Appreciation of our brain and nervous system is never greater than when something goes wrong. Natural processes have equipped us with remarkable "technology" unmatched by the greatest engineering effort. We barely understand the basics of how it all works in health never mind in disease.
The brain operates at an atomic, even quantum level and is not limited in it's ability to process and respond to extremely small signals. The minimum visually detectable signal in the human retina is equivalent to a candle seen from 12 miles and produces a response in the optic nerve to an input stimulus of only 1 photon per second. The minimum threshold for hearing involves a deflection of the basilar membrane of the ear equivalent to the diameter of a hydrogen atom. This sensitivity is remarkable and a source of hope that the keys to help many of those challenged by brain injury are just waiting to be found. Lets consider just one of those challenges - stroke.
Improving daily functioning after a stroke - which includes the improvement of cognitive function and monitoring health and social parameters, is a critical challenge for individuals and for society as a whole. Stroke survivors want to regain a life that is as independent as possible - and in their home environments. Stroke can overnight transform us from enjoying a self-determined, independent life to a state of complete dependence on others. The incidence of stroke increases with age and due to the well known demographic changes in our population, we know that stroke will impose a challenge on our health systems and institutional care for generations to come.
Unfortunately, a huge gap exists between institutionalised rehabilitation and management of stroke survivors in their home environments. Have you noticed that rehabilitation efforts mostly terminate abruptly upon discharge? We also see limited effort to monitor any changes in motor and cognitive function, daily life activities, health parameters and quality of life.
When it comes to rehabilitation we can easily imagine the two main approaches - Compensation and Restitution strategies.
- Compensation as a strategy provides artificial means to make up for the damage done and the support the lost function (for example, orthoses that support the limbs, memory aids that compensate for memory problems and so on)
- Restitution approaches could involve techniques that involve repetitive retraining in the hope of recovering lost function. RehaCom offered by Fixxl in the UK is an example of this approach to cognition training. This type of approach has been receiving more and more attention due to a growing realisation that the body and the brain holds a remarkable ability to recover - if we can find the key.
When it comes to cognition, science has generally been more confident about compensation approaches. You can find a good review in the Book by Brian O'Neill and Alex Gillespie (See below). We have been slower in the UK to adopt restitution strategies for cognition although they have been adopted at a practical level for many years in other countries. Even though it seems to "make sense" that repetitive exercise is a good thing a conservative stance (that's the UK way) has to wait for firm evidence to support such an approach.
Our partners Hasomed who create RehaCom are exploring how to improve this product of course but have also been involved in an exciting venture to bring neurofeedback into routine practice.
This project is called CONTRAST. This collaborative scientific project – ‘Cognitive Enhancement Training for Successful Rehabilitation After Stroke’ – has been supported by the European Union (Seventh Framework Programme). Consortium partners include academic and clinical experts across the EU from such disciplines as clinical psychology, neuropsychology, neurology and psychophysiology.
What is Neurofeedback?
eurofeedback is sometimes known as EEG biofeedback and has foundations that go back as long as 80 years. The principles are fairly simple in the sense that we have long been able to measure and identify brain states via recorded electrical activity (EEG or electroencephalography). We are further able to guide a persons brain to achieve and sustain desirable states by "feeding back" to them information about these states in real time. A conceptual model of neurofeedback is shown in the figure.
A person learns (actually without effort) how to alter their EEG, which can then lead to improved cognitive functioning. Training modules are tailored to the individual, and remote data processing and support systems are designed to allow for continuous monitoring of health parameters to evaluate individual progress and for shared patient-expert decisions.
CONTRAST’s core interventions to improve the recovery after stroke are training modules which address attention and memory. Nevertheless, psychological wellbeing is also an important target for intervention since depression is frequent after stroke and hampers cognitive function and functioning in daily life.
This sounds quite theoretical I know but there is actually great promise here. As a learning and rehabilitation tool, neurofeedback gives the brain the unique opportunity to pair internal brain states with real world events that can be rewarded or reinforced. This provides the opportunity for internal change. The effects of neurofeedback are not limited to particular anatomical, biochemical or other mechanisms as would be the case with interventions such as surgery or medication. Neurofeeback potentially has the power to change brain functioning at any level.
Technical Foundations of Neurofeedback - Thomas F Collura, 2014 Routledge, NY
Assistive Technology for Cognition - Edited by Brian O'Neill and Alex Gillespie in Current Issues in Neuropsychology, Psychology Press, 2015
Derek Jones, PhD, MBA
Director Fixxl Ltd