Information and Instructions About the QEEG Process

Biofeedback Solutions

Information and Instructions About the QEEG Process

INTRODUCTION

The following is information is about the brainwave test (QEEG) that you or a family member will be taking. There are three sections:

1) Basic information related to the QEEG and information about its cost.

2) Instructions for preparing for the QEEG.

3) A questionnaire to be filled out outlining your goals for neurofeedback treatment, and (when appropriate) information needed to insure that the test is specifically customized to your needs (or the needs of your child) so as to insure that we obtain maximum benefit from the test.

While the amount of information provided here might seem like a lot, all you really need to do is to fill out a questionnaire and pay attention to the few instructions for taking the QEEG. The information included here is information that people we have worked with have found useful. Taking time to read through this will help us obtain the maximum benefit possible (in the form of very specific treatment recommendations) from this test.

GENERAL INFORMATION ABOUT THE QEEG

I have recommended that you receive a QEEG to assist us in your treatment planning (or the treatment planning of your child). It is a computerized form of the electroencephalogram (EEG). I have found the QEEG to be of increasing value in guiding the neurofeedback process because of recent improvements in the databases used and in the manner in which the data is utilized to formulate an individualized treatment plan.

The EEG recording is a safe, non-invasive process. You (or your child) will sit in a chair while a number of sensors will be place on your head. When this has been completed you will be asked to sit very still with your eyes still and your upper body muscles relaxed. It is not necessary to remain this way for prolonged periods and it is possible to stop and take breaks during which time you can move around. None-the-less, there are rare instances when it is not possible for the individual to sit still enough or to sufficiently relax upper body muscles. In these infrequent situations, the testing process would be interrupted and only a partial fee will be assessed for the process because it will not be necessary to analyze and interpret the data. Recordings will be made with your eyes closed and with your eyes open.

You should know that neurologists, the physicians whom historically have most utilized EEG information, are divided on the value of the QEEG and that some professionals consider it to be investigational in nature. None-the-less, many clinicians who provide neurofeedback consider the QEEG to be very valuable in planning a neurofeedback treatment course.

As is the case with the neurofeedback process itself, I cannot assure you that the QEEG will lead to successful neurofeedback treatment (or if we have done neurofeedback prior to doing the QEEG, that it will lead to more success than has been achieved thus far). However, it is my experience, and that of many other clinicians, that the QEEG frequently leads to more efficient and more effective neurofeedback. In recent years I have found this increasingly to be the case because of improvements in the normative databases and improvements in how QEEG information is used to guide neurofeedback.

If the individual being mapped takes medication that can interfere with the process (any medication that impacts brainwaves), in some instances it may be desirable, with your physician’s approval and instructions, to discontinue the medication before doing the mapping process. If any such medication is being taken, be sure to discuss it with me before you arrange to take the test.

Once the QEEG data is recorded it will be sent to one of several experts who are highly skilled at analyzing it and creating specific, customized instructions for doing the neurofeedback. I select the expert who will analyze your data based upon the specific history of the problem that brought you to my office and the specific treatment goals we have defined for our work together.

In some instances, the QEEG information will be sent to one of several expert psychologists, who, while not physicians, are very experienced in using QEEG data to guide neurofeedback. While some people believe that QEEG data should always be reviewed by an MD to rule out infrequent medical problems that are occasionally revealed by the QEEG, my thinking is that in most instances, for the purposes of neurofeedback recommendations, such an MD review adds unnecessary cost. However, in cases where a seizure or significant head-injury history is present, or if treatment goals have specifically to do with a number of neurologically related disorders, I will generally recommend that a physician review the QEEG data. Should you, for any reason, think that an MD review of your information is important, please discuss this with me.

COST AND INFORMATION RELATED TO BILLING INSURANCE

The fee for the QEEG is $595.00. Because I will be paying for the cost of the data acquisition, computer analysis, and treatment recommendations from a recognized expert, it will be necessary to pay the QEEG fee before the test is done. While many insurance companies recognize the QEEG test, because the data will be processed and analyzed by experts in states other than Washington, it is very unlikely that your insurance company will cover the cost of the test, nor can I bill your insurance company for any QEEG test-related services we provide you.

PREPARATION FOR THE QEEG

The procedure should take approximately one hour including preparation and recording. To make a successful recording, please follow the steps below. The following instructions apply to the person who will be doing the QEEG:

1. The night before your QEEG wash your hair twice with a non-residue shampoo. Neutrogena is recommended. Do not wash your hair again in the morning. Be sure to scrub your entire scalp, forehead, and earlobes with your fingertips, rinse your hair thoroughly between and after washing. Make sure your hair is completely dry before coming in for the QEEG.

2. Do not braid your hair. Do not apply hair conditioner, mousse, gel, or hair spray, and keep your forehead free of make-up, lotions, and conditioners.

3. Do not wear earrings or ornaments on the day of the QEEG.

4. Be sure the person doing the test is as well-rested as possible and alert prior to the QEEG.

5. If you are taking stimulant medication, it is preferable to do the QEEG recording after a 72-hour medication washout. Please check with your prescribing physician to determine if it is possible to stop taking the stimulants 72 hours prior to recording the QEEG. Be sure to bring medication type and dosage information to the technician to record before the QEEG is done.

6. Other medications: if possible you should be free of medications that may alter the EEG for a period of five times the half-life of the medication. This is a number that your physician or pharmacist can provide you. Some medications may be stopped safely for a period or time, while stopping others may cause serious side effects, neurological impairment, or harm. Furthermore, there may be times when it is not desirable to stop certain medications. If you have and questions about this, please call and discuss them with me at least several days before the test. And remember, you should not make any decisions about stopping medications without first consulting with the physician who prescribed them. Make sure you check with your physician before stopping any medication!

7. Please do not use stimulants the day of the test. Examples are: coffee, tea, cigarettes, caffeinated soft drinks, etc. Also, avoid illegal or over-the-counter drugs, foods, herbs, or herbal teas that promote sleep/relaxation or the awake/alert state on the day of the EEG.

8. Avoid taking any over the counter medication or supplements for three or four days prior to the QEEG.

9. Try to eat a low sugar meal within a few hours before your QEEG. Please do not drink coffee or caffeinated beverages the day of your recording.

10. Please have a list of any medications that you are taking such as antidepressants, anticonvulsants (epilepsy medications) or anxiolytics (anti-anxiety medications) that might affect the QEEG.

11. At the end of the test, the technician will remove as much of the test-related jell as possible. It may be that you will want to brush your hair at the conclusion of the test. Please bring a clean towel to dry your hair after the recording.

12. You may need to read during the test, so if you wear glasses, please bring them with you. Do not wear contact lenses as they may become uncomfortable thereby causing EEG artifact, which disrupts the acquisition of good EEG data.

IN SUMMARY: STEPS TO ARRANGE THE QEEG

1) Please read through the above information and print it for further reference.

2) Fill out the questionnaire below (using your computer to do so if possible), print it, sign it, and mail or bring it to my office. If you child is 14 years old or older, have your child sign it.

3) Include with the questionnaire returned to my office a check for $595.00 to cover the cost of the test-related services.

4) Upon receipt of the signed form and payment for the service, you will receive contact information for scheduling the test.

Beginning on the next page is the questionnaire to fill out. It is in the form of a Microsoft Word document. Please think over your answers carefully. The information will help us and the expert who will be analyzing the resulting information obtain the most value from your QEEG.

Please see the page below. It is the questionnaire that you will fill out.

QEEG Treatment Goals and Additional Information Questionnaire

Person taking test: Birth date:

Is the person taking the test right or left-handed?

Please list any medications the person doing the test will take in the three days before the test:

If the person taking the test has had any head injury (other than minor bumps), or any history of seizures please briefly describe the history here (or indicate that this question does not apply):

If a psychologist or a psychiatrist has given the person taking the test any psychological or psychiatric diagnoses, please list them here:

1.

2.

3

Please list the five (or fewer than five if there are fewer) most important changes you would like to see following neurofeedback (for example: help with anxiety, help with difficulty falling asleep, help with depression, help with reading problems, etc.).

1.

2.

3.

4.

5.

If a child is being tested, please list any significant areas of academic challenge. For example, does your child have particular difficulty with math (or reading, writing, memory, etc.)?

PLEASE READ AND SIGN: I have read the information provided here regarding the QEEG test and associated information. I agree to pay Dr. Rothman for the QEEG-related services he provides or arranges to be provided. I understand that he cannot bill my insurance company. I give Dr. Rothman permission to share clinical information with the individuals who will be collecting, analyzing, and interpreting the QEEG-related information.

______

Name (printed) Signature Relationship to patient

If the patient is a child or young adult 14 years or older, he/she needs to sign this form giving permission to share clinical information with the people dealing with QEEG-related information:

______

Child’s Name (printed) Child’s Signature