1)
Mock NFT
12 (6,6)
77.5
(6.4)
(2.6)
25.4
(1.2)
79.3
(9.7)
MMSE: Mini-Mental State Examination
RBANS: Repeatable Battery for the Assessment of Neuropsychological Status

20. Methods
NFT sessions
Electrode sites: C3, C4, P3, P4
10 min. % z-score ok training
5 min. baseline (eyes closed) pre & post
Brainwave activity recorded with Atlantis I (4+4) system (BrainMaster Technologies, Inc.)
Real-time z-score neurofeedback training provided by using the Z score DLL (Applied Neuroscience, Inc.) in conjunction with Brainmaster 3.21 software (BrainMaster Technologies, Inc.)

21. Methods Training Regimen Sessions 1-4 Sessions 5-8
75% of z-scores within 1 STD of normative range
Sessions 5-8
80% of z-scores within 1 STD of normative range
Audiovisual feedback provided through continuous modulation of the picture contrast of an IMAX nature movie and organ tones when reward criterion sustained for 500 ms
Mock-NFT subjects received feedback in each NFT session based on the recorded brainwave activity across each NFT session of the matched true-NFT subjects

22. Methods Assessment Battery
Several standardized neuropsychological tests of cognitive functions and emotional well-being (RBANS, CAD, GDS)
Resting brainwave activity 64-channel EEG recording (eyes closed)
Behavioral and EEG measures of neurocognitive tests assessing specific component attentional processes

23. Neurocognitive Measures
Alerting, Orienting, & Executive Control
Spatial Orienting/Simon Interference task
Selective Attention & Sensory Integration
Visual Search task

24. Visual Search: Selective Attention and Sensory Integration
Set Size 1
Set Size 3
Set Size 5

25. Visual Search and Sensory Integration:
Healthy Elderly

26. Visual Search and Sensory Integration:
Mild AD

27. Results: Visual Search
Healthy Elderly
Real NFT decreased RTs for both sensory binding conditions
Mock NFT had no effect on RTs for either binding conditions
Mild AD
Real NFT had no effect on RTs for either binding conditions

28. Covert Orienting/Simon Interference
LEFT
Congruent
LEFT
Incongruent

29. Orienting
LEFT
Valid
LEFT
Invalid
Alerting
LEFT
No Cue
LEFT
Double

30. Effects of NFT on Simon Interference
Healthy Elderly
Mild AD

31. Results: Simon Interference
Healthy Elderly
Real NFT had no effect on RTs for either Congruent or Incongruent trials
Mock NFT increased RTs for both Congruent and Incongruent trials
Mild AD
Real NFT had no significant effect on RTs for either Congruent or Incongruent trials
Mock NFT had no significant effect on RTs for either Congruent or Incongruent trials

32. Effects of NFT on Spatial Orienting
Healthy Elderly
Mild AD

33. Results: Spatial Orienting
Healthy Elderly
Real NFT reduced RTs for both Valid and Invalid Cue trials
Mock NFT increased RTs for both Valid and Invalid Cue trials
Mild AD
Real NFT selectively reduced RTs for Invalid Cue trials
Mock NFT had no effect on RTs for either Valid or Invalid Cue trials

34. Effects of NFT on Alerting
Healthy Elderly
Mild AD

35. Results: Alerting Healthy Elderly Mild AD
Real NFT had no effect on RTs for either Double or No Cue trials
Mock NFT selectively increased RTs for No Cue Cue trials
Mild AD
Real NFT reduced RTs for both Double and No Cue Trials
Mock NFT increased RTs for both Double and No Cue Trials

36. Summary: Real NFT Healthy Elderly Mild AD
No effect on cross-cortical sensory integration, but enhanced selective attention in the visual search task
Generalized enhancement of response times in spatial orienting
No effect on either alerting measures or response inhibition in Simon interference
Mild AD
No effect on either cross-cortical sensory integration or selective attention measures in the visual search task
Selective improvement in disengagement in spatial orienting
Enhanced phasic and tonic alerting
No effect on response inhibition in Simon interference

37. Summary: Mock NFT Healthy Elderly Mild AD
No effect on cross-cortical sensory integration or selective attention in the visual search task
Generalized slowing of response times for spatial orienting, alerting and Simon interference measures
Mild AD
No effect on response times for spatial orienting or Simon interference measures
Generalized slowing of response times for the alerting measures

38. Non-Memory Impairments in AD
Attention
Cognitive operations involved in the detection and selection of sensory information
Automatic (stimulus-driven)
Voluntary (controlled, goal-directed)
Different attentional processes mediated by distinct neural subsystems
Sensory Integration
The “Binding Problem”
Moment-by-moment ability to combine distinct sensory inputs related to a single object into a coherent, unified representation
Dependent upon effective interactions across cortical areas
The measures that improve with Real NFT are different across the groups. The most compelling data is from the search task with the healthy elderly real NFT group.  They show enhanced selective attention across both sensory binding conditions.  Real NFT improves attentional disengagement and alerting measures in the mild AD NFT group. Mock NFT either has no effect or elicits generalized slowing for both groups. I have other data I haven't analyzed yet from different tasks (an audiovisual semantic integration task, a stroop real world object task, a different covert orienting and alerting task)--

39. Non-Memory Impairments in AD (and Aging)
Posterior Cortical Processing Systems
Alerting (cortical tonus)
Orienting
Sensory Integration
Inefficient cortical processing in Aging
Corticocortical disconnectivity in AD
Anterior Executive Control Processes
Changes in frontal cortex with age and AD results in less efficient controlled attentional processes
Greater demands placed on anterior executive processes to moderate deterioration in posterior attentional and sensory systems