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Neurofeedback Peak Performance in Microsurgery

Conjunct COST B27 and SAN Scientific Meeting, Swansea, UK, 16-18 September 2006. Neurofeedback Peak Performance in Microsurgery. Tomas Ros Dept. of Psychology Goldsmiths College London. Neurofeedback Peak Performance in Microsurgery. Tomas Ros Dept. of Psychology Goldsmiths College

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Neurofeedback Peak Performance in Microsurgery

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  1. Conjunct COST B27 and SAN Scientific Meeting, Swansea, UK, 16-18 September 2006 Neurofeedback Peak Performance in Microsurgery Tomas Ros Dept. of Psychology Goldsmiths College London

  2. Neurofeedback Peak Performance in Microsurgery Tomas Ros Dept. of Psychology Goldsmiths College London

  3. Rationale • EEG peak-performance enhancements in: • cognition • sport • artistic ability • microsurgical technique uniquely combines the mental and physical skills present in such fields • we assessed the training effects of 2 widespread neurofeedback protocols to the novel area of • eyemicrosurgery

  4. 2 Protocols Research Evidence: • SMR-Theta training can lead to improvements in attention and memory (Vernon et al. 2003, Egner & Gruzelier 2004) • Alpha-Theta has been shown to induce relaxation and reduce anxiety, as well as enhance artistry (Egner & Gruzelier 2003, Raymond et al. 2005)

  5. Neurofeedback Training Alpha-Theta: • auditory feedback only • alpha, theta • alpha (8-11 Hz), theta (4-7 Hz) • referential at Pz • visual feedback •  SMR,  theta,  high beta • SMR (12-15 Hz), theta (4-7 Hz), • high beta (22-30 Hz) • referential at Cz SMR-Theta:

  6. Neurofeedback Training Equipment: • ProComp + amplifier • Neurocybernetics EEGer • 160 Hz sampling, 0.5 s filter • 3-min autothreshold Feedback: • AT alpha: babbling brook • theta: ocean wave • SMR: “Space race” (3-way)

  7. Neurofeedback Training Duration: • 3 min baseline (period 1) • approx. 25 min session Rate: • approx. 1 session / week • 8 sessions in TOTAL

  8. Study Design • randomised, single-blind, controlled • 2 neurofeedback protocols Alpha-Theta (AT) N=10 SMR-Theta (SMR) N=10 • 1 wait-list control group N=8

  9. LOCATION: Western Eye Hospital, London • 20 trainee surgeons • (NHS house officers & registrars) • 10 males, 10 females • mean age 33.5, SD 5.12

  10. Assessment • MOOD questionnaire Spielberger’s state & trait anxiety (pre performance self-report) • SURGICAL performance multi stage surgical task on artificial-eye (~10 min video recording from two angles) • ATTENTION test ‘Attention Network Test’, or ANT (15 min reaction time test on computer)

  11. WAITLIST GROUP (N=8) W A I T TRAINING ONLY GROUP (N=12) N F B

  12. WAITLIST TRAINING ONLY CONTROL pre / post (N=8) W A I T TRAINING pre / post (N=8) TRAINING pre / post (N=12) N F B

  13. 140 120 100 80 time (days) 60 40 20 0 AT SMR C Error bars: +/- 1.00 SE Test-retest intervals p=0.40 • One-way ANOVA:no significant differences between groups

  14. RESULTS NFB training spectra

  15. 1.05 1.02 ] ] 1.03 ] ] ] ] 1.00 1.00 Theta / Alpha ratio ] ] ] ] ] ] ] 0.98 ] 0.98 ] ] ] ] 0.95 0.96 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 9 10 Session Period Alpha-Theta (AT) training p<0.01 p<0.01 AVERAGE for all AT subjects

  16. 0.61 0.65 ] ] ] 0.60 ] ] ] 0.60 0.59 SMR/Theta ratio ] ] ] ] ] ] 0.58 ] 0.55 ] ] ] 0.57 ] 0.50 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 9 Session Period SMR-Theta training p<0.01 p<0.01 AVERAGE for all SMR subjects

  17. RESULTS Surgical Technique

  18. Judges’ ratings • scored independently • score averaged over 2 judges • each judge was blind to: presentation order subject identity

  19. 1.00 pre * post 0.80 technical skill score (%) 0.60 0.40 0.20 0.00 AT SMR C Overall Technique p=1.0 p=0.26 p=0.038 • Paired Wilcoxon: significant increase in SMR group

  20. sideport 20 phaco wound 15 rrhexis knot * 10 technical score change (%) 5 0 -5 AT SMR C Task Technique p=0.018 6.2 % • Paired Wilcoxon: significant increase in SMR group

  21. JUDGE A JUDGE B Inter-rater reliability 1.00 0.90 Overall score (%) 0.80 0.70 0.60 1 5 9 13 17 21 25 29 33 37 44 48 Video number • ICC:0.85 for SMR performances, 0.64 for ALL performances

  22. RESULTS Performance Speed

  23. Performance Speed • objective data calculated from videos OVERALL time = TASK time + PAUSE time OVERALL time: start to finish TASK time: spent in contact with eye PAUSE time: spent otherwise

  24. pre post 12 11 10 Mean time (min) 9 8 7 AT SMR C Overall time p=0.84 p=0.20 p=0.16 15 % • Paired T-test: marginal decrease in AT & SMR group

  25. 10 pre post 9 8 Mean time (min) * 7 6 5 AT SMR C Task time p=0.90 p=0.26 p=0.021 25 % • Paired T-test: significant decrease in SMR group

  26. 5 pre post 4 mean time (min) 3 2 1 AT SMR C Pause time p=0.72 p=0.50 p=0.56 • Paired T-test:no significant changes in groups

  27. 2.5 0 -2.5 time change (min) -5 -7.5 * AT SMR C Individual Tasks sideport phaco wound rrhexis knot p=0.018 6 % • Paired T-test: significant decrease in SMR group

  28. Subjective vs objective scores • Correlation between subjective (technique) and objective (times) performance measures • Positive changes in overalltechnique were coupled to reductions in totaltask time (R= -0.700, p=0.036)

  29. RESULTS Attention Network Test

  30. A N TPosner et al (2002, 2004) • measures 3 separate attentional networks • (alerting, orienting, and conflict) • based on earlier functional studies • (e.g. Posner & Peterson, 1990)

  31. alerting orienting conflict Attention Network Test (A N T) 20 10 Efficiency change ( ms ) 0 p=0.095 -10 p=0.05 -20 25 % -30 AT SMR C • Paired T-test: significant orienting decrease in SMR group

  32. RESULTS State & Trait Anxiety

  33. Spielberger’s Anxiety Inventory • filled in prior to each assessment • 2 parts: STATE anxiety how subject feels at that moment TRAIT anxiety how subject felt in the last week

  34. pre STATE 50 post 40 30 mean ANXIETY score 20 10 0 AT SMR C Spielberger’s Anxiety Inventory p> 0.05 • Paired Wilcoxon:no significant change within groups

  35. pre 50 TRAIT * post 40 mean ANXIETY score 30 20 10 0 AT SMR C Spielberger’s Anxiety Inventory p=0.017 10 % • Paired Wilcoxon: significant decrease in SMR group

  36. RESULTS NFB / surgical performance associations

  37. AT training vs performance • Successful within-session AT training correlated significantly with overall technique(R= 0.638, p=0.047) • Between-session AT training marginally correlated with overalltime of performance (R=-0.523, one tailed p=0.060)

  38. SMR training vs performance • Successful within-session SMR-training ratio was associated with increases in total pausetime(R=0.584, p=0.077) • Pause time was also negatively correlated with task time (R= -0.251) • A significant partial correlation of within-session learning and pause time was obtained (R=0.703, p=0.035)

  39. SMR training vs performance X-axis: SMR group split into two equal halves. GOOD performers were top five subjects with greatest reductions in surgical task time, BAD performers were bottom half Y-axis: meanSMR-theta ratio BARS: between first & second half of all periods between first & second half of all sessions

  40. Periods 2 - 5 Periods 6 - 9 0.60 SMR-Theta ratio 0.40 0.20 0.00 BAD performers GOOD performers PERIOD ratio vs performance p> 0.05 • Paired T-test:no significant change within groups

  41. Sessions 1 - 4 Sessions 5 - 8 0.60 SMR-Theta ratio 0.40 0.20 0.00 BAD performers GOOD performers SESSION ratio vs performance * p=0.001 10 % • Paired T-test: significant decrease in BAD performers

  42. Conclusion & Summary

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