LORETA: low resolution brain electromagnetic tomography
So. I survived my first LORETA neurofeedback session. In some ways, it was familiar. Familiar office where I go for my assessments at the ADD Centre. Familiar start with HRV (heart rate variability) training. Familiar scrubbing of earlobes. But the 19-point EEG cap didn’t feel the same because she wanted to make it un-hugging so that it wouldn’t feel like it was there. Totally unlike the EEG cap for assessments — tight! Not possible, I said to my LORETA trainer. I’m too sensitive to touch, I said. But the cap she chose was pretty good. Felt like it was going to fly right off and not give me a headache.
They schedule about a half-hour to set up. A little less time to remove everything. That’s why the LORETA appointment is an hour and a half. I had answered a questionnaire about a list of symptoms prior to my appointment. Dr. Michael Thompson and Andrea Reid-Chung had put them into the computer, added my EEG assessment readings, and then tweaked it manually when they set up the LORETA neurofeedback program to address everything I had rated a ten, meaning what really, really bothered me, things like executive function, fibromyalgia (the closest to fatigue symptoms in the questionnaire), reading… And so when I got there, the training program was ready to go. All I had to do was choose a movie to watch. I decided on Kratt Brothers Be the Creature — something familiar and fun.
While she injected generous amounts of electrogel into the 19 electrodes of the cap, I did an HRV screen with only the breathing belt and heart rate monitor on. The idea was to induce relaxation. I’m not the only one who arrives nervous. But even once you know what it’s like, it’s good to have a few minutes of decompression with HRV, of transitioning between the busy world outside and the intense brain training.
She used the same head diagram as they did during the EEG assessment to check all the connections were good. The connections only needed to achieve 10 k(omega) resistance for LORETA neurofeedback, a little less sensitive than the assessment. I didn’t need to keep on the breathing belt and heart rate monitor for the neurofeedback because the program doesn’t include them and to run them separately requires too much extra computing power on the system. It’s a bit weird to rely only on me to know if my breathing is okay — not too deep, not too rapid or slow. I no like. But I had to.
The normal setup for my single-electrode gamma brainwave biofeedback is two screens and one computer hidden from view. The second screen is sometimes for a two-screen biofeedback screen but most of the time for recording my data after each training. Here, for LORETA neurofeedback, it was a laptop and a screen. I watch the screen, and the trainer keeps an eye on my readings on her laptop.
Instead of playing a game on my screen, I play the movie I chose. What happens is when the networks in my brain are working and the designated brainwaves are achieving the target amplitudes and it’s all in phase, the movie fills the screen and plays. When my brain gets tired and stops making the desired connections and producing the wanted frequencies at the desired amplitudes, the movie goes away. It shrinks into a tinier and tinier square until finally it disappears. Then all you see is a big, black screen. Intimidating. Frustrating. When your brain begins working again the way it’s been trained to, the movie appears as a teeny square that grows larger and larger until it fills the screen. No matter the size of the square, the movie continues to play. Sometimes it starts to shrink then refills the screen. Sometimes it starts to reappear after disappearing but doesn’t make it all the way back before it begins to shrink again. It can get a bit dizzying, but it rather effectively tells you how you’re doing.
The readings the trainer monitors are divided into amplitude, coherence, and phase and within each is a list of the various frequencies in the various Broadmann areas. The movie plays on my screen, and every time it stops, she checks which reading is going red and compares it to the 10s on the questionnaire I filled in.
While I play a game for three minutes during single-electrode brain biofeedback, during LORETA I watch a movie for five minutes. I was told that if five minutes was too long, then I can go down to four. Or if I can go longer, then next time we could set it to six minutes. We repeat that six times, or up to eight times, or as few as four. And the resting interval in between running the movie with your brain is for however long you want — well, within reason, as you should finish before appointment end. It can’t go on forever and ever! Needless to say, you’re not going to get to watch an entire movie or even much beyond the opening scenes in one session. So don’t get too involved! Another reason I chose Kratt’d Creatures — you can stop that show anywhere and won’t feel like you’ve been cut off just as the story was getting good.
At the end of the first five minutes, she stopped the movie, and she asked me if I knew why the movie had disappeared. Yeah, I replied, my brain was tired. Later, she asked me how I got it to play again. That was tougher to answer. But the closest way I could explain it, was that I stared at the centre of the screen where the movie had shrunk into a tiny square and then vanished until it reappeared. It’s staring, but not just staring. It’s like sharpening the eyes and focussing on the spot. And boom, there comes the movie back into view. Beyond that, I found if I worked to focus and engage, trying to take in the details, not just watching passively, it kept the DVD playing in full size. Yet sometimes, I didn’t know why it played. It didn’t feel like I was doing anything.
It turns out that most of the time when the DVD vanished, it had to do with executive functioning — the frontal lobes. The main area of injury. Surprise, surprise.
The way we gauge progress is different than with single-electrode brain biofeedback. Here, it’s points. The more seconds you keep the DVD running and visible (in full screen, I think), the more points you earn. You compare the number of points you earn from session to session. So you see the number for each five-minute play plus the total of all the screens at the end. You can see how you do within one session and from session to session.
I began with 184 points, then 180, 180, and lastly 182. I was only able to do four screens. I got really hot at one point, but when she opened the blinds and let the sunlight in, I felt better. I like to look out a window or sense natural light. I find it difficult to work in a windowless(-like) room, and somehow the trainer realized that. She’s the same! I had a total of 726 points. The goal for next time is to increase my points. Since I had so many questions during the training and was just getting used to the procedure, she didn’t give me a lot of feedback in the intervals. Next time, it will be a regular type of session where tell them how I did after the previous session and then I receive feedback during the intervals in between neurofeedback screens. I will play a movie, take a break, get feedback on which areas went red, play a movie, take a break, get feedback on which areas went red, repeat three to five times more.
The day after my first session, I felt no different, but for what it’s worth: my athletic therapist said my posture was much improved over the last time he saw me two weeks earlier; my head was straight; and my shoulders were no longer up near my ears. My doc told me I looked like I was in a good place and didn’t want to disturb me out of that by talking about the traumatic memories (that had surfaced a couple of weeks ago). Both made these comments sans prompting from me.
And then on the Saturday I had my first ten minutes or so of normal reading since my brain injury!! Holy —-!!!
I am absolutely not going to get excited about 10min of normal reading in case it's just a blip 13 yrs aftr #braininjury wrecked my reading.
— ShireenJ (@ShireenJ) April 20, 2013
I am not going to get emotional about it either. No way jose. No, just no. Nope. Nope. Nope. #braininjury #reading
— ShireenJ (@ShireenJ) April 20, 2013
