1. after a stroke, accept for MRI and scans, the performance of a q EEG, or quantitative EEG is recommended.

             To start the procedure, a routine EEG is performed. Deficits visible on the routine EEG include slow wave activity, which refers to slow cognitive functioning, poor attention, and concentration especially in the aged or in ADD/ADHD or patients after stroke. Epilepsy is also observed on a routine EEG.

             The q EEG can be compared to observing light through a prism. The detail is accentuated which cannot be seen with the naked eye on a routine EEG recording and provides information regarding brain functioning and cognition, as compared to a normative or reference database (Thatcher Neuro-Guide).

             The main purpose of the q EEG is to suggest treatment montages and not to diagnose however the q EEG is a neurocognitive and neuropsychological instrument that validates brain functioning/behaviour. Results may be supportive of or correlate with, pre-existing diagnoses.

             The brain has been divided into approximately 84 Brodmann areas of which a relatively good knowledge exists of the functions of 48 Brodmann areas.

             The Brodmann areas that are underperforming are indicated on the q EEG and any presence of certain brain frequencies in excess or insufficient frequencies such as delta, theta, alpha, beta, high beta are indicated.

             So what should be done?

             The brain frequencies in excess should be down trained or inhibited and the brain frequencies that lack, or there is a shortage of or are unavailable especially alpha or low beta activity should be enhanced or rewarded.

             Stroke generally results in abnormal brain behaviour/brain functioning and instability in terms of the production or presence of different frequencies (delta, theta, alpha, beta, and high beta activity).

             Stroke generally results in abnormal brain behaviour/brain functioning and instability in terms of the production or presence of different frequencies (delta, theta, alpha, beta, and high beta activity).

             Can a stroke be detected prior to the CVA? Once excess delta in a specific location, spike and wave activity

             or excess slow wave activity is observed, which is a change in the general age-related pattern then one may be alert, however often this EEG recording cannot be compared to a former recording if no recording was performed.

  • will cause memory impairment
  • :  emotional instability,  memory difficulties, difficulties in terms of language impairment referring to receptive and expressive speech, and word-finding when the areas of Broca and Wernicke were included.
  • : inability to do mental shifting or emotional rigidity and stubbornness
  • caudate. It has been reported that a significant number of patients with caudate infarction (tissue death, due to a local lack of oxygen due to stroke) show deterioration in their intellectual function between 1 and 2 years after stroke or injury. Insufficient functioning of the caudate results in specific behavioural and learning disturbances, the ability to follow instructions and conversations, and will influence general comprehension.
  • is involved in reflective self-awareness, reading, spatial focusing, the theory of mind, executive control, action sequences, sentence generation, language difficulties, verbal creativity, numerical facts, calculation, visuospatial perception, and visuopraxis.
  • is involved in emotional in/stability and will impact social in/appropriate behaviour and further suggests fear, anxiety, and poor anger control when indicated with underperformance. The Insula is involved in autonomic system regulation, pain perception, anxiety control, and subjective experience.

             After stroke patients can be treated after the q EEG has been performed to determine a specific protocol that should be followed for the specific patient.

6.6.1    What is Neurofeedback

             The brain is powered by electricity and produces electrical patterns or brainwaves, which determine the level of arousal of the brain.  The more stable the level of arousal of the brain, the more effective is the function.  Neurotherapy is focused on enhancing the stability of the brain to ensure effective processing of the brain. The over-aroused brain results in hyperactivity, high tension levels, aggression, symptoms of PTSD, and panic.  The under aroused brain results in under-performance which is typical of the couch potato, poor focus, lack of concentration, slow processing speed, short attention span,  depression, and being lethargic.

             Brain waves are monitored by placing sensors or electrodes on the scalp, which register the electrical signals inside of the brain across specific associative areas. Brainwaves carry messages to and from the body through the nervous system.  Breathing, heartbeat, muscle coordination, metabolism, blood sugar levels, memory, attention, learning, emotions, and all cognitive functioning or mental activity are controlled by the brain.

             During neurofeedback, the brainwaves are monitored. Neurofeedback is non-invasive in other words, no impulses are sent to the brain.  How does the training work?  Operant conditioning is a process through which the brain gets visual and auditory feedback or is rewarded for producing the frequencies that were identified by the quantitative EEG and needs to be enhanced.  Frequencies the individual produces in excess negatively affecting the behaviour are inhibited and do not get rewarded.

6.6.2                 Expectations of the NF therapy

             Noticeable results generally occur during the first ten sessions. Since neurofeedback is a process, this form of treatment requires a significant number of sessions to ensure consistent and lasting benefits. New neuronal connections enhance new behaviour patterns which are similar to learning to play a musical instrument. Changes are normally seen when symptoms improve and identifiable abnormalities on the quantitative EEG normalize. Typical EEG patterns or phenotypes suggesting Stroke, ADD/ADHD, epilepsy, petit mal epilepsy, and generalized slowing start to change to normal patterns. The most common effects reported: improved sleep, ability to focus and concentrate, decrease of anxiety, improvement of cognitive functioning, and more stable emotions. Good results were noticed with epileptic patients and other syndromes such as Alzheimer’s and stroke that are not cured but neurofeedback contributes to the patient’s quality of life and brings significant changes in terms of emotional instability.

7.         Research: A double-blind controlled crossover study to the best manipulation of Functional Connectivity (FC) after stroke with neurofeedback was conducted.

             Patients succeeded in increasing FC in the motor cortex. This led to an improvement in motor function that was significantly greater than during neurofeedback training of a control brain area and proportional to the degree of FC enhancement. This result provides evidence that FC can be effectively targeted with NF therapy.

             Neuroimage Clin. 2018; 20: 336–346.Published online 2018 Jul 30. doi: 10.1016/j.nicl.2018.07.029. PMCID: PMC6091229 PMID: 30112275. Anaïs MottazTiffany CorbetNaz DoganciCécile MagninPierre NicoloArmin Schnider, and Adrian G. Guggisberg

                          Dr. A Annemie  PECHé 082 3356133 /apecche@vodamail.co.za