News & Events - Trade Press

New Adaptations for Biofeedback
By Michael Samsot

Used to treat a wide range of medical conditions - from head injuries,
through incontinence, stroke, autism and substance abuse - Neurobiofeedback(SM)
is a tool whose use is gaining in range and popularity. "I went to a conference
in Key West, Florida, two years ago," says Nurse Practitioner James White,
Jr., "and there were medical people there from Great Britain, Germany,
Japan, New Zealand, Canada, the USA, and South American countries. All of them
were seeing in their patients what I'd been seeing for six years or so.
This conference heavily validated the use of Neurobiofeedback(SM) in many areas
of medicine."

White, who is a psychiatric practitioner/clinical specialist, works at and
is president and CEO of the Michigan Institute for Neurobiofeedback(SM) in Troy,
Michigan. Its focus is "wholistic health care, with a special emphasis
on central nervous system pathology, using Neurobiofeedback(SM) as the primary
intervention," he says. "The most common types of conditions we treat
at the institute are closed head injury, open head injury, stroke, and ADD/ADHD
(attention deficit disorder/attention deficit-hyperactivity disorder). We usually
have somewhere in the neighborhood of 30-35 patients of this kind per week.
In addition, other patients may be in for traditional treatments.

"What we do," White explains, "is evaluate the brain wave ratios,
shown on a monitor, through the use of sensors on the head. There are beta,
alpha, theta, and delta brain waves that we look at, although we work mostly
with the beta, alpha, and theta. We look at where in the brain these waves occur
and at the number of waves occurring. We know what are normal patterns for most
people and when we see something like much more theta and much less alpha than
we expect, we know the patient needs to work on getting those ratios back into
a more normal range."

"A high concentration of beta waves indicates a very externalized thought
pattern that of someone who is paying attention to something outside himself;
he or she may be interacting with others, or being attentive, listening, and
alert to some external stimulus," White continues. "The alpha wave
is a more relaxed pattern and a person can increase these waves just by closing
his or her eyes. Alpha waves should arise from the occipital lobes, and when
I start seeing them from the front, I know something's out of whack. Too
much theta can be indicative of a person who's doing too much internalized
thinking. This is what we see in autistic patients. They have trouble relating
to people outside themselves and in their brain waves, you see way too much
theta.

"The great news about Neurobiofeedback(SM)," White says, "is
that it puts the patients in control, it gives them the tool they need to play
a big part in their own treatment." He uses the example of autism to illustrate
how this works. "Many autistic kids are bright, but they can't use
that intelligence effectively because it's all locked up. They internalize
too much and have difficulty interacting with other people. You look at their
brain waves and the theta waves just wipe everything else out. We can train
them, though, to learn to suppress that theta out to some extent and to raise
the levels of beta waves.

"It's amazing what this process can do," White says. "One
young man who was autistic was brought to us about a year and a half ago by
his mom; he was 18 and spoke every now and then, but there was little real interaction
with other people, and he'd always gone to a special school. We worked
with him for about 30 sessions, and he's back in a mainstream school now
- with only two of his classes taken in a special school. The big thing
is that he has a restaurant job, waiting tables. I ran into him not long ago;
he looked great and when I told him so, he took by hand and said, ?yeah,
I'm doing good, real good.' I would say that out of 20 or so autistic
people, 18 can be helped by Neurobiofeedback(SM) methods."

White became interested in nursing with a psychology focus when he served as
a field medic in the US Army, from 1969 to 1971. "I actually was in the
Army for then and a half years," he says, "first in primary care,"
but then during the Vietnam era White was doing out-country receiving, mostly
psychiatry-related, for military personnel leaving Vietnam. Following his military
service, he worked for the Sheriff's Departments in Michigan's Wayne
County (Detroit) and Macomb County. "The pathology in such a setting is
so broad and so deep," he says. "You see serial killers, child molesters,
drug runners. As a psychiatric practitioner, I evaluated prisoners for their
medication needs and their placement.

"Substance abuse, particularly alcoholism, was one of the first areas
I became interested in focusing on - years ago, in both Vietnam and in
prison work," White says, "and this is one of the big areas that Neurobiofeedback(SM)
is so effective in. This abuse is a monster that's eating us alive in this
country, and we can see real progress when we treat it with Neurobiofeedback(SM).
We take a look at the alcoholic's brain, and can usually see that there's
way too much beta (the wave produced by external engagement). He or she is concentrating
on three things: worrying about where the next drink is going to come from,
thinking ?What's going to happen to me if I don't get a drink?'
and thinking about how he can continue to justify his lifestyle to others. He's
got tremendously high beta waves and not enough alpha. So, as he watches, we
work on how to raise the level of alpha waves, which is followed by a suppression
of some of the beta waves.

"After about 18 to 20 half-hour sessions, we see a definite change in
the alcoholic's brain wave activity," White reports. "If alcoholism
were just a physical addiction, abstaining for 30 days would cure it; but it's
not, and that's why there has to be a change in the brain. The great thing
is that an actual change in brain chemistry follows the change in brain wave
activity, and eventually the patient will not want to drink - and this
cure can be permanent."

Another malady that White treats with Neurobiofeedback(SM) is tinnitus, or
ringing in the ears. "We saw a man in his mid 50's who had had this
problem for quite a while and had seen several internal medicine physicians,
as well as a couple of psychiatrists," White says. "No one had been
able to do anything for him. It was so bad, he told us, that he didn't
think he could live with it anymore if we couldn't help him. We started
treating him in the sensory motor rhythm strip (area of the brain), and after
10 or 11 sessions, he was reporting some relief. We had found an extreme amount
of beta in the occipital part of the brain, and that's what we worked on
reducing. After about 30 sessions, I ran into him outside the office, and he
said, ?I know you're real busy, but I just want you to know that for
the last three days, I've had no ringing in my ears. That's the first
time that's happened in years.'

"We also do a good deal of training for incontinence," White says.
"Fifty percent of adult women are incontinent at some level, and they can
be helped. We treated a woman in her late seventies for incontinence, and in
addition to the sensors on her head, we also placed sensors in the pelvic area,
because her pelvic floor muscles were weak. As she watched while we taught her
how to tighten those muscles, and she saw what was happening on the screen,
she said, ?Did I do that?' When I answered that she certainly had,
she said, ?Well, now, I just think I'll do that again!' She's
doing very well now, with her problem under control. Our goal is to get people's
incontinence to the point that it doesn't affect their social life. They
don't have to turn down a game of tennis."

Neuromuscular re-education is yet another area where White is finding positive
results from his treatment method. "One lady we treated had suffered a
stroke and when she came to us, her arm was pulled up to her chest, and she
couldn't use it. She told us that more than anything else, she'd like
to be able to reach up with that arm and comb her hair," White says. "It
was an attainable goal, she was able to achieve it, and when she did, it just
made you feel wonderful. Physical therapy works with the muscles, but Neurobiofeedback(SM)
works with the brain, making it easier for the muscles to do their work.

"We often see patients who have had head injuries from automobile accidents,
falls, whatever. I can personally identify with that," says White, "because
at age seven, I had a closed head injury from an auto accident, and was almost
killed. I can tell these patients I know exactly what they're going through.
These types of injuries can cause diffuse axonal shearing, a primary lesion
caused by rotational acceleration/deceleration head injury. This can result
in the patient having difficulty in such things as organizing, remembering where
they're supposed to be, making lists, or balancing a checkbook. This treatment
can bring back a large percentage of those abilities and can actually give back
meaningful life to a head-injury victim.

"The powerful part of Neurobiofeedback(SM) is that it gives the patient
the sense of empowerment. Patients look at the screen, they can see it happening,
and for the first time for most of the, it puts the direction of therapy into
their own hands," White says. "It works in so many different areas,
that I think it's eventually going to impact every aspect of medicine."

James White received his BA degree in Psychology from Northeastern State University,
Tahlequah, OK, in 1969; he received his MS degree in Clinical Psychology in
1972 and his BS degree in Nursing in 1982, both from Pittsburgh State University,
Pittsburgh, PA; and he received his PhD degree in Clinical Psychology/Health
Services Administration from Columbia Pacific University, San Rafael, CA, in
1984. White is Board Certified as a Clinical Specialist and as an NP. In addition
to his psychiatric background, he completed a two-year preceptorship in Family
and General Practice and still consults with various agencies on primary care
issues.

Michael Samsot is a freelance writer in Ellicott City, MD. She is on the Editorial
Staff of NEWSLine for Nurse Practitioners.

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