Z-score LORETA Neurofeedback as a Potential Rehabilitation Modality in Patients with CVA

If you think this is that good write it up as a protocol and do what you are supposed to do to get this delivered to all the stroke rehab centers around the world. There is such a process, ISN'T THERE? Or do really expect all the stroke centers to read the Journal of Neurology & Stroke and know that this is to be followed. But this won't be rolled out because everything in stroke is somebody elses f*cking problem. Who gives a shit if survivors don't recover very well. Take some responsibility and make it your problem to solve.  Sorry for the rant but it is Saturday night and I'm at work.
http://scholar.google.com/scholar_url?hl=en&q=http://www.tallahasseeneurobalancecenter.com/Portals/0/JNSK-CVAFinal.pdf&sa=X&scisig=AAGBfm3u3OOzf65xg3F3bdrDfwK1jmioVw&oi=scholaralrt
Introduction
EEG biofeedback also called neurofeedback (NFB) has been shown to be a promising modality in neurorehabilitation including stroke [1-4]. Recent progress in computer technology and development of newer imaging and NFB techniques including
low resolution electromagnetic tomography analysis (LORETA) as well as Z-score NFB prompted me to apply this therapy in stroke patients. The potential advantage of LORETA Z-score NFB is ability to achieve even faster results than standard one or two channel neurotherapy [5,6]. Deep structures such as the anterior
cingulate cortex [7], insula and mesial temporal lobes [8] can be correctly localized with LORETA. In Z-score biofeedback real-time comparisons to an age matched reference population of healthy
or normal subjects are used as a guide or “compass” to increase specificity and provide a uniform direction and threshold for the
biofeedback process [9]. Prior to Z score biofeedback clinicians had to guess about what threshold to set for a given frequency
or location to trigger the feedback signal or reinforcer signal [9].
Z score biofeedback greatly simplifies and standardizes EEG biofeedback by reducing many different metrics (absolute power, relative power, ratios, coherence, phase) to a single or common
metric of the Z score or a standard deviation with respect to the EEG from a group of age matched healthy normal subjects [9].
Surface Z scores improve specificity by isolating dysregulated locations and rhythms, especially when using the Laplacian transform and LORETA Z scores are even more specific. For example, LORETA Z score biofeedback often also produces
results in one 20 minute session because EEG source localization has accuracies of about 1 cm to 3 cm and thus is much more specific than is surface EEG [9].
In Z-Score NFB, a real-time comparison to an age-matched population of healthy subjects is used for data acquisition, simplifying protocol generation and allowing clinicians to target
modules and hubs that indicate dysregulation and instability innetworks related to symptoms. Z-score NFB increases specificity in operant conditioning, providing a guide that links extreme
Z-score outliers to symptoms, and then reinforcing Z-score shifts toward states of greater homeostasis and stability. The goal is increased efficiency of information processing in brain networks
related to the patient’s symptoms [10].
A recently introduced method called Low Resolution Electromagnetic Tomography (LORETA) Z-score NFB is capable of targeting specific dysregulated anatomical structures, many
of which are in deep cortical locations [11-13]. For example, the insula and anterior cingulate have been identified as potential NFB target sites for improving pain control in patients who
display electrical dysregulation of these areas [12].
In my clinic, we have completed Z-score LORETA therapy with more than 250 patients with different neuropsychiatric conditions including five patients suffering from stroke. One of the patients who was diagnosed with occipital cerebrovascular
accident (CVA) and complained of visual problems due to homonymous hemianopia completed only 3 NFB sessions and reported subjective improvement of his vision. However, no follow up visual fields study was completed. In this paper, I
will present four patients with their rehabilitation outcomes that completed longer courses of Z-score LORETA NFB due to ischemic or hemorrhagic stroke.