03.03.2013 Views

Neurofeedback videogame ADHD technology: Results of the first ...

Neurofeedback videogame ADHD technology: Results of the first ...

Neurofeedback videogame ADHD technology: Results of the first ...

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

<strong>Neur<strong>of</strong>eedback</strong> <strong>videogame</strong> <strong>ADHD</strong> <strong>technology</strong>:<br />

<strong>Results</strong> <strong>of</strong> <strong>the</strong> <strong>first</strong> concept study<br />

Olafur S. Palsson, Psy.D.<br />

Mindspire, LLC<br />

Alan T. Pope, Ph.D.<br />

NASA Langley Research Center<br />

John D. Ball, Ph.D.<br />

Marsha J. Turner, M.A.<br />

Stephanie Nevin, M.S.<br />

Eastern Virginia Medical School<br />

Roger DeBeus, Ph.D.<br />

Riverside EEG Bi<strong>of</strong>eedback Services


Aims<br />

• This project was a randomized and controlled<br />

<strong>technology</strong> concept study, funded by NASA’s<br />

Langley Research Center<br />

• Assessed whe<strong>the</strong>r a new <strong>videogame</strong> bi<strong>of</strong>eedback<br />

<strong>technology</strong> developed at NASA Langley Research<br />

Center was as effective as traditional neur<strong>of</strong>eedback<br />

in treating Attention-Deficit Hyperactivity Disorder<br />

(<strong>ADHD</strong>), and whe<strong>the</strong>r <strong>the</strong>re were significant<br />

differences in its appeal as a clinical method<br />

compared to standard neur<strong>of</strong>eedback treatment<br />

• The study was conducted in <strong>the</strong> Behavioral Medicine<br />

Clinic at Eastern Virginia Medical School


Subjects<br />

• 22 children with <strong>ADHD</strong> <strong>of</strong> <strong>the</strong> hyperactiveimpulsive<br />

subtype (DSM-IV criteria plus<br />

physician diagnosis)<br />

• Age range: 9-13 years, 3 girls and 19 boys<br />

• All <strong>the</strong> children were on short-acting medications<br />

for <strong>ADHD</strong><br />

• The children had to be <strong>of</strong> at least normal<br />

intelligence, and have no history <strong>of</strong> affective<br />

problems or learning disabilities


Design<br />

• The children were randomized to treatment groups:<br />

<strong>videogame</strong> (n=11) vs. standard neur<strong>of</strong>eedback (n=11)<br />

• Children in both group completed 40 individual treatment<br />

sessions, usually seen once or twice a week.<br />

• The children came for one test session before and after<br />

treatment, where <strong>the</strong>y completed QEEG, TOVA and<br />

neuropsychological tests.<br />

• BASC Monitor data and actigraph (physical activity) data<br />

was collected pre-and post-treatment and every ten sessions<br />

• Children in both groups were trained with a single active Cz<br />

electrode, with reference electrode and ground attached to<br />

<strong>the</strong> earlobes


VIDEOGAME GROUP STANDARD GROUP<br />

J&J I-330 EEG hardware, NASAbuilt<br />

modulation unit and a modified<br />

game controller used with a<br />

standard Playstation console<br />

Training displays were EEG<br />

influenced <strong>of</strong>f-<strong>the</strong>-shelf Sony<br />

Playstation games<br />

Training consisted <strong>of</strong> fixed-length<br />

training intervals interspersed with<br />

listening and reading<br />

Thought Technology Procomp+<br />

hardware and Multitrace S<strong>of</strong>tware<br />

Displays were bar graphs and simple<br />

figures representing changes in SMR,<br />

beta and <strong>the</strong>ta bands<br />

Training consisted <strong>of</strong> fixed-length<br />

training intervals interspersed with<br />

listening, reading and unmodulated<br />

<strong>videogame</strong> playing


The Videogame<br />

<strong>Neur<strong>of</strong>eedback</strong> Loop<br />

ADJUSTABLE<br />

MODULATION<br />

UNIT


Spyro <strong>the</strong> Dragon<br />

Examples <strong>of</strong> Games Played in <strong>the</strong> Study<br />

Tony Hawk<br />

Gran Turismo


Beta/(Theta + Alpha)<br />

SMR<br />

Adjustable Offset<br />

for Shaping<br />

Adjustable Threshold<br />

for Shaping<br />

Accelerator (X) Button Pressed<br />

Vibration<br />

Signal<br />

Accelerator (X) Button<br />

Pressed<br />

Vibration Signal<br />

10 seconds<br />

Loss <strong>of</strong> Steering<br />

Full Racing Speed<br />

Speed<br />

Barely Moving


100<br />

95<br />

90<br />

85<br />

80<br />

75<br />

70<br />

Percentiles<br />

Attention Problems<br />

Videogame<br />

Pre 10 20 30 40<br />

BASC Monitor<br />

p


80<br />

70<br />

60<br />

50<br />

40<br />

Percentiles<br />

Internalizing Problems<br />

Videogame<br />

Pre 10 20 30 40<br />

BASC Monitor<br />

p


TOVA:<br />

TOTAL PERCENTAGE OMISSION AND COMMISSION ERRORS<br />

8<br />

7<br />

6<br />

5<br />

4<br />

3<br />

2<br />

1<br />

0<br />

Omission % Comission %<br />

p


320<br />

310<br />

300<br />

290<br />

280<br />

270<br />

260<br />

TOVA:<br />

TOTAL CORRECT RESPONSES AND D PRIME<br />

Total # <strong>of</strong> correct responses D prime<br />

Videogame<br />

PRE POST<br />

p


PARENT<br />

POST-TREATM.<br />

SATISFACTION<br />

SURVEY<br />

10<br />

9<br />

8<br />

7<br />

6<br />

5<br />

4<br />

3<br />

2<br />

1<br />

0<br />

Satisfaction<br />

with results<br />

N.S<br />

How much <strong>the</strong>ir<br />

children enjoyed<br />

coming for treatment<br />

p


CHILDREN’S<br />

POST-TREATM.<br />

SATISFACTION<br />

SURVEY<br />

10<br />

9<br />

8<br />

7<br />

6<br />

5<br />

4<br />

3<br />

2<br />

1<br />

0<br />

Satisfaction<br />

with results<br />

N.S<br />

How much <strong>the</strong>y<br />

enjoyed coming<br />

for treatment<br />

p=.03<br />

Game Standard Game Standard


POST-TREATM.<br />

SATISFACTION<br />

SURVEY<br />

90<br />

80<br />

70<br />

60<br />

50<br />

40<br />

30<br />

20<br />

10<br />

0<br />

ESTIMATES OF HOW MUCH<br />

(0-100%) <strong>ADHD</strong> PROBLEMS HAVE IMPROVED<br />

FOLLOWING TREATMENT<br />

Parent Ratings Children’s Ratings<br />

N.S.<br />

p


Videogame Group: QEEG Treatment Changes<br />

DELTA: 0.50-4.00 Hz (-14%)<br />

SMR: 13.00-14.00 Hz (12.04%)<br />

+2.0<br />

+1.8<br />

+1.5<br />

+1.3<br />

+1.0<br />

+0.8<br />

+0.5<br />

+0.3<br />

0<br />

-0.3<br />

-0.5<br />

-0.8<br />

-1.0<br />

-1.3<br />

-1.5<br />

-1.8<br />

-2.0<br />

+2.0<br />

+1.8<br />

+1.5<br />

+1.3<br />

+1.0<br />

+0.8<br />

+0.5<br />

+0.3<br />

0<br />

-0.3<br />

-0.5<br />

-0.8<br />

-1.0<br />

-1.3<br />

-1.5<br />

-1.8<br />

-2.0<br />

THETA: 4.00-8.00 Hz (-30%)<br />

+2.0<br />

+1.8<br />

+1.5<br />

+1.3<br />

+1.0<br />

+0.8<br />

+0.5<br />

+0.3<br />

0<br />

-0.3<br />

-0.5<br />

-0.8<br />

-1.0<br />

-1.3<br />

-1.5<br />

-1.8<br />

-2.0<br />

+2.0<br />

+1.8<br />

+1.5<br />

+1.3<br />

+1.0<br />

+0.8<br />

+0.5<br />

+0.3<br />

0<br />

-0.3<br />

-0.5<br />

-0.8<br />

-1.0<br />

-1.3<br />

-1.5<br />

-1.8<br />

-2.0<br />

BETA: 14.00-21.00 Hz (117.17%)<br />

ALPHA: 8.00-13.00 Hz (15.02%)<br />

+2.0<br />

+1.8<br />

+1.5<br />

+1.3<br />

+1.0<br />

+0.8<br />

+0.5<br />

+0.3<br />

0<br />

-0.3<br />

-0.5<br />

-0.8<br />

-1.0<br />

-1.3<br />

-1.5<br />

-1.8<br />

-2.0


Standard Group: QEEG Treatment Changes<br />

DELTA: 0.50-4.00 Hz (3.97%)<br />

SMR: 13.00-14.00 Hz (2.40%)<br />

+2.0<br />

+1.8<br />

+1.5<br />

+1.3<br />

+1.0<br />

+0.8<br />

+0.5<br />

+0.3<br />

0<br />

-0.3<br />

-0.5<br />

-0.8<br />

-1.0<br />

-1.3<br />

-1.5<br />

-1.8<br />

-2.0<br />

+2.0<br />

+1.8<br />

+1.5<br />

+1.3<br />

+1.0<br />

+0.8<br />

+0.5<br />

+0.3<br />

0<br />

-0.3<br />

-0.5<br />

-0.8<br />

-1.0<br />

-1.3<br />

-1.5<br />

-1.8<br />

-2.0<br />

THETA: 4.00-8.00 Hz (5.76%)<br />

BETA: 14.00-21.00 Hz (29.51%)<br />

+2.0<br />

+1.8<br />

+1.5<br />

+1.3<br />

+1.0<br />

+0.8<br />

+0.5<br />

+0.3<br />

0<br />

-0.3<br />

-0.5<br />

-0.8<br />

-1.0<br />

-1.3<br />

-1.5<br />

-1.8<br />

-2.0<br />

+2.0<br />

+1.8<br />

+1.5<br />

+1.3<br />

+1.0<br />

+0.8<br />

+0.5<br />

+0.3<br />

0<br />

-0.3<br />

-0.5<br />

-0.8<br />

-1.0<br />

-1.3<br />

-1.5<br />

-1.8<br />

-2.0<br />

ALPHA: 8.00-13.00 Hz (58.36%)<br />

+2.0<br />

+1.8<br />

+1.5<br />

+1.3<br />

+1.0<br />

+0.8<br />

+0.5<br />

+0.3<br />

0<br />

-0.3<br />

-0.5<br />

-0.8<br />

-1.0<br />

-1.3<br />

-1.5<br />

-1.8<br />

-2.0


Personality Inventory<br />

for Children (PIC)<br />

Hyperactivity<br />

70<br />

65<br />

60<br />

55<br />

50<br />

45<br />

40<br />

Videogame<br />

n.s.<br />

Pre Post<br />

n.s.


Summary <strong>of</strong> Findings<br />

• Both <strong>the</strong> <strong>videogame</strong> and standard neur<strong>of</strong>eedback<br />

groups improved significantly on most main <strong>ADHD</strong><br />

outcome measures. No significant difference in<br />

treatment change was seen in group comparisons<br />

• Parents’ subjective appraisal <strong>of</strong> treatment effect on<br />

<strong>ADHD</strong> was more positive for <strong>the</strong> <strong>videogame</strong> group<br />

• The <strong>videogame</strong> treatment was rated significantly<br />

more enjoyable by both parents and children<br />

• Trends on pre-post QEEG change maps indicate that<br />

<strong>the</strong> <strong>videogame</strong> training may have advantages in<br />

creating more quantitative EEG effect in <strong>the</strong><br />

<strong>the</strong>rapeutic direction


Conclusions<br />

• We conclude that <strong>the</strong> <strong>videogame</strong> bi<strong>of</strong>eedback<br />

<strong>technology</strong>, as implemented in <strong>the</strong> NASA prototype<br />

tested, produces equivalent results to standard<br />

neur<strong>of</strong>eedback in effects on <strong>ADHD</strong> problems<br />

• Both <strong>the</strong> <strong>videogame</strong> and standard neur<strong>of</strong>eedback<br />

improve <strong>the</strong> functioning <strong>of</strong> children with <strong>ADHD</strong><br />

substantially above <strong>the</strong> benefits <strong>of</strong> medication<br />

• The <strong>videogame</strong> <strong>technology</strong> provides advantages over<br />

standard neur<strong>of</strong>eedback treatment in terms <strong>of</strong><br />

enjoyability for <strong>the</strong> children and positive parent<br />

perception, and possibly has stronger quantitative<br />

post-treatment effects on EEG


Advantages <strong>of</strong> <strong>videogame</strong> bi<strong>of</strong>eedback<br />

• Inherently motivating, keeps trainees on task continually<br />

• Blends sophisticated neur<strong>of</strong>eedback (or bi<strong>of</strong>eedback)<br />

training into popular entertainment in such subtle ways<br />

that none <strong>of</strong> <strong>the</strong> entertainment value is lost and EEG<br />

bi<strong>of</strong>eedback is no longer a chore but a treat<br />

• Allows individuals to select <strong>the</strong> games that <strong>the</strong>y like<br />

best, making sure that <strong>the</strong> games stay current and are<br />

suitable for each person’s gender and developmental<br />

level<br />

• Can be used largely without clinician involvement or<br />

effort – making group treatment or properly arranged<br />

home use easy<br />

• Is inexpensive <strong>technology</strong>, as game s<strong>of</strong>tware does not<br />

have to be written for EEG bi<strong>of</strong>eedback

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!