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Bio/Neurofeedback Equipment in SA Context

Frequently asked questions

Which equipment should I purchase?


It is important to gain a basic understanding of the field and the various applications of its clinical applications. Please educate yourself on the modalities of Biofeedback and its uses (see recommended reading) as well as about Neurofeedback. Each clinician will have a field of interest that will provide guidance as to which equipment will work best for your needs and practice. Visit and discuss options with clinicians in the field.




Are there any legal requirements?


It is advisable to utilize equipment that, if imported, is approved by the relevant authority. Equipment imported from America should be approved by the FDA and equipment imported from Europe should have CE conformity approval.

Ensure that the equipment and device you select will be sufficient for your requirements.

For example, if you intend to perform pelvic floor biofeedback with women suffering from urinary incontinence, it will not be necessary to purchase a multi-channel system capable of recording EEG.

If you only want to assist clients with one major group of disorders, such as stress-related breathing problems, for which you would like to use only a few biofeedback techniques, like heart rate variability and respiration, you will only need equipment with two channels that can record heart rate and respiration. You will not need to purchase complex software or hardware with additional capabilities. However, you should be certain that this is all you will require as two channels are insufficient to perform a stress profile and for many other types of bio-/neurofeedback training.

Also, the device you choose should be able to record the signals required simultaneously. Some systems can record the signals needed but not simultaneously. If possible, purchase equipment with additional capabilities to have the option of adding modalities to your repertoire at a later stage.




What are sensors?


Sensors are the leads and signal transformers that connect the amplifier to the client. Different types of sensors are specialized for specific signals. The cost of each sensor can increase the cost of a system significantly. Ensure that you know exactly which sensors are required for the tasks you want to perform in bio-/neurofeedback. Purchase only the necessary sensors and be sure that the software of the device can support the sensors you choose. For example, if you want to record respiration patterns from the chest and abdomen simultaneously for breathing assessments relative to stress, be certain that your software and hardware can record and display these measures simultaneously.




Accessories and consumables


Many small items are required for bio-/neurofeedback training sessions. These include disposable pre-gelled SEMG sensor pads, breathable tape used to attach temperature leads, conductive gel for reducing impedance, and adhesive removal pads. Most of these can be purchased from local companies. Obtain quotes from more than one company once you are sure of your requirements. You will get what you pay for so do not trade quality for cost savings.




Do you need a specific computer to run bio-/neurofeedback software?


Most modern bio-/neurofeedback devices will run on any new laptop or desktop. Some practitioners prefer to display the feedback to the client on a separate screen. Most manufacturers of good quality bio-/neurofeedback devices provide the computer specifications needed to run the device. Please check the specs required for the computer needed for specific programmes you want to use. Some programmes require a high-level graphics card and sufficient RAM. If a company insists on you purchasing a computer supplied by the company, ensure that you understand the reason for this. If software cannot be easily installed on a generic computer, be sure that you are informed about the extra costs for repair and technical support before the purchase.




Device portability and durability


Bio-/neurofeedback devices are mostly used in clinicians’ offices or clinics and occasionally transported to other locations. Almost all current bio-/neurofeedback devices can run on modern laptops which ensure portability. Many of the sensors are fragile and do not perform well while recording rapidly moving subjects, such as runners. If you intend to use the device for active sports applications, it is advisable to explore a system that transmits data from the sensor to the bio-/neurofeedback device and then from the device to a computer via a non-wired telemetry system.




Ease of software use


It is important to try out the software for the device before purchase. Some devices require considerable time to learn while others are easier to operate. However, there may be a significant trade-off between ease of use and flexibility. Many practitioners prefer to be able to alter the feedback display screens to accommodate their needs. And some bio-/neurofeedback systems do not have this capability.

Some standalone devices do not display feedback screens that are useful to the clinician or the client. Ensure that the device you choose has the capabilities that meet your requirements.




Other considerations


  • Is training necessary, accessible, and affordable?
  • Do you have the appropriate professional training and accreditation for use of the device?
  • Is there a good tutorial with “live” examples built into the software?
  • Is there adequate technical support available at an affordable cost?
  • Are the warranty, service, and repair specifications adequate for my needs?




Where do I start in making decisions about equipment?


Biofeedback devices (including devices which measure muscle stress or tension, breathing or brain waves, etc.) are actually a combination of highly sophisticated physiological recording equipment and audio and visual teaching display systems. In order to use the equipment and to help to decide which equipment to purchase, you will benefit by having some basic skills in biofeedback techniques, physiology, and biofeedback instrumentation. It is advisable to visit a BCIA certified clinician registered with the HPCSA to experience the functionality of different types of various equipment in order to make an informed decision.




Should I Purchase equipment that focuses only on Neurofeedback or should it have the ability to combine Bio and Neurofeedback?


Do you want to have access to measurements of the autonomic nervous system - monitor body’s stress responses via breathing / heart rate changes / muscle tension patterns / peripheral temperature changes due to stress response or changes in Heart Rate Variability? Then consider equipment that can measure Biofeedback signals in real time.

If your focus is more on the Central Nervous system and the EEG then equipment needs to be able to monitor one / two / 19 - channels of EEG in real time to do an assessment and provide different training options





What’s out there – how to pick the optimal device for your needs:

 

There are many devices available.

See www.AAPB.org or www.BCIA.org for guidance or speak to a certified SA clinician for guidance.

 

AAPB surveys the major manufacturers of biofeedback equipment every few years. They provide descriptive information about each of the devices. Manufacturers can update the information at any time by contacting AAPB. They ask questions such as:

  • how many channels does each device have

  • what it is used for

  • which physiological signals can it measure etc.

 

Current information is dependent on the frequency of information updates by the manufacturer.

Regulation of Biofeedback Devices: 

Clinical biofeedback devices are regulated by the US Government’s Food and Drug Administration (FDA) and in SA such devices need to approved by the SA Department of Health (EC Declaration of Conformity by the manufacturer in terms of EC Directive 93/42/EEC or 90/385/EEC).

 

You should not use any biofeedback device for clinical applications that is not labelled as safe and effective by the FDA unless you are using it for approved research. Look at research papers in the field to identify the superior quality manufacturers of equipment that have effective sampling of signals capacity to meet the stringent research markers.

 

Each device approved by the FDA has a “label” stating those uses that the FDA is of the opinion   have been sufficiently well demonstrated to be efficacious.

You must inform your clients in writing if you use the device off label, in other words for a purpose other than uses listed by the FDA.

For a more complete discussion of FDA considerations including who can prescribe the use of biofeedback devices, please see the discussion at  “Food and Drug Administration (FDA) Biofeedback Equipment Labeling and Approval Issues” – aapb.org

How to Distinguish between Legitimate Biofeedback/Neurofeedback Devices (January 2009 Report – BCIA)

The market of therapeutic biofeedback devices has become flooded with a number of machines purporting to be biofeedback machines when, in fact, they either operate on different principles or otherwise provide an unconventional form of “feedback” to the individual.

This document is meant to offer distinctions from a laboratory research perspective.

Traditionally, biofeedback machines make use of any of a number of sensors that can quantify specific physiological parameters in the body, such as heart rate, blood pressure, skin temperature, muscle tension, sweat gland activity…, etc. Neurofeedback is similar in that it employs electrodes attached with a conducting gel to certain areas of the scalp to monitor EEG (brainwave) patterns. These quantifiable parameters are all indicative of the unconscious state of the autonomic nervous system (for biofeedback) or of brain function (for neurofeedback). The devices typically utilize blinking lights, audible tones or computer software images that alert the individual to their state of being, bringing it into their conscious mind, and providing them with a means to gain control over these otherwise unconscious bodily or cognitive functions. Sensors for biofeedback include: galvanic skin response (skin voltage is very sensitive to moisture levels from sweat glands), thermistors (to measure skin temperature), photoplethysmography (or PPG’s for measuring peripheral blood flow and heart rate), electromyographs (for measuring muscle tension) and others. Wikipedia and other online sources provide ample examples.

Biofeedback has enjoyed great success in training numerous conditions including those related to muscle tension (temporomandibular-joint disorder, back pain, tension headaches/migraines, tendonitis, incontinence), plus anxiety, hypertension, epilepsy, some chronic pain conditions, certain breathing disorders, some types of cardiac arrhythmias, and substance abuse.

Neurofeedback can also address a number of these but is more commonly used to address learning and psychological disorders such as ADHD, obsessive-compulsive disorder, and depression, to name just a few.

Equipment currently used by Clinicians in SA and contact details of representatives:

Bio and Neurofeedback capabilities combined in unit:

  • Thought Technology -  

  • Brain Master  

  • Nexus 

Neurofeedback training units:

  • Brain Master (single channel/4 channel /19 channel training/Zscore/ISF/S-Loreta)

  • Thought Technology (single channel / 2 channel training /Zscore training)

  • Mitsar (for EEG acquisition) in combination with Neuroguide  

  • Nexus

  • EEG Spectrum  

Heart rate Variability training equipment:

19 Channel EEG Assessment capability:

  • Mitsar (for EEG acquisition) in combination with Neuroguide database

  • Brain Master Discovery Unit

PhotoBioModulation:

  • Vielight (Photo Bio Modulation)  

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Thought Technology provides equipment for the full range of biofeedback. They also offer Neurofeedback training – specifically power training and z-score training. TT offers equipment with various capabilities. Please ensure you are aware of what the device you purchase is capable of providing.

Contact Johan Meyer: drjohan@adhdsolutions.co.za

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EEGER specializes in Neurofeedback and provides various types of power and coherence training.

Contact Mitzi Hollander: mitzi@addlab.co.za

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BrainMaster specializes in Neurofeedback and QEEG’s. Their Atlantis device can provide up to 4 channel power, ISF and z score training. The Discovery Device is capable of power training, up to 19 channel z-score training, coherence training, ISF training,  s-Loreta training with ROI training, as well as EEG acquisition for usage with databases giving QEEG results.

Contact McGill Scott:

mcgill@brainwaves.co.za  

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Nexus also specializes in neurofeedback and is capable of power training, up to 19 channel, z-score training, coherence training, s-Loreta training with ROI training, as well as EEG acquisition for usage with databases giving QEEG results which are used for Neurofeedback training.

No South African Provider

 

Contact:

NeXus for Neurofeedback - Mind Media

Mitsar specializes in EEG acquisition which, in conjunction with the Neuroguide database, can provide QEEG data used for training Neurofeedback.

No South African Provider

 

Contact:

https://mitsar-eeg.com/contact/