About tomcollura

Biomedical Engineer, neurophysiologist, mental health counselor, inventor, entrepreneur, educator

Remote Therapy and Neurofeedback with Distant Clients

Tom and Terri Collura

BrainMaster Technologies, Inc.

 

In this discussion we will address some of the clinical, technical, and medicolegal aspects of remote training.  Fundamentally, remote training consists of sending EEG neurofeedback equipment into the home, school, or office, where it is used in the absence of direct supervision of the responsible clinician.  We are seeking a new model, in which the EEG instrument becomes more like an electronic dispenser, that administers treatments according to specific protocols and parameters set by a supervising clinician, and administered in a remote location (home, school, office).  We seek provisions that ensure that the clinician has access to ongoing information regarding the progress of training, and maintains a level of control sufficient to ensure the quality and effectiveness training, without the need to be physically present during all training sessions.

 

There are certain barriers to effective remote neurofeedback that must be cleared, if progress is to be made.  It is an unavoidable fact that neurofeedback is a procedure that requires clinical supervision, and that the requisite equipment is regarded as a prescription device.  Moreover, the clinician is responsible for the conduct and results of neurofeedback training, even if sessions are not conducted in the office.  Finally, it is clear that remote neurofeedback will not gain the acceptance it needs, unless there is a way to ensure that quality is assured, even when equipment leaves the office.

 

Remote neurofeedback training should not consist of simply sending a clinical instrument home with a trainee, while expecting a parent, companion, or the trainee themselves to become a neurofeedback therapist.  Rather, the remote-based system should have a level of simplicity and control that makes it easy to use, while ensuring compliance.  The clinician requires ongoing indications of the progress of treatment, the time, duration, and outcome of individual sessions, EEG changes, behavioral notes, and so on.  The key necessity is that clients can easily perform the training that has been defined, and that the clinician can be made quickly aware of how things are progressing, and has the ability to make changes as necessary.

 

We believe that in order for neurofeedback to reach the next level of acceptance and deployment, costs must be decreased, and time in the clinic must be reduced.  We see the conventional series of 40 in-office visits at $50 to $100 apiece, being replaced by a small number of in-office training sessions, which punctuate the remote training.  We seek a new way of looking at equipment, software, and clinical activities, which will help to transform neurofeedback from a primarily clinic-based activity into one that can be conducted any time, any where, while maintaining a level of clinical supervision and confidence that sufficiently approximates what can be achieved in the clinic.

 

If we can achieve these goals, the following realities may come to pass:

 

  • A reduction in the cost of a typical neurofeedback regimen from the current level of $2000-$4000, to $500-$1000.  This will have a profound effect on the attitudes of insurance providers, schools, parents, and other entities that bear the financial burden of the training.

 

  • An increase in the number of clients that a given practitioner can serve, from 20-40, to 100 or more.

 

  • A shift in the professional and financial picture of clinical neurotherapy, in which charges for professional services, equipment rental, remote supervision, and ongoing assessment supplement or replace the usual office visits, making the clinical task less labor-intensive, and more cognitive in nature.

 

  • A broadening of the client base of all clinicians, who now can overcome geographical and financial barriers, as they serve a wider range of clients than ever before.

 

  • An increased awareness and acceptance of neurofeedback, as more clients are able to afford training, and reap the benefits.

 

Many practitioners believe that effective remote training requires some form of real-time connectivity, so that the training session(s) can be monitored live, to ensure that all is necessary is to ensure that the training is proceeding as planned, but this can be managed by a system that allows the supervising clinician to see results, review self-assessments and related reports, and discuss progress over the telephone.  Indeed, one of the more active clinicians we know has more than 30 EEG systems in the field, in various states, some thousands of miles from the office.  All clients must being with an in-office orientation and training, and then proceed to a home-based training program, in which geographical distance is not so much of an issue.

 

While this practice has been successful so far, it clearly taxes the abilities of clinicians and trainees, as well.  Home users are obligated to learn to use equipment according to the same procedures as a clinician, including setting up the protocols, managing thresholds, monitoring progress, reviewing summary information, and determining whether the progress is satisfactory.  We seek to relieve much of this burden on both sides, while ensuring the quality and effectiveness of remote training.

 

Overall, we see the use of home/school/office EEG increasing 10-fold or more, as a result of simple, yet crucial changes in how we approach the total set of issues.

 

To these ends, we see the following components as being critical to the effectiveness of remote training:

 

  • Provisions for clinicians to design protocols and sessions on one system, that can be conducted on another system.

 

  • Means to convey protocol and session settings to the remote system via inexpensive and simple means (email, floppy disk, internet, etc).  This should include a method for remote trainees to incorporate this information into their system in a simple, fail-safe manner.

 

  • Means to ensure that remote trainees are limited to the prescribed activities, and cannot go outside the boundaries that have been defined.  This should also include a means to ensure that trainees have actually conducted the prescribed training, for the recommended times and durations, and that the resulting EEG data reflect appropriate changes.

 

  • Means to convey results to the clinician, again via inexpensive and simple means (email, floppy disk internet, etc). Results should include general session data (time, duration, etc), training results (points scored, percent rewards, etc), specific EEG results (amplitudes, etc), and associated self-report and behavioral data.

 

  • Means for the clinician to review training results, make changes when indicated, and convey these changes back to the remote location.

 

Based on a focus on these simple requirements, it is possible to configure systems that effectively address remote training needs, without increasing their complexity or cost.  Indeed, it is possible to produce home-based systems that are considerably affordable, with an initial capital cost of $1000 or less, and that can be leased, loaned, or otherwise allotted to remote trainees who do not have to bear the purchase cost of equipment.  Overall, we see it possible for remote trainees to subscribe to “pay as you go” plans, in which EEG training is made available for on the order of $100 or $300 a month, thus reaching a considerably enlarged client base, while providing effective, quality training.

 

 

BrainMaster receives new patent on unique QEEG-based Live Z-Score Neurofeedback

Bedford, OH

August 8, 2017

BrainMaster Technologies, Inc., an Ohio-based medical and mental health technology company, today announced that it has received its most recent in a series of patents covering its innovative hardware and software technology.  The new patent is currently in effect, and will be in effect until the year 2030.

US Patent Number 9,7066,939 has been issued as off July 18, 2017, after nearly 10 years of review by the U.S. patent office since the provisional application was filed on November 7, 2007.  During this time, while the patent was pending, the claimed technology underwent extensive review and documentation, leading the examiner to determine that the claimed methods are sufficiently nonobvious, original, and unique to merit patent recognition and protection.  The subject of the patent is “Multi-Channel, Multi-Variate Whole-Head Normalization and Optimization System Using Live Z-Scores.”  The inventors are Thomas F. Collura, William Mrklas, and Theresia Collura, from Chagrin Falls and Streetsboro, Ohio.  This patent describes a uniquely simple yet powerful way to incorporate data from a sophisticated computer analysis (Quantitative EEG or “QEEG”) into a system that modifies the brain in real-time, using proven learning methods.  The patent documents include laboratory and clinical data demonstrating the effectiveness of this method.

In the patent examination, the office cited a number of publications and prior patents by authors including the primary inventor, as well as other experts in the field.  The patent describes a method by which a complex set of brain-based measurements can be combined into a simple, intuitive training system that can be understood and used widely for brain-based neuroplasticity training.  In subsequent clinical and research reports, this method has been found effective in a wide range of scenarios, from clinical mental health to sports and optimal performance.  While other providers have implemented their own forms of similar neurofeedback protocols, BrainMaster is unique in having developed and offered this particularly simple yet encompassing method to the neurofeedback community.

The same patent has been filed in Canada, and is pending at this time.

The US patent can be accessed online at:

http://www.freepatentsonline.com/9706939.pdf

 

 

ISF neurofeedback as an individually empowering intervention – brain politics and policy

ISF (infra-slow fluctuations) neurofeedback is an approach that uses extremely slow EEG fluctuations as the feedback mechanism. The client hears and sees feedback that indicates the presence of shifts in slow potentials, which reflect brain excitability in general. Insofar as ISF is based upon the slow changes in postsynaptic potentials in pyramidal neurons, as well as shifts in transmembrane potentials of the glia, it reveals to the client when the brain is undergoing changes in excitability, either to become more excitable, or less excitable, in general.

Consider the analogy of the U.S. senate. 100 senators combine their votes to make decisions on public policy and lawmaking, based on a combination of ideology and specifics. Suppose there are 52 senators rigidly fixed on a conservative agenda, and 48 fixed on an activist agenda. If this situation never changes, then the results of any vote would be “automatic poker,” with no flexibility. There is no possibility that any particular issue will receive an unbiased or considered vote, since all votes are along fixed lines. This is a rigid and inflexible situation. What would it take to introduce some flexibility and choice in this system?

If some (not too few, and not too many) senators decide to reconsider their positions, then there can suddenly be a new flexibility, new options. However, if too many senators start to rethink their positions, chaos might result. There would be an optimal amount of this shifting about, in which enough senators are willing to rethink and possibly change their votes, but not too many. What is needed is a handful of conservatives willing to think a bit more liberal, and few liberals willing to think a bit more conservative. With that addition, the senate becomes a powerful decision-making body, not just a reactive pool of rigid reactive responders.

If it becomes possible to cause 10 of the senators to reconsider their positions and vote more based on consideration of specifics, then the senate has the power to make actual decisions. Indeed, a few senators do appear to have this flexibility, and are able to vote on their own, not based on party lines. In the same way that a few more of this type would have tremendous impact on flexibility and appropriateness of legislative decisions, a brain that has a few more neurons on the edge of decision-making rather than reacting can result in a more decisive and empowered brain. It is on the edge of these shifts that decisions (votes) can be made that instrument change and adaptation, rather than rigidity.

So with ISF training, the brain is being informed when there are shifts in the general excitability of the brain, similar to learning how many senators may be reconsidering their positions. The population dynamics of the EEG make this all possible. In the EEG, we know that as few as 5% of the neurons are sufficient to alter 100% of the EEG activity, because of the amount of cancellation that occurs over the vast number of neurons. The few can make decisions that affect and in fact empower the masses.

Politics and the Brain

Dr. Ron Bonnstetter has shown significant new results that demonstrate the brain activation patterns when people are making political choices.  He is using live 3-D imaging of frontal gamma activation patterns, in response to politically-charged stimuli.  His results are described in the following broadcast:

http://www.12news.com/news/local/valley/the-brains-of-democrats-vs-republicans/326483029

This is significant because it shows the brain’s pre-conscious responses that shape and determine individual feelings and decisions.  Dr. Bonnstetter has shown that while Democrats respond most strongly to things that they do not like, Republicans tend to respond more strongly to things that they like.  This shows a fundamental difference in individual decision-making patterns.  This helps us to understand political leanings and decisions amidst the confusion and questions that are being asked.

 

 

Trauma and the Brain

screen.2013.09.19_13.31.53The attached talk was presented at the 27th Annual Psychological Trauma Conference in Boston on June 2, 2016.  These results show brain activation patterns that found in individuals experiencing traumatic and emotionally charged stimulation and experiences.  We find that the responses of the frontal lobes demonstrate specific positive and negative emotional responses, and underlie decision-making processes.  The frontal hemispheres are lateralized, in that the left hemisphere and right hemisphere perform different functions, and that both are necessary for healthy, flexible, adaptable responses.  Depending on past experiences, particularly trauma, this balance of reactivity may be affected.  The left hemisphere takes care of sequential, logical processing, and produces positive, or “approach” responses.  The right hemisphere takes care of parallel, recognition-based responses, and produces negative, or “avoid” responses.  Both of these are important, so that the individual is able to respond appropriately to positive or negative stimuli and situations.  Examples are given of both adaptive, flexible responses, as well as fixed, inflexible responses.  Inflexibility is associated with reactive, fixed, and maladaptive responses.  Imaging an biofeedback of brain activity according to this model can be applied to counseling and other clinical activity, to help to empower and enable clients to have healthy responses, that are consistent with goals and produce beneficial mental states and behaviors.2016 Trauma Collura EEG

The following link is to a large collection of published papers describing neurofeedback in various clinical situations, showing effectiveness in treating various disorders, including those associated with trauma.  Collected Publications

 

Neuroeconomics

By looking at the brain as a goal-seeking system, independent of our ideas of values and the meaning of life, we can arrive at a very objective understanding of why people do what they do.  This includes decisions having to do with how we feel, and how we feel about how we feel.  Our work in emotional decision-making moves along these lines, and reveals brain imaging methods to explore these concepts.  The field of formal Neuroeconomics is also growing, for example:

neuroeconomics course

We view the brain as a goal-seeking system that recognizes patterns, and attempts to make decisions to ensure survival, well-being, and positive affect.  When goals are confounded or subverted, then we see suboptimal, even self-destructive thoughts, feelings, and behaviors.  Neurofeedback is an important way to re-orient the brain, but giving it new goals, e.g. “change your electrical patterns in this way.”  Without knowing why, the brain will seek the new goals, the new setpoint, and a new set of attractors in its dynamic repertoire.

 

BrainAvatar Muse – a new tool for psychotherapy and mental health

We have been spending some time lately refining and releasing a new set
of software, designed to use the new Interaxon Muse brain-sensing headband.
This was shown at ISNR, and employs some new modeling of gamma activation
in the frontal lobes, in particular. We have published several articles and given
talks on it this year, as well. A lot of the basic information and downloadable
software is online at:

http://www.brainavatar.com/brainavatar-muse.html

This is a heads-up that we will be deploying this new software, as well as
the Muse headbands, for applications in counseling, psychotherapy,
neuromarketing, and many other new uses, taking it beyond the traditional
scope of neurofeedback or even neuromonitoring. We will shortly put out an
announcement of our partnership with Interaxon, and how clinicians can get
involved, using Muse for office or home use, taking neuroscience into a new
generation of mental health practice.

For example, the following file contains a downloadable pdf just published in
Counseling Today, talking about how we can use frontal activation imaging in
counseling. The goal is to put this in the hands of mental health practitioners,
who can use a simple, low-cost device that can be applied in less than a
minute, and provide valid EEG data with clinical value.

http://www.brainm.com/kb/file/560/545/

Looking forward to sharing the journey,

Tom, Terri, Bill, & the team