Arizona Center for Advanced Medicine - Martha M. Grout, MD, MD(H)
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MARTHA GROUT MD MD(H) 
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BrainAdvantage™

BrainAdvantage™ is a non-invasive, drug-free system for making the human brain work better. Who does it help?
• Those who experience normal loss of memory because of aging
• Those with AD/HD who are unable to focus
• Those with migraine headaches
• Those with depression or schizophrenia
• Traumatic brain injury patients – post-concussion syndrome
• Those with sensitivities to chemicals, mold, or neurotoxins
• Those with neuro-degenerative disease – MS, encephalitis, Parkinson's Disease, motor neuron disease, demyelinating diseases, Reynaud's disease

Brain Advantage™ is a highly integrated approach to improve thinking, memory, focus and attention. It can also improve brain/body communication, and play an important role in the treatment of autonomic nervous system dysfunctions.

More Oxygen Equals More Brain Power

The frontal lobes of the brain are where the executive functions reside. Executive functions are brain activities that have to do with paying attention to details and remembering them, organizing, strategizing, and planning.

The harder the brain cells work, just like muscle cells, the more they demand nutrition. And just like muscle cells, the nutrition they need is provided by oxygen. Blood brings oxygen and the basic nutrient, glucose, at life-sustaining levels to all parts of the brain. Without oxygen, the brain cells cannot convert glucose into the energy they need to do the work of directing our body's functions. Our brains have an amazing ability to supply extra blood preferentially to those parts in active use.

Extra blood supply over a period of time means you build new neuron connections. And when you exercise those new connections, they become permanent, rather than being pruned out by your nervous system.

The brain has its own method of expanding frequently used pathways, and "pruning" those connections that aren't used. This happens in much the same way you prune deadwood off a tree. Pathways that are more consistently utilized are protected from the pruning process. Stimulation of the pathways increases oxygen to the frontal lobes, and that improves the ability of the "executive functions".

Hemoencephalography – HEG

Hershel Toomim, DSc, discovered that when stimulated, the blood supply flowing to the active area of the brain carries more oxygen. He used this fact to develop Hemoencephalography biofeedback – HEG for short. This non-invasive, safe technique uses near-infrared light to measure the degree of increase in oxygenation of the blood, when stimulated with neurofeedback techniques.

BrainAdvantageHEG uses the same principle as the little fingertip clip-on oximeter that reads your pulse rate or your oxygen levels in the hospital. It's clean and quick. In 1994, Dr. Toomim began teaching people to control the amount of oxygenated blood flowing to their frontal lobes. BrainAdvantage™ holds the exclusive license for this technique.

The BrainAdvantage™ system feeds the oxygen demand information back to the patient in the form of sounds, numbers, or game or video progress. The average patient quickly learns how to exercise these brain cells.

Sessions are about 30 minutes long for HEG, a maximum of 10 minutes on each point treated. A standard course of treatment consists of 20 sessions, spaced a minimum of 24 hours apart, maximum of 3 days apart.

Brain training is more effective, faster, cleaner and more cost-effective than traditional EEG-based systems:
• No messy gelled electrodes
• No interference from facial muscles
• Less cost

Ultimately, after about half the number of sessions typically used for the older style of EEG-feedback training, a person achieves permanent gains in brain function with Brain Advantage™.

Poor executive function, as shown by low function of the frontal lobes, is a factor in many brain dysfunctions, including AD/HD, short-term memory loss, migraine headaches, and in some cases of autism, depression, anxiety and even schizophrenia.

Retraining our minds with sound

Sound plays an important role in our life. We use it when we learn to read. We sound out the letters and learn to hear combination of sounds as words. We hear the sounds that the brain interprets as information. However, many people don't hear the same way others do. They hear the same frequencies as everyone else, but their brain has trouble making sense of what they hear. Tuning out unwanted sounds in their surroundings is often difficult. So they find it hard to focus and concentrate, and their frontal lobes function poorly. The result is poor executive function, poor decision making, and inability to think through the consequences of an action. In the end, poor decision-making ability leads to behavioral problems and poor social skills.

Sound Therapy uses music and sounds specially engineered to help retrain the way you process sound and the way you listen. We can help restore the ability to process sounds that may have become diminished (or become hypersensitive) through ear infections or exposure to loud noise.

Sometimes an AD/HD individual has been robbed of the ability to process specific frequencies, because of chronic ear infections or severe allergies. Sometimes this ability may simply never have been acquired during the normal course of development.

Are you a Baby Boomer who went to too many Grateful Dead concerts? The cells which process specific frequencies may have been damaged by the loudness of the music, but perhaps they have not been completely destroyed.

Whether you are a Baby Boomer or a child (or adult) with AD/HD, we can help. We can train your brain cells and pathways to process the sounds better, so that whatever is available is working at maximum capacity, and the functional ability to distinguish sounds is improved.

This auditory processing technique retrains the brain's ability to listen and receive auditory signals so the individual can learn to focus on the desired sounds while ignoring other less important sounds in their surroundings. With AD/HD, the ear may have shut down certain frequencies of sound. The ear cells become unresponsive and must be stimulated to be able to tune into the desired sound. Attention, focus, learning, and language abilities can all be improved by retraining the ear to listen using different frequency sounds.

A vibration sensor within the ear serves as a collector for high frequency sounds – sounds which are used to "charge" the entire body, providing energy to our bones, joints and muscles, and to our brains to enable us to focus, think, create and move. These high frequencies are conspicuously absent in heavy rock and rap music, and are found in music by Baroque composers, or in Gregorian chant. We use psychoacoustically engineered classical music, in a program designed to help your ear and the brain learn to work together to process sound input.

You listen to beautiful music for 15-30 minutes per day, 5 days per week, and over a period of about 20 weeks you will be astounded at the improvement in both your hearing and your listening ability.

Audio/Visual Entrainment (AVE)

This is another powerful training tool for enhancing brain function. BrainAdvantage™ uses a dual system with both light and sound to bring the mind gently to a relaxed, calm alpha state, similar to the state often achieved only after years and years of meditation.

AVE also incorporates the technique of heart rate variability to achieve long, graceful breathing cycles. This breathing technique has also been a traditional part of classic meditation.

Scientifically, heart rate variability has been shown to calm a stressed autonomic nervous system. Both sympathetic (flight-or-fight) activity and para-sympathetic (the brain's efforts to compensate) activity settle down dramatically using heart rate variability techniques.

We use AVE any time there is hyperactivity or anxiety and agitation, to help restore the brain to a calm meditative and focused state. About the only time that AVE is not appropriate is in the case of flickering-light-induced seizures. About 1 in 10,000 adults and perhaps 1 in 4,000 children are sensitive to light-induced seizures, most particularly to light pulses presented in the form of a square wave, with rapid rise and fall of intensity. Red light is particularly good at generating seizure activity.

For this reason, the light pulses used in our AVE equipment are in the form of sine waves, with a slow rise and fall, rather than in the less expensive and easier to generate square waves with rapid rise and fall. We use white light.

AVE has been used – and studies show its effectiveness – in conditions of AD/HD, PMS, SAD, migraine headache, chronic pain, anxiety, depression and hypertension.

Rhythm and balance, motor planning and sequencing

Motor planning and sequencing are crucial to everyday life – climbing stairs, getting out of bed, ordering words in a sentence to provide meaning. Restoring rhythm and balance will help anyone with any central auditory or visual processing disorder, because if the body does have rhythm, then neither does the brain. Nerve impulses cannot get from where they start to where they are supposed to go in the correct sequence and timing, and everything which depends on timing functions poorly – physical activity, listening to directions and following them, coordinating the hand and the eye… all activities which require accurate sequencing.

Our computer-assisted exercises help restore the functions of rhythm and balance to the body, by increasing internal processing speed within the nervous system. Without rhythm, our brains have no idea in what order and with what speed to process information. Everything comes in with the same importance, and therefore nothing stands out as worthy of focus.

Using our training system, our patients synchronize a variety of hand and foot movements to a computer-generated tone heard through headphones. Immediate feedback is provided, so that the patients know how well they were able to focus and filter out distractions.

How well do your eyes see what they are looking at?

Convergence and tracking can both be significant issues for children whose eyes do not cooperate in these tasks. If we cannot use both eyes to see and object, and cannot follow a line of text without skipping two or three lines down (or up) the page, then reading will always be a tremendous chore, and the child may well be diagnosed with AD/HD simply on the basis of being unable to read and unwilling to sit around not reading. Typically these children listen pretty well, but become antsy and poorly attentive when asked to read aloud themselves. Vision therapy can be extremely effective. We screen for these difficulties. Some convergence and tracking problems can be treated during the sessions in our office, with additional sessions accomplished at home. Some may require referral to a developmental optometrist.

How well do you think? How good is your judgment? Your memory?

Children with AD/HD frequently have very poor blood supply to the frontal lobes. They often do not develop the neural nets necessary to learn the cognitive skills they are required to have in school. And as we get older, we also seem to have less blood going to the frontal lobes. Our BrainAdvantage™ program with HEG neurofeedback directs more oxygen to those areas of the brain, resulting in building of more neural connections. Using these neural connections, our cognitive training then gives us the skills which allow us to learn new material. As these skills are learned and newly developed pathways are exercised, we develop more neural nets in our brains, making it easier to recall information.

But why do we lose function as we get older? Why do we have more trouble remembering things as we go into middle age even though we use our brains every day?
• Stress is a huge factor. The more stress, the more cortisol in the system, and the less we are able to remember anything other than the immediate stressful issue. What we had for dinner last night does not generally come very high on the list. Unfortunately, where we put the car keys, or the name of the latest plumber, whom we really liked, doesn't generally come to the top of the list either.
• Poor food choices are another factor. The standard American diet provides lots of sugar, which gives us tremendous highs and lows of blood sugar, resulting in intermittent low brain sugar and less energy to remember anything.
• Poor sleep patterns – without sleep we gain weight, we are always fatigued, and our ability to remember is significantly diminished.
• Simple lack of brain exercise is another factor. If we do the "same old, same old" in our jobs every day, we are on autopilot, not using those parts of the brain which require planning or decision-making. The Chinese have their older people play chess, because they find that the game exercises the frontal lobes of the brain.

Many different pieces of software have been developed which purport to do cognitive training. Many things are available over the Internet which say they do exactly that. Many of these devices use computer games and other things which exercise the visual system – that part of the brain which is already extremely well exercised in most children, since they play computer games all the time.

BrainWare SafariWhat makes BrainAdvantage™ different?

The softwarewe use exercises the auditory system as well as the visual system, using fun activities that you will enjoy doing. The system allows us to track your scores and monitor improvement over time – whether you use it at home or in the office. So you know whether the program is working or not – no guesswork involved. We even have really fun software for use with younger children, so that they can also benefit from the training, even though their exercises are on a different level of difficulty.

How do you know if you are getting results?

We track progress with objective measurements which can be shared with your doctor, your teachers, your school.

When neurofeedback is not working…

Neurofeedback is generally very successful at retraining the brain. However, according to Siegfried Othmer of EEG Research, when neurofeedback is less than very successful, the reasons tend to fall into the following set of categories of physical or metabolic dysfunction:
• Allergic reactions cause the effect of neurofeedback training to be highly variable, and to fluctuate with the severity of the allergic challenge.
• Food intolerances present a physiological challenge to the patient that we cannot fully overcome with neurofeedback.
• Dietary insufficiencies don't allow the full benefit of neurofeedback training to be felt. For example, deficiency of Vitamin B12 or Vitamin D are both well known to cause memory impairment. Simple replacement of B12 will improve the memory, and allow training to be fully effective.
• Digestive malabsorption impinges negatively on function, including in particular brain function.
• Heavy metal toxicities or excesses in certain minerals frustrate our efforts because metal are neurotoxins, plug up the body's metabolic processes, and can create "brain fog." because the brain cells cannot produce enough energy to function at full capacity.
• Irlen Syndrome, and other disturbances in visual processing, limit our gains.
• Primary auditory processing disorder can tax the brain.
• Deficits in blood glucose regulation (dysglycemia) impinge directly on brain function.
• Poor sleep or poor sleep hygiene is detrimental to learning of the process and the consolidation of gains.
• Degenerative conditions prevail, especially among the elderly, leading to fading of the neurofeedback gains on some time scale after the sessions.
• Structural injury in the brain limits what can be accomplished in the training. This is an obvious one that we usually know about in advance: stroke injury; brain tumor; arteriovenous malformations; hydrocephalus; history of meningitis, etc.
• Cerebral under-perfusion. This may result from the use of anti-hypertensive medications in the elderly, leading to compromised brain function.
• Environmental factors within the home or school that limit success: emotionally unsettled or even a traumatizing home environment; being subjected to bullying behavior at school, etc.

Bringing It All Together

For those with short-term memory loss, increasing the blood supply to the frontal lobes can make a world of difference.

In addition, it is crucial to clean up the diet and remove the body's burden of toxins from our systems, in order to have maximal improvement. Some people will need to undergo heavy metal detox to increase their mental capacities. It is very difficult for anyone to avoid exposure to any of the many harmful heavy metals that are so prevalent in our environment. Heavy metals toxicity often leads to short term memory loss, mood swings, irritability, and mental confusion. Getting the metals to leave the body is a process that usually requires professional help to clear the bowel, manage parasites, and protect the organs.

For those with ADHD, there is often a gut issue that can create environmental allergies and a need for a gluten-free diet. The Arizona Center for Advanced Medicine is one of the few clinics in the United States that can produce custom formulated, preservative-free allergy remedies, in addition to helping formulate a nutritional program that is tolerable, easy to learn and does not force you to spend your life in the kitchen.

The Arizona Center for Advanced Medicine is the only medical clinic in the United States that offers BrainAdvantage™ – plus the ability for a full diagnostic workup for a truly integrative, holistic approach.


Resources

http://www.brainadvantage.net

http://www.isnr.org

http://www.biocompresearch.org/articles.htm

http://sica.stanford.edu/cast/rhythm/files/Siever-Overview-AVE.pdf

http://www.soundtherapyinternational.com

http://arksped.k12.ar.us/documents/policy/rulesandregulations/Section5.pdf - Guidelines for Determining a Central Auditory Processing Disorder

http://irlen.com/distortioneffects.php - Examples of the distortions which may be experienced by individuals with Irlen syndrome

http://www.asha.org/docs/pdf/TR2005-00043.pdf - The American Speech-Language Hearing Association

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