A vital aspect to the neurofeedback session is the symptom assessment. At Rose City Therapeutics, we do not diagnose or provide specific treatment of mental or physical disorders. Instead, we follow symptoms as reported by the client and/or the client’s caretakers, teachers, therapists, etc. This information helps the neurofeedback provider tailor the protocol for the best outcome in symptom relief or peak performance. Therefore, it is of utmost importance that there be a free and clear flow of communication between the client and/or the client’s caretakers, etc., and the neurofeedback practitioner.
Since we do not use an operant conditioning method or model for neurofeedback training at Rose City Therapeutics, we do not use the information from the EEG as objective data to determine the progress or success of the neurofeedback training. The neuroscience literature does not provide sufficient evidence to support the use of EEG data in this way, although quantitative EEG (QEEG) may be of use at some point in the future.
Since the purpose of neurofeedback training is to help clients improve their symptoms and optimize performance, then the gold standard of assessment will always be the individual and somewhat subjective feedback from the client on the improvement of these symptoms and performance. Therefore, we have the client (or their caretakers) fill out a survey of symptoms and rate the level that each symptom has affected them either currently or at some point in the past. Then, we choose a selection of those symptoms to track over the course of the neurofeedback training. At periodic points during the course, we have the client rate the levels of this reduced list of symptoms, thus tracking the progress in symptom reduction over the course of the training.
The closest objective measure of progress over the neurofeedback training is the continual performance test (CPT) that was specifically designed for neurofeedback assessment called the QIK-Test. This is similar to the TOVA (Test of Variables of Attention ®), which is a common test that is used to measure impulsivity and sustained attention, and is often used to aid in the diagnosis of attention deficit disorders. The QIK-Test is a go/no-go challenge test where there is a target or non-target that flashes via red LEDs on the device and the testee clicks the button upon determination of the target. The device measures the accuracy of target clicks as well as the time interval between when the target is flashed and the testee clicks the button.
There are five phases of the test that takes a total of 21 minutes. The first two phases are low-demand, meaning that there are fewer targets that are more spread out between non-targets; the third and fourth phases are high-demand. The fifth phase returns to low-demand, which tests the ability of the testee to transition back into a low-demand phase after high-demand. These different phases challenge different aspects of attention, impulsivity, and performance. From the data collected, the QIK-test online software via EEG Expert calculates omission errors (not clicking when it is a target), commission errors (clicking when there is not a target), reaction time, and variability in reaction time. These measures are then compared to a database of all the QIK-test results from thousands of other test results, and the statistical comparison of the results are provided for the comparable sex and age group. This analysis helps to determine the client’s performance relative to their peers.
The data consistently indicate that QIK-test results improve with neurofeedback training. This is a consistent finding no matter what symptoms the client is working to improve or what protocol the practitioner is using to improve them. Therefore, we use the QIK-test for all clients that are capable of taking it (which tends to exclude young children) in order to have at least one objective measure of progress.
For more information on the QIK-test, please visit EEGInfo