It's been so long since I've blogged on my brain biofeedback treatments, it almost feels like I'm not doing them. But I am. I continue trucking along, each session a 3-minute assessment, 5-minute HRV screen aka deep breathing in rhythm with heart rate going up and down, three neurofeedback screens of 3 minutes each bowling, maze, sailboats racing on three day-glo seas SMIRB for 5-10 minutes (writing out one’s ruminating thoughts), and 5 minutes of reading philosophy material online.
Since I began laser therapy for my painful muscles injured way back in 2000, my heart rate has droppede, despite continuing high stress. Turns out, that drop could be because the deep, penetrative laser on my neck affects the cerebrospinal fluid, increasing its flow. Better flow = brain working better. (Though why I see the brain effect mostly on my heart rate, I don’t know.) We’re finally seeing the beat rate in the low 100s. Mind you, my GP took it and my blood pressure with his fancy, automatic machine and declared 118 high. I almost choked. When it was in the 120s or 130s, it got little attention, but now it's high?! Doctors are weird.
Seriously though, my GP is a good guy, and he took the time to commiserate with me about the suckage of being diabetic again. He encouraged me to feel that since I normalized my blood sugar once, I could do it again. I am only 3kg away from where I achieved it last time. I suppose. My athletic therapist and other professionals treating me all expressed surprise I was diabetic again because my weight doesn't compute with having type II diabetes (I'm not big enough). It strengthens in my mind that my brain injury is responsible. I may have the gene, but under normal circumstances, I would still need lots more poundage on me to trigger it. And I'm not that bad an eater. My fatigue is my biggest enemy. How can I cook my own meals when I don't have the energy, when my muscles refuse to obey me from central fatigue not fatigue from working hard and activating muscle cells is an act of will so intense there are too many days I just don't have it? How do I remain healthy on prepared foods?
One strategy I'd forgotten (or was so zonked I couldn't even do it) is to add frozen veg to prepared food, frozen or takeout, to bulk it up so that feel satiated.
On the plus side, my appetite has been normalizing after LORETA neurofeedback. It was returning to normal even with gamma enhancement. But I think the LORETA accelerated that process, and spontaneous healing of my appetite is continuing. (After biofeedback treatments are over, spontaneous healing continues, at least it did and is for me. It's like the treatments kickstart a cascading effect of regeneration.)
Anyway, though it should be easy, I don't know how I'll lose such a tiny amount of weight, but with doctors and therapists having faith in me, I feel a tiny glimmer of hope that I will.
This week marks the end of another phase of my biofeedback journey. This week my LORETA neurofeedback treatments came to an end. Although I'm relieved I won't have to travel to Mississauga anymore, I will miss seeing the people, saying hello, discussing my progress, talking brains.
I am now happily embarking on a ten-day staycation of sorts before I resume my journey with the one biofeedback appointment per week. What will I do with myself on my time off? Read!
Then I will continue with gamma biofeedback and with tDCS, increasing the stimulation of Wernicke’s area gradually to the standard ten minutes. At some point, we’ll switch from PZ-O1 to PZ. If I stop progressing too much or too long, I'll resume twice weekly treatments. Let’s hope I won't have to!
With one less appointment per week, I am considering trying laser treatments for my sore shoulders, back, and hips. Bloody seatbelt injuries. Seatbelts save your face and your life, but they do do a number on your muscles, especially if, like me, you've been in more than one crash.
This week, I said to my trainer: sometimes I wonder if my perception of a change is real or fanciful. She asked me if I was getting philosophical. Well yes. Heh. But I also wonder if I think my reading is getting easier because I'm wishing really hard that it is or if it really, truly is, if a slow, gradual miracle is taking place?
I didn't stutter over the opening sentences this week when I began my reading during tDCS. And during the reading screen while hooked up at PZ-O1, the auditory feedback buzzed on and off, a sign of improvement over last week. Because it wasn't constant, it was a tad distracting. Eventually, I got used to it suddenly sounding. The buzzing white noise was the auditory feedback that told me all my brainwaves were co-operating: gamma going up, low alpha going down, and busy brain going down. It's a good thing to hear, and I didn't recall hearing it much if at all never mind this much during previous sessions. I also achieved gamma/EMG ratios above 1.0 in every screen after HRV except during reading. Ah well. Next time, I'll try for a clean sweep! Pretty neat to see them all in a row like that. And then after that achievement, I drafted part of this blog on my iPod Touch till all of a sudden I needed to sleep. I then tried not to nap on the subway. I didn't want to miss my stop!
The LORETA neurofeedback, the twentieth and last session, went equally well . . . well, after we wrestled the electrodes into picking up my brainwaves and got my left side to relax. We began with an assessment, then we got on with the feedback.
For the second week, we kept the z-score threshold at 1.9. Yet, I achieved all scores above 183, two at 190. Woot! Even weirder my scores repeated themselves. This happened during gamma training too when my first two gamma readings and first two EMG readings were exactly the same. Rather freaked my trainer out as at first thought she’d lost the first set of readings. I didn’t notice the repeating LORETA scores till later: 183, 190, 188 (turn subtitles off) 183, 190, 188. Neat.
The same week we began stimulation of my Wernicke’s area, we saw beta spikes for the first time during my LORETA neurofeedback session. It began right with the first screen. And it wasn’t just a spike of five or six standard deviations from the norm, it was an off-the-chart spike.
My trainer spoke to Andrea Reid-Chung, Clinical Coordinator of the ADD Centre, and Dr. Michael Thompson to see what’s up with that while I continued on training for another five-minute screen. Andrea came to look at the results and to discuss my experience of it. The training on August 8th felt different to me because the display flickered like crazy, with the display unable to make up its mind whether to fill the screen or disappear. Well, okay, it was my brain unable to decide what to do. Although it’s not clear in the above picture, we began to see a trend. First, the usual kind of spike in coherence in the alpha band, then the picture would shrink right down to nothing, then right after that the beta spike, and right after that the picture would fill the screen. The image below shows this. The Percent Reward shows the picture size and below it the corresponding average Z scores of the brainwave amplitudes and coherences. You can see the relatively small coherence spike, followed by the beta spike (which is labelled), and how the picture correspondingly disappears and reappears. The numbers on the right reflect another one happening (Percent Reward is about 0 at the end of the line). All the Z scores in red are the amplitudes and coherences above 2.1 standard deviations above the norm in Brodmann areas 30L (beta), 31L (beta), 31R (beta and beta 1), 32R (alpha and alpha 2), 9L and 9R coherence in alpha 2, and 9R and 32R in alpha 2. It seems to be usually beta 1 in Brodmann areas 30L or 30R that spikes off the chart, that is to ten standard deviations from the norm or higher.
So what does this mean? And was it related to the Wernicke’s area stimulation?
The theory was that, although I’m sensitive, it couldn’t be the stimulation since the effect of tDCS in the first few sessions lasts minutes or hours not days. Only when done over time, does the effect last days. I’d had exactly one stimulation. I still think there must be some connection because those beta spikes didn’t show until the same week I began tDCS at Wernicke’s area. Could it really be just a coincidence?
The beta spikes appeared again last week and again this week, although that initial flickering I experience has not happened since. The spikes are also reducing in frequency and in height.
We’ve decided that the spikes mean my brain is resetting. Basically, it stops trying to keep under that 2.1 standard deviation threshold and goes off to sit in the default network for a second, kind of like Windows closing all programs and rebooting. The beta brainwave spikes, and it’s way off the norm for the default network. Beta waves are the waves of an active brain. So it’s a very high, sudden, short burst of brain activity. The beta spike’s location apparently reflects the connection between emotion and memory. So let’s see if I can think this through: my brain goes into default network, it then emits a beta spike in Brodmann area 30 left or right, and immediately after that, the picture reappears in full. It’s like my brain needs to reset in order to establish a connection between emotion and memory, which connection has been short-circuited for a long, long time since my brain injury and, perhaps relevant to this particular brain event, bad things that happened after my injury that had not elicited emotions for longer than a day or two and so memories were laid down sans emotion. Then biofeedback in 2005 began to re-awaken those emotions, such that they overwhelmed me. We dialled things back, but although my emotional centre slowly began to inch towards normal functioning, I still laid down memories of bad events without corresponding emotions or, at best, emotions that lasted a short while and then went off on holiday again. I knew what emotions I should feel, but I just didn’t. Also, when I did have emotional reactions, they were hours or days after the fact. Perhaps these beta spikes are the brain starting to connect memory A to emotion A and memory B to emotion B as current bad events cascade old post-brain injury memories into my consciousness that then connect to how things used to be before my injury that then starts the grieving process and also cycles back to present day and the memories in between. And with the connection between emotion and memory being suddenly active, my brain coherences between Brodmann areas 9 and 32 or 9L and 9R, which I think are related to my working memory network, get going again. And we have a picture to watch again.
Anyway, that’s as near as I can figure out. The thing is I don’t actually feel all that stuff during that brief beta spike; it’s what’s happening now these past three weeks or so.
We’re bouncing between Frozen Planet and Born to be Wild these weeks. Since it was hot and humid and melty today, I was all for watching the Winter part of BBC’s Frozen Planet. Unfortunately, it ended with a grisly scene. So my brain was having a mighty battle with itself in the last minute of the last screen: one side wanted to keep the picture up, my mind was all for shutting it down and not watching the bison kill the wolf. As a result, I think my last score is lower than it otherwise would’ve been.
We dropped the threshold to 1.9 standard deviations above the norm, which theoretically made it harder. I certainly felt like doing a face plant and having an instant snooze after the second screen. But after the third, I began to feel bright and refreshed and alert. An hour or so after the session, I began to feel dizzy. My new theory is that dizzy isn’t a sign of improvement but a sign of change, kind of like when your skin is scratched. It’s painful and itchy at first and after when it begins to heal too. It’s the context that tells you whether it’s injury or improvement. So in this case, it’s improvement. My scores were all in the 180s, except during the screen when we switched off the sub-titles (I am reading subtitles for the first three screens and not during the last three; last week I read for the first four screens). A pretty consistent performance.
I walked in to the ADD Centre and saw a familiar face I haven't seen in six years: my old trainer. Cool! Last time I saw her, she and I were working on me getting a ball to roll across a gorilla’s arm, over the shoulders, and across the other arm, from my left to my right. Virtually of course. Heh. It was to increase the coherence between two points. We’ve come a long way since two-point coherence training in 2007. Now we do 19-point, full cap (i.e., LORETA neurofeedback).
She sat in to observe part of my LORETA training. It was fun, and I got to pick her brain a little!
This week, for the first time ever, I got a higher than 16x or 17x score on my first five-minute screen. 180 for the win!
This week’s session was the opposite of last week’s: first three screens had no subtitles. Then my trainer turned subtitles on during screen four, and I read as well as watched BBC's Frozen Planet, Disc 2, during the last three screens. And since she knew what to do this time, it took only thirty seconds to turn them on. Still, my score was 174 for screen four. So there must be some sort of lag in my brain adapting to the switch, or maybe being distracted during it . . . or maybe not as the distractions during the earlier screens were way worse: motor cars racing in other biofeedback sessions, yak yak, phones, etc. And of course I wanted to hear what the two trainers were saying about my brainwaves on the second display (I watch a DVD on one display; trainer watches my brain data on a second one). Heh.
I didn't score above 190 in any screen this week. But my scores were more consistent than last week’s, and I at least ended on a high note: 189. After a couple of weeks of achieving more and more above 190, no 190s was a bit disappointing. The lack of 190s could’ve been because of starting off sans subtitles — which felt naked — or maybe because of having had a bad week culminating with a ridiculous commute that got me there rather late. First the TTC had a stall on the subway, then the Mississauga bus driver took his time with his pee/water break while the sun sliced and diced us waiting commuters. Or maybe my brain was just consolidating past improvements.
I overheard my trainer telling my former trainer that people usually begin with scores for the first screen between 150 and 160. Oh. I have high standards for myself I guess because I didn't like seeing any score as low as 168 since I first tried LORETA neurofeedback.
I also learnt that in addition to hunger, other clients develop hot heads (increased blood flow to the head, and I can relate especially this week), feel like they've run a marathon (no kidding!), and sometimes need to nap for a half hour or so afterwards before they leave. Hearing that brought back memories of napping after acupuncture in the office before I left or on the subway after my neurofeedback sessions with the psychologist I saw before I found the ADD Centre. I've learnt that eating more, especially sweet stuff, helps a lot with alleviating the need to nap. That and water.
That lesson came home this week because I was pretty tired after the session. With having to go via public transit to the clinic, I had left too early to eat a full lunch (I had a one-egg cheese omelette) and then because of the delays I didn't get an early supper early enough. Needless to say, I napped on the subway and only didn’t on the bus because it rattles too much. Food, especially cake, woke me up when I got home. Still, I was more tired than usual and if I knew I would sleep till the next morning, I would’ve hit the sack by 7:00 pm.
Well, as I mentioned in my last post, we changed up the LORETA protocol a bit this week. We used an educational-type DVD – David Attenborough narrating BBC’s Frozen Planet – holy cow, what incredible photography! And the music was dramatic and pulled on all the emotional muscles, even though I didn’t feel emotion or fear (poor seal, those Killer Whales were cruel) very much . . . well, okay, my brain did decide to stop working at the moment the whale was dragging the seal off its little ice floe with this terrible look in the seal’s eyes of succumbing to its fate. And it didn’t bring the picture back up till the moment would be well over.
Attenborough’s narration had two challenging things for me: first, just following and processing it in real time; second I still have trouble with accents, and so his accent added to the difficulty. We also turned on subtitles to add the challenge of reading. I decided to do the first three five-minute screens with subtitles on, and the second set of three screens with subtitles off.
As expected, every time Attenborough began speaking and I began reading, zoop, the DVD picture would shrink. The first screen of the LORETA neurofeedback session is always a bit of a warm-up, of getting used to how your brain is interacting with the DVD and software that day. You’re not fully in control, like when you’re first learning a new skill in basketball. You’re not quite sure what you’re doing. (I assume the reason is because your brain has changed enough as spontaneous healing continues after each session, so that the brain you train is not quite the same brain as the previous weeks.) By the end of the five minutes, you have a sense of how it’s going to go for the session. This week, I knew it was going to go much better. Yes, the darn picture kept shrinking on me willy nilly every time I tried to read. But I felt better. I physically felt better! It wasn’t so much that my muscles had stopped feeling weak and stiff (my traps, particularly on the right, are bricked, as my athletic therapist put it), as a feeling of well-being was growing in me. And a feeling of hope. Both my trainer and I were startled to see I achieved 179 in score because it looked like I wasn’t holding the picture to full size that much.
Why the good score and feeling better? Even though I’m reading, the software is still training the same networks and symptoms. And so we saw the same coherence pairs showing up as in previous sessions. Why I felt better could be because psychologically I’m comfortable with reading; written words are comfortingly familiar. Yet I don’t watch DVDs or TV shows or movies at home with the closed captioning on. It’s too distracting for one thing. So why do I like it during training? Maybe it’s because reading engages those problematic networks with more strength and pull to keep them up than simply listening to narration or watching a movie. Clearly, no dialogue, narration, or subtitles is not stimulating enough for me. But reading seems to potentiate narration.
The next screen, I began working. And it was hard. My breathing and focus and eyes were all working it, trying to sustain the networks and coherences so as to keep the picture visible and, moreso, full size. Every time the picture disappeared into a rabbit hold of black nothingness, I let go, straightened up, and tried to refocus without getting anxious about how long it was taking to get the picture to reappear. The score went up to 181. At least it was up.
The third screen I worked just as hard. It really didn’t feel any different than the second screen, except that the picture wouldn’t automatically disappear every time I began to read, but wow, the score shot up to 196. What did you do, my trainer asked. Heck if I know. I guess my brain liked that kind of workout. We noticed the box showing the Average Z Score per Second looked messier in the three reading screens (they looked cleaner in the non-reading screens that followed). Last week, we’d seen clean seconds of all coherences below the threshold of 2.1 standard deviations in between the peaks where all the coherences and brainwave amplitudes rose above the threshold. This week, individual coherences would pop over the threshold in between those blank-out peaks.
During the fourth screen, my trainer switched the subtitles off. It took a couple of minutes to find the part in the DVD where she could access setup, and I tried to keep the picture visible as much as I could. Perhaps because of that, or because of the weirdness of not seeing any text on the screen and only listening to narration (which rather felt like flying without a net), the score dropped to 175. But after that, the scores went up. It really felt like a cascading effect of improvement was going on in those neurons inside my skull, an effect that felt stronger in the sixth screen. 191 and 190.
That means I not only achieved my highest score yet – 196 – I also achieved three screens above 190 for the first time. Woot!
Gamma training didn't work as well as usual. It didn't help that my heart rate was way up there (let's pretend we didn't see those 130+ figures shall we, and why didn't rest while I was thankfully waiting for my appointment to start drop it? Scary to think maybe it did.), probably because I stupidly climbed the stairs out of the subway station instead of taking the escalator. What was I thinking? My leg muscles, busily seizing up and going into pain, were asking the same thing. My legs recovered pretty quickly. Breathing and heart not so much. Oh well, live and learn.
We didn't really train for inhibiting 8-10Hz today I noticed, but it made no diff because it dropped really low anyway. However, 2-4Hz, which we only monitor, was not so hot. You're tired, my trainer told me. Yeah, that's what happens when, except for the first two nights after last week's LORETA, you can't even reach six hours of sleep. Argh! Even those first two nights were not rocking it at only seven hours of sleep. I napped both days this past weekend. Truly, a need to nap is no longer normal for me.
I actually ended up hating the effects of last week's LORETA so much, I emailed my feedback early. Not enough stimulation, we decided, given there was no narration, no text to read, no dialogue, just music and visuals. Nice DVD, not running it with my brain again, let me tell you, for it deep-sixed my reading, blanked my mind completely for long minutes at a time, hid words from my word-retrieval system, and made me go the wrong way on the subway. Talk about feeling like a twit. It also put me into Flatville, which the gamma training this week reversed. I felt like I'd regressed a few years and was back in those old fun-brain-injury times. So a lesson learned: that DVD may be good for beginners and people with high anxiety, but not for someone like me.
Actually, because it had such a profound effect on my reading — no initiation, stuttering comprehension, little processing — that I checked my logs and realized I've actually been reading less and less since the beginning of July. I went from achieving six to seven hours per week in June to three the first week of July, then an hour and 45 minutes in the next two weeks, and a whopping eleven minutes total today and yesterday. (Side note: I'm finding and fixing several verbos, like in the old days, getting a bit ridiculous. Hope I don't miss any!)
Working on the working memory network was supposed to help my reading, but maybe my reading problems are so multi-faceted, that we need to work on several aspects at once, aspects like slow reading, word find, working memory network, (multi-tasking?), stuff like that. We're going to try having me read closed captions again in the kind of educational DVDs I'd been watching up till last week for half the LORETA session this week. They'll analyze the results, and I'll tell them how the following days went, and then we'll decide the following week whether to continue with the new protocol with reading or return to the old protocol. In addition, during next week's gamma session, we'll assess my brain activity at Wernicke's area. If it's too alpha-intense, we'll try stimulating it to produce more brain activity. Wernicke's is involved in language. I recall back in 2005/2006 some discussion about that area in me not working all that well. I still don't know what kind of aphasia I had because people told me when my brain was busy napping instead of processing. What got in, I retained. But an awful lot didn't get in, and that was one of them.
I'm just going to say one thing: it's the cruellest joke ever that my brain injury kiboshed my reading. OK, back to dealing with it. Because, really, what else can one do?
New movie for this week’s LORETA: Antarctica Dreaming. Though I hadn’t seen it or read the Amazon reviews, I chose it because I was hot, and the idea of looking at snow and ice was rather appealing. But it turned out this DVD was good for another reason.
Unlike previous DVDs, this one had no narration, no dialogue, and no written text on the screen. As such, it was not engaging my listening, encoding, auditory or language processing areas. That would make it easier since trying to follow auditory or written language is difficult for me, but also harder because it could capture areas normally ignored by the program as it focussed on the tougher stuff. I noticed right away that though calming, it required me to pay attention more intentionally than the previous DVDs and so it required more motivation from me. The content was not grabbing my attention and pulling me in like a storyline or narrator would. I had to want to attend and make myself attend.
Visually, the DVD was so stunning that I noticed it almost overwhelmed my visual senses. Also, since there was no narration, I was free to make up my own stories about the penguins as, for example, when a line of them was waddling to a destination and one stopped. The one behind it waddled around it, and I could hear it saying, “Hey, bub, move it, would you.” The colours and textures made the cold come alive, and I imagined my skin cooling pleasurably. It was no wonder the DVD engaged areas involved in sensory integration.
Because the DVD was so different from previous ones, the z-score lines were different too. For the first time, there were up to 10 seconds of every single coherence pair and brainwave amplitude below the threshold 2.1 standard deviations (as between about 19:42 and 19:52 below). Even when the always troublesome coherence pair of Brodmann area 9R and area 32R in the high alpha band would poke its head up a wee bit (see below), it too dropped along with the rest to give several seconds of perfect performance.
As the session went along, these stretches improved. The other thing that my trainer noticed was that when I moved a little bit, all the waves went up. But I only moved after the DVD picture disappeared to nothing. I would feel my brain stop, would be either surprised by it or be unable to get it working again, watch the picture disappear rapidly to nothing, and then would “let go” meaning relax (that’s the small physical movement my trainer observed), maybe take a breath, and then try again by staying relaxed or focussing hard. Sometimes the picture would come right back up, other times it would resist for awhile and then fill the screen. You can see in the image below the pesky coherence pair(s) that would stop working and cause the picture to disappear followed by the bunch of waves rising above threshold that signalled my physical movement.
If you look carefully, you can see it’s the purple line that was implicated in the drop to zero picture at 14:50 minutes. That purple line was the coherence between the two frontal lobes in Brodmann area 9 in the high alpha band (and was probably because I was accessing emotions at the time, which are only just starting to normalize and have been disconnected from “me” since the brain injury in 2000 – the coherence failing is a sign that emotions and I assume emotional control are still not stable). The image below shows that same coherence pair rising above 2.1 standard deviations up to 2.77.
My scores this week were all above 180. Woot! And two this week were above 190! That’s due to those long stretches of everything below 2.1. Now I just have to gain better control over coherences involving Brodmann areas 9, 32, and 31, and maybe soon they’ll be able to drop the threshold down. To what, I don’t know. I guess I’ll find out when it finally happens, when I consistently achieve all scores above 190.
How I fare over the next few days will tell my trainer whether we should continue using this DVD or return to one with narration.
Every so often, my LORETA neurofeedback trainer mentions that when I reach 190 consistently for each five-minute screen, they'll drop the z-score from its current 2.1 to 1.9 or thereabouts. In other words, reaching 190 consistently means I am ready to train at a harder level.
At the moment, at level 2.1 standard deviations from normal, the LORETA software is picking up on only the working memory network — Brodmann areas 9, 30, 31, and 32 — the same as last week. It probably won't pick up on other issues until we drop the standard deviations to 1.9, for example. At that point, symptoms or networks that are not as bad but still out of whack, will be noticed by the computer and trained towards normal. It'll be harder work then both because I'll be training more networks and/or symptoms and because I'll be setting a harder level for the working memory network.
When she mentioned the above at the start of this week's session, I basically said, “yeah, yeah. I haven't reached 190 yet, I'm not holding my breath that today will be any different,” particularly since during the deep breathing (HRV) portion, I began to fall asleep in addition to being my usual tired self. That did not bode well for a good training session. We stopped the deep breathing, and I began talking while she finished hooking my brain up to the computer so that I could stay awake.
It's been a stormy week, literally and figuratively. Record rainfall. Phone down. Trees down. Internet down. And power outages slowing everything down from being fixed. Despite the challenges, I was able to react in real time. It's only now when life is returning to my usual routine that I realize that. I'm amazed! I didn't have my usual delayed reaction of 12 hours or so! Whoa. It did take me awhile to process and problem solve, but to do that when needed not hours later was extremely helpful in getting things fixed. I also didn't get overwhelmed to the same degree as I'm used to. In fact, I wasn't overwhelmed with the first couple of SNAFUs. It was the third one that did me in. Still, I didn't become a puddle on the floor. Awesome not to lose one's self-dignity, let me tell you. Although I did enter busy brain mode on steroids — round and round went the thoughts — I remained calm enough to be able to cope. This was even more surprising given that the storm kiboshed my regular gamma brainwave biofeedback. Even if I'd been able to go, my trainer said that I'd be too distracted with all that I had to do to be able to focus on the training.
It was a reminder that training is hard work, and you need to be fully present to be able to profit from it. Some people think: what work? You're just playing games or watching a movie. Well, the fact that it's normal to be staaarrvvvinnngggg after a LORETA session tells you that your brain has consumed a lot of fuel, which could only happen if you've been working it hard. Apparently, every client realizes this quickly and brings snack bars. I brought two for this week's session. Good thing, for making the effort to reach 192 on the very last screen, after starting the session at 178, made me very, very hungry. I ate both snack bars, a chocolate cupcake with vanilla icing, an iced coffee, and was still ready to eat more. This on top of the fact that I always, always attend a neurofeedback session well fed. If you're not fully fuelled up, you're wasting your time and money, IMHO. It would be like starting a marathon having eaten one pancake and drunk a small glass of orange juice then thinking you'll last the whole way.
I didn't send my feedback email in this week to the ADD Centre because of the storm. I could've after my Internet was restored, but I was in busy brain mode till Wednesday night when all the work was finally finished and I didn't remember and couldn't focus on one darn thing but the repair work. I've been duly reminded to send my feedback in for this week. Okey doke.
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.
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.
Uh-huh.
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.
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.
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.
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