First Visit Form
INFORMED CONSENT FOR NEUROFEEDBACK PEAK PERFORMANCE/BRAIN-BASED COACHING
Dr. Charlene Heyns-Nell is a Neurofeedback Practitioner (New Mind) and has extensive experience and expertise with the brain and brain related behaviours.
Please read through the informed consent and complete all the relevant information.
WHAT IS NEUROFEEDBACK?
EEG neurofeedback, or brain wave biofeedback is a non-medical, but science-based, general training that takes advantage of the body’s natural ability to self-regulate and seek balance. Non-invasive sensors or “electrodes” are connected to specific sites on the surface of the head. The sensors pick up brain waves and display them on a computer screen. The computer assists the brain in recognising normal brainwave patterns and produces either visual or auditory feedback. When the brain is producing the appropriate balance of waves, it will receive positive feedback. When the brain is not producing the correct balance of waves, it will receive negative feedback. The specific type of neurofeedback you will be receiving is dependent upon the protocol. The protocol is determined by the brainmap assessment which will be discussed in session.
Neurofeedback allows the brain to learn to produce balanced, efficient brainwave patterns more frequently. In Dr. Charlene’s observation of this kind of training it has proved to increase the strength and flexibility of the brain, supporting healthy brain/body functioning. Additionally, as the EEG dynamics stabilise, many improvements in sleep, concentration, and behaviour can be seen by her clients. Dr. Charlene cannot, however, guarantee what the exact changes will be, or if they will occur at all. Most, but not all, see extensive improvements.
THE STATUS OF NEUROFEEDBACK
While neurofeedback has been approved by the Food and Drug Administration (FDA) for the treatment of medical conditions and peak performance (Hammond, 2006), it is still considered experimental.
Neurofeedback often produces beneficial and lasting changes. Dr. Charlene generally expects a positive response within the first 10 sessions. If no improvement is achieved in that time, she might recommend suspending training. In most of the cases where there is improvement in function, the client is required to monitor progress, and to continue training until the desired results are achieved. While there are often improvements in the first few sessions, neurofeedback peak performance training usually requires at least 10 sessions for permanent change to take place.
LIMITATIONS OF TRAINING AND POTENTIAL RISK
It is important to understand that a QEEG (quantitative electroencephalography scan) is NOT the same as a “clinical EEG” which is used in medical diagnosis to evaluate epilepsy or to determine if there is serious brain pathology, such as a tumour. The neurofeedback computer records the way a client’s brain waves function. It is not designed and is not used to diagnose medical conditions. Neurofeedback is a non-invasive, safe procedure, and no electrical current is put into the brain. To obtain good electrode connections, it is necessary to clean small areas of the scalp with rubbing alcohol and apply paste to attach the electrodes. This might cause slight discomfort in these areas for a short period of time. In terms of the neurofeedback training itself, rarely have significant side effects been reported. Occasionally, someone may feel tired, spacey, anxious, experience a headache, have difficulty falling asleep, or feel agitated or irritable. Many of these feelings pass within a brief time following the training session.
If your symptoms do not dissipate, you should report this at your next session so that the training protocol can be modified. The goal is to keep you as comfortable as possible, although this does not affect any effectiveness of training (e.g. feeling sore after going to the gym does not mean you are not benefitting from the workout). Some clients may feel an increased need to sleep during the first few weeks of training. This may be due to a variety of factors, but in general, is considered normal and a sign that the brain is improving its performance between sessions. Please make allowances for the increased need to sleep, and sleep as your body requires. Please be aware that training can be incredibly relaxing. Please exercise usual caution and good judgment regarding your ability to drive afterwards.
MEDICATIONS AND CONSULTATION WITH YOUR PHYSICIAN
You should also be aware of the relationship between neurofeedback and medications. Sometimes more neurofeedback sessions are needed if a client is on medication, and neurofeedback may change the dosage requirements for some medications. Therefore, it is very important that the physician monitoring your medication is made aware that you may require a dosage change. You will be asked to complete a release form, so Dr. Charlene may communicate with your prescribing physician regarding your neurofeedback participation, and the need to monitor you for overmedication. If you are experiencing unusual symptoms, you should discuss them with your physician. Do not stop or alter your medications without consulting with your physician. Neurofeedback is not a substitute for effective standard medical treatment. Neurofeedback training can substantially affect your glucose level as your brain works very hard when you train. Please have a meal or snack with protein before coming to your session and let us know if you are diabetic or hypoglycemic. In addition, it is very important for Dr. Charlene to know if you have or have had epileptic seizures.
CONFIDENTIALITY
Information shared in sessions is kept confidential and will not be disclosed except in cases of: 1) Situations in which you are deemed to be a danger to yourself or others (i.e. threats of homicide or suicide); 2) Situations in which children are endangered or have been abused. 3) Information from training sessions that will be shared with professional colleagues. If you see Dr. Charlene in the community, she will not approach you; however, if you would like to approach her, that is completely acceptable and welcome. Dr. Charlene takes confidentiality seriously, and by adopting a “you first” policy, she gives you the option to acknowledge your professional relationship with her on your own accord.
When participating in EEG Neurofeedback training, you are granting Dr. Charlene permission to share information regarding your medical history, training sessions, and training results with colleagues within in the field of neurofeedback for the purpose of case consultation and treatment enhancement. Names or other primary identification information will not be shared. In participating in this treatment, you understand that a commitment of twice a week is expected to ensure optimal treatment effects.
Additional information may be shared with related parties, at your request, with a signed Release of Information.
CANCELLATION POLICY
If you need to cancel a session for any reason, you must do so more than 24 hours before your session. This gives Dr. Charlene a chance to contact the people who may have wanted a session, but could not get in. If you cancel within 24 hours or do not show up for the session, you are financially responsible for the full fee. The only instances where the fee will be waived are in cases of sickness, or family emergency. If illness or family emergencies become abundant, Dr. Charlene will discuss with you whether you believe you are able to commit to the sessions, or if sessions should be put on hold until you are well enough, or your environment stabilises. Your session times will not be held during that period. If you are more than 15 minutes late for your session, your session will be cancelled, and you will be billed for a missed session at the full fee. If Dr. Charlene is late, you will still receive your full session. If you are concerned about your ability to make it to your session on time or at all, please cancel your session 24-hours before your session. Otherwise, the cancellation fee will be applied to the session.
FINANCIAL POLICY
All payments are to be made before the time of sessions.
ADDITIONAL INFORMATION
When you arrive for your session, please use the restroom BEFORE you come into the office. Once the electrodes have been placed and training has begun, you will not be able to use the restroom until the training has been completed. The duration of training is approximately 60 minutes. Parents are welcome to sit in on a few sessions initially to ease your child’s anxiety and/or to gain a better understanding of the training experience and ask any questions that may arise. After the first few sessions, parents will be invited into the session for the first few minutes to discuss any changes your child is experiencing. Even though neurofeedback is not like traditional therapy, Dr. Charlene requests that her office be viewed as a quiet space. Once a session has started, it will not be stopped unless the client requires a break. Dr. Charlene respectfully requests that parents, or friends and family, do not disrupt the session except in the case of an emergency. If the client starts to fall asleep during treatment, Dr. Charlene will give three warnings to wake up. If three warnings are given and the client continues to sleep, the session will be an expensive cat nap. So, please ensure you obtain an adequate amount of sleep before each session. Dr. Charlene’s neurofeedback process takes into consideration the person as a whole. She may provide you with specific interventions designed to further improve your peak performance outcomes.