We just returned from the 14th annual Winter Brain Conference in Palm Springs. I can give only a partial perspective on it since it is impossible for any one person to take it all in. Conference attendance was impacted both by the Biofeedback Foundation of Europe Conference, which drew away some of the usual key contributors to Winter Brain, and some felt that the Super Bowl kept folks at home. Those folks should get acquainted with TiVo so that they can get their life back.

Joe Kamiya was here in fine form, and he contributed his perspective also to the Foundations Course. Every time I hear him, he fills in more of the early history of his research. On this occasion, I learned more about the precursors to his initial alpha experiments. The objective was to ascertain the degree to which people are aware of their own states and behavior, leading possibly to means toward heightening self-perception about their own behavior.

The setup was as follows. Students were to walk from the back of the room up to a blackboard in front, and place a checkmark either in the left or right spaces as they were moved to do. Kamiya, sitting off on the side, would then inform them as to whether they were right or wrong. As they approached the blackboard, he would randomly tap his pencil lightly on the desk as they planted either the left foot or the right. The taps were infrequent enough that the subject could not detect any kind of cadence. Subjects required a mere ten or fifteen minutes to get it right: they were to match their checkmark to the side that corresponded with Kamiya’s irregular tapping.

With regard to the initial alpha experiments, it was Kamiya’s principal interest to determine what level of awareness of state was possible for people, and more particularly what feelings correlated with the state in which alpha was present in visual cortex. His first and best subject, Richard Bach, was of little help even after he had reached the point of perfect discrimination of the “alpha-present” from the “alpha-absent” states (“A” and “B”, respectively): “It just feels like sometimes I should say ‘A’.” Kamiya said that his first subject was a second-year chemistry student at the time. It seemed unlikely to me that a chemistry major would end up authoring “Jonathan Livingston Seagull” some years later, but Kamiya could not resolve the issue. He lost track of his participant. A Google search reveals it to be unlikely that we are talking about the same Richard Bach. If it is indeed the same person, one suspects that his alpha training must have been a singular transformational experience, just as it was for Jim Hardt, another student of Joe Kamiya. In that case it was a physics student who saw his life transformed.

In a follow-up experiment, Kamiya asked Bach to see if he could produce alpha spindles at will in response to a bell tone, and it turns out that he could indeed learn the task. And thus the feedback paradigm on alpha spindles emerged. This early work dates back to 1953 in Chicago. The only other biofeedback work of which Kamiya was aware of at the time was the EMG training of the hand done by Ralph Heferlin in the late 50’s.

Kamiya’s main message, as it has been in some of his past presentations, is that the inherent social nature of man cannot fail to have implications for research methodology in biofeedback. (Ed Taub even reported that clinicians facing clients in the course of their work got better outcomes.) As a result, he saw his participants less as subjects and rather more as collaborators. Kamiya recalled one particularly absurd example of a psychologist trying to approach the ideal of a neutral stimulus object. The fellow decided to wear a white sheet over his body and simply cut out two eyeholes. He also adopted a monotone in conversation in order “to maintain neutrality”—a living Turing machine, if you will. Kamiya found this example described in a journal article. To his chagrin, the author had been one of his own graduate students and later became one of the biofeedback luminaries: Johann Stoyva.

The example causes me to have sympathy for Jon Stewart. How does one parody a reality that already features such absurdities?

George Martin reported on his work with “Adolescents in the System.” He achieved IQ improvements in 100% of the trainees, but CPT improvements were observed in only 60%. The disappointing finding was attributed to the fact that retests typically occurred on the morning of the day of release. I sympathize. We have observed the same phenomenon, as children are retested just hours before they are scheduled to take a flight back home. That is not an auspicious setting for testing. More significantly, however, the drop in recidivism was only 15%, down to some 45%. 15% must be just barely above the noise level. In looking for factors that might correlate with success or failure, George failed to find them in the CPT data, or in prior drug history, or in prior ADD diagnosis. On the basis of resiliency research over the last fifty years, he postulated that the significant variable might be the connection to a non-familial adult who was keenly interested and engaged with the success of the particular adolescent. It may be that there is no purely psychophysiological remedy here at all. There must be a social dimension to the rescue of dead-ending adolescents.

In a talk on the other side of the house, Bret Stephenson (www.AdolescentMind.com) recalled the natural history of delinquency in this country, reminding us of how recent this all is. The first child did not get locked up in prison until 1899. Even in 1950 there were only 170 serious crimes committed by teenagers in the whole country. Over the next thirty years this number escalated by a factor of more than 100, a growth rate of about 17% per year. Stephenson’s own work is at a center that houses some 1000 delinquents. This private enterprise rakes in $50M per year. The management has no incentive whatsoever to actually solve the problem. For investment purposes private prisons are little more than hotels without a vacancy problem, and without much concern about complaints from the customers.

Bernard Brucker (bbrucker@med.miami.edu) was back after some years’ absence. In honor of the neurofeedback conference he had put neurofeedback in his title, but that was just about the end of the matter. Clearly his heart is in his traditional work, which is peripheral EMG training for neuromuscular re-education, primarily for spinal cord injury. He also made the case for specificity of the technique. Particular muscle groups would remain inaccessible until explicitly trained, even if nearby muscle groups were already working again. These consistent findings also document the difference between the structural and the functional realm. Recovery of structural integrity meant nothing for the recovery of function, which required an additional process of learning. It is the medical fixation on structural models of injury that caused his work to be overlooked in the US for all these decades.

It was Brucker who, following John Basmajian, gave rich meaning to the phrase “neurons exhibit behavior.” Some 1000 trillion synapses are in inactive states at any one time, and represent a potential resource for recruitment in a recovery process. Brucker has been getting the halt and the lame to function for more than three decades—all of them given up on by rehabilitation medicine. There isn’t even a placebo model here to offer refuge to the skeptic. There is no question of spontaneous self-recovery. Yet essentially nobody took notice. It just boggles the mind.

Bernard Brucker’s work would be regarded as impossible by most rehabilitation professionals in the US to this day. Apparently the work remains somehow under a cloud of exaggerated expectations early on, and perhaps it remains under the handicap that it cannot be readily subjected to group studies. The clinical populations are too heterogeneous; outcomes are too variable; and results are not systematically predictable. Unsurprisingly, there are many treatment failures, and even many failures on the long-term trajectory toward eventual success.

So on the one hand there are memorials to Brucker being established in Latin America while on the other his work remains virtually unknown in the United States. Recently, we understand, his own university president discovered what a cash cow he has on his hands in Brucker’s operation, so with the help of Mammon things may be about to change.

Tom Gross, a chiropractic neurologist, spoke in a way that indicated chiropractic may be moving toward a model that is very congenial to neurofeedback. I have long surmised that the various adjustments done in chiropractic (“force kinesiology”) may have the effect of sending a synchronous volley of afferent impulses to the thalamus from regions that are usually quiet. The result is to reset the thalamo-cortical networks toward a different state of activation through a kind of mini-ECT.

Gross spoke respectfully of his own mentors, one of whom (Ted Carrick) has apparently succeeded in bringing about 1000 people out of coma with chiropractic procedures. Chiropractic of course has had its own difficulties with mainstream medicine. So it is perhaps not too surprising to find that such results are also smothered in neglect.

Stan Tatkin (stan@ahealthymind.org) spoke of “The Primacy of Arousal Regulation in Psychotherapy.” This title was like music to my ears, given the centrality of arousal regulation in our own model, but the talk by this couples therapist was more about affect regulation and attachment theory than about arousal per se. The talk was given from a “pre-neurofeedback” perspective, where affect and arousal regulation needed to be achieved in the actual encounter between the parties. “If patients are lost it is probably due to a moment of disregulation that disrupts the therapeutic dyad—and is not repaired.” Hard work without neurofeedback.

Paul Swingle talked about an approach to trauma resolution that involved training up theta in the back of the head, if necessary with his BrainDriver stimulation technique. Results are obtained quickly. He talked calmly about “emotional release” events that ensued, otherwise known as abreactions. Now that we have discovered a more benign, self-paced, and gradual means of working through trauma, I am reluctant to go back to something closer to the “Sturm und Drang” school of trauma resolution. Why push the process just because we can? Swingle talked about a number of ways in which the speed of the neurofeedback process can be enhanced. Of these, it was only the issue of trauma resolution that gave me pause.

Bill Scott demonstrated his new feedback software during his talk. He maps information on three EEG bands into a program that generates fractal images for feedback, and asks trainees to feast their eyes on the evolving imagery. Complexity increases over time with success. Protocols are derived algorithmically, and updated on the basis of results session-to-session.

Bob Whitehouse spoke at length on billing for neurofeedback. I could only listen to this presentation with deep ambivalence. It is certainly inevitable that neurofeedback should be reimbursed under some circumstances and for some conditions. And it is part of the clinician’s job description that this be handled competently. But overall such a development will likely both stunt and distort the growth of the neurofeedback field. Just today I heard of a psychiatrist in Switzerland who witnessed the transition in which acupuncture became a reimbursable procedure. His income from acupuncture significantly dropped with the change, as the number of approved visits was suddenly restricted. Once people adopted the mindset that their insurance should cover the service, the self-pay market just collapsed. With more restricted service, outcomes were not as good as before, and the reputation of acupuncture (as well as that of the practitioner) inevitably took a hit.

One of the most unambiguous cases for reimbursement is the work of Bernie Brucker, and his work just happens to fall into the very category for which Medicare actually reimburses–i.e. neuromuscular re-education. But some years back he lamented to me that he would be better off if Medicare was not involved at all. For one thing, a Medicare provider is majorly constrained with respect to services that can be provided outside of the bounds of Medicare.

On the last day we heard Jonathan Walker and Jerry Kozlowski present on functional organization of brain networks in general and on targeted training of coherence in particular. There is little question anymore that such targeted coherence-based training leads to better and quicker results in seizure management and in the treatment of brain insults. My own presentations at the conference emphasized the complementary domain of the “Disregulation Model,” which covers most of the traditional mental health concerns. This model lays the basis for generic training approaches as the appropriate remedy. There is no conflict between the two perspectives. They simply have their respective domain of preferential application. If we can stay simple and direct for most conditions that walk in the door, all the better. If we can also deploy advanced techniques to cover a variety of medically intractable brain insults as well as specific learning disabilities, then that is the best one could hope for.

In the exhibit hall, EEG Support showed off a new infrared thermal sensor for tracking cortical temperature at Fpz, based on all the prior work of Jeff Carmen. The signal is exceedingly sensitive, with resolution at the level of 15 millidegrees. One may argue about how much of the thermal emission from the forehead actually reflects cortical activity, but the momentary changes in thermal emission surely do. And that is all that we care about. So we simply strip off the dc pedestal and work on the time derivative of the signal for feedback. With the high resolution offered, the trainee can work down near the noise level of the signal. In other words, we can let the brain do some of the averaging as the data unfolds on the screen. This signal is then translated to a feedback display using abstract rendering such as Particle Editor. This addresses one of the residual shortcomings of this kind of feedback, namely the boring nature of the slowly-changing signal and the long epochs in which the signal trends the wrong way even when good training is being done.

The thermal sensor is so sensitive that one can simply point it at the tip of the nose and register the breath through variations in thermal emissions. With such sensitivity, the differences between the thermal band infrared sensor and Hershel Toomim’s near infrared sensor become more apparent. The combination of Toomim’s pIR HEG and the new NeuroAmp was also on exhibit, and it nicely revealed the pulsed blood-flow signal at the forehead. It is clearly tracking blood flow, or blood volume, in a way that the thermal sensor is not. This observation may prompt another look at the issue of whether “passive infrared hemoencephalography” (pIR HEG) really expresses what is being accomplished.

With respect to practical applications, it is particularly appealing to have a non-contact feedback option available for the first clinical encounter with autistic children exhibiting tactile defensiveness. If we can just get a baseball cap onto their heads, we can do thermal feedback training to activate the pre-frontal region. This may achieve sufficient calming to set the stage for Toomim’s nIR HEG headband, and for the subsequent placement of electrodes on the scalp.

For general applications, one envisions the thermal sensing or the nIR HEG as a five- or ten-minute entrée into EEG neurofeedback. Much of EEG training appears to promote appropriate activation, and in this case there need be no concern about parameter specificity. It is hardly possible to get it wrong. The only hazard appears to be one of over-training. For the thermal sensor, we thought it appropriate to arrange for three independent sensor channels. The intention is to train at the central placement (Fpz) as Jeff Carmen has done all along, and to monitor the ratio of thermal signature at Fp1 versus Fp2 in order to observe any lateralized activations.

The thermal sensor also lends itself to home training, once the person’s response to the training has been monitored in the office. We can imagine that migraineurs might want to have such a unit standing by while they are in the initial stages of neurofeedback training and are still experiencing breakthrough migraines. Families of autistic children might want to use the unit daily between neurofeedback sessions. One imagines that any condition that can be helped with hyperbaric oxygen treatment might also benefit from thermal or nIR HEG training.

None of the above would be happening but for the existence of the NeuroAmp, a new offering of EEG Support to complement the impedance meter. The instrument interfaces with BioExplorer software. Firstly, the amplifier incorporates the impedance meter function, where we have chosen to keep the measurement function entirely disengaged when not being called into use. Secondly, it provides a pathway for tactile, visual, or electromagnetic stimulation. Thirdly, it offers access for up to three peripheral sensors.

Finally, the relatively sparse attendance at this year’s conference begs the question as to what the future might hold for this type of conference. In the coming year, the AAPB is going to be sitting on Winter Brain’s footprint, with an early February schedule in Monterey, CA. With all of the contentiousness in this field, and in view of the residual bias against neurofeedback, one can only surmise that the intentions here were predatory. However that may be, the Winter Brain Conference is left only with less attractive alternatives. We understand that next year’s conference is planned for the third week in January, which places it closer to the year-end holiday and still very close to the AAPB meeting.

A natural evolution is taking place in which the ISNR Conference is emerging as the venue for the more formal scientific work, drawing increasingly from academia for attendance, but with a continued primary focus on neurofeedback. The AAPB remains the most obvious face of our community to the outside world, and will continue to draw its speakers from related fields. The Winter Brain Conference could become more of a continuing education venue for active neurofeedback clinicians. Its strength would continue to be the exploration of the clinical frontier of the field, along with training programs directed toward the consolidation of clinical skills. The technical program, infrastructure organization, and pricing of the conference would ideally be adapted accordingly.

The growing constituency of professionals is large enough to support all of these conferences, provided that they indeed fill their respective niches. I estimate that there are now some 8,000 clinicians more or less active in the field of neurofeedback, which means a potential attendance of some 1,000 per year at the specialized conferences.

This entry was posted on Wednesday, February 8th, 2006 at 1:31 am and is filed under Conferences. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.