About Neurofeedback - For Healthcare Providers
What is the indication for neurofeedback and is it approved by the FDA?
Neurofeedback is approved by the FDA for relaxation and stress management
Neurofeedback is still considered “experimental” for the treatment of medical/psychologic conditions
Who might benefit from neurofeedback?
Patients whose health and/or function are suffering related to symptoms associated with stress
First line or traditional treatments and therapies have been offered and are not tolerated or a plateau of progress has been reached with traditional therapies
What evidence is available to support neurofeedback?
Only Cognitive Behavioral Training has been studied more in the literature
Efficacy has been difficult to establish related to the study designs
Clinical improvement in individuals has been noted in most cases, but not always statistical significance
Research is conducted in relation to a specific conditions. Existing research areas include: TBI, seizure, stroke, migraine, chronic pain, addiction, tinnuitis, sleep disorders, autism, trauma, anxiety, depression, ADD
ADD has the most support in the literature for the use of neurofeedback
There is sufficient evidence to establish safety and support further and more stringent research
Is neurofeedback safe?
Equipment and the normative database used for comparison are registered with the FDA
Only minor side effects have been reported in multiple studies over many years
The stringent intake process, careful attention to individual needs in planning, and ongoing clinician reassessment is protective for adverse events that could result from inappropriate training
What is the training and scope of practice for a neurofeedback clinician?
Board certification in neurofeedback via professional organization BCIA
Training consists of didactic work and mentoring with a experienced clinician
There is currently no state regulation of biofeedback/neurofeedback providers in TN
A healthcare license is necessary for certification in neurofeedback via BCIA; Neurofeedback clinicians treat medical conditions only within the scope of their license
I am working within my RN scope of practice, rather than advanced practice. Coaching and support are substantiated by nursing training and experience, but not intended as medical care.
I remain up to date with ISNR membership and continuing education
Most recent continuing education opportunity in Neuromeditation
What do I NOT do?
Diagnose or Treat Medical or Psychological Conditions
What do brain maps mean and NOT mean?
Electrical activity is measured at the scalp. The activity is amplified and quantitatively analyzed by sophisticated software. The information is visually projected onto an image of the brain.
The quantitative analysis is how QEEG differs from raw EEG data used by neurologists to evaluate for seizures
Electrical activity is compared to a normative database. The normative database consists of individuals with no mental health diagnosis and no 1st degree relative with a mental health diagnosis. Zscores are utilized to identify areas of excessive and deficit activity compared to the normative database. Additional information is available upon request regarding the validity of the database utilized.
The brain map is NOT diagnostic. Patterns of excessive and deficit activity can be compared with individuals with diagnosis, but data is not sufficient to diagnose conditions based on QEEG at this time.
Symptoms are ALWAYS more important than the map. The information in the brain map can only be interpreted within the context of a patient’s symptoms.
Question about Planning/Training
Can patients continue on traditional medications while training? How should I expect neurofeedback to affect the medications I prescribe for patients who are training?
Yes. My approach is to start neurofeedback training where the patient is and watch closely for changes with training that may indicate a need for medication changes.
All medication decisions are to be made between the medical provider and patient. I encourage patients to follow the advice of their medical provider regarding medication. I am not prescribing medications in this setting.
It is common for medication needs to decrease as neurofeedback training progresses. This may present as a new side effect from an old medication. As a prescribing provider, it is helpful to look at “new symptoms” within the context of neurofeedback training
With patient consent, I am happy to discuss patient’s QEEG findings, neurofeedback training, and possible effects on medications with the prescribing provider
So what about coaching and support?
Clients are encouraged to create a healthy environment in their brain for training with lifestyle coaching
Diet, exercise, Nutrition, Sleep hygiene, Self-regulation, Avoiding negative thoughts, Relaxation Techniques, Mindfulness
Reinforcement of healthy lifestyle discussed in medical visits with your patients
My nursing background allows me to triage for problems out of my scope and refer to appropriate providers
Education regarding navigation of the healthcare system: Assisting patients to direct their concerns to the appropriate provider for efficient resolution
Coordination of complex care between multiple providers as requested
My goal is to collaborate with other providers with patient’s consent. I appreciate your interest in patients of yours who are training. Please contact me and I am happy to communicate with you via phone or email with patient consent.