By Valerie Chernek   |   Download the final report

Neurofeedback in the Clinical Setting

Since the early 80’s, Domenic and Lindsay Greco, co-founders of CyberLearning Technologies,  have used neurofeedback in their clinical practice to help children and adults address their attention, learning and cognitive challenges. 

Recognizing the potential of neurofeedback as a tool for understanding the special symptoms of attention-related disabilities, the couple decided to explore new ways to use it to improve cognitive function, while addressing concentration and behavior issues in their clients. In addition to applying what they refer to as “the rather mundane and boring neurofeedback training screens,” the Grecos looked to the latest neurofeedback technology advancements to provide more opportunities and to reach many more people in need. They believed that the excitement of video games could offer a more inviting experience for their clients, improve outcomes and provide a way for them to test their ideas about neurofeedback outside of a clinical setting. To test these ideas, they needed to find a tool to collect and analyze brainwave data connected with a gaming activity.

Neurofeedback Technology from NASA

The Greco’s saw the potential in technology being used in NASA’s neurofeedback research and pursued the idea of a technology transfer. In 2001, they received a commercialized license from NASA for patented technology developed to train pilots. The NASA technology used sophisticated flight simulators to address critical attention span and response time issues in an airplane cockpit during flight.

Obtaining a license for NASA’s neurofeedback technology was a “slow and painstaking process.” It took about two years, but was “certainly worth the effort,” says Lindsay Greco. The process began at the NASA Langley Research Center’s Commercialization Department which is responsible for identifying NASA inventions that have a commercial application, that is, a potential to create a technology in the private sector for the betterment of mankind. This department is responsible for finding the best partners to commercialize patented NASA inventions. CyberLearning Technology was one of approximately ten companies which submitted an application for the rights to the video game neurofeedback technology. With NASA’s approval of their application, CyberLearning Technology was granted exclusive rights to manufacture and distribute NASA’s patented neurofeedback technology using off-the-shelf video games. CyberLearning’s next step was to find engineers to develop the additional technology needed to manufacture and distribute what would become the SMART BrainGames Technologies product.

SMART BrainGames provides a link between NASA’s sophisticated neurofeedback technology and off-the-shelf racing video games, like the Sony PlayStation® and Microsoft XBOX®, to measure brainwave patterns coming from the player and feedback this information during game play. Using the signals from a specially designed Sony PlayStation® game controller, the system ‘modulates’ and governs the speed and maneuverability of the race car depending on brain wave patterns picked up by the sensors. This neurofeedback ultimately guides and measures brain activity in individuals with attention, cognitive and learning problems.

Transferring Neurofeedback Technology to the Home

Since its beginnings as an equipment manufacturer in the early 1980s, CyberLearning Technology has directly served a clinical population. This unique advantage has enabled the company to see its technology used in many environments, including the homes of its clients. The Grecos began working with families beginning in 2002 in a ‘clinically-supervised home training model’ to evaluate the use of the SMART BrainGames’ neurofeedback features in the home to test its overall success and identify issues of compliance. Since then, they have continued to test and research its use and perfect its technology. The process has helped them to determine that their approach of using neurofeedback could be overwhelmingly successful depending upon family dynamics, compliance, and severity of condition being treated.

Dr. Judith Pokorni, now a researcher for the Pacific Institute for Research and Evaluation (PIRE), learned of the Grecos’ research and neurofeedback technology system while participating in a PIRE group discussion led by Henry Harbin, a consultant for CyberLearning Technology. Judy had not previously experimented with video as a medium but was fascinated by the use of neurofeedback in video games to improve intervention strategies for high-risk children and youth. Judy immediately began designing her next research project with SMART BrainGames in mind. As a prelude to a more formal study, she spent two months working with the technology considering possible populations and research designs with which it might be useful.

Judy pitched the idea of studying neurofeedback within video games through the NCTI Technology in the Works competition to the Grecos. Together they began their trek to become one of the 2007 NCTI Bright Ideas awardees. Judy wanted to study the effects of memory concentration with adolescents with attention deficits who, by all reports, would respond well to an intervention using video games. She also wanted to test the technology in a non-clinical environment while using a rigorous research design. A neurofeedback-based system would record the BETA/ALPHA brainwave patterns of teens during the video game play. The records would then be sent over the Internet to the Greco’s team for analysis.

Although the Grecos had evidence that their neurofeedback-based program worked in supervised clinical and home environments, they were excited to work with Judy in a controlled study that would gather empirical evidence with adolescents in the home setting with minimal direct contact and supervision. Both teams agreed that they had the research expertise and technology, but needed to identify a population of students with special needs to test their theories. Through her network of educators and researchers, Judy turned to trusted colleague, Dr. Patricia Jamison, Director of Special Education for the public school district in Kent County, Maryland for assistance. Patricia made recommendations and contacts with families based on a population of students who were identified as having attentional problems and whose families would be amenable to participate in a home-based study. Patricia introduced Judy to six families who participated in the trial over an 8-week period using the SMART BrainGames technology 4 or 5 times a week.

The Neurofeedback Research Project

As part of the neurofeedback research project, the team had to prepare a proposal describing the study and detailing the requirements of study participants. The American Institute of Research’s (AIR) Institute Review Board (IRB) reviewed the project to ensure compliance with federal regulations which included rigorous standards to protect the subjects and families in the study. This initial obligation of the neurofeedback research proved to be an important first step for researcher and developer to iron out all the details of the project. Speaking for Cyberlearning Lindsay Greco reflected,

We were extremely appreciative of Judy’s expertise and patience when it came to preparing this document to the Board’s questions. Judy understood the issues and procedures and was highly supportive of our team and the time constraints we were under.

Overcoming Challenges

Lindsay and Judy summarized the project,

We definitely had some challenges. We were on the west coast; Judy was on the east. Due to funding limitations, we were afforded only a small sample of teens. The timing of the award happened in May which wasn’t the best to work with a school partner and to find a student population willing and interested in working with us over the summer in a home-based setting. The families who participated in our research lived on the Maryland eastern shore; two hours away from Judy. They had never experienced this type of neurofeedback technology, but were determined to execute the rigorous demands we asked of them.

A home-based research project has many more variables than in a clinical setting. At times we were skeptical that compliance and consistency would be maintained by the families, but we were wrong. They followed the criteria we set and met all of our expectations. We want to thank the families who stood by us. These challenges became a true testament the integrity of the SMART BrainGames Technology, our ability to work with challenges from a great distance, to work together as a ‘team’ to solve problems as they arose, and eventually break new ground in neurofeedback research! This research was uniquely positioned to prove that we can support many more persons with developmental issues—not only in a clinical environment, but in a home-based setting. It also reinforced what we had learned working in our clinical practices and opened our eyes to new possibilities using neurofeedback technologies to help individuals. It is a great motivator to recognize that we can serve families who would not ordinarily be able to seek this type of assistance. It strengthens our professional resolve to serve the greater good with substantiating research proven to be effective.

Outcomes of the Neurofeedback Study

This study was designed to pilot the use of a home-based neurofeedback intervention. As such, it represents the first attempt to bring neurofeedback from the clinic to the home and without face to face oversight of a treating professional. Outcomes on both attentional and academic measures were difficult to determine because of the small size. However, the pilot has demonstrated that:

• neurofeedback technology can be used outside a clinical setting;
• the video-based technology is engaging enough to result in compliance of adolescents over the full eight-week period;
• families can successfully oversee intervention sessions of their children with minimal oversight from professionals;
• data transmission and technical assistance regarding the use of the technology and recording and transmission of the data can be accomplished with minimal telecommunication and Internet support of the clinicians.

Areas for further development suggested by the subjects and families include refinements to the neurofeedback technology to make it less cumbersome, increased variation in the video games (the research design required the use of only one game), and a more comfortable head set.

The results of this small pilot suggests that the neurofeedback technology using video games has merit in eliciting cooperation of adolescent males in need of intervention because of attentional difficulties. Its use in the home setting further expands its usability. The next generation of the technology will need to address some of the issues related to ease of use. Larger controlled studies are needed to substantiate the intervention’s positive effects for both social and academic outcomes.

The Future of SMART BrainGames Technologies

CyberLearning’s Lindsay Greco looks forward to a bright future for neurofeedback as a tool for addressing cognitive, attention and learning challenges.

We are excited to continue to be an important part of future research that exposes diverse populations of children and adults to SMART BrainGames Technologies and neurofeedback. Further examining a school based model for both special needs and even mainstreamed children is of great interest to us as well. We are also very interested in participating in autism research, recognizing that although practitioners around the world are having tremendous success with using our technology with this population, there exists no true research with neurofeedback and the Autistic Spectrum. We are in development of our next generation technologies that will offer greater simplicity of use with diverse consumers. The ability to connect our technology with a stand-alone DVD Player, television and any game system will provide much value to those of any age who wish to improve cognition and overall efficiency in processing information. Additionally, we are very sensitive to making the SMART BrainGames Technologies affordable to those who can benefit from its use and will continue to evaluate a cost savings in our development.

The promise of SMART BrainGames’ neurofeedback demonstrated in recent tests is mirrored in the excitement of those who see it in operation. When demonstrated at conferences and exhibitions, crowds gather to have a look at its popular video game interface. SMART BrainGames Technologies was also the winner of the first-ever Bright Ideas Peer Award at the Technology Expo portion of the 2007 NCTI Technology Innovators conference.

Bios

Dr. Judith Pokorni, Senior Research Scientist at Pacific Institute for Research and Evaluation in Calverton, MD: Judy has devoted her career to working with and for children with special needs, Judy’s expertise ranges across public and private organizations including a school system, a medical center, university, and nonprofit agencies and includes both service and research. She has studied the impact of developmental interventions for premature babies and their caregivers, designed community-based developmental services for high risk children and youth, studied long-term effects of prenatal exposure to cocaine, and designed and implemented interventions for children and youth with learning disorders, attention deficits and other special needs. This study is her first using neurofeedback which she considers a technology that has great merit in the future for providing support for children and youth with special needs.

Dr. Domenic Greco holds a doctorate in clinical psychology and is also licensed as a Marriage, Child Therapist. He has served children and adults providing biofeedback and neurofeedback services since 1982. He has presented as an expert in neurofeedback at Children with Attention Deficit Disorder (CHADD), the National Institute of Mental Health, (NIMH) and the Veterans Administration. He served as an expert consultant to Johnson & Johnson on ADHD and neurofeedback and was co-investigator for a randomized controlled neurofeedback study. He is CEO of CyberLearning Technology, and received an exclusive NASA license manufacturing videogame neurofeedback technology.