感觉统合功能训练可有效治疗儿童注意缺陷多动障碍

探讨感觉统合功能训练对儿童注意缺陷多动障碍(ADHD)的治疗效果。选取2016年1月至2016年5月在我院儿科住院病房接受治疗的ADHD患儿324例,随机分为实验组168例和对照组156例,对照组采用常规护理,实验组实施小组感觉综合功能训练,每周训练3~4次,单次训练时间为90~120 min,40次为一个治疗周期,分别在干预前后观察两组患儿的疾病治疗效果、注意力和感觉功能变化。实验组患儿使用感觉综合功能训练后,疾病显效率,注意力集中情况和感觉功能均优于干预前,差异有统计学意义(p0.05);对照组患儿干预前后无明显改变,差异无统计学意义(p0.05)。感觉统合功能训练可显著改善ADHD患儿的治疗效果,提升注意力集中程度,改善感觉功能,可广泛应用于临床。     

肌电生物反馈疗法预防偏头痛发作疗效的对比研究

目的:探讨肌电生物反馈疗法对偏头痛的治疗效果。方法:40例偏头痛患者随机分为治疗组(n=20)和对照组(n=20),治疗组接受生物反馈治疗,每周两次,每次30分钟,共2个月,并随访2个月。记录基线期、治疗期及随访期头痛发作频率的变化。结果:肌电反馈组的头痛发作频率明显低于对照组,两组差别有显著性统计学意义(P=0.025)。结论:肌电生物反馈疗法能有效预防偏头痛发作。     

血清微量元素与多动症患儿行为症状的相关性研究

目的:探讨多动症(ADHD)患儿血清中微量元素水平与患儿行为症状的相关性。方法:以原子吸收光谱仪检测6~14岁80名ADHD患儿及72名正常儿童血清中的铁(Fe)、锌(Zn)、铜(Cu)、钙(Ca)、镁(Mg)、镉(Cd)、铅(Pb)等微量元素的含量,应用Conner氏量表评价患儿行为症状,分析血清微量元素与行为症状评分的相关性。结果:ADHD患儿血清中Zn水平明显低于正常儿童、Pb水平明显高于正常儿童,差异均有统计学意义(P0.05);Fe、Ca略低于正常儿童,Cu、Cd略高于正常儿童,但差异均无统计学意义(P0.05)。ADHD患儿品行问题、学习问题、冲动-多动、焦虑指数较正常儿童相比有显著差异(P0.05);经Pearson相关分析,ADHD患儿血清Zn与学习问题、冲动-多动、多动指数呈负相关(P0.05),血清Pb与患儿冲动-多动、多动指数呈正相关(P0.05)。结论:ADHD患儿血清中Zn与Pb异常表达,与行为症状密切相关。在治疗ADHD患儿过程中,可以通过检测这些指标进行针对性或预防性治疗,有一定的指导价值。     

营养性缺铁性贫血与注意缺陷多动障碍的临床关系研究——258例病例分析

目的:通过对营养性缺铁性贫血与注意缺陷多动障碍的病例研究,探讨两者之间的关系。方法:对258例NIDA的病因、临床表现和治疗进行临床分析,包括其中的31例中重度ADHD。结果:本组NIDA患儿病因主要为未及时添加富铁辅食、饮食结构不合理、消化道疾病、鼻衄等,临床主要表现为头晕、乏力、注意力不集中、记忆力减退等,对患者进行病因治疗以及服用生血宁片;ADHD的病因不明,临床表现为注意力不集中、活动过度、行为冲动等,通过综合治疗可以改善症状。NIDA的患儿ADHD的发病率较正常儿童为高。结论:NIDA与ADHD的关系密切。     

生物反馈电刺激联合Kegel训练对产后盆底功能障碍性疾病患者盆底功能电生理指标和生活质量的影响

目的:观察生物反馈电刺激联合Kegel训练对产后盆底功能障碍性疾病(PFD)患者盆底功能电生理指标和生活质量的影响。方法:研究对象为2018年3月~2020年12月我院收治的80例产后PFD患者。采用双色球随机分组法将患者分为对照组(n=40)和研究组(n=40)。对照组给予Kegel训练,研究组给予生物反馈电刺激联合Kegel训练,两组均治疗8周。对比两组治疗8周后的疗效和尿失禁、盆底器官脱垂程度的改善情况。对比两组治疗前、治疗8周后的盆底功能电生理指标、日常生活质量和性生活质量。结果:治疗8周后,研究组的临床总有效率较对照组高(P<0.05)。治疗8周后,研究组I类肌纤维疲劳度、Ⅱ类肌纤维疲劳度、快肌最大肌电值及阴道动态压力均优于对照组(P<0.05)。研究组治疗8周后尿失禁、盆底器官脱垂程度的改善情况优于对照组(P<0.05)。治疗8周后,研究组盆底功能影响问卷简表(PIFQ-7)评分、盆腔器官脱垂-尿失禁性功能问卷(PISQ-12)评分均低于对照组(P<0.05)。结论:产后PFD患者采用生物反馈电刺激联合Kegel训练治疗疗效明确,可促进尿失禁、盆底器官脱垂程度情况及盆底功能改善,提高患者日常生活质量和性生活质量。     

40例慢性脑型血吸虫病的脑电图分析

目的:了解脑型血吸虫病脑电图(EEG)的脑电活动状况,为临床诊断与治疗提供参考。方法:收集1997~2004年临床诊断为脑型血吸虫病的40例EEG资料,主要分析异常EEG的脑电活动状况与异常程度、临床分型及预后的关系。结果:31例出现不同程度的EEG异常改变,异常率为77.5%,其中癫痫性为70%;脑瘤型为100%。绝大部分EEG检查是患者经治疗后作的。治疗前后均作了EEG检查的仅9例。治疗前,9例均有不同程度异常,治疗后7例有不同程度改善,2例恢复正常。结论:EEG对脑型血吸虫病的诊断及预后的评价有参考价值。     

悬吊训练疗法联合生物反馈电刺激对产后压力性尿失禁患者盆底功能和尿流动力学的影响

摘要 目的：观察悬吊训练疗法联合生物反馈电刺激对产后压力性尿失禁（PSUI）患者盆底功能和尿流动力学的影响。方法：选择2019年7月~2021年8月期间我院接收的PSUI患者96例,符合要求的患者根据信封抽签法分为对照组（48例）和研究组（48例）。对照组患者接受悬吊训练疗法,研究组患者接受悬吊训练疗法联合生物反馈电刺激,对比两组疗效、盆底功能指标和尿流动力学指标,观察两组尿垫试验漏尿量、国际尿失禁咨询委员会尿失禁问卷简表（ICI-Q-SF）问卷评分。结果：研究组的临床总有效率高于对照组（P<0.05）。治疗1个月后,两组24 h尿垫试验漏尿量和ICI-Q-SF问卷评分降低,且研究组低于对照组（P<0.05）。研究组治疗1个月后盆底肌力改善效果优于对照组（P<0.05）。两组治疗1个月后最大尿道闭合压力（MUCP）、功能尿道长度（LES）、腹压漏尿点压（ALPP）、与最大尿流率（Qmax）升高,且研究组高于对照组（P<0.05）。结论：PSUI患者经悬吊训练疗法联合生物反馈电刺激干预,可有效改善临床症状,促进盆底功能和尿流动力学恢复,效果显著。     

注意缺陷多动障碍低觉醒模型的新证据

注意缺陷多动障碍(Attention Deficit Hyperactivity Disorder,ADHD)是儿童期常见的一种发展性的异常,其病因及发生机理至今未明。低觉醒模型是ADHD成因的一种假设。本文从睡眠障碍导致的低觉醒探讨ADHD发生机理。通过对ADHD儿童的睡眠障碍进行分析以及将ADHD外在表现与睡眠剥夺后的表现进行对比分析,得出ADHD儿童存在的低觉醒是由于外显的或内隐的睡眠障碍引起的,一方面间接证明了低觉醒模型,另一方面为ADHD的成因研究开拓了新的思路。     

注意缺陷多动障碍低觉醒模型的新证据

注意缺陷多动障碍（Attention Deficit Hyperactivity Disorder,ADHD）是儿童期常见的一种发展性的异常,其病因及发生机理至今未明。低觉醒模型是ADHD成因的一种假设。本文从睡眠障碍导致的低觉醒探讨ADHD发生机理。通过对ADHD儿童的睡眠障碍进行分析以及将ADHD外在表现与睡眠剥夺后的表现进行对比分析,得出ADHD儿童存在的低觉醒是由于外显的或内隐的睡眠障碍引起的,一方面间接证明了低觉醒模型,另一方面为ADHD的成因研究开拓了新的思路。     

脑电生物反馈疗法联合米氮平对老年抑郁症患者临床治疗效果观察

为了探讨脑电生物反馈疗法联合米氮平对老年抑郁症患者临床治疗效果,本研究采用随机数字表法将146例老年抑郁症患者随机分为两组,每组各73例,对照组给予米氮平治疗,观察组在对照组的基础上给予脑电生物反馈疗法,两组均以8周为一疗程。通过分析两组治疗前、治疗后2周、治疗后4周、治疗后6周、治疗后8周汉密尔顿抑郁量表(hamilton depression scale,HAMD)和蒙哥马利抑郁评定量表(montgomeryasberg depression rating scale,MADRS)评分,以及对血清皮质醇(cortisol)、去甲肾上腺素(norepinephrine,NE)、5-羟色胺(5-hydroxytryptamine,5-HT)和多巴胺(dopamine,DA)水平进行检测,我们发现观察组治疗后4周、治疗后6周、治疗后8周HAMD评分和MADRS评分均低于对照组,差异有统计学意义(p0.05);观察组治疗后皮质醇水平低于对照组(p0.05),NE、5-HT、DA水平低于对照组(p0.05),说明脑电生物反馈疗法联合米氮平疗法不仅可改善老年抑郁患者的抑郁症状,且效果优于单纯药物治疗,值得临床推广应用。     

Training of attention functions in children with attention deficit hyperactivity disorder

Pharmacological treatment of children with ADHD has been shown to be successful; however, medication may not normalize attention functions. The present study was based on a neuropsychological model of attention and assessed the effect of an attention training program on attentional functioning of children with ADHD. Thirty-two children with ADHD and 16 healthy children participated in the study. Children with ADHD were randomly assigned to one of the two conditions, i.e., an attention training program which trained aspects of vigilance, selective attention and divided attention, or a visual perception training which trained perceptual skills, such as perception of figure and ground, form constancy and position in space. The training programs were applied in individual sessions, twice a week, for a period of four consecutive weeks. Healthy children did not receive any training. Alertness, vigilance, selective attention, divided attention, and flexibility were examined prior to and following the interventions. Children with ADHD were assessed and trained while on ADHD medications. Data analysis revealed that the attention training used in the present study led to significant improvements of various aspects of attention, including vigilance, divided attention, and flexibility, while the visual perception training had no specific effects. The findings indicate that attention training programs have the potential to facilitate attentional functioning in children with ADHD treated with ADHD drugs.     

Discourse on the development of EEG diagnostics and biofeedback for attention-deficit/hyperactivity disorders

This article presents a review of work that my colleagues and I have been doing during the past 15 years developing a rationale for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and treatment of ADHD employing EEG biofeedback techniques. The article first briefly reviews the history of research and theory for understanding ADHD and then deals with the development of EEG and event-related potential (ERP) assessment paradigms and treatment protocols for this disorder, including our work and that of others who have replicated our results. Illustrative material from our current research and child case studies is included. Suggestions for future experimental and clinical work in this area are presented and theoretical issues involving the understanding of the neurophysiological and neurological basis of ADHD are discussed.Over the years, many people have been involved both in my laboratory and at Southeastern Biofeedback Institute working with me in developing this area; I wish to acknowledge some of them. They are specifically Dr. Margaret Shouse and Dr. Chris Mann, who have been involved in the initial and recent stages of my research; Ms. Jennifer Samples, who has worked with us in the Institute for many years and has helped us in training many of the children that have benefited from EEG biofeedback. I would especially wish to acknowledge the skill and dedication of Judith O. Lubar, of Southeastern Biofeedback Institute, who has worked with me clinically in terms of developing treatment protocols for ADHD biofeedback and who has trained many of the children who have successfully completed EEG Biofeedback. I would like to acknowledge the generous help of the Lexicor Corporation of Boulder, Colorado who have provided support and instrumentation for recent studies in this area. Mr. Rod Bunn and Mr. Robert Muenchen, who have provided computer support, programming, and statistical assistance in evaluating data in various studies, are gratefully acknowledged. Some of this research was supported by a grant under the ESEA Title IV-C Program for the handicapped. I also gratefully acknowledge Children's Hospital of Knoxville, TN, who have provided essential contract support for our laboratory at the University of Tennessee.     

A Brain-Computer Interface Based Attention Training Program for Treating Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) symptoms can be difficult to treat. We previously reported that a 20-session brain-computer interface (BCI) attention training programme improved ADHD symptoms. Here, we investigated a new more intensive BCI-based attention training game system on 20 unmedicated ADHD children (16 males, 4 females) with significant inattentive symptoms (combined and inattentive ADHD subtypes). This new system monitored attention through a head band with dry EEG sensors, which was used to drive a feed forward game. The system was calibrated for each user by measuring the EEG parameters during a Stroop task. Treatment consisted of an 8-week training comprising 24 sessions followed by 3 once-monthly booster training sessions. Following intervention, both parent-rated inattentive and hyperactive-impulsive symptoms on the ADHD Rating Scale showed significant improvement. At week 8, the mean improvement was −4.6 (5.9) and −4.7 (5.6) respectively for inattentive symptoms and hyperactive-impulsive symptoms (both p<0.01). Cohen’s d effect size for inattentive symptoms was large at 0.78 at week 8 and 0.84 at week 24 (post-boosters). Further analysis showed that the change in the EEG based BCI ADHD severity measure correlated with the change ADHD Rating Scale scores. The BCI-based attention training game system is a potential new treatment for ADHD.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01344044","term_id":"NCT01344044"}}NCT01344044     

A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities

Eighteen children with ADD/ADHD, some of whom were also LD, ranging in ages from 5 through 15 were randomly assigned to one of two conditions. The experimental condition consisted of 40 45-minute sessions of training in enhancing beta activity and suppressing theta activity, spaced over 6 months. The control condition, waiting list group, received no EEG biofeedback. No other psychological treatment or medication was administered to any subjects. All subjects were measured at pretreatment and at posttreatment on an IQ test and parent behavior rating scales for inattention, hyperactivity, and aggressive/defiant (oppositional) behaviors. At posttreatment the experimental group demonstrated a significant increase (mean of 9 points) on the K-Bit IQ Composite as compared to the control group (p<.05). The experimental group also significantly reduced inattentive behaviors as rated by parents (p<.05). The significant improvements in intellectual functioning and attentive behaviors might be explained as a result of the attentional enhancement affected by EEG biofeedback training. Further research utilizing improved data collection and analysis, more stringent control groups, and larger sample sizes are needed to support and replicate these findings.This research was supported by an equipment grant by Autogenics Systems. Portions of this paper were presented at the annual convention of the Association of Applied Psychophysiology and Biofeedback, March, 1993 in Los Angeles and at the annual meeting of the Biofeedback Society of California, November, 1992 in Monterey, California. The authors gratefully acknowledge Todd Fischer and Paul Clopton for their valuable assistance in statistical analysis for this article.     

Electroencephalographic Biofeedback in the Treatment of Attention-Deficit/Hyperactivity Disorder

Historically, pharmacological treatments for attention-deficit/hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of case and controlled group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment. This review paper critically examines the empirical evidence, applying the efficacy guidelines jointly established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). On the basis of these scientific principles, EEG biofeedback was determined to be “probably efficacious” for the treatment of ADHD. Although significant clinical improvement was reported in approximately 75% of the patients in each of the published research studies, additional randomized, controlled group studies are needed in order to provide a better estimate of the percentage of patients with ADHD who will demonstrate such gains in clinical practice.     

Neurofeedback for Children with ADHD: A Comparison of SCP and Theta/Beta Protocols

Behavioral and cognitive improvements in children with ADHD have been consistently reported after neurofeedback-treatment. However, neurofeedback has not been commonly accepted as a treatment for ADHD. This study addresses previous methodological shortcomings while comparing a neurofeedback-training of Theta-Beta frequencies and training of slow cortical potentials (SCPs). The study aimed at answering (a) whether patients were able to demonstrate learning of cortical self-regulation, (b) if treatment leads to an improvement in cognition and behavior and (c) if the two experimental groups differ in cognitive and behavioral outcome variables. SCP participants were trained to produce positive and negative SCP-shifts while the Theta/Beta participants were trained to suppress Theta (4–8 Hz) while increasing Beta (12–20 Hz). Participants were blind to group assignment. Assessment included potentially confounding variables. Each group was comprised of 19 children with ADHD (aged 8–13 years). The treatment procedure consisted of three phases of 10 sessions each. Both groups were able to intentionally regulate cortical activity and improved in attention and IQ. Parents and teachers reported significant behavioral and cognitive improvements. Clinical effects for both groups remained stable six months after treatment. Groups did not differ in behavioural or cognitive outcome.     

Neurocognitive training for children with and without AD/HD

There is accumulating evidence that computerised cognitive training of inhibitory control and/or working memory can lead to behavioural improvement in children with AD/HD. Using a randomised waitlist control design, the present study examined the effects of combined working memory and inhibitory control training, with and without passive attention monitoring via EEG, for children with and without AD/HD. One hundred and twenty-eight children (60 children with AD/HD, 68 without AD/HD) were randomly allocated to one of three training conditions (waitlist; working memory and inhibitory control with attention monitoring; working memory and inhibitory control without attention monitoring) and completed with pre- and post-training assessments of overt behaviour (from 2 sources), trained and untrained cognitive task performance, and resting EEG activity. The two active training conditions completed 25 sessions of training at home over a 4- 5-week period. Results showed significant improvements in overt behaviour for children with AD/HD in both training conditions compared to the waitlist condition as rated by a parent and other adult. Post-training improvements in the areas of spatial working memory, ignoring distracting stimuli, and sustained attention were reported for children with AD/HD. Children without AD/HD showed behavioural improvements after training. The improvements for both groups were maintained over the 6-week period following training. The passive attention monitoring via EEG had a minor effect on training outcomes. Overall, the results suggest that combined WM/IC training can result in improved behavioural control for children with and without AD/HD.     

Processing of Continuously Provided Punishment and Reward in Children with ADHD and the Modulating Effects of Stimulant Medication: An ERP Study

Objectives

Current models of ADHD suggest abnormal reward and punishment sensitivity, but the exact mechanisms are unclear. This study aims to investigate effects of continuous reward and punishment on the processing of performance feedback in children with ADHD and the modulating effects of stimulant medication.

Methods

15 Methylphenidate (Mph)-treated and 15 Mph-free children of the ADHD-combined type and 17 control children performed a selective attention task with three feedback conditions: no-feedback, gain and loss. Event Related Potentials (ERPs) time-locked to feedback and errors were computed.

Results

All groups performed more accurately with gain and loss than without feedback. Feedback-related ERPs demonstrated no group differences in the feedback P2, but an enhanced late positive potential (LPP) to feedback stimuli (both gains and losses) for Mph-free children with ADHD compared to controls. Feedback-related ERPs in Mph-treated children with ADHD were similar to controls. Correlational analyses in the ADHD groups revealed that the severity of inattention problems correlated negatively with the feedback P2 amplitude and positively with the LPP to losses and omitted gains.

Conclusions

The early selective attention for rewarding and punishing feedback was relatively intact in children with ADHD, but the late feedback processing was deviant (increased feedback LPP). This may explain the often observed positive effects of continuous reinforcement on performance and behaviour in children with ADHD. However, these group findings cannot be generalised to all individuals with the ADHD, because the feedback-related ERPs were associated with the severity of the inattention problems. Children with ADHD-combined type with more inattention problems showed both deviant early attentional selection of feedback stimuli, and deviant late processing of non-reward and punishment.     

Improving Executive Functioning in Children with ADHD: Training Multiple Executive Functions within the Context of a Computer Game. A Randomized Double-Blind Placebo Controlled Trial

Introduction

Executive functions (EFs) training interventions aimed at ADHD-symptom reduction have yielded mixed results. Generally, these interventions focus on training a single cognitive domain (e.g., working memory [WM], inhibition, or cognitive-flexibility). However, evidence suggests that most children with ADHD show deficits on multiple EFs, and that these EFs are largely related to different brain regions. Therefore, training multiple EFs might be a potentially more effective strategy to reduce EF-related ADHD symptoms.

Methods

Eighty-nine children with a clinical diagnosis of ADHD (aged 8–12) were randomized to either a full-active-condition where visuospatial WM, inhibition and cognitive-flexibility were trained, a partially-active-condition where inhibition and cognitive-flexibility were trained and the WM-training task was presented in placebo-mode, or to a full placebo-condition. Short-term and long-term (3-months) effects of this gamified, 25-session, home-based computer-training were evaluated on multiple outcome domains.

Results

During training compliance was high (only 3% failed to meet compliance criteria). After training, only children in the full-active condition showed improvement on measures of visuospatial short-term-memory (STM) and WM. Inhibitory performance and interference control only improved in the full-active- and the partially-active condition. No Treatment-condition x Time interactions were found for cognitive-flexibility, verbal WM, complex-reasoning, nor for any parent-, teacher-, or child-rated ADHD behaviors, EF-behaviors, motivational behaviors, or general problem behaviors. Nonetheless, almost all measures showed main Time-effects, including the teacher-ratings.

Conclusions

Improvements on inhibition and visuospatial STM and WM were specifically related to the type of treatment received. However, transfer to untrained EFs and behaviors was mostly nonspecific (i.e., only interference control improved exclusively in the two EF training conditions). As such, in this multiple EF-training, mainly nonspecific treatment factors – as opposed to the specific effects of training EFs—seem related to far transfer effects found on EF and behavior.

Trial Registration

trialregister.nl NTR2728. Registry name: improving executive functioning in children with ADHD: training executive functions within the context of a computer game; registry number: NTR2728.     

A pilot study: differential effects of methylphenidate-OROS on working memory and attention functions in children with attention-deficit/hyperactivity disorder with and without behavioural comorbidities

To examine the effects of methylphenidate-OROS (MPH-OROS) on working memory (WM) and attention functions in children with attention-deficit hyperactivity disorder (ADHD), and to investigate whether there is a differential effect in ADHD children with (ADHD+) and without (ADHD-) behavioural comorbidities. Participants included a clinic referred sample of 12 stimulant na?ve school-aged children with a diagnosis of combined ADHD according to the DSM-IV criteria (6 ADHD+, 6 ADHD-), and 11 healthy children. A neuropsychological protocol was applied at three different moments: before treatment, after one those of MPH-OROS, and after one month of MPH-OROS daily treatment. The protocol was simultaneously administered to the control group. Initial differences in attention parameters between na?ve children with ADHD and the control group disappeared after the first dose of MPH-OROS. For WM, one month of daily treatment was necessary to achieve this pattern of results. Both ADHD groups (ADHD+ and ADHD-) showed these differences, but there was a greater improvement in (ADHD-). MPH-OROS had an immediate effect on attention deficits, but long-term treatment was needed to improve WM to the level of healthy subjects. The presence of comorbid behavioural conditions determined a less robust response in neuropsychological performance to stimulant treatment.