Blueprint for Study for Neurotherapy Certification Examinations

The candidate for certification in neurotherapy will meet all of the requirements of the Neurotherapy Blueprint and pass the certification examination. When you pass that examination you may become certified as a Neurotherapy Specialist, Stress Management Specialist, or both.

Those items marked (*) are required of all Certified Neurofeedback Technicians (See Technicians) and need not be completed a second time.

***PLEASE NOTE: It will be necessary to conduct a personal study of each of the areas specified by the Neurotherapy Certification Examinations. Additional information provided by Brain State Technologies within this document is not comprehensive or complete; however it is designed to give you basic information to conduct a self study.

Basics of Neurotherapy (4 CEU Required) (*)

A. Definition of Neurotherapy

Neurotherapy is a clinical process for changing the electrical activity, of either cortical or sub-cortical origin, of the Central Nervous System using electroencephalography-based feedback and/or electrical stimulation.

B. Objective and Goals of Neurotherapy

The objective and goals of neurotherapy vary considerably according to the client's needs. Clinicians should have a good understanding of the objectives and goals for treating a variety of disorders including but not limited to addictions, attention disorders, closed head injuries, learning disorders, mood disorders, pain management, peak performance, and stress management.

C. Definition of Neurotherapy

Neurotherapy is a process for teaching clients how to relax and re-education their muscles in order to manage stress, pain and hypertension so they can relieve their pain and suffering. This is similar to the definition most equipment manufacturers are required to use by law in North America, Europe and most of the world. Licensed professionals may define neurotherapy according to their scope of practice.

D. Objective and Goals of Neurotherapy

The objective and goals of neurotherapy for non-licensed professionals are to assist clients in learning how to relax and re-educate their muscles in order to manage stress, pain and hypertension so they can relieve their pain and suffering. Licensed healthcare professionals may use neurotherapy to accomplish any objective or goal permitted by the scope of their practice as defined by their license.

E. History and Development of Neurotherapy

Be familiar with the pioneers in neurotherapy and their contributions to the science of neurotherapy including:

Tom Budzynski:

• Budzynski’s research for the military in the 1960’s showed that people in a theta state were “hypersuggestible,” as people are in a hypnotic induction, and learned new information extremely rapidly and uncritically, apparently because being near a state of sleep enabled patients to bypass the conscious mind.

• Budzynski is a neurofeedback researcher at the University of Washington who developed a device he called a Twilight Learner. Tape-recorded messages switch on as the frequency reaches theta, and the information that people want to learn plays through headphones. The message gets louder as the frequency diminishes so the person doesn’t fall asleep. Because theta is also a stage of hypersuggestibility, some subjects had suggestions implanted in the state and felt that it made their efforts to do such things as stop smoking and lose weight much more effective.

(SINB)

Elmer Green:

• He is perhaps best known today as the founder of clinical Biofeedback and as the founder of the Voluntary Controls Program at the Menninger Clinic. He and his wife and colleague, Alyce, co-authored "Beyond Biofeedback" and for twenty years they lectured and conducted workshops on the theory and practice of Biofeedback Training in the U.S., Australia, Canada, India, Great Britain, Holland, Russia, and the Philippines.

• In 1973, green undertook one of many projects that would bring a great deal of attention to the field of biofeedback when he and a research team took a portable psychopsysiological lab to India. There they studied the Eastern holy men and their mastery of physiology, using the tools and methods of western science. Green led numerous studies in which he researched individuals who had the ability to control physiology.

• In the last seven years of her life, Alyce had Alzheimer's. During these years, Elmer and Alyce explored the realms of consciousness beyond Alzheimer's and death, and in the process discovered how we, too, can experience these mysterious and transformative realms.

Joe Kamiya:

• Joe Kamiya popularized neurofeedback when an article about the alpha brain wave experiments he had been conducting was published in Psychology Today in 1968. Kamiya’s experiment had two parts. In the first part, a subject was asked to keep his eyes closed and when a tone sounded to say whether he thought he was in alpha. He was then told whether he was correct or wrong. Initially the subject would get about fifty percent correct, but some subjects would eventually develop the ability to distinguish between states and be correct a highly significant percentage of the time. In the second part of the study, subjects were asked to go into alpha when a bell rang once and not go into the state when the bell rang twice. Once again some subjects were able to enter the state on command. Others, however, could not control it at all. Nevertheless, the results were significant and very attractive. Alpha states were connected with relaxation, and alpha training had the possibility to alleviate stress and stress-related conditions.

Joel Lubar:

• Dr. Lubar was responsible for developing the use of EEG Biofeedback (Neurofeedback) as a treatment modality for children, adolescents, and adults with Attention Deficit Hyperactivity Disorder, starting with his controlled studies in the mid-1970's. This application of Neurofeedback is now becoming widespread in clinics and schools throughout the United States, Canada, Australia, Israel, Europe and Mexico. Currently, more than 1500 health care organizations are using the EEG biofeedback protocols that Dr. Lubar has developed. Dr. Lubar is currently developing databases for the assessment of individuals with ADD/ADHD, and is a consulting in several controlled studies evaluating the effectiveness of Neurofeedback. In a 1992 publication, in Pediatric Neurology, he and his colleagues showed, for the first time, that children with the inattentive form of ADD (without hyperactivity), differ significantly in terms of quantitative EEG patterns, from matched control non-ADD children.

• Dr. Lubar is the past president of AABP(Association for Applied Psychophysiology) He has been the president of the Academy of Certified Neurotherapist which now offers specialty certifications in EEG Biofeedback as part of the Biofeedback Certification Institute of America (BCIA). He has also been the president of the EEG Division of the AAPB.

Siegfried Othmer:

• Since 1987 Siegfried Othmer has been engaged in research and development of clinical applications of EEG biofeedback. Currently he is Chief Scientist at the EEG Institute in Woodland Hills, CA. From 1987 to 2000 he was President of EEG Spectrum, and until 2002 served as Chief Scientist of EEG Spectrum International. Dr. Othmer provides training for professionals in EEG biofeedback, and presents research findings in professional forums. He has been involved continuously in the development of computerized instrumentation to provide EEG biofeedback training since 1985.

• The initial impetus was the brain-training of their son Brian for his seizure disorder. The training was life-transforming for their son, which redirected their professional lives to the further development of Neurofeedback as well as to the promotion of its public acceptance.

• Partnered with Margaret Ayers and Ed Dillingham to create the first computerized neurofeedback instrument.

Gene Peniston:

Barbara B. Brown:

A research psychologist who popularized biofeedback and neurofeedback in the 1970s. "Brown was the biofeedback field's most prolific writer and most successful popularize." Dr. Brown created and popularized the word "biofeedback". She did her ground-breaking research when she was Chief of Experiential Physiology Research at the Veterans Administration Hospital in Sepulveda, California. Brown was co-founder and first president (1969-1970) of the Biofeedback Research Society, which evolved into the Biofeedback Society of America and then into the Association for Applied Psychophysiology and Biofeedback. The books included New Mind New Body, and Stress and the Art of Biofeedback. Brown took a creative approach to neurofeedback, linking brainwave self regulation to a switching relay which turned on an electric train.

F. Research

Be familiar with the seminal studies in neurotherapy reported in peer-reviewed journals such as the Journal of Neurotherapy. Articles from this journal can be found free on line at the International Society for Neurofeedback and Research at: http://www.isnr.org.

Professional Conduct (8 CEU Required) (*)

A. Professional Code of Ethics (2 CEU Required) 1. Know and adhere to the NTCB Code of Ethics (Addendum) 2. Study other codes of ethics used in the biofeedback profession

(see manual) 3. Write your own professional code of ethics

B. Scope of Practice (2 CEU Required)

1. Know what you can and cannot legally do in your biofeedback practice

2. Write an acceptable description of your scope of practice 3. Write an acceptable waiver and disclosure form for clients to sign

(see manual)

C. Writing Informed Consent Forms (2 CEU Required) (see manual) 1. Identify the services you do not provide 2. Identify the services you do provide 3. State any requirements clients must satisfy 4. Offer to make referrals 5. Have client print their name, address and contact information 6. Require client signature (keep this form in your file) 7. Make a copy for your client

D. Working with Other Professionals (2 CEU Required) (Your research)

0. Know what services are available from other professionals 1. Know when and to whom to make referrals for medical care 2. Know when and to whom to make referrals for psychotherapy 3. Know when to ask for expert advice from other professionals 4. Know when and how to ask for expert biofeedback advice

Neurophysiology and Neuroanatomy* (16 CEU Required)

A. Neurophysiology 1. Know the bioelectric origin of Alpha, Beta, Delta, Gamma,

Lambda, Mu, SMR and Theta in the EEG

Delta= is the frequency range up to 3 Hz. It tends to be the highest in amplitude and the slowest waves. It is seen normally in adults in slow wave sleep. It is also seen normally in babies. It may occur focally with subcortical lesions and in general distribution with diffuse lesions, metabolic encephalopathy hydrocephalus or deep midline lesions. It is usually most prominent frontally in adults (e.g. FIRDA - Frontal Intermittent Rhythmic Delta) and posteriorly in children e.g. OIRDA - Occipital Intermittent Rhythmic Delta).

Theta= is the frequency range from 4 Hz to 7 Hz. Theta is seen normally in young children. It may be seen in drowsiness or arousal in older children and adults; it can also be seen in meditation]. Excess theta for age represents abnormal activity. It can be seen as a focal disturbance in focal subcortical lesions; it can be seen in generalized distribution in diffuse disorder or metabolic encephalopathy or deep midline disorders or some instances of hydrocephalus.

Alpha= is the frequency range from 8 Hz to 12 Hz. Hans Berger named the first rhythmic EEG activity he saw, the "alpha wave." This is activity in the 8-12 Hz range seen in the posterior regions of the head on both sides, being higher in amplitude on the dominant side. It is brought out by closing the eyes and by relaxation. It was noted to attenuate with eye opening or mental exertion. This activity is now referred to as "posterior basic rhythm," the "posterior dominant rhythm" or the "posterior alpha rhythm." The posterior basic rhythm is actually slower than 8 Hz in young children (therefore technically in the theta range). In addition to the posterior basic rhythm, there are two other normal alpha rhythms that are typically discussed: the mu rhythm and a temporal "third rhythm". Alpha can be abnormal; for example, an EEG that has diffuse alpha occurring in coma and is not responsive to external stimuli is referred to as "alpha coma".

Mu= rhythm is alpha-range activity that is seen over the sensorimotor cortex. It characteristically attenuates with movement of the contralateral arm (or mental imagery of movement of the contralateral arm).

Beta is the frequency range from 12 Hz to about 30 Hz. It is seen usually on both sides in symmetrical distribution and is most evident frontally. Low amplitude beta with multiple and varying frequencies is often associated with active, busy or anxious thinking and active concentration. Rhythmic beta with a dominant set of frequencies is associated with various pathologies and drug effects, especially benzodiazepines. Activity over about 25 Hz seen in the scalp EEG is rarely cerebral (i.e., it is most often artifactual). It may be absent or reduced in areas of cortical damage. It is the dominant rhythm in patients who are alert or anxious or who have their eyes open.

Gamma= is the frequency range approximately 26–100 Hz. Because of the filtering properties of the skull and scalp, gamma rhythms only be recorded from electrocorticography or possibly with magnetoencephalography. Gamma rhythms are thought to represent binding of different populations of neurons together into a network for the purpose of carrying out a certain cognitive or motor function.

2. Know the definitions for the following as they relate to EEG

Amplitude: The amplitude is the height of the wave. Its most general definition is that the amplitude is the maximum positive displacement from the undisturbed position of the medium to the top of a crest. This is shown in the following diagram:

Amplitude can be thought of as representing how “loud” a wave is playing if it were sound.

asymmetry: is the absence of, or a violation of, a symmetry or the lack of balance. is the absence of, or a violation of, a symmetry.

Asymmetry in organisms Due to how cells divide in organisms, asymmetry in organisms is fairly usual in at least one dimension, with biological symmetry also being common in at least one dimension.

Asymmetry in physics Asymmetry arises in physics in a number of different realms. Thermodynamics

Thermodynamics is asymmetrical in time: the entropy in a closed system can only increase with time. A consequence of this is Clausius' Second Law, which states that there is no thermodynamic process whose sole effect is to extract a quantity of heat from a colder reservoir and deliver it to a hotter reservoir.

Particle physics Symmetry is one of the most powerful tools in particle physics, because it has become evident that practically all laws of nature originate in symmetries. Violations of symmetry therefore present theoretical and experimental puzzles that lead to a deeper understanding of nature. Asymmetries in experimental measurements also provide powerful handles that are often relatively free from background or systematic uncertainties.

Coherence: Coherence (from Latin cohaerere = to be connected) describes in physics a property of waves, that enables stationary (i.e. temporally and spatially constant) interference. More generally, coherence describes all correlation properties between physical quantities of a wave. When interfering, waves add constructively or subtract destructively, depending on their relative phase. Two waves are said to be coherent if they have a constant relative phase, which also implies that they have the same frequency. The degree of coherence is measured by the interference visibility, a measure of how perfectly the waves can cancel due to destructive interference. coherence (plural coherences)

the quality of cohering; of being coherent a logical arrangements of parts (physics) (of waves) having the same wavelength and phase

Frequency: Frequency refers to how many waves are made per time interval. This is usually described as how many waves are made per second, or as cycles per second

Frequency band: Or frequency range is a rand of wave frequencies. It most often refers to either a range of frequencies in sound or a range of frequencies in electromagnetic radiation, which includes light and radio waves.

Magnitude: (plural magnitudes) The absolute or relative size, extent or importance of something. (mathematics) A number, assigned to something, such that it may be compared to

others numerically

Phase: (plural phases) A phase is one point or portion in a recurring series of changes

That which is exhibited to the eye; the appearance which anything manifests, especially any one among different and varying appearances of the same object.

Any appearance or aspect of an object of mental apprehension or view The problem has many phases.

Any one point or portion in a recurring series of changes, as in the changes of motion of one of the particles constituting a wave or vibration; one portion of a series of such changes, in distinction from a contrasted portion, as the portion on one side of a position of equilibrium, in contrast with that on the opposite side.

Phase coherence: The state in which two signals maintain a fixed phase relationship with each other or with a third signal that can serve as a reference for each

Power: In physics, power (symbol: P) is the rate at which work is performed or energy is transmitted, or the amount of energy required or expended for a given unit of time.

Ratio A ratio is a quantity that denotes the proportional[citation needed] amount or magnitude of one quantity relative to another.

Ratios are unitless when they relate quantities of the same dimension. When the two quantities being compared are of different types, the units are the first quantity "per" unit of the second — for example, a speed or velocity can be expressed in "miles per hour". If the second unit is a measure of time, we call this type of ratio a rate. Spectra: Spectra (plural of spectrum) are conditions or values that vary over a continuum.

Symmetry: Generally conveys two primary meanings. The first is an imprecise sense of harmonious or aesthetically-pleasing proportionality and balance; such that it reflects beauty or perfection. The second meaning is a precise and well-defined concept of balance or "patterned self-similarity" that can be demonstrated or proved according to the rules of a formal system: by geometry, through physics or otherwise.

Synchrony: If the same kind of waves ocured simultaneously on both sides of the head, they would be in phase and bisynchronous. Waves that occure in different channels without a contant time relationship to each other are called asynchronous.

3. Know the clinical applications for amplitude, asymmetry, coherence, frequency, frequency band, magnitude, phase, phase coherence, power, ratio, spectra, symmetry and synchrony as they relate to neurotherapy and be able to identify when each is appropriate and inappropriate.

4. Know the clinical signs of activation via classical and reticular routes in the EEG.

B. Neuroanatomy 1. Know the location of the more important sites on the cortex of

the brain and be able to describe the basic function of each site including the frontal, parietal, occipital and temporal lobes (see manual), the frontal, occipital and temporal poles,

Frontal Poles: Anterior end of the frontal lobe is named the frontal pole. Occipital Ploles: Posterior end of the occipital lobe is named the occipital pole. Temporal Poles: Anterior end of the temporal lobe is named the temporal pole. Inferior and superior temporal gyrus: Rolandic and Sylvian fissures: Central and parietal-occipital sulci: Premotor, primary and secondary audio: Primary and secondary visual: Primary and secondary motor cortices: Broca's and Wernicke's areas:

2. Know the location and function of the major components of the brain including the:

Amygdala = Its function is Arousal. It controls the Autonomic Responses Associated with Fear; Emotional Responses and Hormonal Secretions. Location: The amygdala is an almond shaped mass of nuclei located deep within the temporal lobes, medial to the hypothalamus and adjacent to the hippocampus. Brain stem = There are three main functions of the brainstem. The first is its role in conduit functions. That is, all information related from the body to the cerebrum and cerebellum and vice versa, must traverse the brain stem. The ascending pathways coming from the body to the brain are the sensory pathways. Descending tracts are upper motor neurons destined to synapse on lower motor neurons. Third, the brain stem has integrative functions (it is involved in cardiovascular system control, respiratory control, pain sensitivity control, alertness, and consciousness).

Cerebellum = The cerebellum is involved in the coordination of voluntary motor movement, balance and equilibrium and muscle tone.

Cortex = The cerebral cortex is a structure within the brain that plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness.

Hippocampus = The hippocampus is a part of the forebrain, located in the medial temporal lobe. It belongs to the limbic system and plays major roles in short term memory and spatial navigation.

Hypothalamus = The hypothalamus links the nervous system to the endocrine system via the pituitary gland (hypophysis). The hypothalamus controls body temperature, hunger, thirst, [1] fatigue, anger, and circadian cycles. The hypothalamus, (from Greek = under the thalamus) is located below the thalamus, just above the brain stem. The hypothalamus is responsible for certain metabolic processes and other activities of the Autonomic Nervous System. It synthesizes and secretes neurohormones, often called hypothalamic-releasing hormones, and these in turn stimulate or inhibit the secretion of pituitary hormones.

Limbic system = The limbic system is a term for a set of brain structures including the hippocampus and amygdala and anterior thalamic nuclei and a limbic cortex that support a variety of functions including emotion, behavior and long term memory. The limbic system operates by influencing the endocrine system and the autonomic nervous system.

Medulla = The medulla oblongata is the lower portion of the brainstem. It deals with autonomic functions, such as breathing and blood pressure. The cardiac center is the part of the medulla oblongata responsible for controlling the heart rate. The medulla oblongata controls autonomic functions, and relays nerve signals between the brain and spinal cord. It is also responsible for controlling several major points and autonomic functions of the body: respiration (via dorsal respiratory group and ventral respiratory group); blood pressure; swallowing; vomiting and defecation.

Midbrain = The midbrain controls many important functions such as the visual and auditory systems as well as eye movement. Portions of the midbrain called the red nucleus and the substantia nigra are involved in the control of body movement. The degeneration of neurons in the substantia nigra is associated with Parkinson’s disease.

Pineal = The pineal gland (also called the pineal body) is a small endocrine gland in the brain. It produces melatonin, a hormone that may modulate wake/sleep patterns. It is shaped like a tiny pine cone, and is located near the center of the brain, between the two hemispheres, tucked in a groove where the two rounded thalamic bodies join.

Pituitary = The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea. It is a protrusion off the bottom of the hypothalamus at the base of the brain. The pituitary fossa, in which the pituitary gland sits, is situated in the sphenoid bone in the middle cranial fossa at the base of the brain. The pituitary gland secretes hormones regulating homeostasis, including trophic hormones that stimulate other endocrine glands. It is functionally connected to the hypothalamus by the median eminence.

Pons = The pons (sometimes pons Varolii after Costanzo Varolio) is a structure located on the brain stem. The pons relays sensory information between the cerebellum and cerebrum; aids in relaying other messages in the brain; controls arousal, and regulates respiration. In some theories, the pons has a role in dreaming.

Thalamus = The thalamus is a pair and symmetric part of the brain. The thalamus is known to have multiple functions. The thalamus is believed to both process and relay sensory information selectively to various parts of the cerebral cortex, as one thalamic point may reach one or several regions in the cortex. The thalamus also plays an important role in regulating states of sleep and wakefulness. The thalamus plays a major role in regulating arousal, the level of awareness, and activity. Damage to the thalamus can lead to permanent coma.

3. Know the fundamental elements of the central nervous system such as:

Axons = An axon or nerve fiber is a long, slender projection of a nerve cell, or neuron, that conducts electrical impulses away from the neuron's cell body or soma.

cell nucleus = In cell biology, the nucleus (pl. nuclei; from Latin nucleus or nuculeus, "little nut" or kernel) is an enclosed membrane found in most cells. It contains most of the cell's genetic material. The function of the nucleus is to maintain the integrity of these genes and to control the activities of the cell by regulating gene expression.

Dendrites = Dendrites (from Greek dendron, “tree”) are the branched projections of a neuron that act to conduct the electrical stimulation received from other neural cells to the cell body, or soma, of the neuron from which the dendrites project.

Neurons = Neurons, also known as neurones and nerve cells, are electrically excitable cells in the nervous system that process and transmit information. Neurons are the core components of the brain, and spinal cord in vertebrates and ventral nerve cord in invertebrates, and peripheral nerves.

pyramidal cells = A pyramidal cell (or pyramidal neuron, or projection neuron) is a multipolar neuron located in the hippocampus and cerebral cortex. Pyramidal cells are tall and conical, triangular in tissue sections. Their apex points toward the brain surface. Pyramidal neurons compose approximately 80% of the neurons of the cortex, and release glutamate as their neurotransmitter, making them the major excitatory component of the cortex (see synapse).

synapses = Information from one neuron flows to another neuron across a synapse. The synapse contains a small gap separating neurons.

Neurotherapy Coaching Training* (40 CEU Required)

A. Licensed Healthcare Therapists May Be Exempt 1. If Biofeedback is within their scope of practice - this may

include those licensed as medical doctors, chiropractors, counselors, dentists, licensed counselors, veterinarians.

2. If their license is approved by their State or Provincial government and clearly states that biofeedback is within their scope of practice. (Does not include Licensed Massage Therapists).

B. Some Unlicensed Professionals May Be Exempt * 1. Life Coaches certified by a recognized authority 2. International Coach Federation Certified Life Coaches

Please check with the NTCB to see if you qualify. Must provide a personal (not copied) informed consent form and code of ethics to the NTCB for approval.

COACHING REQUIREMENTS

A. Coaching Course Requirements 1. Values Clarification

2. Mission Statements 3. Code of Personal Ethics 4. Active Listening Skills 5. Reflective Listening Skills 6. Use of Empowering Questions 7. Beginning level Coaching Skills

B. Accredited Providers

0. The Biofeedback Coach 1. The Quantum Center of Excellence

C. Coaching Resources

0. What are Therapy and Coaching? 1. The Language of a Biofeedback Coach

Instrumentation (24 CEU Required)

A. Know the definitions and applications of the following terms related to EEG instruments:

1. Amplifier - Reads and amplifies the EEG signal from the electrodes that are placed on the scalp.

2. Analog filters – In line filters used for eliminating 50Hz (Europe) or 60Hz (North America) extracranial activity for routine recording.

3. Analog to digital converters – Digital converters are usually solid state circuits placed on a computer board. Digital converters measure the continuous analog EEG signal at discrete time intervals, i.e., sampling the signal at a fixed rate. Samples must be high enough to accurately represent complex waveforms without overloading the computer unnecessarily.

4. Band pass A filter formed by cascading a high-pass and a low-pass filter. The filter amplitude frequency characteristic is often represented by two parameters. First, there is the cutoff frequency, which corresponds with the frequency at which the output amplitude has dropped to 70.7% (3dB) of the filter output amplitude at zero attenuation; second, there is the slope in decibels per octave, which is a measure of the maximum gradient of attenuation outside of the pass-band.

5. Common mode rejection – The input amplifier should be more sensitive in relation to the signal components that are different at the electrodes than to those components that are of equal amplitude and polarity (common mode).

6. Differential amplifier– Made up of a pair of amplifier circuits that are symmetrically connected with respect to ground and are balanced regarding the symmetrical active and passive components of the two circuits. (Layman terms - Measures the voltage difference between the two signals at each of its inputs. The resulting signal is amplified, and then displayed as a channel of EEG activity.) Digital filters In line filters which do not cause any delay in the signal they pass, and provide tremendous flexibility by removing the need for a technician to anticipate the need for filters.

7. Electrode impedance– When a DC voltage is applied between electrodes placed in an electrolytic solution, the electrical double layers are disturbed and an electrical current flows. The magnitude of this current is dependent mainly on the transport of ions at the metal/electrolyte junction. The relation between voltage and current can be represented by a time-dependant electrode impedance.

8. Fast Fourier transforms (FFT– An efficient algorithm to compute the discrete Fourier transform and it’s inverse. FFT’s are of great importance to digital signal processing in EEG applications. The Cooley-Tukey algorithm is the most commonly used.

9. Impedance – The total opposition of a circuit to the flow of alternating current. It includes resistance and reactance, and is measured in ohms.

10. Impedance testing – checking the connection and signal from the electrodes by use of a sensor or test unit.

11. Integral average 12. Montage The representation of the EEG channels. 13. Optical isolation – Two electrical networks that are connected through an

LED (Light Emitting Diode) and a photoelectric receiver. There is no electrical continuity between the two networks.

14. Peak to peak – The amplitude (voltage) difference between the most positive and the most negative excursions (peaks) of an electrical signal.

15. Root mean square – The effective value of an alternating voltage or current.

Signal-to-noise ratio – The ratio between the received signal power and the noise at the receiver of a communications system. Volume conduction– Concept from physics and biology, the fact that the electrical potential generated by the heart and as measured by an electrocardiograph can be recorded from any site on the body.

B. Sources of artifact 1. Know how to evaluate environmental noise 2. Know how to evaluate instrument noise 3. Know how to check electrode impedances 4. Know how to perform a continuity checks on electrodes 5. Know how to perform continuity checks on cables 6. Know how to identify short and open circuits.

C. Signal acquisition 1. Know how to attach electrodes to your clients (manual) 2. Know which ear to choose as a reference and why 3. Know when to use a reference other than one ear 4. Know when to use and apply a neutral reference 5. Know when to use and apply a scalp reference 6. Know which locations to use and why those locations were chosen 7. Know how electrode impedance affects the EEG 8. Know the potential effects of prescription, illicit and over-the-

counter drugs and remedies on EEG.

D. Signal processing 1. Know the sites on the l0-20 system (see manual) 2. Know the montages that derive from the 10-20 system (see manual) 3. Know how to explain offset voltages – When an electrode is placed in a

conducting solution and no current is flowing, an electrical potential difference exists between the electrode and the bulk of the solution. This electrode potential results from a difference between the electrical charge caused by the flow of ions from the metallic surface of the electrode into the solution and that caused by the flow of metallic ions from the solution into the metallic surface of the electrodes. An excess of charge in the solution causes the formation of an electrical double layer; in this way, an equilibrium is established. The value of the electrode potential is a

function of the electrode material, the electrolyte composition, and the temperature. It may have values ranging from millivolts to volts. When scalp electrodes are used, depending on the electrolyte composition and the condition of the skin, a similar DC potential is generated at the skin/electrolyte junction. These steady potentials generated at the electrodes, which cannot be eliminated, result in a DC offset voltage.

4. Know how a PET is different from a QEEG – Positron Emission Tomography – A method for imaging cerebral blood flow and, indirectly, brain activity making use of tracers that emit positrons. The tracer is introduced into the subjects blood, and then its concentration is measured using the emitted positrons.

5. Know how a SPECT is different from a QEEG Single Photon Emission Computed Tomography – A brain imaging process that measures the emission of single photons of a given energy from radioactive tracers.

6. Know how a fMRI is different from a QEEG functional Magnetic Resonance Imaging – A special imaging technology used to view the structure of the brain and show the relativity between physical changes in the brain and mental functioning.

7. Know how a MEG is different from a QEEG– Magnetoencephalogram – Monitors brain activity by measuring magnetic fields of the brain.

E. EEG 1. Be able to recognize normal EEG patterns for the frequency

ranges traditionally called delta, theta, alpha, smr, beta, gamma, deltha, thalpha, mu, and lambda in the raw EEG and QEEG.

2. Be able to recognize common artifacts in the raw EEG such as drowsiness, eye blink, eye movement both vertically and laterally, muscle activity such as EMG, EOG, TMJ, frontalis, jaw and neck tension, sleep spindles, sweat, loose or poorly attached electrodes, heart pulse (EKG), electrode wire movement, skin potentials and static electricity, and electromagnetic noise.

3. Be able to identify abnormal EEG patterns, such as those associated with seizure disorders, stroke, memory loss and dementia, attention and learning disorders, addiction, mood disorders, and closed head injuries

F. QEEG 1. Be able to explain the clinical uses of spectral arrays. 2. Be able to explain the clinical uses of compressed spectral arrays. 3. Be able to explain the clinical uses of topographic brain maps. 4. Be able to explain the clinical uses of databases and discriminant

functions - http://books.google.com/books?id=3CuM6MviwMAC&pg=PA146&lpg=PA146&dq=clinical+use+of+databases+and+discriminant+functions&source=web&ots=PBhmkAscSv&sig=vgpBJ7y0w4Dq4YLQm1Utf77_Y-A&hl=en&sa=X&oi=book_result&resnum=1&ct=result

G. Computers in Neurotherapy 1. Know how to use a computer with at least one computerized EEG

system (see manual) 2. Know how to use at least one neurotherapy software package with

a computer (see manual) 3. Know how computer speed affects the speed of neurotherapy.

The computer is a non-invasive tool, and it makes no changes to your brain--it simply provides feedback about the activity in your brain. For neurofeedback, you train your own brainwaves based on that feedback signal. Newer computer chips allow you to see your brainwaves on a computer screen a few thousandths of a second after they occur, and gives you the ability to influence and change them. Before now, computer processors were too slow to effectively measure brainwaves and provide the feedback fast enough to the brain.

4. Know how FFT and digital filtering delays neurotherapy.

FFT (Fast Fourier Transform) and (DFT) Discrete Fourier Transform

http://www.dsprelated.com/showarticle/26.php

http://www.elisanet.fi/mnentwig/webroot/FFT_smoothness_cyclic/index.html

http://cnx.org/content/m10250/latest/

http://www.elisanet.fi/mnentwig/webroot/FFT_bin_frequencies/index.html

http://www.elisanet.fi/mnentwig/webroot/FFT_filter_example/index.html

Physiology and Anatomy* (40 CEU required)

A. Physiology 1. Recognize the names of the major muscle groups which generally

respond to biofeedback training 2. Recognize the names of the major bones associated with these

muscles 3. Know the names and be able to describe the disorders which are

generally expected to respond to biofeedback training 4. Know the clinical applications for EMG, SEMG, temperature

training, heart rate variability and EDR/GSR as they relate to biofeedback training and be able to identify when each is appropriate and inappropriate

5. Know the clinical signs for hypertension, stress, pain and be able to describe how to handle each in a clinical setting

B. Basic Anatomy 1. Know the location and function of the major components of the

skeletal and muscle system, endocrine glands and the immune system

2. Know the fundamental elements of the major body systems including the digestive, circulatory, respiratory, excretory, nervous, lymphatic, urinary and hormonal systems

Digestive system: The digestive system is made up of the digestive tract—a series of hollow organs joined in a long, twisting tube from the mouth to the anus—and other organs that help the body break down and absorb food (see figure).

Organs that make up the digestive tract are the mouth, esophagus, stomach, small intestine, large intestine—also called the colon—rectum, and anus. Inside these hollow organs is a lining called the mucosa. In the mouth, stomach, and small intestine, the mucosa contains tiny glands that produce juices to help digest food. The digestive tract also contains a layer of smooth muscle that helps break down food and move it along the tract.

Two “solid” digestive organs, the liver and the pancreas, produce digestive juices that reach the intestine through small tubes called ducts. The gallbladder stores the liver’s digestive juices until they are needed in the intestine. Parts of the nervous and circulatory systems also play major roles in the digestive system.

Circulatory system: The Circulatory System is responsible for transporting materials throughout the entire body. It transports nutrients, water, and oxygen to your billions of body cells and carries away wastes

such as carbon dioxide that body cells produce. It is an amazing highway that travels through your entire body connecting all your body cells.

On average, your body has about 5 liters of blood continually traveling through it by way of the circulatory system. The heart, the lungs, and the blood vessels work together to form the circle part of the circulatory system. The pumping of the heart forces the blood on its journey.

The body's circulatory system really has three distinct parts: pulmonary circulation (lungs), coronary circulation (heart), and systemic circulation(the rest of the system). Each part must be working independently in order for them to all work together.

Respiratory System: This is the oxygen delivery system. The primary function of the respiratory system is to supply the blood with oxygen in order for the blood to deliver oxygen to all parts of the body. The respiratory system does this through breathing. When we breathe, we inhale oxygen and exhale carbon dioxide. This exchange of gases is the respiratory system's means of getting oxygen to the blood.

Respiration is achieved through the mouth, nose, trachea, lungs, and diaphragm. Oxygen enters the respiratory system through the mouth and the nose. The oxygen then passes through the larynx (where speech sounds are produced) and the trachea which is a tube that enters the chest cavity. In the chest cavity, the trachea splits into two smaller tubes called the bronchi. Each bronchus then divides again forming the bronchial tubes. The bronchial tubes lead directly into the lungs where they divide into many smaller tubes which connect to tiny sacs called alveoli. The average adult's lungs contain about 600 million of these spongy, air-filled sacs that are surrounded by capillaries. The inhaled oxygen passes into the alveoli and then diffuses through the capillaries into the arterial blood. Meanwhile, the waste-rich blood from the veins releases its carbon dioxide into the alveoli. The carbon dioxide follows the same path out of the lungs when you exhale.

The diaphragm's job is to help pump the carbon dioxide out of the lungs and pull the oxygen into the lungs. The diaphragm is a sheet of muscles that lies across the bottom of the chest cavity. As the diaphragm contracts and relaxes, breathing takes place. When the diaphragm contracts, oxygen is pulled into the lungs. When the diaphragm relaxes, carbon dioxide is pumped out of the lungs.

Excretory System: The excretory system is an organ system that performs the function of excretion, the bodily process of discharging wastes. It is responsible for the elimination of the waste products of metabolism as

well as other non-useful materials. The main components of the excretory system are the sweat glands, the liver, the lungs, and the kidneys.

Nervous System: The nervous system is a very complex system in the body. It has many, many parts. The nervous system is divided into two main systems, the central nervous system (CNS) and the peripheral nervous system. The spinal cord and the brain make up the CNS. Its main job is to get the information from the body and send out instructions. The peripheral nervous system is made up of all of the nerves and the wiring. This system sends the messages from the brain to the rest of the body.

Central nervous system: The brain keeps the body in order. It helps to control all of the body systems and organs, keeping them working like they should. The brain also allows us to think, feel, remember and imagine. In general, the brain is what makes us behave as human beings.

The brain communicates with the rest of the body through the spinal cord and the nerves. They tell the brain what is going on in the body at all times. This system also gives instructions to all parts of the body about what to do and when to do it.

Peripheral Nervous System: The nervous system is made up of nerve cells or neurons that are "wired" together throughout the body, somewhat like communication system. Neurons carry messages in the form of electrical impulses. The messages move from one neuron to another to keep the body functioning.

Neurons have a limited ability to repair themselves. Unlike other body tissues, nerve cells cannot also be repaired if damaged due to injury or disease.

Lymphatic System: The lymphatic system consists of organs, ducts, and nodes. It transports a watery clear fluid called lymph. This fluid distributes immune cells and other factors throughout the body. It also interacts with the blood circulatory system to drain fluid from cells and tissues. The lymphatic system contains immune cells called lymphocytes, which protect the body against antigens (viruses, bacteria, etc.) that invade the body. The main functions of the lymphatic system are: to collect and return interstitial fluid, including plasma protein to the blood, and thus help maintain fluid balance: to defend the body against disease by producing lymphocytes; and to absorb lipids from the intestine and transport them to the blood.

Urinary System: The urinary system includes the kidneys, bladder and tubes. These organs control the amount of water and salts that are

absorbed back into the blood and what is taken out as waste. This system also acts as a filtering mechanism for the blood.

Your body takes nutrients from food and uses them to maintain all bodily functions including energy and self-repair. After your body has taken what it needs from the food, waste products are left behind in the blood and in the bowel. The urinary system works with the lungs, skin, and intestines—all of which also excrete wastes—to keep the chemicals and water in your body balanced.

The urinary system removes a type of waste called urea from your blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys. Urea, together with water and other waste substances, forms the urine as it passes down the renal tubules of the kidney.

From the kidneys, urine travels down two thin tubes called ureters to the bladder. The bladder is a hollow muscular organ shaped like a balloon. It sits in your pelvis and is held in place by ligaments attached to other organs and the pelvic bones.

Circular muscles called sphincters help keep urine from leaking. The sphincter muscles close tightly like a rubber band around the opening of the bladder into the urethra, the tube that allows urine to pass outside the body.

Nerves in the bladder tell you when it is time to urinate, or empty your bladder. When you urinate, the brain signals the bladder muscles to tighten, squeezing urine out of the bladder. At the same time, the brain signals the sphincter muscles to relax. As these muscles relax, urine exits the bladder through the urethra. When all the signals occur in the correct order, normal urination occurs.

Hormonal (Endocrine) System: Endocrine glands make chemicals called hormones and pass them straight into the bloodstream. (Glands that pass their secretions down tubes or ducts to particular places are called ‘exocrine glands’.) Hormones can be thought of as chemical messages. They communicate with the body and bring about changes. Usually, hormones take effect quite slowly. The endocrine system works with the nervous system and the immune system to help the body cope with different events and stresses.

Some of the roles of the endocrine system include: Growth, Repair, Sexual reproduction, Digestion, Homeostasis (constant internal balance). A hormone will only act on a part of the body if it ‘fits’. A hormone can be

thought of as a ‘key’, and its target site (such as an organ) has specially shaped ‘locks’ on the cell walls. If the key (hormone) fits the lock (on the cell wall), then the hormone will work. The endocrine glands get feedback from the body so they can adjust the hormones and keep them at the right levels.

The glands of the endocrine system include:

• Pituitary gland - is inside the brain. It oversees the other glands and keeps hormone levels in check. It can bring about a change in hormone production somewhere else in the system by releasing its own ‘stimulating’ hormones. The pituitary gland is also connected to the nervous system via part of the brain called the hypothalamus.

•Thyroid gland - is inside the throat. It controls the rate of metabolism.

• Parathyroid gland - is inside the throat. It controls the level of calcium in the bloodstream.

• Adrenal glands - are on top of each kidney. They make a number of different hormones, such as adrenaline and cortisol in times of stress, and sex hormones.

• Pancreas - an organ of digestion, which is inside the abdomen. It makes insulin, which controls the amount of sugar in the bloodstream.

• Ovaries - are inside the female pelvis. They make female sex hormones like oestrogen.

• Testes - they hang in the male scrotal sack. They make male sex hormones like testosterone.

Glands that secrete straight to a target site via ducts or tubes are called exocrine glands. Some examples include: Salivary glands: Sweat glands and Sebaceous glands.

Clinical Neurotherapy (40 CEU Required)

A. Client Intake Skills (2 CEU Required) 1. Know interview techniques to obtain all the information necessary

for treating your client. (see manual) 2. Know how to obtain a complete medical and personal history of

pertinent data. (see manual)

3. Know how to explain training rationale and expectations to clients with varied backgrounds and life experiences (see manual)

4. Know how to motivate client compliance with your training strategy. (see manual)

5. Know how to discover the potential effects of prescription, illicit and over-the-counter drugs and remedies on prospective neurotherapy interventions

6. Know the potential effects prescription, illicit and over-the-counter drugs and remedies on learning tasks such as neurotherapy

7. Know the contraindications for proscription, illicit and over-the-counter drugs and remedies

8. Know how your client can be expected to relate to training indications (see manual)

9. Know how to develop and write a neurotherapy training program (see manual)

10. Know how to develop and write a comprehensive training program (see manual)

B. Initial Assessment (2 CEU Required) 1. Know how to prepare the client for a full-cap QEEG 2. Know how to collect sufficient artifact-free data for quantitative

analysis (see Manual) 3. Know how to prepare the client for a neurotherapy session (See

Manual) 4. Determine the number of sites to be used in each session (See

Manual) 5. Know how to remove or otherwise accommodate non EEG artifact

(See Manual) C. Training protocols (8 CEU Required)

1. Know how to develop protocols based on the results of EEG and QEEG analysis.

2. Know and be able to implement several training protocols for relaxation and stress management (see manual)

3. Know and be able to implement several training protocols for muscle re-education and pain management (see manual)

4. Know and be able to implement several training protocols for peak performance training (see manual)

5. Know and be able to implement several training protocols for quality of life enhancement (see manual)

6. Know how to evaluate the effectiveness of any training protocol (see manual)

7. Know how to adjust training procedures to improve outcome (see manual)

D. Complementary Therapies (4 CEU Required) 1. Know how to implement relaxation and autogenic training (see

manual) 2. Know how to use deep breathing techniques (see manual) 3. Know how to use affirmations (see manual) 4. Know how to use visualization and guided imagery techniques (see

manual) 5. Know how to use other selected techniques (see manual)

E. Practicum in Neurotherapy (10 CEU Required)

1. Shadowing (4 sessions minimum) 2. Constant supervision (8 sessions minimum)

Internship (500 Hours of Supervision Required)

A. Supervision By Qualified Neurotherapy Supervisor Required 1. Qualified = certified as a NTCB supervisor or instructor 2. Qualified = licensed therapist practicing biofeedback 3. Qualified = certified as a BCIAC-EEG Fellow

B. NTCB Supervision Model must be used

C. Licensed Healthcare Therapists May Be Exempt

1. If Biofeedback is within their scope of practice - this may include those licensed as medical doctors, chiropractors, counselors, dentists, licensed counselors, veterinarians.

2. If their license is approved by their State or Provincial government and clearly states that biofeedback is within their scope of practice. (Does not include Licensed Massage Therapists).

D. Responsibilities of the Supervisor 1. Require ethical conduct by intern at all times 2. Require professional conduct by intern at all times 3. Require intern to provide personal Code of Ethics to each client 4. Require intern to provide each client a copy of any waivers 5. Require intern to fully disclose scope of practice to clients 6. Report any deviations therefrom to NTCB headquarters 7. Report outstanding performance to NTCB headquarters

E. Responsibilities of the Intern 1. Be ethical in all neurotherapy undertakings at all times 2. Be professional in all neurotherapy undertakings 3. Write an acceptable Code of Ethics and comply therewith 4. Provide each client a copy of your Code of Ethics 5. Provide each client a copy of any waivers you require 6. Fully disclose your scope of practice to each client 7. Keep a record of all activities done under supervision

a. Include date and times b. Include name of your supervisor c. Include client code or number for future reference (no

names) d. File a copy of the completed record with NTCB

headquarters 8. Read the Internship Instructions.

Biofeedback

While there is no requirement for learning biofeedback theory and practice to be certified as a neurotherapy specialist or technician, it is suggested that candidates also meet the requirements of the Biofeedback Blueprint.