Finding an Alternative to In-Person Brain Biofeedback

A single subject study on oneself is sometimes the only recourse one has.

Posted Apr 20, 2020

Shireen Anne Jeejeebhoy
Source: Shireen Anne Jeejeebhoy

Hodge podge describes brain health care within cities, between cities, and across countries. You spend years cobbling together appointments with psychologists and psychiatrists, trainers and therapists to effect some sort of decent functionality after brain injury, only for COVID-19 pandemic to thrust you into your home and slam the door shut against all in-person treatments. Another loss.

Virtual cannot always replace in-person. What is acupuncture without needles penetrating your skin? Or physiotherapy without a skilled professional working strains out of your muscles? Or orientation and mobility training without actually walking the streets with your trainer close by guiding you? Sometimes a clinic can offer viable virtual care, the most obvious being talk therapy through private, encrypted one-on-one videoconferencing. Less obvious is brain biofeedback. The technology must be couriered to you. You must learn to apply electrodes to your scalp in the correct positions. And you must have reliable videoconferencing software. Even with talk therapy, the therapist's face freezing in mid-movement, probably with eyes closed, can disconcert and interrupt a train of thought towards unearthing a key grief. Having your brain trainer freeze mid-instruction or you freeze mid-biofeedback screen can stall training the brain.

The hodge podge of care means that whereas medicare may cover virtual talk therapy, it won't cover the costs of medical devices nor a virtual session with a brain trainer or psychologist at a clinic. I cannot afford the increased costs of virtual brain biofeedback, and I lack the physical endurance to apply electrodes to the top of my head. I had to quickly find an alternative, or suffer decreasing functionality amid rapidly increasing anxiety and vigilance. Not a pleasant state.

Fortunately, Mind Alive Inc. had recently added three gamma brainwave sessions to their medical devices, the DAVID Delight Plus and DAVID Delight Pro. I could both replace (partly) brain biofeedback and test a theory I’d posited back in 2017.

In 2012, following my inclusion in and subsequent exit from a drug trial that increased GABA in the brain, the ADD Centre, working with me, demonstrated that brain biofeedback of 39 to 42Hz at CZ can increase gamma brainwaves and effect radical improvement in a person with brain injury (see Chapter R in Concussion Is Brain Injury: Treating the Neurons and Me).

Single- or two-electrode brain biofeedback uses a brain map from a qEEG assessment to target a specific location or locations, and it includes both enhancement and inhibition at the same time while either monitoring or providing feedback to reduce muscle tension or EMG. One of the key issues in training gamma brainwaves up is that the person must be able to achieve EMG below 2µV. Most people find this difficult. In contrast, audiovisual entrainment (AVE) is a passive method. AVE affects the brain through the eyes and ears, does not require a qEEG to be used (though research with it does), is not targeted to a single location on the brain, and doesn’t require EMG to be reduced, although most sessions reduce blood pressure and relax the muscles. AVE can entrain one or two frequencies, but only to enhance them.

I suggested in Chapter R that one way around the problem of keeping EMG below 2µV is to use gamma AVE.

For my single-subject study on myself, I hypothesize that AVE can be used to enhance gamma brainwaves in a person with diffuse axonal brain injury from a three-impact car crash 20 years previously and who has previously received gamma brainwave biofeedback at CZ, without requiring the reduction of EMG. I want to study if gamma AVE at 38 to 42Hz can decrease vigilance and anxiety while promoting cognitive activity and sleep. A refurbished DAVID Delight Pro with the new gamma sessions on it was all I needed, costing considerably less than virtual brain biofeedback, although without the support of a brain trainer working by my side or virtually on a screen. A clinician is monitoring me, though, through phone calls.

As a side note, COVID-19 presents a tremendous research opportunity to see if virtual (video or phone) proximity to another human being has the same effect as physical proximity on brain function, health, and productivity.

When I conducted a single-subject study for treatment of ADD for my third-year university thesis in psychology, I did it as proof of concept. But today, the trend towards individualized medicine means that the single-subject study is both proof of concept and an individual treatment plan. Also, many must resort to this kind of study as a kind of DIY in our hodge podge of brain-injury care to get better.

Neuroplasticity almost requires individualized medicine. It means designing treatments that target particular brainwaves in particular brain areas or networks, responding to an individual’s sensitivity and quirks, among other aspects. But clinicians could use single-subject studies such as mine to tailor treatment towards their clients who have similar issues that include long-standing diffuse axonal brain injury. And researchers can use it as a launching pad to study virtual at-home neuroplastic therapies in large populations and sub-populations. The one downside to my study is lack of access to the objective measurements that brain biofeedback provides of brainwaves, heart rate, breathing rate, EMG, and skin temperature. However, when I return to in-person appointments, I could obtain those. In the meantime, I will track writing and reading productivity, morning heart rate, and number of hours slept.

I will be posting my weekly progress on my website and wrapping up in mid-May with results and a discussion. A month may seem like a short time-frame to people used to medications as treatment, but AVE begins to work within minutes during the session and its most potent effects last during and a few or many hours after.

Copyright ©2020 Shireen Anne Jeejeebhoy. May not be reprinted or reposted without permission.