What other tools are used with neurofeedback training?

Many experienced clinicians add tools to their arsenal.  They combine these tools with neurofeedback training.  Sometimes they send them home with clients, sometimes they use them in the office, selectively by client. For clinicians new to neurofeedback, there's no reason to rush into these.  You've might want to gain a better sense for neurofeedback before adding in new tools.

All the tools listed below are being used by clinicians.  Each has their proponents.  Based on feedback from many clinicians, they all seem to help - though some are more appropriate for certain situations than others.  No one has really quantified if any one is better than another. Since all clients are different, they may respond differently to each too.

There's a clear clinical sense the combination often helps speed up the self-regulation (or brain-regulation) process, though it depends on the clinical problem.  Here's a brief discussion of some common options.

1. Hand Temperature Training.   Raising hand temperature has had a track record of success with migraines.  It's inexpensive and easy to send home.  Some clinicians say they are having good success with neurofeedback and migraines, so why bother.  Others say, they get more consistent results when their clients do this at home.  We say - if you have a migraine, it makes no sense not to send it home with them.
    
2. GSR/EDR Galvanic Skin Response/Electrodermal. These inexpensive devices used to be more popular.  The tone changes when you get more relaxed.  However, they lost popularity - perhaps they were boring or difficult for people with the problem to control. If you practice, it can certainly be helpful.
    
3. Heart Rate Variability. There are several companies that make devices to measure heart rate variability.   HeartMath has conducted major research into heart rate variability.  Poor heart rate variability has been associated with things from heart disease to poor learning.  It's a very good indicator of stress and the problems that it can produce in a system.
    
4. AVE - Audio Visual Entrainment. Though now specifically considered a biofeedback device, it clearly is a tool for self-regulation.  This is a light and sound device.  You put headphones on for hearing beeping tones - auditory stimulation. You put special eye frames on with flashing lights for visual stimulation. 
    
5. Breathing. Breathing regulation may be the earliest and most common method of improving brain regulation.  Some clinicians say they teach proper breathing and breathing exercises to everyone.  They feel it helps or supports the neurofeedback training. Of course, you can do breath training as part of any therapy, and there are a variety of ways to teach it.  There is some reported research that poor breathing may contribute to excessive slow EEG activity (theta activity.)
    
6. Binaural or Other Types of Special Sound CDs. These CDs, made popular by the Monroe Institute but now available from other companies, help regulate mood and can be used to "entrain" brain wave states.  There are a number for improving sleep, reducing anxiety, helping focus.  They certainly can be useful adjuncts or used by themselves with various clients.
    
7. Alpha-Stim. This FDA registered medical device has growing popularity among clinicians for anxiety patients in particular. It can also be made available to patients at home.  It produces a tiny low level electrical stimulation that often is very calming, is used to help sleep onset, etc.  Though it does not provide a strong training effect that holds over time like neurofeedback, it can be useful.
    
8. HEG. There are two types of HEG (hemoencephalography) which is another form of biofeedback.  Instead of using EEG, it uses either oxygenation in blood or infra-red as the measure for feedback.  It's often added as an effective adjunct to EEG biofeedback.  The Infra-red EEG has been reported to be in particular very effective as a tool for migraines.  There are those HEG advocates who argue it replaced EEG biofeedback, and it can be done standalone.  This may be true.  In talking with lots of experienced clinicians, most clinicians start with EEG biofeedback and use it as a broader clinical tool.  They might end up adding HEG as a component of training.   If you're going to use both of them, you want training to help you understand how and when to combine them with neurofeedback for maximum effect.
    
9. pRoshi. This is also not very well known.  A unique device, with flashing lights only but with a proprietary algorithm. It's not biofeedback, and it's a bit hard to explain actually what it does. Some call it a disentrainment device, which can help desynchronize (flatten) the EEG - though we're not sure if that's a proven explanation.   It's not inexpensive. Some good clinicians say it can be a very powerful adjunct to neurofeedback, or even used standalone with patients. It can be sent home with them also.
    
10. LENS. This is much less well known than EEG biofeedback.  It's described as another form of neurofeedback except, it's really not.  It uses very low power electromagnetic field to stimulate changes in the EEG. It's more of a passive tool - the client doesn't have to engage in learning in the way they do in neurofeedback, where they learn to change their own EEG.  Though it's quite a different mechanism than EEG Biofeedback (and hard to explain well), the effect is supposed to to create better regulation of the EEG.  It is often touted as being very fast in making changes.  Sometimes sessions for this electromagnetic stim may last 6 seconds or less.  It's a very interesting tool, and has some strong proponents. In our discussions with clinicians, if you're going to choose this tool, we still think the combination of this tool with others such as EEG Biofeedback as the core is the most powerful approach for maximum change in clients.  Time will tell. 
     
11. Interactive Metronome. Another form of biofeedback, it uses timing as its mechanism of action. In simplistic terms, you are trying to clap to a beat that plays through headphones.  There are sensors on your hands. The closer you get to clapping exactly on the beat, the better your timing becomes. You get very clear measures of your improvements.  With better timing comes better sports performance and better attention at school. Often used by Occupational Therapists, there are several neurofeedback providers who report the combination of neurofeedback and Interactive Metronome very useful for many clients. Learning how to combine them is useful.  There are definite logistic issues in running both neurofeedback and Interactive Metronome with the same client.