On the Efficiency of Individualized Theta/Beta Ratio Neurofeedback Combined with Forehead EMG Training in ADHD Children.
On the Efficiency of Individualized Theta/Beta Ratio Neurofeedback Combined with Forehead EMG Training in ADHD Children.
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关于个性化theta/beta比的效率神经反馈与多动症儿童的额头EMG培训相结合。
DOI：
10.3389/fnhum.2018.00003
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发表时间：
2018
影响因子：
2.9
通讯作者：
Sapina EA
中科院分区：
文献类型：
--
作者：
Bazanova OM;Auer T;Sapina EA
背景：降低θ/β比率（TBR）的神经反馈训练（NFT）已用于治疗注意缺陷多动障碍（ADHD）的多动和冲动症状；然而，其效率往往较低。脑电图（EEG）特征的个体差异会干扰NFT，因为如果忽略这一点，可能会导致影响不相关的活动。更重要的是，它可能会对与ADHD相关的活动产生不利影响，甚至可能导致ADHD症状恶化。从实际和心理学角度来看，前额肌肉产生的肌电（EMG）信号也可以解释NFT在ADHD治疗中效率低下的原因。本研究的第一个目的是确定与ADHD的主要特征（如冲动和多动）最相关的EEG和EMG生物标志物。第二个目的是验证我们的假设，即通过对频带进行个体调整以及同时对前额肌肉张力进行训练，可以提高TBR - NFT的效率。
方法：我们招募了94名被诊断为ADHD的儿童和23名健康对照者（HC）。所有参与者均为男性，年龄在6至9岁之间。分别使用Go/No - Go任务和延迟满足任务评估冲动性和注意力；并记录19通道EEG和前额EMG。然后，将ADHD组随机细分为（1）标准组、（2）个体化组、（3）个体化 + EMG组和（4）假NFT（对照组）。根据TBR和EEGα活动以及多动和冲动情况，在NFT前、NFT后和NFT后6个月（随访）这三个时间点对各组进行比较。
结果：ADHD儿童的个体α峰值频率降低、α带宽变窄、α振幅抑制幅度增大，以及α1/α2（a1/a2）比率升高和头皮肌肉张力增加（η2≥0.212）。所有相应的TBR - NFT组都显示出与NFT相关的TBR显著降低，而对照组则没有这种情况。此外，我们在个体化NFT组中检测到总体α活动较高，但在标准NFT组中没有。考虑组间因素GROUP和组内因素TIME的混合多变量方差分析（MANOVA）表明，个体化 + EMG组表现出最高水平的临床改善，与其他方法相比，在6个月随访时个体α活动增加相关（事后t = 3.456，p = 0.011）。
结论：本研究确定了各种（调整后的）α活动指标作为与ADHD症状密切相关的生物标志物，并证明针对α活动差异进行个体调整的TBR - NFT比标准的、非个体化的NFT更成功，在临床上更有效。此外，个体化TBR - NFT与EMG结合时，这些训练效果持续时间更长。
Background: Neurofeedback training (NFT) to decrease the theta/beta ratio (TBR) has been used for treating hyperactivity and impulsivity in attention deficit hyperactivity disorder (ADHD); however, often with low efficiency. Individual variance in EEG profile can confound NFT, because it may lead to influencing non-relevant activity, if ignored. More importantly, it may lead to influencing ADHD-related activities adversely, which may even result in worsening ADHD symptoms. Electromyogenic (EMG) signal resulted from forehead muscles can also explain the low efficiency of the NFT in ADHD from both practical and psychological point-of-view. The first aim of this study was to determine EEG and EMG biomarkers most related to the main ADHD characteristics, such as impulsivity and hyperactivity. The second aim was to confirm our hypothesis that the efficiency of the TBR NFT can be increased by individual adjustment of the frequency bands and simultaneous training on forehead muscle tension. Methods: We recruited 94 children diagnosed with ADHD (ADHD) and 23 healthy controls (HC). All participants were male and aged between six and nine. Impulsivity and attention were assessed with Go/no-Go task and delayed gratification task, respectively; and 19-channel EEG and forehead EMG were recorded. Then, the ADHD group was randomly subdivided into (1) standard, (2) individualized, (3) individualized+EMG, and (4) sham NFT (control) groups. The groups were compared based on TBR and EEG alpha activity, as well as hyperactivity and impulsivity three times: pre-NFT, post-NFT and 6 months after the NFT (follow-up). Results: ADHD children were characterized with decreased individual alpha peak frequency, alpha bandwidth and alpha amplitude suppression magnitude, as well as with increased alpha1/alpha2 (a1/a2) ratio and scalp muscle tension when c (η2 ≥ 0.212). All contingent TBR NFT groups exhibited significant NFT-related decrease in TBR not evident in the control group. Moreover, we detected a higher overall alpha activity in the individualized but not in the standard NFT group. Mixed MANOVA considering between-subject factor GROUP and within-subject factor TIME showed that the individualized+EMG group exhibited the highest level of clinical improvement, which was associated with increase in the individual alpha activity at the 6 months follow-up when comparing with the other approaches (post hoc t = 3.456, p = 0.011). Conclusions: This study identified various (adjusted) alpha activity metrics as biomarkers with close relationship with ADHD symptoms, and demonstrated that TBR NFT individually adjusted for variances in alpha activity is more successful and clinically more efficient than standard, non-individualized NFT. Moreover, these training effects of the individualized TBR NFT lasted longer when combined with EMG.
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