Fakulti Sains Kognitif dan Pembangunan Manusia speech assistive tools for... · menyanyi bersama sambil menonton beberapa video berbentuk nyanyian, dan berrnain permainan tindakbalas

Fakulti Sains Kognitif dan Pembangunan Manusia

DEVELOPING SPEECH ASSISTIVE TOOLS FOR NEUROFEEDBACK TRAINING

Osvera Bella William

RJ 496 S7

Bachelor of Science with Honours (Cognitive Science) 2015

W719 2015

____ __ UNIVERSITI MALAYSIA SARAWAK

Grade: __~;1 Please tick one

Final Year Project Report ~

Masters 0 PhD 0

DECLARATION OF ORIGINAL WORK

This declaration is made on the 15 day of JUNE year 2015.

Student's Declaration:

I, OSVERA BELLA WILLIAM, 39945, FACULTY OF COGNITIVE SCIENCES AND HUMAN

DEVELOPMENT, hereby declare that the work entitled, DEVELOPING SPEECH ASSISTIVE TOOLS

FOR NEUROFEEDBACK TRAINING is my original work. I have not copied from any other students' work or from any other sources with the exception where due reference or acknowledgement is made explicitly in the text, nor has any part of the work been written for me by another person.

15TH JUNE 2015

Date Submitted Osvera Bella William (39945)

Supervisor's Declaration:

I, ASSOCIATE PROFESSOR DR. NURSIAH BTE FAUZAN , hereby certify that the work entitled, DEVELOPING SPEECH ASSISTIVE TOOLS FOR NEUROFEEDBACK TRAINING was prepared by the aforementioned or above mentioned student, and was submitted to the "FACULTY" as a *partiallfull fulfillment for the conferment of BACHELOR OF SCIENCE WITH HONOURS (COGNITIVE SCIENCE), and the aforementioned work, to the best of my knowledge, is the said student's work

15TH JUNE 2015 Received for examination by: Date: ___________

ESSORDR. NURSIAH BTE FAUZAN)

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I

I

Pusat Khidrnat Maklumat AkademH' UNlVERSm MALAYSIA SARAW-\J<

DEVELOPING SPEECH ASISSTIVE TOOLS FOR NEUROFEEDBACK TRAINING

OSVERA BELLA WILLIAM

This project is submitted in partial fulfilment of the requirements for a

Bachelor of Science with Honours (Cognitive Science)

Faculty of Cognitive Sciences and Human Development UNIVERSITY MALAYSIA SARAWAK

(2015)

Pusat Khidmat Maklumat Akademik UNIVERSm MALAYSIA SARAVtAJ<

DEVELOPING SPEECH ASISSTIVE TOOLS FOR NEUROFEEDBACK TRAINING

OSVERA BELLA WILLIAM

This project is submitted in partial fulfilment of the requirements for a

Bachelor of Science with Honours (Cognitive Science)

Faculty of Cognitive Sciences and Human Development UNIVERSITY MALAYSIA -SARAWAK

(2015)

The project entitled 'Developing speech assistive tools for neurofeedback training' was prepared by Osvera Bella William and submitted to the Faculty of Cognitive Sciences and Human Development in partial fulfillment of the requirements for a Bachelor of Science with Honours (Cognitive Sciences)

Received for examination by:

~ (ASSOCIATE PROFESSOR DR~;:;-~5-;:~;;~)

Date: 15 JUNE 2015

Grade

A

11

ACKNOWLEDGMENTS

Firstly, I thank God for bringing this work to completion. I thank Him for giving me

the strength when I needed the most, courage when I thought that I could not go further

anymore, and knowledge when I lacked of confidence in my making decision. I am grateful to

Him for giving me the opportunity to study and work with my friends and lecturers who gives

me all kind of ideas and support me in finishing my thesis successfully.

To my supervisor, Associate Prof. Dr. Nursiah Fauzan, thank you for your guidance

for two semesters long and I appreciate your time, and effort that you have devoted in me

throughout this process. Thank you also for believing in me and for encouraging me

throughout this journey even though I always said that I do not have the confidence to

continue the research but you were there to support me and push me to my limits.

To my family especially to my parents, thank you for your unfailing love and support

to me. I would not have the urged to finish what I have started earlier. To my sisters and

brothers, thank you for your support and your understanding when I needed your help the

most. To my friend Fiqa, thank you for your loves and cares as my close friend, you always

there when I need your help, thank you for being such an understanding friend and mostly all

your encouragement when I felt down. My research partner Farhan, thank you for your

helped, kindness, patients and brilliant ideas when I am totally felt confused and completely

lost. And lastly, to all my friends and my relatives, thank you for all your endless help and

support in me. I greatly blessed to have you all in my life. God bless.

III

P~at Khidmat MakJumat Akademik flVERSm MALAYSIA SARAWA

TABLE OF CONTENTS

ACKNOWLEDGEMENTS ...................................................................................................... iii

LIST OF FIGURES ................................... ................................................................................. v

LIST OF TABLES .................................................................................................................... vi

ABSTRACT ............................................................................................................................. vii

ABSTRAK ................... ......................................... .. .................................................. .............. viii

CHAPTER ONE INTRODUCTION ....................... ................. .......... .. ..................................... 1

CHAPTER TWO LITERATURE REVIEW ............................................................................. 5

CHAPTER THREE METHOD................................................................................................ 17

CHAPTER FOUR RESULTS ..................................... .. ......... .............. .................................... 23

CHAPTER FIVE DISCUSSION .. .. ................................................. .. ...................................... 36

REFERENCES ........ .......... .................................................................................. ..................... 42

APPENDIX A INFORM CONSENT LETTER ...................................................... ........ ........ 46

APPENDIX B NEUROFEEDBACK RESULT TEST ............................................................ 48

IV

LIST OF FIGURES

Figure I Delta wave (0.1 to 3 Hz) ............................................................................................ 13

Figure 13 A numbers song to the ten little tunes designed to help children learn the names and

Figure 14 Participants' A Neurofeedback Training (NFT) result based on collected

Figure 15 Participants' B Neurofeedback Training (NFT) result based on collected

Figure I Theta wave(4-8 Hz)...... ....................... ........................................... ........................ 14

Figure 3 Alpha wave (8 - 12 Hz) ... ........... .. ................. ...... .... ............. .. .. ............. ......... .. ..... .... 15

Figure 4 Beta wave (above 12 Hz) .......................... ...................................... ....................... .... 16

Figure 5 Self-made Video Speech Toolkits for One Syllable in Bahasa Melayu ..... ... .......... .. 23

Figure 6 Self-made Video Speech Toolkits for Two Syllables in Bahasa Melayu ... ..... ......... 24

Figure 7 Self-made Video Speech Toolkits for Three Syllables in Bahasa Melayu ....... ...... ... 25

Figure 8 Five Little Ducks the traditional nursery rhyme .. ............................... ... ............ ........ 27

Figure 9 A song for children about some of the animals that you can see at the zoo ..... ........ 28

Figure 10 BINGO Song......... ...... .................. ......................... .. ........... ............ .. .... ...... ...... .... ... 29

Figure II A Phonics song to help children learn the letter sounds .... .................... .................. 30

Figure 12 A Shapes song for children ................................ ..... .. ..... ...... ........... .. .... ............ ...... . 31

the spelling of numbers ....... ........ ........ .................. ........................ ................ .. ....... ....... ........... 32

Electroencephalogram (EEG) data ... ......... ................. ... ...... .. .......... ... ......... ........ .. ....... ....... .. .. . 33

Electroencephalogram (EEG) data .................. ........ ......... .. ..... .. ........ ................ .................. ..... 34

v

LIST OF TABLES

Table 1 Procedures for Neurofeedback Training using Video Speech Toolkit ..... ........ .. ........ 20

Vl

ABSTRACT

Speech assistive tools are devices that help to enhanced children who are having a speech

delay problem. In this research, we developed a video speech toolkit that could help to

enhance the children speech. This study aims to determine the effectiveness of the speech

assistive tools in enhancing speech delay. The purpose of this study is to prove that there is

improvement in participant's speech after they undergoes several neurofeedback training

using the video speech toolkit. During training, participants were asking to watch and learn

according to the video speech toolkit, sing along while watch several video songs, and play

the neurofeedback games to train their relaxation during play. Both participants shows an

immense improvement in their speech and also changes in their behaviour during the

neurofeedback training. Both participants were also able to focus and give full attention

during the training which can be seen on their Electroencephalogram (EEG) neurofeedback

result.

Keywords: speech assistive tools, speech delay, video speech toolkit, neurofeedback training,

electroencephalogram (EEG)

Vll

ABSTRAK

"Speech assistive tools" merupakan salah satu alat yang dapat membantu menyelesaikan

sekaligus memperbaiki masalah pertuturan dalam kalangan kanak-kanak. Dalam kajian ini,

kami telah menyediakan satu video khas untuk kanak-kanak yang mempunyai masalah dalam

menghasilkan sesuatu pengucapan sebagai medium bagi memudahkan kanak-kanak tersebut

dapat menzahirkan pertuturan. Kajian ini dilaksanakan bertujuan mengkaji sejauh mana

keberkesanan sesuatu medium penghasilan pengucapan itu mampu memperbaiki masalah

dalam menzahirkan bahasa atau komunikasi dalam kalangan kanak-kanak. Selain itu, objektif

kajian ini juga untuk membuktikan bahawa terdapat penambahbaikkan dalam pertuturan pada

mereka yang mengalami masalah ini setelah menjalankan beberapa latihan tindak balas neuro

melalui kaedah video pertuturan ini. Sepanjang kajian ini dijalankan, subjek diminta untuk

menonton dan belajar menyebut sesuatu perkataan tersebut melalui video yang disediakan,

menyanyi bersama sambil menonton beberapa video berbentuk nyanyian, dan berrnain

permainan tindakbalas neuro bagi melatih ketenangan mereka ketika sedang berrnain. Hasil

kajian ini menunjukkan kedua-dua subjek memberikan keputusan yang positif dimana

terdapat penambahbaikkan dalam pertuturan dan juga terdapat perubahan pada tingkah laku

mereka setelah menjalankan latihan tindakbalas neuro ini. Tambahan itu, kedua-dua subjek

juga dapat memberikan tumpuan dan memberikan sepenuh perhatian sepanjang kaedah ini

dijalankan dimana dapat dilihat melalui output yang dihasilkan dan diinterpretasikan pada

Electroenpephalogram (EEG).

V III

CHAPTER ONE

INTRODUCTION

This study focuses on developing a speech assistive tool for neurofeedback training to

help children with speech disorder. Speech disorder also known as speech delay is the most

prevalent developmentally disabling disorder affecting children (Macias & Wegner, 2005).

Children with speech delays assumed by Macias & Wegner (2005) as 'late talkers' but soon

will catch up their language ability a bit later and it is not long-lasting. Around 30% of all

parents are concerned about their child speech and language skills when asked by their child's

physician despite the fact that their chi lid were naturally acquire normal language

understanding and expression (Macias & Wegner, 2005).

Early identification and management of this disorder is to minimize or eliminate the

social and educational problems that arise (Macias & Wegner, 2005). A long-term study

revealed by Macias & Wegner (2005) stated that 42.5% of young children whose early

language delays showed improvement in their speech. According to Macias & Wegner (2005)

also indicate that current prevalence estimates of speech and language delay in preschool

children range from 7 to 10% with significantly higher proportion of boys being affected.

One of the medium used to help in stimulating speech are Assistive Technology

(Proen~a, Quaresma, & Vieira, 2014). Producing an assistive tool for children with speech

disabilities is not necessarily the same as the one that built for the general public (Proen~a et

aI., 201 4). Journal of School Health article (as cited in Proen~a et aI., 2014) described that the

assistive tool should contribute in five keys areas which are generalizing, sequential skill

building, and control over the environment, continuous and efficient feedback and

multisensory approach to learning.

1

Brewer claimed (as cited in Isaila & Nicolau, 2010) that the existing of the Braille

display, the Braille keyboard, the electronic magnifiers and screen readers are people with

disabilities. Therefore a special category of assistive technology software were developed

based on general applications that seems useful and responsible in providing accessed to

computing and communication to several categories of users with difference disabilities

(Isaila & Nicolau, 2010). For this reason, there were two categories were included which are

voice recognition that function to allowed an automatic conversion of words given in the text,

and the vocal synthesis which together with screen reader is a way of interaction that offered a

countless of better information per time unit (Isaila & Nicolau, 2010).

PROBLEM STATEMENT

There are two problem statements found in this case study. The first one is an existing

speech assistive tools are developed for normal circumstances but not much are developed for

children with speech delay (Alper & Raharinirina, 2006) in which the development are

different from one another (Proenrya et aI., 2014).

Another problem statement found in this case study is almost every existing tool are

based on the western culture instead of local culture that consisted of our own language,

choice of words, and pronunciations (Moharir, Barnett, Taras, Cole, Ford-Jones, & Levin,

2014).

OBJECTIVES OF STUDY

The purpose of this study was to determine the effectiveness of implementing speech

assistive tools in enhancing speech among children with speech delay. Second objective is to

examine the improvement in children ability to enhance their speech after undergoing several

neurofeedback trainings with the help of speech assistive tools.

2

DEFINITION OF TERMS

Speecb Delay

Speech delay refer to problems in communication and related areas such as oral motor

function and it range from simple sound substitutions to the inability to understand or use

language or use the oral-motor mechanism for functional speech and feeding (Speech &

Language Impairments, 2004).

Assistive Tools

Any items, piece of equipment, or product system, whether acquired commercially,

modified or customized, that is used to increase, maintain, or improve functional capabilities

of individuals with disabilities (Alper & Raharinirina, 2006).

Neurofeedback Training

Neurofeedback training is a type of biofeedback that allows the individual to train and

influence brainwave patterns of the patients (McCulloch, 2011). It involves encouraging

desirable brain activity and inhibiting undesirable brain activity in patient's brain (Margetson,

2010).

Electroencephalogram (EEG)

According to Nunez study (as cited in Kaiser, 2005) EEG is a chaotic signal comprise

ofnon-periodic (spikes, 'random noise'), non-sinusoidal and periodic (mu), or sinusoidal and

periodic (alpha, delta) signals. EEG determines the electrical changes in our brain that

represent as spikes, transients, or seemingly random events and rhythms (Kaiser, 2006).

SIGNIFICANCE OF STUDY

This research will contribute in giving references to the area of special needs

education and specifically for speech disabilities children. It will also provide the parents with

3

a simpler and home based speech tool kits that will fill the gaps of the lack in speech

therapist. This research also will help to treat the children with speech disability using

appropriate assistive tools and also support into improving the awareness on the use of speech

tool kits with visual and auditory stimulus in stimulating speech production and phonology.

Apart from that, hopefully this research will also help those children whose suffers different

type ofdisorders and recognize this type of treatment as a new way to treat the disorders.

SCOPE OF STUDY

The scope of study in this research focused on two children diagnosed with speech

delay problem as our volunteered participants with the consent from their parents.

4

r

P~sat Khidmat MakJumat Akadem;t­lJNJVERsm M,-\LAYSIA SARAW ,.

CHAPTER TWO

LITERATURE REVIEW

Speech and Language

Speech and language is a two difference basic understanding which Trevino-

Zimmerman (2006) explained that speech is the ability towards emitting a speech sound while

language is the cognitive system which allow a person to understand the language system.

According to NIDCD Fact Sheet: Speech and Language Development Milestones (2010),

speech refer to as talking which is one way to express language and it involve coordinated

muscle actions of the tongue, lips,jaw, and vocal tract to produce the recognizable sounds

that make up language.

Macias & Wegner (2005) explain that speech produced a complex acoustic signal that

conveyed a meaning and is the result of interactions involving the respiratory, laryngeal, and

oral structure. This acoustic signal according to Macias &Wegner (2005) differs with regard

to vocal pitch, intonation, and voice quality of a person. Macias & Wegner (2005) further

explained that language implied both expressive and receptive components where expressive

language involved the interaction between ideas, intentions and also emotions. In contrast,

receptive language have to with the interpretation and understanding what is said by someone

else which include the auditory comprehension (listening), literate decoding (reading), and

gain control of visual signing (Macias & Wegner, 2005).

Speech and Language Disability

A speech disorder based on Macias & Wegner (2005) described that it indicates the

difficulty in creating a proper sounds that corresponds to the language symbols (the words),

and as for that reason, communication is impaired. Several problems in speech disorder

5

include speech fluency disorder (stuttering), voice disorders, and articulation disorders but

then again speech disorder mayor may not also involve the weaknesses in expressive

language (Macias & Wegner, 2005). Hence, speech disability or speech disorder is when a

children having trouble producing speech sounds correctly or who hesistate or stutter when

talking to another person (NIDCD Fact Sheet: Speech and Language Development

Milestones, 2010). Other term refer to speech disability is apraxia of speech that makes the

person having the difficulty to put sound and syllables together in the correct order to form

words (NIDCD Fact Sheet: Speech and Language Development Milestones, 20 I0).

Based on Westerlund's study (as cited in Selassie, 2010), around 15% of all children

are affected by speech and language delay where parents had to take their children to be

referred to a speech language pathologist. In Law }'s research (as cited in Selassie, 2010) also

stated that several studies had showed a gender ratio of two boys to one girl were affected.

Several previous studies by Fernell, Westerlund, Conti-Ramsden and Hesketh, Webster and

Shevell, Bruce, and Miniscalco's (as cited in Selassie, 2010) have shown that subtle sign of

neurodevelopmental dsyfunction often follow the speech and language impairment.

Futhermore, Gilbert and Miniscalco's research (as cited in Selassie, 2010) also stated that

language disorder often found in children with attention deficit hyperactivity disorder

(ADHD) and autism spectrum disorder (ASD). In Cohen's study (as cited in Selassie, 2010)

also stated that ADHD is the most common additional disorder present in language

impairment.

Moharir et al. (2014) stated that there are four types of speech disorders are addressed

by the tool which are voice disorders, motor speech disorders, articulation delays, and

dysfluency (stuttering). These four types of speech disorders are described in the next

paragraph.

6

Voice Disorders. Voice disorder is an atypical change in voice quaility like rough and

harsh sound and / or a harsh vibrating noise when breathing, which may indicate vocal-fold

pathology (eg. Nodules, paralysis) or a more complex disease process (Moharir et aI., 2014).

At this moment, Moharir et ai. (2014) suggest that the childs are not encourage to reduce his

or her vocal abuse and stress.

Motor Speech Disorders. Motor speech disorder also called as childhood apraxia of

speech (CAS) which the child has difficulty producing sounds, syllables or words (Childhood

Speech and Language Disorders, n.d.). Instead of not having muscle weakness that affects the

speech production, according to Childhood Speech and Language Disorders, (n.d) there is a

breakdown in the childrens' center of the brain that plans the muscle movements needed for

speech.

Another causes of motor speech disorder is dysarthria which characterized by poor

strength and mascular control causing poor intelligibility and a slower rate of speech, and may

involve compromised velopharyngeal function resulting in hyper or hyponasal speech

(Moharir et aI., 2014). Patient history may include feeding difficulty, drooling, open-mouthed

posture and tongue protrusion and the cause of these impairment is characterized by

inaccurate and inconsistent orofacial movements critical to the production of intelligible

speech (Moharir et aI., 2014).

Articulation Delays. Articulation delays by means is a poor speech intelligibility

characterized by omissions, substitutions or additions of individual sounds, or that the child

has not acquired target sound by the appropriate age (Moharir et aI., 2014). In the study by

Moharir et al. (2014) stated that these delays are appropriate for clinical identification if they

remain present in children approaching three years of age, but if it is not present after the age

then an articulation delay is present.

7

Dsyfluency. Dsyfluency or stuttering usually associated with tension, struggle, and

sudden repetitive, nonrhythmic motor movements (tics), impediments to the flow of speaking,

and irregular rate, rhythm and repetition of words (Moharir et aI., 2014). According to

Moharir et aI., (2014) dysfluency are typically normal development variants in children with

onset before three years of age, but should be identified for referral and monitored if there is

an impairing communication function or onset occurs after three years ofage.

Assistive Tools Used for Speech Disability

Assistive tools device based on Individual with Disabilities Education Act (as cited in

Hasselbring & Bausch, 2005) describes it as any items, piece of equipment, or product system

that used to increase, maintain, or improve functional capabilities of individuals with

disabilities. Other terms of assistive devices or assistive technology can refer to any device

that helps a person with hearing loss or a voice, speech, or language disorder to communicate

(Assistive Devices for People with Hearing, Voice, Speech, or Language Disorders, 2011).

Based on Hasselbring & Bausch (2005), assistive technology devices and services

form such high-tech innovations as computer screen and readers for people with visual

impairments to lower-tech products, such as head pointers or pencil grips; have aided learning

for many students with physical impairments. Previous study from the National Assistive

Technology Research Institute (NA TRI) had examined the use of assistive technology in 10

states in United State of America in 2005 and found that. assistive technologies are much

likely to be used by students in low-incidence special education categories such as autism,

hearing impairment, or visual impairment than by students with learning disabilities

(Hasselbring & Bausch, 2005).

Based on the Assistive Technology Act's finding stated that substantial progress has

been made in the development of assistive technology devices, including adaptations to

8

existing devices that facilitate activities of daily living, which gives benefit to individuals with

disabilities (Alper & Raharinirina, 2006). The main purpose of assistive technology paradigm

is to help the children with multiple disabilities in their play, to be a useful tool in the context

ofrehabilitation and to facilitate this process also at home (Proen9a et aI., 2014).

However, despite the increased attention and awareness of the potential Assistive

Technology to help individuals with disabilities; there still several barriers remain according

to Alper & Raharinirina (2006). First, Zhang's study (as cited in Alper & Raharinirina, 2006)

stated that accessible technologyis unavailable to many students with disabilities and their

family. Norman's observation (as cited in Alper & Raharinirina, 2006) explained that not all

groups have equal access, primarily due to limitied financial resources. Second, Wehmeyer's

explained (as cited in Alper & Raharinirina, 2006) the high costs of equipment and lack of

funding to access devices or services, and also lack of information regarding Assistive

Technology for families of individuals with disabilities. Third, a professional's that lack of

knowledge about the assistive technology (Alper & Raharinirina, 2006). Fourth, lack of

ongoing support can constitute (Alper & Raharinirina, 2006); and fifth, according to

Wehmeyer (as cited in Alper & Raharinirina , 2006) the eligibility issues are often important

obstacles, and have led to the underutilization of Assistive Technology by individuals with

disabilities.

Yamada, Javkin, & Y oudelman (2000), explained that there are fews features of a

number ofexisting speech training system in the United States and Japan and the majority of

speech aids are designed to assist in the training or remediation of speech production.

According to Yamada et aI., (2000), the most comprehensive system available in the US is

Kay Elemetrics's set of programs that designed as much as for research at it is for therapy.

Fletcher's explained (as cited in Yamada et aI., 2000) that it is include the sophisticated tools

9

for the measurement of the acoustics of speech. There a few number of existing speech

training that had been use as decribed below.

Speech Viewer III (IBM). The system did not use separate instruments and it

includes games that provide practice for children in speech such as pitch, amplitude, duration,

and voicing (Yamada et al., 2000). Any phoneme can be included on the basis of the training

by the therapist (Yamada et al., 2000).

Idioma (Granot). Based on Yamada et al., (2000), ldioma (Granot) system were

designed for training in the articulation of phonemes and phonemic contrasts. The system also

uses speech recognition which is speaker independent within gender and age categories,

utilizing a switch for a male, female or child's voice (Yamada et al., 2000).

Dr. Speech (Tiger Electronic / Laureate). Yamada et al., (2000) explained that

thissystem is a suite programs, which avalible separately and require a separate pre-amplifier.

Similar to mM system, the system can be trained with models by the therapist, with the result

that any phoneme can be trained can be included (Yamada et al., 2000).

VideoVoice (Micro Video). According to Yamada et al., (2000), this system provides

a games for pitch, amplitude, duration, voice-onset, and permits the training of models created

by the therapist to be matched by the client and it is one of the few systems available for both

Macintosh and pc.

Video Prism (Language Vision). Yamada et al., (2000) described this system is

designed for sophisticated users and therapists where the waveform and spectrographic data

are displayed using various colors that correspond to pre-set colors on a vowel chart.

10

Neurofeedback Training & Quantitative Electro Encephalogram (QEEG)

Neurofeedback also name biofeedback or neurotheraphy is a form of modification of

electrical brain activity which involve in encouraging the desirable brain activity and

inhibiting undesirable brain activity (Margetson, 20 I 0). Neurofeedback training were

described as a painless, non-invasive method which helps the patient to modify their

brainwave activity to improve attention and concentration, reduce impulsivity, and to control

hyperactive behaviors, essentially the technique trains the brain to regulate and adjust itself to

function more effectively (Margetson, 20 I 0). Neurofeedback aims to teach the brain to help

to improve its ability to manage bodily functions, and to self-regulate (Margetson, 20 I 0) by

make use of brain-computer interface to rebalance the brain and central nervous system

(McCulloch, 20 II). Margetson (20 I 0) study also stated that by challenging the brain same as

like challenging the body during exercise suggest that the brain can be trained to learn to

function more effectively.

Neurofeedback training consists of three stages which are the initial assessment

includes a quantitative electro encephalogram (qEEG) assessment, a clinical interview, and a

nnge of standard neurophysiological tests and questionnaires (Margetson, 2010). When in

early training. patient will showed an improvement in energy and mood with the development

ofa more positive outlook, thus this rapid improvement can be seen in as few as three or four

training sessions (McCulloch, 2011). Training session usually required patient to attend a

eeldy training for two or three sessions which last for about 30 minutes each, but to get a

lasting improvement in result; there should be at least twenty sessions to be attended

(McCulloch, 2011).

Based on Hammond (2011) study, during neurofeedback training there will be one or

more electrodes are placed on the scalp and one or two are usually put on the earlobes. The

11

electrodes will records electrical activity within the brain from 24 channels which gives us the

ability to view the dynamic changes throughout the brain during processing tasks and assists

us in determining which areas of the brain are fully engaged and processing inefficiently

(QEEG Brain Mapping: An Innovative Diagnostic Tool for Neurological and Behavioral

Disorders, n.d.).

The advantage of using neurofeedback training with patient is that they frequently

report feeling greater resilience and flexibility. McCulloch (2011) study shows that improved

resilience means that they may be upset by a disturbing event, the duration of the upset

feelings will be shorter or the feeling may be mild. Another study also stated by McCulloch

(2011) that improved mental flexibility means decreased tendency to feel stuck in old patterns

and openness to new ideas which gives the brain the ability to react to new situations more

readily and efficiently.

A quantitative electroencephalogram (QEEG) in other means as topographic EEG, or

brain electrical activity mapping (BEAM), is a visual of enhancement of a traditional surface

EEG (Quantitative Electroencephalogram (QEEG), 2006). The EEG data were transformed

into a pictorial mapping then placed on schematic map of the brain, and the activity data is

analysed by comparing to a database of normal patient brainwave activity to determine

possible underlying medical conditions (Quantitative Electroencephalogram (QEEG), 2006).

Electroencephalogram (EEG) is a physiological indicator of brain activity and is a

non-invasive recording of the activity of the brain at different locations on the outside surface

of the scalp (Margetson, 2010). Electroencephalogram (EEG) is useful in the evaluation

involving patient with several types of neurological disorder namely seizure, encephalopathy,

andfocal cerebral abnormalities (Quantitative Electroencephalogram (QEEG), 2006).

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