As intervenções com neurofeedback têm tido grande difusão na área como uma alternativa possível para tratamento do Transtorno de Déficit de Atenção/Hiperatividade (TDAH). Este estudo tem o objetivo de avaliar a viabilidade da utilização de um sistema de neurofeedback de baixo custo chamado Near Infrared Spectroscopy/Hemoencephalography Neurofeedback (NIR/HEG-NF) para tratar crianças com TDAH. Método: trata-se de um estudo clínico piloto aberto, que incluiu 5 crianças (3 meninos e 2 meninas - idade 10,4 ± 0,89 anos) com TDAH-C (tipo combinado). Os indivíduos completaram um programa de 24 sessões de NIR/HEG-NF, duas ou três vezes por semana. Os seguintes desfechos foram avaliados pré e pós-tratamento: 1) sintomas de desatenção e hiperatividade; 2) desempenho neuropsicológico; 3) imagens de SPECT cerebral; 4) qualidade de vida; e 5) efeitos adversos. Resultados: houve maior resistência do que o esperado para a participação dos indivíduos devido a vários fatores, tais como logísticos para a participação nas sessões e requerimento de não uso de medicação durante o protocolo. Detectamos uma diferença significativa na comparação pré e pós-intervenção nos escores atribuídos pelos pais na dimensão de hiperatividade e impulsividade do Swanson, Nolan and Pelham Questionnaire (SNAP-IV) (p = .042; tamanho de efeito [ES] =.38) e uma tendência de melhora nos escores atribuídos pelos pais e professores na dimensão desatenção (p = .066; ES = .47 / p = .068; ES = .60) naquelas crianças que finalizaram o tratamento. Detectamos uma tendência de aumento perfusional em diferentes partes do córtex cerebral em três indivíduos. As comparações pré e pós-intervenção nas outras medidas não indicaram diferenças estatisticamente significativas. Não foram relatados efeitos adversos significativos. Discussão: Os achados iniciais sugerem que o NIR/HEG-NF como tratamento para sintomas de TDAH pode ser promissor e deve ser melhor investigado. O protocolo lança luz sobre novas abordagens para avaliar a eficácia da intervenção. Pode-se, por exemplo, implementar o programa de intervenção no ambiente escolar e com uso concomitante de medicamentos para superar as resistências na alocação de pacientes e para uma avaliação com maior validade externa. / Background and objectives: Neurofeedback interventions have been quick and extensively introduced for clinicians to treat Attention-Deficit/Hyperactivity Disorder (ADHD). This study aims to assess the feasibility of using a low cost neurofeedback system called Near Infrared Spectroscopy/ Hemoencephalography Neurofeedback (NIR/HEG-NF) for treating children with ADHD. Method: This open pilot clinical study included 5 children (3 boys and 2 girls - age 10.4 ± 0.89 years) with ADHD-C (combined type). The subjects completed a program of 24 sessions of NIR/HEG-NF, two or three times a week. The following outcomes were assessed pre and post-treatment: 1) clinical symptoms of inattention and hyperactivity; 2) neuropsychological performance; 3) brain SPECT images; 4) quality of life and; 5) adverse effects. Results: Higher resistance than expected was experienced for patient allocation due to logistic reasons to attend the sessions in the hospital and the requirement of not using medication during the protocol. We detected a significant decrease in hyperactivity/impulsivity comparing pre and post-intervention scores in the parent’s Swanson, Nolan and Pelham Questionnaire - SNAP-IV (p = .042; Effect Size [ES] r = .38) and a trend of improvement in scores attributed by parents and teachers in inattention (p = .066; r = .47 / p = .068; r = .68) . We detected a trend for increased perfusion in different parts of the entire cortex in 3 subjects. Comparisons between pre and post-intervention scores in other measures did not suggest meaningful differences. No significant adverse effects were reported. Discussion: Our initial findings suggest that NIR/HEG-NF technique might be promising and should be further investigated. The protocol shed light on new approaches to assess the effectiveness of the intervention such as the need to both implement the intervention program in a school environment and to pursue the investigation of the treatment effects with concomitant use of medications to surpass resistances to enroll patients and to have an assessment with more external validity.

As intervenções com neurofeedback têm tido grande difusão na área como uma alternativa possível para tratamento do Transtorno de Déficit de Atenção/Hiperatividade (TDAH). Este estudo tem o objetivo de avaliar a viabilidade da utilização de um sistema de neurofeedback de baixo custo chamado Near Infrared Spectroscopy/Hemoencephalography Neurofeedback (NIR/HEG-NF) para tratar crianças com TDAH. Método: trata-se de um estudo clínico piloto aberto, que incluiu 5 crianças (3 meninos e 2 meninas - idade 10,4 ± 0,89 anos) com TDAH-C (tipo combinado). Os indivíduos completaram um programa de 24 sessões de NIR/HEG-NF, duas ou três vezes por semana. Os seguintes desfechos foram avaliados pré e pós-tratamento: 1) sintomas de desatenção e hiperatividade; 2) desempenho neuropsicológico; 3) imagens de SPECT cerebral; 4) qualidade de vida; e 5) efeitos adversos. Resultados: houve maior resistência do que o esperado para a participação dos indivíduos devido a vários fatores, tais como logísticos para a participação nas sessões e requerimento de não uso de medicação durante o protocolo. Detectamos uma diferença significativa na comparação pré e pós-intervenção nos escores atribuídos pelos pais na dimensão de hiperatividade e impulsividade do Swanson, Nolan and Pelham Questionnaire (SNAP-IV) (p = .042; tamanho de efeito [ES] =.38) e uma tendência de melhora nos escores atribuídos pelos pais e professores na dimensão desatenção (p = .066; ES = .47 / p = .068; ES = .60) naquelas crianças que finalizaram o tratamento. Detectamos uma tendência de aumento perfusional em diferentes partes do córtex cerebral em três indivíduos. As comparações pré e pós-intervenção nas outras medidas não indicaram diferenças estatisticamente significativas. Não foram relatados efeitos adversos significativos. Discussão: Os achados iniciais sugerem que o NIR/HEG-NF como tratamento para sintomas de TDAH pode ser promissor e deve ser melhor investigado. O protocolo lança luz sobre novas abordagens para avaliar a eficácia da intervenção. Pode-se, por exemplo, implementar o programa de intervenção no ambiente escolar e com uso concomitante de medicamentos para superar as resistências na alocação de pacientes e para uma avaliação com maior validade externa. / Background and objectives: Neurofeedback interventions have been quick and extensively introduced for clinicians to treat Attention-Deficit/Hyperactivity Disorder (ADHD). This study aims to assess the feasibility of using a low cost neurofeedback system called Near Infrared Spectroscopy/ Hemoencephalography Neurofeedback (NIR/HEG-NF) for treating children with ADHD. Method: This open pilot clinical study included 5 children (3 boys and 2 girls - age 10.4 ± 0.89 years) with ADHD-C (combined type). The subjects completed a program of 24 sessions of NIR/HEG-NF, two or three times a week. The following outcomes were assessed pre and post-treatment: 1) clinical symptoms of inattention and hyperactivity; 2) neuropsychological performance; 3) brain SPECT images; 4) quality of life and; 5) adverse effects. Results: Higher resistance than expected was experienced for patient allocation due to logistic reasons to attend the sessions in the hospital and the requirement of not using medication during the protocol. We detected a significant decrease in hyperactivity/impulsivity comparing pre and post-intervention scores in the parent’s Swanson, Nolan and Pelham Questionnaire - SNAP-IV (p = .042; Effect Size [ES] r = .38) and a trend of improvement in scores attributed by parents and teachers in inattention (p = .066; r = .47 / p = .068; r = .68) . We detected a trend for increased perfusion in different parts of the entire cortex in 3 subjects. Comparisons between pre and post-intervention scores in other measures did not suggest meaningful differences. No significant adverse effects were reported. Discussion: Our initial findings suggest that NIR/HEG-NF technique might be promising and should be further investigated. The protocol shed light on new approaches to assess the effectiveness of the intervention such as the need to both implement the intervention program in a school environment and to pursue the investigation of the treatment effects with concomitant use of medications to surpass resistances to enroll patients and to have an assessment with more external validity.

It is understood that in order for athletes to perform to their potential consistently they must learn to optimally self-regulate their psychological and physiological states. Yet, the process by which this is accomplished is not well understood. The purpose of this doctoral dissertation was to explore the concept of self-regulation in the Olympic athlete population through the use of biofeedback and neurofeedback. To address this purpose, two studies were conducted. Study One (Article 1) used a quantitative methodology to explore the relationship between Olympic athletes’ overall self-regulation ability and world ranking. Fifteen Olympic level athletes underwent a 9-stage psychophysiological stress assessment to determine each athlete’s ability to return to baseline after a stress load was applied. Findings revealed that there was a significant correlation between the athletes’ overall self-regulation ability and their ranking at the world level, meaning the better the overall self-regulation ability of the athlete the better the world ranking. Study Two (Articles 2 and 3) employed a qualitative methodology and explored what and how five Olympic level athletes learned from participating in a 20 session biofeedback and neurofeedback training intervention. Data was collected from post-intervention interviews with the athletes. In Study Two, Olympic athletes perceived that the biofeedback and neurofeedback training intervention assisted them in learning to improve self-awareness and self-regulation of their physical and mental states enabling them to feel more in control during sport performances. Engaging in active learning exercises, receiving real-time formative feedback, and utilization of the intervention exercises in training and competition environments were how athletes perceived they learned to self-regulate. Together, the findings from the two studies highlight the relevance and intricacies of self-regulation in high performance sport. Overall, the present dissertation makes a contribution to the sport psychology literature particularly with regard to our understanding of the use of biofeedback and neurofeedback for enhancing self-regulation with Olympic athletes. Thus, learning to improve self-regulation skills using biofeedback and neurofeedback training should be an integral part of a comprehensive and holistic approach used by sport psychology practitioners in assisting athletes to perform to their potential.

This two-part study investigates the effectiveness of neurofeedback training for reducing behavioral problems commonly observed in abused/neglected children, and compares its efficacy to other treatment interventions with this population. Neuro-developmental sequelae of early relationship trauma are explored as an etiological framework for understanding disturbed affect-regulation, which appears central to the behavioral and emotional difficulties commonly experienced by this pediatric population. It is suggested that neurofeedback teaches children to self-regulate brain rhythmicity mechanisms, which in turn affects global improvements in behavior and mood. The pilot study utilizes records of 20 children removed from their biological homes by Child Protective Services. Children were assessed prior to treatment using the Child Behavior Checklist (CBCL) and the Test of Variables of Attention (TOVA), and again after 30 sessions of individualized, qEEG-guided neurofeedback training. A t-test analysis of pre- and post-scores was computed, and indicated significant improvements following treatment. A meta-analysis of existing literature on treatment interventions with abused/neglected children provides individual and aggregate effect sizes for 33 outcome studies with this clinical population, and contextualizes the results of the present pilot study within other empirically validated treatment modalities. Establishment of an overall effect size for treatment for this pediatric population provides a needed method of comparing research results across studies when control groups may not be ethical or feasible.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / This paper seeks to study the correspondence between the results of the test of variable of attention (TOVA) and the signals acquired by the Muse electroencephalogram (EEG) in the positions AF7 and AF8 of the cerebral cortex. There are a variety of research papers that estimates an index of attention in which the different characteristics in discrete signals of the brain activity were used. However, many of these results were obtained without contrasting them with standardized tests. Due to this fact, in the present work, the results will be compared with the score of the TOVA, which aims to identify an attention disorder in a person. The indicators obtained from the test are the response time variability, the average response time, and the d′ prime score. During the test, the characteristics of the EEG signals in the alpha, beta, theta, and gamma subbands such as the energy, average power, and standard deviation were extracted. For this purpose, the acquired signals are filtered to reduce the effect of the movement of the muscles near the cerebral cortex and then went through a subband decomposition process by applying transformed wavelet packets. The results show a well-marked correspondence between the parameters of the EEG signal of the indicated subbands and the visual attention indicators provided by TOVA. This correspondence was measured through Pearson’s correlation coefficient which had an average result of 0.8. / Revisión por pares / Revisión por pares

In dieser Dissertation untersuchten wir die neuronalen Korrelate des Training-Effektes einer auditorischen P300 Gehirn-Computer Schnittstelle mittels fMRI Analyse in einem prä-post Design mit zehn gesunden Testpersonen. Wir wiesen in drei Trainings-sitzungen einen Trainingseffekt in der EEG-Analyse der P300 Welle nach und fanden entsprechende Kontraste in einer prä-post Analyse von fMRI Daten, wobei in allen fünf Sitzungen das gleiche Paradigma verwendet wurde. In der fMRI Analyse fanden wir fol-gende Ergebnisse: in einem Target-/ Nichttarget Kontrast zeigte sich verstärkte Aktivie-rung in Generatorregionen der P300 Welle (temporale und inferiore frontale Regionen) und interessanterweise auch in motorassoziierten Arealen, was höhere kognitiver Pro-zesse wie Aufmerksamkeitslenkung und Arbeitsspeicher widerspiegeln könnte. Der Kon-trast des Trainingseffektes zeigte nach dem Training einen stärkeren Rebound Effekt im Sinne einer verstärkten Aktivierung in Generatorregionen der P300 Welle, was eine ver-besserte Erkennung und Prozessierung von Target-Stimuli reflektieren könnte. Eine Ab-nahme von Aktivierung in frontalen Arealen in diesem Kontrast könnte durch effizientere Abläufe kognitiver Prozesse und des Arbeitsgedächtnis erklärt werden. / In this dissertation we investigated the neuronal correlates of the training effect of an auditory P300-based brain-computer interface using fMRI analysis in a prae-post de-sign in a group of ten healthy probands. We showed a training effect during three training sessions with EEG analysis of the P300 wave and found corresponding contrasts in a prae-post analysis of fMRI data, while using the same paradigma in all sessions. In the fMRI analysis we found the following results: in a target / nontarget contrast we found enhancement of activation in generator regions of the P300 wave such as temporal and inferior frontal areas and interestingly also in motor associated areas which could reflect higher cognitive processes such as attention and working memory. In the contrast of the effects of training we found a stronger rebound effect as a correlate of stronger activation after training in generator regions of P300, possibly reflecting better discrimination and processing of stimuli. The decrease of activation in frontal areas in this contrast could be explained by increased efficiency of cognitive processing and working memory through training.