Date of Award

8-2019

Degree Name

Doctor of Philosophy

Department

Interdisciplinary Health Sciences

First Advisor

Dr. Kieran Fogarty

Second Advisor

Dr. Mary Lagerwey

Third Advisor

Dr. Carla Chase

Fourth Advisor

Dr. Linda Walker

Keywords

Parkinson’s Disease, neurofeedback, comorbidity, tremor, cognition, single subject design

Abstract

The purpose of this research was to determine the impact of neurofeedback (NFB) on Parkinson’s symptoms that patients identify as priorities. First, a focus group of patients helped identify priority symptoms, then a pilot study tested protocols resulting from the focus group, and finally, an intervention study using a single subject design was conducted.

In the focus group, tremor and activity planning were identified as issues affecting every group member. The pilot study was conducted with three mid-stage Parkinson’s patients, who received a sensory motor (SM) protocol to address tremor, a SM plus cognition protocol (SM+Cog) for tremor and planning (cognition), or no protocol. Theta and high beta were inhibited, while SMR/beta were rewarded in 12 sessions. The chief outcome measure was overall disability percentage using World Health Organization Disability Assessment Scale (WHODAS).

Participants who received either protocol reported less disability posttest and one-month followup. The person in the control group reported increased disability across measurements. Analysis of pre- and posttest quantitative electroencephalogram (QEEG) showed posttest reductions in delta, theta, and high beta, as well as increases in beta for participants in the intervention groups. QEEGs also demonstrated variation in brain disregulation, even among participants in the same disease stage.

Next, an intervention study was conducted with seven participants with varying levels of affectedness from the disease. Outcome measures were self-reported tremor using the Unified Parkinson’s Disease Rating Scale (UPDRS) and cognition using the WHODAS; and a single protocol that included both the SM+Cog conditions was used in 20 sessions. Two baseline EEG measures were taken to document pre-intervention status, and a qualitative component was added to document changes that participants noticed.

For the three participants who were the furthest away from initial diagnosis, tremor scores improved at posttest, and EEG measures showed desired reductions in theta and high beta. Tremor improvement was sustained at follow-up for two of these three participants. Tremor improved per verbal report, but not quantitative score, for an additional 2 participants. Cognition scores improved at posttest for four of seven participants and for an additional participant at follow-up. Of the participants who reported improvement at posttest, cognition scores returned to pretest levels at the one-month follow-up for three participants and worsened for the fourth, but not back to pretest levels. Cognition improved per verbal report for one additional participant. Qualitative reports of improvement during the intervention included motor symptoms of tremor, walking and balance; cognitive symptoms of memory, focus, word-finding, and holding a train of thought in spite of tremor; and other symptoms of sleep, restless leg syndrome, anxiety/agitation, fatigue, and light-headedness upon standing.

Recommendations were: 1) including self-report and more precise, objective measures and 2) conducting studies to more accurately delineate changes based on pre-intervention functioning and attempt to capture symptom delay. The study adds to the evidence that NFB can be a useful therapy in alleviating motor symptoms of Parkinson’s, as well as cognitive issues, which are not typically addressed with medication.

Access Setting

Dissertation-Open Access

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