DOPAD EEG BIOFEEDBACKU NA MOTORICKÉ SCHOPNOSTI DETÍ MERANÝ PANESS TESTOM

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1 DOPAD EEG BIOFEEDBACKU NA MOTORICKÉ SCHOPNOSTI DETÍ MERANÝ PANESS TESTOM INFLUENCE OF EEG BIOFEEDBACK ON MOTOR ABILITIES OF CHILDREN MEASURED WITH PANESS TEST Abstrakt Elena Žiaková, Iveta Schusterová EEG biofeedback je nová neurorehabiltačná metóda, ktorá pomáha pri špecifických neurologických a psychických poruchách. Jeho využitie v rehabilitačnej praxi a výskume bolo dodnes dosť zriedkavé. Cieľom práce bolo analyzovať vplyv EEG biofeedbacku na motorické zručnosti detí so snahou preukázať zlepšenie pozornosti a zníženie impulzívnosti. Detskí probanti boli po terapeutických sedeniach testovaní PANESS testom a CIT testom. (Concentration Index Tool). Výsledky ukazujú, že EEG biofeedback terapia výrazne znižuje impulzívnosť a posilňuje kontrolu pozornosti u detí s rozličnými neurologickými poruchami a zlepšuje vôľové, mimovoľné a koordinačné pohybové schopnosti. Kľúčové slová: EEG biofeedback, motorická ne/zručnosť, PANESS test, ADHD, ADD Abstract EEG biofeedback is a new special neurorehabilitation method that helps with various neurological and psychological disorders. Until now, it has not been used very frequently in neurorehabilitation practice and research. The aim of the study is to analyze the influence of the neurofeedback technique on motor abilities of children with various motor disabilities and to try to document its possible influence on improvement in motor, attention and impulsivity domains. After therapeutic sessions, subjects were tested with PANESS and CIT (Concentration Index Tool) tests. The results suggest that EEG biofeedback therapy significantly improves of strengthening impulsivity and attention control in children with various neurological disorders and improves their voluntary, involuntary and coordination movement abilities. Key words: EEG biofeedback, motor dis/abilities, PANESS test, ADHD 1. INTRODUCTION EEG biofeedback is a new special neurorehabilitation method that helps with specific mean in different neurological and psychological disorders. Until now, there is used not very frequently in neurorehabilitation practice and research. 2. AIM To analyze influence of the neurofeedback technique on motor abilities of children with various motor disabilities and to try to document its possibilities on motor, attention and impulsivity domains. 162

2 3. MATERIAL AND METHOD The study was conducted on the group of 20 children (4 girls, 16 boys), mean age 8.6 yrs (7-12 years) in RC Harmony n.o. Bratislava, with diagnosis 1. Cerebral Palsy with left sided symptomology of mild form, associated with hypotonic syndrome and axial hypotonia, 2. Cerebral Palsy with diparetic syndrome of mild form, associated with spina bifida and light sphincter disorders. In all patients it was found out ADHD (attention-deficit/hyperactivity disorder), ADD (attention deficit disorder), learning disorder. Neurorehabilitation procedure consists of 30 sessions of neurofeedback procedure with duration of minutes/one session (Pendant EEG Pocket, Pocket Neurobics, Australia). Before and after therapy there were performed PANESS test (Physical and Neurological Examination for Subtle Signs) for assessment of motor skills of children and CIT test (Concentration Index Tool) for assessment of impulsivity and attention disorders. The PANESS test assess characteristic components of motor skills including lateral preference, gaits, balance, coordination, overflow, dysrythmia, repetitive time movements and pattern time movements. We evaluated 1. Achieved times, 2. Overall score (consists of all errors and all tested signs observed by test). Software SPSS 16.0., paired-samples t-test was used for statistical evaluation. 4. RESULTS Paness test 1. We have assessed achieved scores of gaits, hopping and station before and after neurofeedback (lesser score is better). Table 1 s and SDs of Input and Final Scores of gaits, hopping and station N Deviation Input Score 27, , ,03961 Final Score 13, , ,66085 This table indicates that the mean achieved score after finishing neurofeedback (M=13.3) was lower than the mean achieved score before the procedure (M=27.4). Table 2 Differences between Input and Final Score of gaits, hopping and station Input Score Final Score ed Differences Deviatio n 95% Confidence Interval of the Difference Lower Upper t df Sig. (2-tailed) 14, , , , , ,073 19,0001 Tables shows statistically significant improvement (t(19)=9.073, 2-tailed p=0.0001) of performance in gaits, hopping and station after neurofeedback therapy. 2. We have assessed achieved scores and times of repetitive and pattern movements before and after neurofeedback (lesser score and lesser time are better). 163

3 Table 3 s and SDs of Input and Final Score&Time N Deviation 1 Input Time 125, , ,82880 Final Time 102, , , Input Score 32, , ,69344 Final Score 13, , ,91517 This indicates that the mean achieved time after finishing neurofeedback (M=102.34) was lower than the mean achieved time before the procedures (M= ); This indicates that the mean achieved overall score after neurofeedback (M=13.9) was lower than the mean achieved overall score before neurofeedback (M=32.1). Table 4 Differences between Input and Final Score&Time of repetitive and pattern movements 1 Input Time Final Time 2 Input Score Final Score ed Differences Deviatio n 95% Confidence Interval of the Difference Lower Upper 22, , , , , , , , , , , ,12 7 t df 19,015 19,006 Sig. (2-tailed) Tables shows statistically significant improvement in time (t(19)=2.687, 2-tailed p=0.015) and scores (t(19)=3.127, 2-tailed p=0.006) of repetitive and pattern movements after neurofeedback therapy. This analysis provides evidence that the neurofeedback therapy was effective in all followed parameters. CIT test 1. We have assessed achieved age (higher age is better) and score (lesser score is better) of impulsivity before and after therapy and 2. we have assessed achieved age (higher age is better) and score (higher score is better) of attention before and after therapy. 164

4 Table 5 s and SDs of and N Deviation 1 Input Score 39, ,682 6,637 Final Score 16, ,709 2,842 2 Input Score 723, ,712 43,092 Final Score 838, ,784 36,847 3 Input Age 9, ,248,503 Final Age 10, ,103,470 4 Input Age 7, ,315,518 Final Age 9, ,342,524 results indicates that the mean achieve age after the therapy (M=9.3) was higher than the mean achieved age before the therapy (M=7.9) and attention results indicates that the mean achieve age after the therapy (M=10.0) was higher than the mean achieved age before the therapy (M=9.0)., Table 6 Differences between Input and Final Scores and Age of and ed Differences 95% Confidence Interval of the Input Final Difference Sig. Deviation Lower Upper t df (2-tailed) 22,800 20,829 4,658 13,052 32,548 4,895 19,000 Input -115,000119,934 26, ,131-58,869-4,288 19,000 Final Input Age -1,000 1,947,435-1,911 -,089-2,297 19,033 Final Age Input Age -1,400 2,257,505-2,456 -,344-2,774 19,012 Final Age 165

5 Tables shows statistically significant improvement in achieved age of (t(19)=-2.774, 2-tailed p=0.012) and (t(19)=-2.297, 2-tailed p=0.033) after neurofeedback therapy. This analysis provides evidence that the neurofeedback therapy was effective also in these parameters. 5. DISCUSSION Like other forms of biofeedback, Neurofeedback training uses monitoring devices to provide moment-to-moment information to an individual on the state of their physiological functioning. The characteristic that distinguishes Neurofeedback training from other biofeedback is a focus on the central nervous system and the brain. Neurofeedback training (NFT) has its foundations in basic and applied neuroscience as well as data-based clinical practice. It takes into account behavioral, cognitive, and subjective aspects as well as brain activity. (This definition was ratified by the ISNR Board of Directors on January 10, 2009 and edited on June 11, 2010). From the study of available literature are known only casuistic dealing with the possibility of affecting the motor ability with Neurofeedback therapy. Since the first reports of neurofeedback treatment in ADHD, many studies have investigated the effects on different symptoms such as inattention, impulsivity and hyperactivity. The goal of this study was to verify and demonstrate positive effect of neurofeedback therapy on motor abilities of children. 6. CONCLUSION 1. In line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude similarly to literary data that neurofeedback treatment for ADHD can be considered efficacious and specific"(level 5) with a large effect size for inattention and impulsivity and medium effect size for hyperactivity." 2. Using neurofeedback to improve balance, there are data reporting the successful treatment of balance problems in patients utilizing a specific protocol. 3.Tonic spasticity comes from the upper cerebral cortex, so focusing on neurological site specific inhibition of abnormal theta on the leg, arm and facial areas of the sensorimotor cortex brings improvement in motor development and function. Our study has shown that EEG biofeedback therapy significantly improves strengthening of impulsivity and attention control in children with various neurological disorders and improved their voluntary, involuntary and coordination movement abilities. 7. USE IN TEACHING PRACTICE Work with eeg biofeedback and Paness test shows importance for teaching experience. Their use supposes to have some practical experience and therefore it is suitable at postgraduate level. In this way, future physiotherapists can verify the effectiveness and legitimacy of EEG biofeedback, which gives meaning to their work. 166

6 8. REFERENCES ARNS, M. et al Efficacy of Neurofeedback Treatment in ADHD: the Effects on Inattention, and Hyperactivity: a Meta-Analysis. CLINICAL EEG and NEUROSCIENCE, 40, AYERS, MARGARET, M Neurofeedback for Cerebral Palsy. Journal of Neurotherapy, 8(2), HAMMOND, D. C Neurofeedback to improve physical balance, incontinence, and swallowing. Journal of Neurotherapy, 9(1), Definition of Neurofeedback [Online] [Date: ] Kontaktné údaje: Name And Surname: PhDr. Elena Žiaková Workplace: Rehabilitation Centre Harmony, Bratislava, Slovak Republic, Faculty of Health Care and Social Work, Trnava University in Trnava Department of Nursing Univerzitné námestie 1, Trnava, Slovak Republic elenaziakov@gmail.com Name And Surname: Mgr. Iveta Schusterová, PhD. Workplace: Faculty of Philosophy and Arts, Trnava University in Trnava Department of Psychology Hornopotočná 23, Trnava, Slovak Republic ivaschuster@gmail.com 167