The basics of biofeedback and neurofeedback and the relevance to brain injury rehabilitation

1. Derek Jones PhD, MBA
Biofeedback
Neurofeedback
Brain Computer Interfaces
FIXXL Ltd * fixxl.co.uk * rehacom.co.uk * better-grip.co.uk * biofeedback-tech.com
BF Skinner

2. Feedback Control System
System
Measurement
Error
Desired
State
Actual State
Sensor
-

3. Definitions
❖ Biofeedback
❖ Gaining awareness of (many) physiological functions
we are not normally consciously aware of by means
of electronic monitoring instrumentation…and then
❖ Presenting this data in order to train someone to
acquire voluntary control of that function.
❖ Once trained - equipment not needed

4. Definitions
❖ Neurofeedback or EEG Biofeedback
❖ A form of biofeedback training that uses the EEG as
the signal to control feedback. Sensors applied to the
scalp identify the EEG signals which are processed
by computer software. Visual, auditory and tactile
feedback can be used to encourage learning
❖ Different from clinical EEG and qEEG but make use
of the same signal
❖ Aim is to gain positive changes without
instrumentation.

5. Definitions
❖ BCI - Brain Computer Interface
❖ Measures CNS activity and converts into an artificial
output that replaces, restores, enhances,
supplements or improves the natural CNS output
❖ Thereby changes ongoing interactions between the
CNS and it’s internal or external environment
❖ Real time interaction between the user’s intention and
the outside world

6. So What?
❖ Effects of TBI on the Autonomic Nervous System (ANS)
are many and varied - e.g. Post-TBI temperature
intolerance; PSH (Paroxysmal Sympathetic Hyperactivity)
❖ ANS normally maintains homeostasis in the face of life’s
challenges without our conscious attention
❖ Sympathetic and Parasympathetic nervous systems
❖ TBI and many things disturb the ANS balance
❖ Can Biofeedback help achieve greater ANS balance?

7. “Neverseenalion” tribe

8. Cortex
Thalamus
Amygdala
Our Response is..
•Instantaneous
•Doesn’t involve “thinking”
•Influenced by Early Learning
•Emotionally DrivenBehaviour - Physiology - Immunology
Perception of Stress

9. ANS Balance
❖ High Effort
❖ Fight of Flight
❖ Adrenaline
❖ Low Effort
❖ Relaxation
❖ Acetylcholine
Sympathetic Pathway
Signals flow from our brain to the
heart, adrenal glands, blood vessels
etc speeding up these body
systems. Shaped by our
perception
Parasympathetic Pathway
Opposite effect to the Sympathetic
and acts to slow down or “cool down
the heart and other organs
“Accelerator” “Brakes”

10. Stress depends on your individual perception

11. Hormonal System
Positive Emotion
Well/Being
Success
Negative Emotion
Submission
Despair
Many hormones - “Molecules of Emotion” are produced
including DHEA (Precursor to Testosterone and Oestrogen)
and the body’s main stress hormone Cortisol
Imbalance is linked with
many chronic diseases

12. Hormonal
Long term
Short Term
ANS
Physiology
High
Performance
Low
Performance
High Arousal - Effort
Low Arousal - Relaxation
Fight Flight
Positive
Emotion
Negative
Emotion

13. Applications
Biofeedback and EEG Biofeedback
1 Anxiety
2 Attention Deficit Disorder
3 Headache- Adult
4 Hypertension
5 Temporomandibular Disorders
6 Urinary Incontinence in Males
1 Alcoholism/Substance
Abuse
2 Arthritis
3 Chronic Pain
4 Epilepsy
5 Fecal Elimination Disorders
6 Headache- Pediatric
Migraines
7 Insomnia
8 Traumatic Brain Injury
9 Vulvar Vestibulitis
Efficacious and specific (Fifth level): Efficacious (Fourth Level) :
1 Urinary Incontinence in Females
Probably efficacious (Third level):
Possibly Efficacious (Second level):
Stroke
Post Traumatic Stress disorder
Chronic Obstructive Pulmonary Disease
Raynaud's Disease
Many more

14. System Design
•Data Acquisition
•Signal Processing/Feature Extraction
•Feedback/Command Generation
•Learning takes place
•Maintenance of Learning ?

15. GSR
Temp
BVP
HRV
Respiration
Sp02
Force
qEEG
sEMG
ECG
EOG
SCP
ERP
P300
Data
Acquisition
Data Acquisition

16. Signal Processing Client FeedbackData Acquisition
Biofeedback Process
Learning

17. Conceptual view of Neurofeedback
EEG
Brain
Events
Behaviour
Thought
Externalised
Internalised
Perceived as Thoughts
Perceived as Behaviour
Perceived as Neurofeedback

18. Signal Processing
Feature Extraction
Translation of
features into
Commands
Data Acquisition
BCI Process
Replace
Restore
Enhance
Supplement
Improve

20. • Thinking activates brain regions
• Imagine “move left hand”
• System Recognises pattern via
EEG
• Feedback imagery
• FES Activation of wrist muscles

21. Disorders of Consciousness
mindBEAGLE
Alternative to fMRI
assessment of consciousness
P300 Approach

22. Contrast Project - EU
Remote Control Cognitive Training
EEG neurofeedback headset
Single or dual channel
Semi-dry electrodes

24. Derek Jones PhD MBA
Anatomical Concepts (UK) Ltd - Masters of Rehabilitation Engineering
Fixxl Ltd - Bringing Technology to Life