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Among the following, the finding that is most suggestive of intussusception is: A. Currant jelly stools B. Hematemesis C.

Normal temperature D. Stabbing subdiaphragmatic pain E. Tea-colored urine

Intussesception
Proximal portion of bowel invaginates into the distal portion, dragging the mesentery with it.
most common site is the junction of the ileum and colon

Only 20% of infants with classic triad


vomiting without diarrhea; colicky, intermittent abdominal pain; and hemepositive stool.

Incidence is seasonal Usually occurs before 24 months of age Air or barium enema initial treatment

Neurofeedback: A Brief Introduction


Elizabeth Doll, PGY2

Tum-mo Yoga

Benson et al, 1982

Definitions
Biofeedback: technique that involves use of scientific equipment to measure and relay information about physiological processes
Goal is to help patients become aware of their ability to control physiologic changes so they can continue to do so without the biofeedback equipment (Culbert et al, 1996)

Neurofeedback: specific field that uses electroencephalogram (EEG) to modulate patterns

Applications of Biofeedback

Culbert et al, 1996

Children are uniquely equipped for biofeedback, despite developmental challenges


Enthusiasm Quick learners Less skeptical More confidence in special abilities Enjoy practice sessions Fewer treatment failures More reliable at symptom monitoring
Culbert et al, 1996

Brain Waves Basics


From low to high frequency: Delta

Theta
Alpha Beta Gamma

Kraft, 2006

Sensorimotor rhythm (SMR)


12-15 Hz Located in sensorimotor cortex Studies with felines in 1960s (Kraft, 2006)
SMRs present in relaxed, awake state Strengthened with reward Monomethylhydrazine

Strengthened SMRs correlated with decreased seizures in human epileptics (Egner and Gruzelier, 2004)
Thalamic inhibitory mechanism

Attention-deficit Disorder
SMR
Theta

Children with ADHD have reduced levels of higher-frequency waves, especially in prefrontal cortex How do we train children to enhance the higher-frequency waves?

Video Games!
The planes motion reflects the childs brain signals

Negative (blue) deflection flies plane upward. Positive (red) deflection flies plane downward.
Kraft, 2006

Slow cortical potentials (SCPs)

Event-related shifts in the EEG


Negative depolarization = decreased excitatory potential

Originate from upper cortical layers 23 children with ADHD


30 total sessions, spanning ~18 weeks

After training, significant improvement in behavior, attention, and IQ score was observed
Stable changes at 6 months follow-up
Strehl et al, 2006

Functional MRI

ACC

Levesque et al, 2006

Two Two Two

Functional MRI

ACC

Levesque et al, 2006

Brain-Computer Interface

Breshears et al, 2011

References
Benson H, Lehmann JW, Malhotra MS, Goldman RF, Hopkins J, Epstein MD. Body temperature changes during the practice of g Tum-mo yoga. Nature. Jan 21 1982;295(5846):234-236. Breshears JD, Gaona CM, Roland JL, et al. Decoding motor signals from the pediatric cortex: implications for braincomputer interfaces in children. Pediatrics. Jul 2011;128(1):e160-168. Culbert TP, Kajander RL, Reaney JB. Biofeedback with children and adolescents: clinical observations and patient perspectives. Journal of developmental and behavioral pediatrics : JDBP. Oct 1996;17(5):342-350. Egner T, Gruzelier JH. EEG biofeedback of low beta band components: frequency-specific effects on variables of attention and event-related brain potentials. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. Jan 2004;115(1):131-139. Kraft U. Train your brain. Scientific American: Sci Am. June 2007; 17:76-81. Holtmann M, Steiner S, Hohmann S, Poustka L, Banaschewski T, Bolte S. Neurofeedback in autism spectrum disorders. Developmental medicine and child neurology. Nov 2011;53(11):986-993. Strehl U, Leins U, Goth G, Klinger C, Hinterberger T, Birbaumer N. Self-regulation of slow cortical potentials: a new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics. Nov 2006;118(5):e1530-1540. Strehl U, Trevorrow T, Veit R, et al. Deactivation of brain areas during self-regulation of slow cortical potentials in seizure patients. Applied psychophysiology and biofeedback. Mar 2006;31(1):85-94. Yucha C, Montgomery D. Evidence-based practice in biofeedback and neurofeedback. 2008 ed. Wheat Ridge, CO; 2008.

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