Jul 042013

This week, the new protocol for my LORETA neurofeedback began. Since April, the protocol was based on the symptoms I’d listed as being at a 10, the worst ones of all my symptoms. This time, it was based on my top six symptoms, not all the ones rated at 10, and on the working memory network. This network is not on the symptom list but does affect many of them.

As I understand it, working memory — like attention or mood — isn’t based in one anatomical location but operates as a network that connects several areas of the brain. It’s less about the amplitude of a brainwave at a certain frequency and more about coherence between areas within a certain brainwave frequency (or maybe several frequencies, although the ones that popped up for me were all in the alpha band). Networks are something I’m going to have to learn more about.

Working memory is the memory you use while your brain is working, whether you’re adding 2+3, or having a conversation, or reading, or organizing your schedule. As you work on a task or follow a lecture or participate in a conversation, working memory updates the information going in. For example, if someone tells you, "I was going to the store. And I met an old friend there," working memory updates the first sentence with information from the second sentence so that you see the two sentences as one unit and remember it as one unit. In that way, you can follow the story. I see them as two separate units. That means my working memory is not so hot. I’ll drop one of those units and remember only that she went to the store. The lack of updating may contribute to why I have trouble seeing the big picture when I’m reading or writing — why I need an outline to follow my own stories when I’m writing them. And even with an outline, why I cannot see if the story is flowing or not, if there are holes or not. You need working memory before anything can be encoded into short-term memory. And you need short-term memory in order to encode and store long-term memories. As you can see, bad working memory would create a domino effect down the memory line.

From the assessment done last week, Andrea Reid-Chung determined that my top symptoms are slow reading and perception of letters. Working memory is implicated in the former for sure. The next two less-severe symptoms are anxiety and attention. Attention comes before working memory. If you don’t pay attention, nothing gets into memory in the first place. Working memory thus depends on attention. Anxiety happens a lot when you have brain injury because you don’t know what’s going on or if you just did something, like lock the door. You literally forget a nanosecond after you turned the key and pulled it out of the lock. As you could see, that level of confusion increases anxiety. A good working memory would help that a lot because you’d know you’d locked the door – for at least a few seconds anyway!

The least severe of the top six symptoms are symptoms of fibromyalgia and word finding. I don’t know if working memory is implicated in either, but improving the former would certainly alleviate my fatigue and pain levels; improving the latter would make reading and writing a lot less frustrating.

The threshold for these six symptoms was 2.1 standard deviations (SD).

While I’m playing the DVD with my brain during LORETA neurofeedback, the trainer is watching several measurements. One of them is a graph of the average z scores per second for the brainwave amplitudes, coherences, and phases that the software is tracking. This graph (below) looked a lot different than we’re used to seeing.

Average Z Scores Per Second

For the last 11 sessions, all those z scores have been pretty high up there with not such a huge gap between the problematic ones and the not-so-bad ones. This week, for the first time, most of the z scores were below 1.5 SD. And so the few out of whack – the ones above 2.1 — really popped out, especially when they spiked as you can see in the above graph. This high spiking of up to 6 SD also was new. While I was playing the DVD with my brain, the trainer saw these spikes and asked me what I was doing. I wasn’t meant to answer right then and there but to think about it so that I could tell her when the 5-minute training screen was over. I had no clue. Then she asked me again, and because it was in my mind now, I knew the second time. I had blanked out.

I have blanked out since my brain injury. I don’t think any health care professional has ever noticed before, or didn’t comment on it anyway. I used to blank out for long seconds and lose time too. I think only one person ever noticed. And he no liked. It is really strange that all these years later when this blanking out has become such a part of me and is a lot less problematic such that I hardly notice it, that now — now!!! — it is picked up and commented on.

My trainer told me she’d tell me when she saw that spike so that I could prevent it. I stared at her. How the heck was I supposed to prevent something I didn’t know was about to happen? Well, she retorted, by making me aware through saying "now" every time she saw it, I would start to notice what I felt like as it was happening and then hopefully as it was about to happen. Thus, I would try to stay focussed as I felt that feeling coming on.


Well, it worked.

The spikes continued but contained fewer problematic coherences. The graph above is the improvement from one screen to the next after she had instructed me. In the previous screens, those spikes were much more crowded with lines of spiking z scores, all in the 9 and 32 Brodmann areas and then also in areas 30 and 31 (sounds so sci-fi’ish).


The above picture shows the tracking of the brainwaves (which here were all behaving nicely). AP is for amplitude. In this section, the lower beta frequencies in Brodmann area 31 on the right side had the highest z score of 1.69 SD from normal. COH is for coherence. In this section, the coherence between Brodmann area 9 on the left side and Brodmann area 32 on the right side in the higher alpha band had the highest z score of 1.9 SD from normal. Those z score numbers turn red when they go over 2.1, which is the threshold that has been set for me, so that it’s easy to see which coherences are dropping. (For me, it’s mostly a coherence problem rather than an amplitude problem. The phases aren’t shown in this picture, as  we don’t really pay attention to them and I don’t think they’ve been a problem anyway.)

I am now no longer reading the closed captions while I play the DVD with my brain because we don’t want my really bad reading problem to prevent other symptoms and the working memory network from being picked up on by the software and worked on. Every now and then, we’ll do it, but not regularly. Training is a lot easier, I have to say, without reading.

Progress LORETA Neurofeedback

The progress chart as seen above, shows how long I keep the movie full screen (100) and the times when the screen size shrinks, grows, shrinks, disappears to nothing (0) and then zips back up to full screen. It is a nice feeling to not see anything and suddenly the picture reappears and fills the screen in one smooth move. This graph is pretty good. Up to now, I’ve had a hard time keeping the screen at 100 for more than a second or so. It’s been improving, but today was much, much better than previous sessions.

The times the picture went to zero was when the coherence in Brodmann areas 9R and 9L, 32R, 31L and R, and 30, went way above 2.1 SD. Area 32 was pretty problematic and is involved in the working memory network. None of these were involved in the symptoms that had been input into the LORETA software except for word finding and anxiety. But Brodmann areas 9L and R have been consistently popping up since day one and are associated with things like failure to initiate and executive function. However, the program is not set to work on those areas. Even so, my initiation was hot to trot after the session. Man, it felt so good to just do and not have to pep talk myself the whole damn time. I wish it would stay that way. In the past, it has lasted only a few days, up to four if I’ve been lucky. This is even more energetic though than past turnings-on of initiation.

Brodmann Areas 9 and 32

I went in feeling physically weak and like something was sitting on my chest. I came out with the pressure gone and my muscles feeling stronger. I found the session tiring and really wanted a nap afterward. Yet with each passing hour after the session ended, my brain revved more and more until I felt rather high. The after-session cupcake and iced coffee probably helped that revving. But I have those every week. It felt more like I’d had a gamma brainwave biofeedback session (but without the release-of-stress effect).

I improved through the first four screens, dropped in the fifth, and achieved my highest score in the last screen. The second-wind effect, I call it. Or maybe, like other clients, my competitive side came out, and I wanted to end with a bang.

LORETA Neurofeedback Scores