About Neurofeedback - For Healthcare Providers

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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?

  • ISNR Comprehensive Bibliography of Neurofeedback Research

  • 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

  • BCIA link; ISNR link; Neuromeditation link

What do I NOT do?

  • Diagnose or Treat Medical or Psychological Conditions

  • Prescribe medications

  • Psychotherapy


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.