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Effective Use of LENS Unit as an Adjunct to Cognitive Neuro-Developmental TrainingCurtis T. Cripea

a The Crossroads Institute, Phoenix, AZ

To cite this Article Cripe, Curtis T.(2006) 'Effective Use of LENS Unit as an Adjunct to Cognitive Neuro-DevelopmentalTraining', Journal of Neurotherapy, 10: 2, 79 — 87To link to this Article: DOI: 10.1300/J184v10n02_07URL: http://dx.doi.org/10.1300/J184v10n02_07

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Effective Use of LENS Unit as an Adjunctto Cognitive Neuro-Developmental Training

Curtis T. Cripe, PhD

SUMMARY. This article describes three case studies where the Low Energy Neurofeedback Sys-tem (LENS) was used to augment neurotherapy/neuro-development training to help overcomecognitive and developmental issues. Simultaneously applying neuro-developmental exercises andLENS training has reduced treatment time in our clinic for certain conditions such as PervasiveDevelopmental Disorder (PDD) and Autistic Spectrum Disorder. The LENS training actuallyseems responsible for allowing other forms of treatment to take place.

The first case study was of 4 1/2-year-old identical twins, with developmental delay and autisticspectrum that completed their training within 18 months and graduated out of our program symp-tom-free, performing as normal 6-year-olds. The second case involved Attention Deficit Disorderwith hyperactivity and Oppositional Defiant Disorder in a 12-year-old male with comorbid learn-ing and memory issues compounded by undetected food allergies which had affected CNS func-tioning since birth. The final case was a 43-year-old female with a mild head injury and significantvisual and auditory processing problems. In all cases the post-treatment quantitative EEG resultsdemonstrated normalized Z-scores. Cognitive ability testing with the Woodcock-Johnson® IIITests of Cognitive Abilities (Woodcock, McGrew, & Mather, 2001) likewise documented thatpost-treatment cognitive abilities had normalized. Following the case presentations clinical im-pressions about LENS training and its effectiveness are presented. doi:10.1300/J184v10n02_07 [Ar-ticle copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail ad-dress: <docdelivery@haworthpress.com> Website: <http://www.HaworthPress.com> © 2006 by The HaworthPress, Inc. All rights reserved.]

KEYWORDS. Neurotherapy, neuro-development, EEG and cognitive abilities, toxicity

INTRODUCTION

Based on the objectively measured out-comes, we first noticed how effective the addi-tion of the Low Energy Neurofeedback System(LENS) was in working with cases of extremepervasive developmental disorder (PDD). Laterwe found it was equally effective in most of thecases coming to our clinic. Due to the nature of

the PDD condition, progress can be very slowand in some cases we found these children sim-ply were not able to respond to training withoutusing the LENS treatments. Based on our clini-cal experiencewe have found that cases involv-ing excess delta or theta brain wave activity, es-pecially when there is a concurrent underlyingmedical condition, seem to be particularly re-sponsive toLENStreatment.Assuming thatwe

Curtis T. Cripe is affiliated with The Crossroads Institute, 18404 North Tatum Boulevard, Suite 207, Phoenix,AZ 85032 (E-mail: ctcripe@att.net).

[Haworth co-indexing entry note]: “Effective Use of LENS Unit as an Adjunct to Cognitive Neuro-Developmental Training.” Cripe, Curtis T.Co-published simultaneously in Journal of Neurotherapy (The Haworth Medical Press, an imprint of The Haworth Press, Inc.) Vol. 10, No. 2/3,2006, pp. 79-87; and: LENS: The Low Energy Neurofeedback System (ed: D. Corydon Hammond) The Haworth Medical Press, an imprint of TheHaworth Press, Inc., 2006, pp. 79-87. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service[1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: docdelivery@haworthpress.com].

Available online at http://jn.haworthpress.com© 2006 by The Haworth Press, Inc. All rights reserved.

doi:10.1300/J184v10n02_07 79

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address the medical condition and apply a com-prehensiveneuro-developmentprogramwhichincludes LENS training, we make comparablerapidprogresswith thePDD clients. Inourclin-ical experience we have found LENS treatmentis limitedor has no effect in cases where there isan excess of beta brain wave activity. We havefound that the majority of these cases that in-volve excess betaactivityseem to involvemed-ical conditions, falling under the category ofmalabsorption and/or neurotoxicity.

Recently in the field of neuroscience, manystudies are beginning to demonstrate that cog-nition, even though it is influenced by geneticfactors, is also a developmentalage appropriateprocess based upon the maturationof the client.Specific cognitive abilities are associated withunique EEG patterns in both the non-engaged(resting) and engaged states of different cogni-tive activities (Goel & Dolan, 2004; Gray,Chabris & Braver, 2003; Prabhakaran, Smith,Desmond, Glover & Gabrieli, 1997; Rivera,Reiss, Eckert & Menon, 2005; Zhang & Poo,2001). Using quantitative EEG (QEEG) mea-sures along with evoked potentials (EP andERP) measures, cognitive processes can bequantified and a more specific determinationmade as to which brain functions appear to beinhibiting an individual’s performance (Zani &Proverbio, 2003; Atherton, Zhuang, Bart,Hu, & He, 2003; Aleksandrov, Polyakova, &Stankevich, 2003; Ferstl & von Cramon, 2001;Newman, Carpenter, Varma, & Just, 2003;Geake & Hansen, 2005). When reviewing thebiomedical literature it has also been found thatsome of the underlying cognitive performanceproblems may be related to underlying healthissues which disturb cognitive processes. Thisresults in what can be more accurately de-scribed as a loss of functional performance(Beauchaine, 2001; Burgess, Zhang, & Peck,2000; Porges, 2001; Burns, Baghurst, Sawyer,McMichael, & Tong, 1999; Kidd, 2005; Uhlig,Merkenschlager, Brandmaier, & Egger, 1997;Tang et al., 1999; Eydie et al., 2005). Thesehealth/medical issues may include such thingsas neurotransmitter problems due to mal-ab-sorption issues, allergy irritations, medicationeffects, etc.

Our clinical assessment procedure evaluatesage-appropriate cognitive abilities and perfor-mance. This requires us to both understand if

theclient is functioningatoptimalage-appropri-ate cognitive levels, as well as to understand theunderlying reasons why normal performance isnot being achieved.

This paper presents three different case stud-ies where LENS was used and where we docu-mented that afterwards functional brain pro-cessing issues were normalized. Brain functionwas measured with both QEEG and psychometricmeasures of cognitive functioning. The threecases involved (a) developmental issues asso-ciated with autistic tendencies, (b) attentiondeficit disorder (ADD) problems that appearedto be associated with health related issues, and(c) auditory-visual hypersensitivity and learn-ing disability problems associated with a headinjury.

METHOD

Analysis Perspective

At the Crossroads Clinic and Centers the fo-cus is on evaluating and improving cognitiveabilities. Examining the client from a cognitiveneuro-functioning perspective requires one toassessan individual’scognitiveabilitiesaswellas to seek to determine the possible root causesof poor cognitive performance. In the educa-tional literature there appear to be four primaryschools of thought concerning intellectual cog-nitive function: (a) the Cattell-Horn-Carroll(CHC) theory (Cattell, 1971; Sternberg, 2000;Sternberg, & Kaufman, 1998; Gilhooly, 1994)which outlines 10 primary cognitive process-ingdomainsthat interact;(b) theLuriaschoolofthought (Cattell, 1971; Sternberg & Kaufman,1998; Sternberg, 1998, 2000), which focuseson the interaction between cognitive process-ing engagement and executive functions;(c) the Gardner school of thought (Gardner,1983; Sternberg, 2000; Sternberg & Kaufman,1998) which focuses on cognitive processingstyles; and finally (d) the Sternberg method(Sternberg,2000;Sternberg&Kaufman,1998)which focuses on theconceptof developing lifemastery skills. As in personality theory, eachschool of thought has its place in evaluating aclient’s overall cognitive profile.

Greenspan and his colleagues (Murray,Clermont, & Brinkley, 2005) defined a term

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which they called “personal competence,”which helps to define many areas of naturalcognitive ability. Personal competence isviewed as comprising a set of skills that we usein attaining our goals and solving problems.Cognition refers to the sub-component of theseskills involved in thinking and understanding.The Greenspan model consists of three ele-ments: physical competence, personal compe-tence and performance competence.

The evaluation model we use in our clinicmodel extends the Greenspan model’s defini-tion by including a fourth factor adapted fromSternberg’s (2000) learned mastery concept.We seek to quantify and track changes in over-all levels of performance abilities as a personprogresses through our clinic program. This isdone through defining in a practical mannerwhat we term PQ™ or Performance Quotient.This initialqualitativemathematicalfunction isdefined as: PQ = w1*P1 + w2*P2 + w3*P3 +w4*P4 and consists of four main weighted (wi)domains (Pi) with several components: P1 =physical competence, P2 = personal compe-tence, P3 = performance competence, and P4 =P-factor (the life mastery or maturity level ofthe child). The broad domains defined aboveare further divided into twelve sub-domains.

• Physical competence consists of thehealth of our brain and nervous system, aswell as organ (e.g., vision, heart function-ing) and motor competence (e.g., strength,coordination).

• Personal competence consists of temper-ament (e.g., emotionality, distractibility),natural personality (e.g., gregariousness,social orientation), and our level of matu-rity.

• Performance competence includes practi-cal competence (i.e., the skill to thinkabout and understand problems in every-day settings), conceptual competence (i.e.,the skill to think about and understandproblems of an academic or abstract na-ture), language (i.e., the skill to under-standandparticipate incommunications),and social competence (i.e., the skill tothink about and understand social prob-lems).

• Pi Factor represents both our innate andlearned ability to incorporate the concept

of “mastery.” It requires thatwe learnhowto interact with life, learn from it, and ulti-mately contribute to its direction by help-ing shape the events that come into ourworld. Generally, this is measured by howwe are performing in life.

Weighting factors are determined basedupon the initial intake assessment and is biased,based upon the areas where the client needs tofocus (i.e., health issues, skill development, de-velopment of cognitive abilities). The weight-ing factor is derived from both objective physi-ological measures as well as client or parentreports.AllPi factorscoresareacombinationofphysiologic measures, test scores and subjec-tiveratings.Lowscores indicatetheneedfor fo-cus on the physiological needs; medium scoressuggest the need to focus on personality or skillset development, and higher scores indicate aneed for peak performance training or learnedmastery skill development. For younger chil-dren the importance of using the Pi factor ismore apparent than for adults, due to lack of de-velopmentally age appropriate cognitive pro-cessing skills which generally are learned atyounger ages.

Training Methods

In all cases, training methods includedneuro-sensory stimulation during the use ofeither the LENS unit and/or in combinationwith conventional neurotherapy. Neuro-sen-sory stimulation includes tactile, visual, andauditory training, generally targeted towardsengagement of frontal/temporal/parietal inter-actions. More specifically, these consist of aseries of exercises uniquely assigned and tai-lored to the individual’s needs. Training exer-cises and neurotherapy protocols were selectedbased upon the QEEG, cognitive ERP data, andstandardized cognitive performance test dataobtained through cognitive ability tests, as wellas client goals. As the sessions progressed, ex-ercises and protocols were adjusted duringtreatment based upon follow-up QEEGs,ERPs, and cognitive performance testing.

Case 1: Autistic Spectrum Disorder

Identical twins entered the program at age 41/2. Both girls were cognitively present, but

Curtis T. Cripe 81

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overall age maturation was estimated at onlyabout 24 to 30 months of age based upon theNepsy (Kirk, Korkman, & Kemp, 1999) andDoman Delacato (Doman, Spitz, Zucman,Delacato, & Doman, 1960) scores. They bothfell within the Autistic Spectrum Disorder(ASD) based upon the Gilliam Autism RatingScale (Gilliam, 2002) and had previously beendiagnosed with the classification of ASD. Lan-guage expression was “twin speak,” in that youcould only understand some of their expres-sions, but they knew what was being said be-tweenthem.Whenlookingat theirQEEGsbothgirls had nearly identical values within all fre-quency bands. The most remarkable featuresincluded excess absolute delta and beta values,which exceeded three Z-scores as well ashypercoherence in all frequency bands in ex-cess of three Z-scores. Medical measuresshowed that there was a significant gut dys-biosis (intestinal inflammation often affectingnutritional absorption, due to many possibleunderlying issues including yeast overgrowth,food allergies, antibiotic reactions, etc.) forboth girls, as well as heavy metal in their sys-tem. It appeared from other medically basedmeasures that their neuro-immuoendocrinesystems were in a hypersensitive state whichresulted in other autonomic reactivities.

Looking at the Performance Quotient (PQ)factor it was apparent that treatment biasneededtobe towardremediatingthephysiolog-ical system and promoting enhanced cognitiveperformance, which meant helping them ma-ture to a more age appropriate natural ability.For both girls the more problematic cognitivesystems were the auditory memory system, aswell as auditory processing, which impactedtheir overall maturation and ability to engagesocially.

Treatment for both girls consisted of a twopronged approach that included a set of sensoryintegration/differentiation exercises along witha set of cognitive development exercises. Thiswas combined with a medically based set oftreatments targeted at improving the functionof the gut, organ systems, and replenishing nu-tritional support which biological test resultsdetermined was missing. During each of theirtreatment sessions neuro-developmental exer-cises were applied along with targeted auditorytraining in conjunction with LENS neurofeed-

back. In working with this population wediscovered empirically that during auditorytraining sessions, if we would apply the LENStraining in each session for a certain number ofseconds in sequence at electrode sites F4, F3,Fz, Cz, and Pz (which we have labeled the“T-Walk™”), these cognitively compromisedchildren subsequently tend to respond morerapidly to their cognitive developmental exer-cises. Additionally, we find that the sensorysystems tend to begin to “calm down” or nor-malize at a more rapid rate following the intro-duction of LENS training.

As the twins matured their PQ scores im-provedso thatby theeighthmonthweneededtoshift the treatment focus to teaching social skillsets. Both girls responded well to the programand at age six they have both improved to thepoint that they now hit their age appropriate de-velopmental milestones. One became righthanded and the other left handed. Additionally,their speech improved to a clear non-compro-mised speech pattern and all cognitive abilitiesnormalizedto thatofa typicalsix-year-old.Dueto overdependence on each other, catching upon socialization required the children to beplaced in different kindergarten class rooms.Table 1 displays the treatment progress of thetwins on various ratings, and Figure 1 presentsthe QEEG of one of the twins that was done atthe beginning and at the completion of treat-ment.Theextremeexcesses inabsoluteand rel-ative power beta, as well as absolute and rela-tive power alpha, are almost entirely normalized.The most extreme beta absolute power ex-cesses were at Fz, Pz, Cz, and T5 in the map

82 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM

TABLE 1. Progress of Case One in Treatment

Treatmenttime

PQScore

GARS Doman-DelacatoIndications

Intake 22 130 Severe 23 to 30 month cognitivedevelopment

4 months 33 119 aboveaverage

33 to 36 month cognitivedevelopment

8 months 42 98 average 46 to 60 month cognitivedevelopment

12 months 66 69 very low 60 to age appropriatedevelopment

18 months 86 12 none Age appropriatedevelopment

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foundinFigure1,andrepresenteddeviationsof3.4,3.1,3.02,and2.98Z-scores, respectively.

Case 2: ADD with Comorbid ODD/Learningand Memory Issues

Thesecondcasewasa12-year-oldmalewhowas diagnosed by his psychiatrist with Atten-tion Deficit Disorder (ADD) and OppositionalDefiant Disorder (ODD), with comorbid learn-ing and memory problems. Food allergies werediscovered to be present which affected centralnervous system functioning. The parents be-lieved that this had been a problem since birth.This young man presented clinically as well in-tended, but extremely absent-minded or inat-tentive, as well as argumentative. His gradeswere mostly Ds because of his failure to turn inhomework, combined with his C and high Dgrades on tests. He was in resource (specialclasses for academic remediation) for math andreading. He was very cranky and resisted anydirection unless it was self-initiated. His scoreson the Woodcock Johnson showed low normalGeneral Intellectual Ability (GIA) and atten-tion issues, combined with a problem withauditory working memory.

Medication treatmenthad been recommend-ed,buthereactednegatively toRitalin,Concertaand Strattera. The Doman-Delacato develop-mental profile also validated problems withworking memory and suggested a lack of brain

system maturation in the ear and eye domi-nance factor, and in basic mobility factors. Thisresulted in anxiety and emotional ups anddowns.

His PQ factor score indicated that treatmentshould focus on health, brain developmentalfactors and basic academics. A three prongtreatment approach was initiated. Specific al-lergytestingwasundertakenwith thediscoverythat an allergy to wheat and dust mites both sig-nificantly affected his ability to perform on theclassic aural digit span for working memory. Indigit span testing his capacity ranged from 2digits to 4 digits. For his age he should havebeen attaining digits span scores of 6 or more,whichhewasable toattainafter threemonthsoftreatment.

LENS neurofeedback was used to help re-duce the excessive delta and theta brainwaveactivity as well as to augment his developmen-tal memory training during lab sessions. Dur-ing his in-office lab training sessions he per-formed neuro-developmental exercises alongwith conventional theta inhibit/SMR enhanceneurotherapy protocols based upon his QEEG.The results after 24 sessions showed his perfor-mance at school had improved in most classesfrom Ds to Cs and Cs to B +. At the end of 12weeks he had graduated out of resource classes,buthewasstill strugglingwithhisbasic readingcomprehension.

Curtis T. Cripe 83

FIGURE 1. Case 1 Pre-/Post-Treatment QEEG

Initial Nx Link QEEG 18-Month Follow-Up

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Initially, the family did not want to addresshis academic issues, hoping they would justclear up, but his PQ factor indicated a need toshift to enhancing his personal skill sets. TheWide Range Achievement Test III (Wilkinson,1993) was administered and it was discoveredthat it would be necessary for the young man torelearn some academic basics in the area of vo-cabulary building and reading strategies. A tu-toring program was recommended and imple-mented, which allowed his academic testgrades in the classroom to catch up. On a per-sonality level, this initially cranky 12-year-oldbecame quite pleasant and helpful to staff. Sim-ilar reportsbyhisparentsweremadeonhisa sixmonth follow up. Table 2 summarizes treat-ment progress, and Figure 2 displays his pre-and post-treatment QEEG findings. As seen inFigure 2, the extreme excesses of absolute

power across frequency bands were normal-ized by the end of six months.

Case 3: Mild Head Injury

The final case is a 43-year-old female whowas suffering from a mild head injury with sig-nificant visual and auditory processing hyper-sensitivity. The sensory hypersensitivity cre-ated harsh headaches and emotional pain. Theaccident occurred from a hit-and-run car acci-dent two years prior to her coming to our office.She also presented with problems with mem-ory, focus and attention. Memory aural and vi-sual digit span scores indicated that somethingwas interfering with her memory system inter-actions. Her General Intellectual Abilities (GIA)score on the Woodcock-Johnson III Test ofCognitive Abilities (Woodcock et al., 2001)

84 LENS: THE LOW ENERGY NEUROFEEDBACK SYSTEM

TABLE 2. Progress of Case Two in Treatment

Treatment time PQ Score WJC III Doman-Delacato Indications

Intake 33 GIA 83-89 weak thinking ability, normal cognitiveefficiency

Need for memory work, cross pattern

2-months 63 GIA 98-104 normal thinking ability, normal cognitiveefficiency

Need for memory work, cross pattern

6-month follow up 88 GIA 105-115 normal thinking ability, normalcognitive efficiency

Within normal ranges

FIGURE 2. Pre-/Post-Treatment QEEGs for Case 2

Initial Nx Link QEEG QEEG at 6-Month Follow-Up

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was between 83 and 95, far below her level ofeducational achievement. (She had a bachelor’sdegree in English.) Testing on the Doman-Delacato profile indicated that her develop-mental profile was age appropriate and her lackof cognitive performance was most likely dueto a loss of memory function. She was assignedcognitive development exercises which con-sisted mostly of sensory system desensitizationcombinedwithauditoryandothercognitivede-velopmental training as indicatedby her QEEGand other testing. Within twelve sessions of us-ing the LENS combined with frequency spe-cific auditory training, her hypersensitivity tobothsoundand lightbegan tonormalizeas indi-cated from retesting and her self report. Cogni-tive function returned to normal within 20 ses-sions.

Table 3 summarizes her treatment progressand Figure 3 presents her pre-/post-treatmentQEEG results. The pre-treatment QEEG showedexcess absolute power alpha and in absolutepower averaged across frequency bands. Thiswas no longer present after treatment. The pa-tient’s traumatic brain injury discriminantfunction scores and patterns normalized fol-lowing treatment.

DISCUSSION AND CONCLUSION

Neurotherapy with the LENS is one of manytools thatweuse. Ithasbeenourexperience thatLENS can be very effective when used appro-priately and in conjunction with neurodevelop-ment, bio-chemical, physiological and bodyhealth interventions. The LENS unit acts as avery precise and specific tool. It is my impres-sion, as was the case with the twins cited above,that patients who are more significantly devel-

opmentally and learning disabled, or individu-als with brain injuries are able to progress inneurocognitive exercises because of the facili-tating effects that come from LENS training.Commonly LENS training seems to help jumpstart cognitive systems, as it did with the twins,and not only allow them to perceive what is be-ingaskedof them,butalsoallowthemtobeableto engage in the neuro-rehabilitation exercises.In the case of the 12-year-old ADD/ODD malecited in thispaper,LENStrainingseemed tonotonly accelerate the progress of this young man,but it alsoenabledus tohelpnormalize theaudi-tory processing to allow more normal auditoryperceptual integration. For the 43-year-oldwoman who had experienced a traumatic headinjury, the LENS unit affected a change in herhypersensitivity to both the auditory and visualinput. The LENS training seemed to be the fac-tor that allowed subsequent desensitization ex-ercises to become more effective, reducingtreatment time, and allowing her to regain nor-mal functioningofherauditoryandvisualbrainsystems.

Although our clinical results are uncon-trolled and confounded by the inclusion ofother forms of treatment, it was our experiencethat prior to implementing LENS training ourtreatment program with both children andadults required 8 to 12 months for us to achievethe same results that we are now achievingwithin 3 to 6 months, once we added the com-ponentof LENS training. It appears thatLENSneurofeedback may be able to help acceleratethe reduction of the slow brainwave activityduring our treatment of allergies, as well ashelp augment the performance of the memoryexercises during neurocognitive training ses-sions.

Curtis T. Cripe 85

TABLE 3. Summary of Treatment Progress in Case 3

Treatment time PQ Score WJC III Doman-Delacato Indications

Intake 55 GIA 83-95 (weak thinking ability, weak cognitiveefficiency)

Normal development, hypersensitivesensory processing

2-months 83 GIA 110-115 (normal range thinking ability, normalcognitive efficiency)

Normal development, sensitivesensory processing

6-month Follow up 93 GIA 110-115 (normal thinking ability, normalcognitive efficiency)

Normal development, normal sensoryprocessing

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