This only goes to reinforce the necessity for fora where practising clinicians can exchange ideas and tips on good practice. Unfortunately I agree we are in the foothills, and there has been too much propoganda and extravagant claims. Nevertheless there are some astonishingly fruitful applications of Neurofeedback with MTBI that I think justify cautious optimism.
I am finding that one generally needs to proceed slowly and cautiously with Neurofeedback with patients with MTBI, headaches, emotional and sleep disturbance can be side-effects if one proceeds too rapidly.
Headaches can also be a precursor to improvement. It is important to hold one's nerve.
From: "Gruzelier, John H" <j.gruzelier@xxxxxxxxxxxxxx> Reply-To: esnr@xxxxxxxxxxxxx To: <esnr@xxxxxxxxxxxxx> Subject: [esnr] Re: drawbacks and modesty please Date: Wed, 21 Jul 2004 15:47:01 +0100
Your thoughts are well received. In all of this work we are in the foothills, if we have even reached that far.
I hope you might join in discussion of this approach at the next meeting.
Together with Niels Birbaumer's work with locked-in patients, work with spinal cord injury seems to me the most difficult Everest to climb.
From: esnr-bounce@xxxxxxxxxxxxx [mailto:esnr-bounce@xxxxxxxxxxxxx]On Behalf Of h.a.baas
Sent: 21 July 2004 13:30
Subject: [esnr] Re: drawbacks and modesty please
i'm happy the baltic forum was such a succesand that people felt very inspired after attending. I am especially happy that dr. schalow is going to be part of the movement
this month january already i came across prof schalows ideas via internet and spoke to him about the possibilites of combining neurofeedback and his dynamic coordination therapy. he then was still unaware of neurofeedback and had his head elsewhere
this whole concept of c.d.t. for me was very interesting. i am a psychologist, and tried to help a person very seriously damaged by T.B.I. with neurofeedback. Despite all the efforts that were made, she never profited in any way. And believe me we worked on it!
So together with a physiotherapist I thought that maybe I should start in a more simple way and that's were dynamic coordination therapy came in handy. In the end we did not go to prof. Schalow but his principles were worked out in Switserland in the Giger md machine. Before we bought this machine we went to Switserland to see how the machines were used in a physiotherapy practise, and everything seemed fine. we bought the machine and read the book by prof Schalow.
However, although the principles are very interesting and clever, there is little talk of the drawbacks. After three weeks of intensive training my patient started suffering from a pain very similar to R.S.I. This is still going on since four weeks and has not stopped. I am not saying that we are now completely lost, the concept and ideas are really great, but they lack carefull
When the idea started of SAN I was positive, especially as I was so
fed up with american propaganda. Now I just hope the european branche will not go the same direction. I like enthousiasme, i am impressed by intelligent people, but i would like a bit more honesty about limitations, deceptions,dangers.
----- Original Message ----- From: Gruzelier, John H <mailto:j.gruzelier@xxxxxxxxxxxxxx> To: esnr@xxxxxxxxxxxxx Sent: Wednesday, July 21, 2004 1:24 PM Subject: [esnr] Baltic States Forum Feedback Report
Baltic Forum, Riga, Latvia, 2-3 July, 2004.
Professor Paulis Butlers hosted the first neurofeedback meeting in the Baltic States at the Riga Stradins University, where he is Assistant Professor of Medical Physics. It is to his credit and considerable entrepreneurial skills and dedication to the field (he part funded the meeting himself) that he assembled participants from Estonia, Lithuania, Poland, and Russia, while I presented on behalf of the society. Around 60 people attended for the two day meeting.
The meeting represented to me a prototype of how the Society could develop, to embrace applied neuroscience and encourage cross fertilisation between clinical therapeutic and optimal performance approaches on the one hand, and basic science on the other.
The meeting began with the current perspective on the brain mechanisms underpinning operant conditioning by Professor Liga Aberberga-Augskalne, who heads the Department of Neurophysiology. This was an insightful introduction. This was followed by presentations by medical students from the Department of General Medicine who under the supervision of Paulis Butlers have examined how SMR training and suppressing theta in healthy volunteers also elevated alpha2, which is implicated in working memory, and shifted the alpha peak upwards.. These were mature presentations and I have encouraged them to submit the SMR paper for publication. Further analysis may also shed light on learners versus nonlearners. The results contribute to the debate on specificity of bandwidth training.
After morning tea I presented our work with alpha/theta training, to include our latest findings in enhancing ballroom and Latin dance performance in competitive university dancers, and in elevating mood and well being in withdrawn students. Professor Klonowski from the Polish Academy of Sciences, Warsaw then presented his advanced methods of EEG nonlinear complexity analysis, which incidentally could provide a new metric for neurofeedback training. In identifying sleep stages in the EEG the procedures were superior to trained experts. To conclude the morning session Dr Helena Ciavko introduced stabilography methods from St Petersburg. The participant steps on a bathroom scales type stand and a spectrum of movements is recorded. There are clinical applications such as tremor and applications with dancers and sportsmen. Again there are implications for biofeedback developments which Professor Butlers will consider.
In the afternoon we were treated to a fascinating, inspiring and very moving introduction to the pathfinding 'coordination dynamics therapy' for spinal cord injury of Professor Giselher Schalow, formerly of Switzerland, but now based in Tatin, Estonia. He outlined his highly creative theory and then proceeded to introduce us to two patients, one in a wheel chair and another a Norwegian youth who hit his head on the bottom of a river when diving in, and is a paraplegic as a result, but following very arduous training is now able to walk and even run with assistance. We were given demonstrations of the approach, and alas time quickly ran out. There is not space to go into this now, but the aim is to create new neurological connections, and it was clear to this psychophysiologist, how important topdown influences were in forging these neuronal changes. Clearly much potential can be derived from combining our techniques to achieve these goals. It is food for thought that his highly innovative methods, which fly in the face of contemporary neurophysiological thinking, were not acceptable in Switzerland, and have found a receptive home in Estonia.
Perhaps our society could provide an important political role in science to counteract conservative constraints.
The next day was mainly devoted to the work of Professor Dangole Zemaitye and colleagues. Professor Zemaitye heads an Institute for Psychophysiology and Rehabilitation in Lithuania. Apparently we first rubbed shoulders in Montreal at the founding meeting of the International Organisation of Psychophysiology in the early 1980s. 11 papers were presented focussing on one aspect of their work, consisting of the manifold clinical implications of heart rate variability for diagnosis and rehabilitation. Highly sophisticated methods of analysis were demonstrated with a clinical yield not available in conventional HRV analyses. This very expert clinical team would provide an ideal setting for a RCT of heart rate coherence training for cardiovascular disorders.
The forum ended with Professor Olegs Timms work in instating Swiss methods of neurostimulation and neural prosthesis with cochlear implants in Latvian children.
There was throughout the Forum a splendid spirit of openmindedness, and opportunities for neurofeedback and biofeedback were widely discussed. Professor Butlers is to be congratulated for his initiative in planning the meeting. There is to be a followup via internet later in the year - see our website.
Offers from all the Baltic States to host a society meeting were received with enthusiasm, and I have received again a request today from Professor Schalow to host the next meeting in Tatin. I would very much like us to go there.
We also took in the jazz festival, which just happened to on at the time, and we missed the opera festival by only a few days! These are very beautiful cities, and I believe Tatin is an absolute jewel. In Riga there is unspoiled architecture going back to the middle ages, art noveau turn of the century buildings, and a river with handsome bridges. It is very green everywhere. Prices are affordable before the EU takes hold, as are flights booked in advance. The food is particularly excellent and cheap.
How about the Baltic States for our next meeting!
Professor John Gruzelier Division of Neuroscience & Psychological Medicine Imperial College London Charing Cross Campus St Dunstan's Road London W6 8RP UK
Phone 44 020 8 846 7386: Fax 44 020 8 846 1670: e-mail j.gruzelier@xxxxxxxx Secretary: Mrs Ann Ebberson: Phone 44 020 8 846 7246