Biofeedback for Brain Health in Developing Countries

Neurofeedback is effective in improving brain health among children with learning disabilities, attention deficit, autism spectrum, and anxiety disorders in developed countries. We will implement a modified community-based neurofeedback system to help children in developing countries, who rarely have access to effective and/or affordable treatment for these disabilities.

Evidence suggests that neurodevelopmental-cognitive disorders such as attention deficit/hyperactivity disorder (ADD/ADHD), autism spectrum (ASD), anxiety (AD), and learning disabilities (LD) exact a significant burden in Latin America and the Caribbean and tropical regions globally. Despite this heavy burden, available care for individuals with these disorders is frequently nonexistent, inadequate, or inequitably distributed. The LAC Region needs to expand access to the continuum of mental health services, including promotion, prevention, and rehabilitation, with a special emphasis on the most vulnerable populations. Based on epidemiological evidence, 64% of people with bipolar disorder and 63% of people with anxiety disorders do not have access to any kind of treatment in primary or specialty care settings. In Central American countries, a very small percentage of primary care doctors and nurses have been properly trained in mental health, primary care doctors do not usually interact with mental health professionals, and psychotropic drugs are not regularly available at primary care centers. The financial burden of seeing one of the few available brain health specialists is a significant barrier. When patients have access to a healthcare professional, they often cannot afford the long-term use of commonly prescribed medications to address developmental-cognitive disorders such as ADD/ADHD or AD. The use of cognitive-behavioural therapies, while limited in duration and thus potentially more affordable, is often not available given the shortage of qualified experts. To address affordability and lack of expertise, we will investigate the use of modified community-based biofeedback in a developing Caribbean country. The automated nature of modern neurofeedback systems means that a community health care provider with limited training can administer sessions, thereby eliminating the major hurdles to care: (1) lack of any effective treatment services; (2) lack of resources to pay highly-trained professionals for treatment; (3) getting “locked” into a never-ending cycle of costly prescription medications. 

Despite the heavy burden of neurodevelopmental-cognitive disorders in Latin America and the Caribbean, available care for individuals with these disorders is frequently nonexistent, inadequate, or inequitably distributed: 64% of people with bipolar disorder and 63% of people with anxiety disorders do not have access to any kind of treatment, either in primary or specialty care settings. A small percentage of primary care doctors have been properly trained in mental health, primary care doctors do not usually interact with mental health professionals, and psychotropic drugs are not regularly available at primary care centers or are too costly for patients to access. 

There are three major barriers to accessing brain health care in developing countries: (1) lack of any effective treatment services; (2) lack of resources to pay highly-trained professionals for treatment; (3) getting “locked” into a never-ending cycle of costly prescription medications. Neurofeedback alters the functioning of the brain without the use of medications. With new advancements, it can be run in a semi-automated format on low-cost equipment in community-health centres by a trained non-specialist community health worker. Our study will prove this concept and demonstrate long-term, cost-effective and accessible impact on brain health in a low-resource setting.  

We will demonstrate that a low-cost community-based biofeedback system is effective at improving brain health in individuals living in a developing tropical setting. Critically, we will demonstrate that this biofeedback system is equally (or more) effective at improving brain health and is more cost effective than existing therapies available on the ground. This proof of concept will be easily replicable in other developing tropical settings around the world and thus, will pave the way for a paradigm shift in the way that some brain diseases/mental illnesses are treated in low resource settings.

Groups of patients with targeted brain diseases will receive treatment-as-usual versus biofeedback. Group differences in outcomes will be compared via professional assessment and validated outcome measures - Community-based biofeedback system will Improve brain health similarly or better than existing therapies on the ground

Economic analysis of the cost to achieve target health outcomes between treatment-as-usual group versus biofeedback group - Community-based biofeedback system is more cost effective than existing therapies on the ground

Blinded expert reviewers will assess the protocols used by the community health worker once s/he has been trained - A developing country-based non-specialist community health worker is as effective at administering biofeedback sessions as a specialist

Biofeedback is a paradigm-shift in the way brain health is assessed and treated. However, it based on an ancient idea: In order to change the way we processes information, it is necessary to spend effort analyzing our thoughts and emotions. Only by becoming conscious of how one reacts to his/her environment can one hope to react in more effective or positive ways. This process, known as mindfulness meditation, normally takes many hours of practice. By using EEG-based technology, we can greatly speed up this learning process, changing patterns of brain activation in the process.

Since biofeedback is a cutting-edge technology, it is currently available only to those with resources in developed countries. However, the technology is expanding rapidly, and we believe that the cost of the technology has come down enough that it is now feasible to roll it out in developing country settings. We know that treatment for brain illness is woefully lacking in developing countries. This solution, which will be assessed in a tropical middle-income country in close collaboration with community health workers on the ground, will directly impact these underserved communities. 

The island of Grenada has a Universal health care program that is free for all citizens of the country. We will provide training to a targeted number of existing community health workers and purchase the necessary equipment to carry out the neurofeedback sessions. Patients with targeted brain illness/mental illness will be randomly assigned to receive neurofeedback or treatment-as-usual, free of charge. This will be used to assess the effectiveness of the neurofeedback system. An economic analysis will de developed to assess the feasibility of implementing the system in other developing country settings including those with a fee-based healthcare system. 

Our financial plan is to initially secure grant funding to prove our concept – that neurofeedback can be as effective as treatment-as-usual to ameliorate targeted brain illnesses in low-resource settings, and that it is more economical than treatment-as-usual in those settings (where any treatment exists). Once we have proven the concept, we will seek socially-minded angel investors to market the system and make it easily available to other low-resource settings worldwide. Through our non-profit foundation, we will seek to cover the costs of the system, thereby making it available to as many low-income settings as possible, while simultaneously ensuring the long-term sustainability of our enterprise.  

1) Difficulty adapting neurofeedback technology for a low-resource setting, including the fragility and cost of the necessary equipment.

2) Difficulty translating the use of Neurofeedback so that those with less expertise and education (e.g., Bachelor’s level or lower) than neurofeedback experts (e.g., PhD, PsyD, MD) are not able to understand the protocols for altering brain activation in a way that improves brain health for each individual patient.

3) Difficulty proving the concept because the patients assigned to the neurofeedback and treatment-as-usual groups are not equivalent/comparable or there is a problem with the assessment of outcomes. 

We are applying to Solve because of the human-centered technology that we hope to use to ameliorate one of the greatest health challenges of the 21st century. We are health experts and social innovators who are passionate about addressing health inequities and helping those most in need. We see the massive disparity in treatment for brain illnesses between those with resources in developed countries and those with few resources in developing countries. We believe that the rapidly-declining cost of technology can be leveraged to make a significant difference but we need tech expert partners to help us implement our vision. 

St. George's University

Windward Islands Research and Education Foundation

Government of Grenada

The International Fetal and Newborn Growth Consortium for the 21st Century - Oxford University

Stanford University

We do not have any competitors that we are aware of.