UNKNOWN IN BANGLADESH Paper presented in “BACAMH” (Bangladesh Association of Child and Mental Health) Annual conference on 24-25/11/2014 None in the conference ever had heard the term Neurofeedback in Bangladesh. Discovered SPECTRUM LEARNING Received Training Practiced Started Neurofeedback in Bangladesh First case 16-year-old girl with ADHD Second case 12-year-old boy with Autism Review by Dr. Kenneth Kang First Neurofeedback Centre in Bangladesh Established on 12/12/12 Spectrum Neurology and Neurofeedback Centre In affiliation with Spectrum learning Asia, Singapore The outcome of My experience ADHD:Very good response AUTISM: Remarkable Changes REDUCED impulsivity and Hyperactivity, Tantrum Improves Cognition, Speech, and Sociability Controls Emotional Regulation EPILEPSY: Reduces Seizure severity, and frequency and increases seizure-free period

1. P R O F . D R . M O K W A H E D I
P R O F E S S O R O F PA E D I AT R I C S
M E D I C A L C O L L E G E F O R W O M E N & H O S P I TA L
F O U N D E R
S P E C T R U M N E U R O L O G Y & N E U R O F E E D B A C K C E N T R E
D H A K A B A N G L A D E S H
( I N A F F I L I AT I O N W I T H S P E C T R U M L E A R N I N G , S I N G A P O R E )
NEUROFEEDBACK IN BANGLADESH

2. Prof. MOK WAHEDI
Medical College for Women & Hospital, Dhaka
MBBS 1982
DCH 1995
MRCP (UK) 1998
MRCPCH 1999
FRCP 2008
Member of
BPA, BMD&C , BSCNDD, BPMPA, RCP Edin, RCPCH, London
Fellow RCPE

3. Working for the Special Children
Centre for Children with Special Needs
[CCSN]
A project of Rotary Club of Banani, Dhaka
• Provides clinical management
• Physiotherapy
• Occupational therapy
• Counseling
• Rehabilitation
• Financial support

4. Centre for Children with Special Needs

5. Teaching Early Child Development (ECD )

6. Introducing Bangladesh

7. Bangladesh
People's Republic of Bangladesh
Capital :Dhaka
Language : Bangla
Population :150 million (2011 Census )
Literacy Rate : 60%
Annual growth rate (2001-11): 1.34 %
Population density :964 /sq km

8. Sunderban : Mangroove forest

9. Royal Bengal Tiger

10. Paharpur: Archeological remains

11. Land of Dance & Music

12. Pink Dolphin in Bay of Bengal

13. Cox’s Bazar: Worlds Longest Sandy beach

14. Geographical Location
Latitude between 20°34' and 26°38' North
Longitude between 88°01' and 92°41' East
Area: 147,570 sq. Km
Boundaries
North - India (West Bengal and Meghalaya)
West - India (West Bengal)
East - India (Tripura and Assam) and Myanmar
South - Bay of Bengal.
Bangladesh Location Map

15. Bangladesh Location

16. Population % by Age

17. Major Religions %

18. World Disability Situation
500 to 650million Impairment
10 % world’s children
200million
sensory, intellectual or mental health impairment.
80% in developing countries.
2.5% children (0-14): moderate to severe levels of
sensory, physical and intellectual impairments.
8% learning or behavioral difficulties, or both
(UNICEF 2007).

19. Bangladesh Disability Situation
<18 years - 6 %
>18 years -14%
3.4 million children
with disability
10.2 million adults
with disabilities.
(World Bank 2004).
10% population 16 million with a disability

20. Bangladesh Disability Situation
“Survey of Autism and Neurodevelopment Disorders”
2013
DGHS, MOHFW, Bangladesh.
 Total of 7280 children surveyed in 8
Division
 Cognitive Delay highest prevalence.
 Prevalence very High :Dhaka city- 3%
 Prevalence lower in rural population - .07%.
 Mean prevalence of ASD - 1.55/1000

21. Type Prevalence of Disability
NEUROBEHAVIORAL
46/1000 (Cognitive
Disorder);
12/1000 (Developmental
Motor Disorder);
20/1000 (Expressive
Language Disorder);
7/1000
(Seizures/Epilepsies);
7/1000 (Mental Health
disorder);
PHYSICAL
4/1000 (Cerebral
Palsies);
3/1000 (Blindness or
VI);
5/1000 (Deafness or
HI);
4/1000 (Genetic,
Syndrome, Anomaly).

22. Mean prevalence per 1000 by Diagnostic
groups in all sites combined
Figure-5: Mean prevalence per 1000 by Diagnostic groups in all sites combined.

23. Bangladesh ASD Prevalence
Figure-6: Mean prevalence per 1000 of Autism Spectrum Disorders in Dhaka city, in
rural populations (7 Upazillas), and combined.

24. CNAC Reports
Number Percentage
Cerebral palsy 1681 13.51%
Epilepsy 2983 23.97%
ASD 1090 8.76%
Speech delay 1061 8.53%
Headache 711 5.71%
Downs syndrome 300 2.41%
Mental Retardation 293 2.35%
Developmental delay 1915 15.39%
ADHD 283 2.27%
Behavioral disorder 252 2.03%
Others 1876 15.07%
Total: 12445 100.00%
Child Neurology and Autism Centre, BSMMU reports of one year
statistics showed

25. Bangladesh Disabilty
 10% of population of Bangladesh suffers from
some sort of Disability
 High prevalence of Neurodevelopmental
disorder.
 Autism is the commonest form diagnosed
 ADHD is also common
 ADHD and autism has increased
[Rashed et al 2005]

26. Neurofeedback in Bangladesh
NEUROFEEDBACK
?????
UNKNOWN IN
BANGLADESH

28. Paper presented BACAMH

29. Neurofeedback : a new treatment Modality
Paper presented
in
“BACAMH”
(Bangladesh Association of Child and Mental Health)
Annual conference on 24-25/11/2014
None in the conference ever had heard the
term Neurofeedback in Bangladesh.

30. Explorer’s discovery
Discovered SPECTRUM LEARNING
Received Training
Practiced
Started Neurofeedback in Bangladesh
First case 16 year old girl with ADHD
Second case 12 year old boy with Autism
Review by Dr. Kenneth Kang

31. At Spectrum Learning

32. A mission coming true
First Neurofeedback Centre in Bangladesh
Established on 12/12/12
Spectrum Neurology and Neurofeedback Centre
In affiliation with
Spectrum learning Asia, Singapore

33. My Experience
11 Cases
5 ADHD,
3 Autism,
2 ESN,
1 epilepsy.

34. Outcome of My experience
ADHD :Very good response
AUTISM: Remarkable Changes
 REDUCED impulsivity and Hyperactivity, Tantrum
 Improves Cognition, Speech, Sociability
 Controls Emotional Regulation
EPILEPSY: Reduces Seizure severity, frequency anf increases
seizure free period

35. Comments of My Experience
Peopledoes not know about Neurofeedback
 Parents to take up anything that would help their
children.
 Neurofeedback is expensive
Long duration Therapy
 Results not always obvious, feel hesitant

36.  Autism a national priority in Bangladesh.
 Government Child Neurology and Autism Centre
(CNAC) in Bangabandhu Sheikh Mujib Medical University
(BSMMU)
Bangladesh Army has specialized disability Centre and
school “Proyash”
 Prevalence of AUTISM and ADHD increasing
 No Centers have facility of Neurofeedback.
Opportunity of Neurofeedback in
Bangladesh

37. Case History - CASE-1
Practical Experiences of Neurofeedback

38. 19 years old girl
Case of ADHD: Inattentive type
Major problem school failure
Changed few school
Very poor grade
 Parent Disappointed
Practical Experiences of Neurofeedback

39. Observations: Her Delta Theta high and Beta is small.
Aim of therapy: Delta Theta should reduce during activity and
Beta should go higher.
 Neurofeedback : Theta Beta Training
Outcome:
 After 20 and 30
 Attention increased, vocabulary and comprehension improved.
 Task completion , drawing of geometric and biology figures were
complete.
 School performance improved
Practical Experiences of Neurofeedback

40.  After one year of therapy started passing
regularly.
 Appeared 10th grade and was unsuccessful
before Neurofeedback
Practical Experiences of Neurofeedback

41.  The child could not complete the home tasks and pass the
regular class exams
 Successfully passed Secondary School Certificate-10th grade
 Parents highly satisfied calls it unbelievable
 going to appear 12th grade in 2015
 Teachers and mother hopes that she will pass at once. (passed
all subjects in test exams with good grade)
 Teachers comments remarkable improvement
 Example in the school –if one tries then one can
Practical Experiences of Neurofeedback

42. Trend of EEG amplitude

43. Figure-999: Trend Analysis of EEG frequency amplitude (ADHD) on 29/8/13

44. Figure-7c: Trend Analysis of EEG frequency amplitude (ADHD) on 5/12/14

45. CASE - 2
A diagnosed case of Autism
 Age/DOB- 16th September 1999, Weight- 27 Kg, Height-
4.5 feet.
 Major Problems:
 Obsession: Severely obsessed. He walks in a line, Keeping
particular doors and windows open/closed.
 Repetitive speech
 Run away

46. Evaluation Questions
When you first thought that he has problem?
 Around age 2.5 to 3 years
What were those problems?
 He was not communicating much.
 His stock of words were reducing.
 He had a tendency to run away.
 He was not making conversation

47. Evaluation Questions
What treatment or therapy you have provided:
 On January 2003. Homeopathic medications.
 On 2007, at age of 8 years: Occupational therapy from
school.
 Received supplements like GABA, TMG, and Omega three
from KIRKMAN, USA for 2 years
 On 2010 and 2011: Speech therapy.

48. Evaluation Questions
Does he go to special school, which class? Is he attentive?
He is going to a special school.
Learning Math (counting, additions),
Science (general knowledge on animals, fruits, sun,
earth, food, healthy, colors etc.
English literature. Can read easy English
Write free hand with a poor handwriting.
He plays computer games of cooking, dressing,
restaurant games, puzzles (both paper and computer)

49. Initial Measures and Reactions
 Did not allow putting the clips on ear or head.
 After explaining and persuasion for several times
by his father he actually started accepting the clips
and went on taking NF.
 Since he was restless and not willing to sit ideally
we started giving him to play games on computer.
 He enjoyed games on computer so we started some
Beta Theta training and as in ADHD to reduce his
impulsivity.

50.  It worked the child calmed and started taking
Neurofeedback regularly.
 Mother Reported very positively. Kept School was
unaware of the NF therapy and asked mother about
teacher’s comments.
 Teachers Report: he was cooperating them much more
than before in school, and also sitting in the chair more
quietly. I was thrilled with the experiences. One day
mother said that now he is asking for food in full
sentences.
Initial Measures and Reactions

51. Outcome of Neurotherapy
After 20 session
The result was immense: Compared and found very positive
response mostly in vocabulary, speech, attention and
impulsivity
 Occasionally the child became violent two or three times with her
sister and bitten her but later he realized and apologize which he
never did before.
 His hand writing and drawing also improved.
 He became more cooperative and took part in household choirs.
Parent’s expectations were also to have some improvements on
bowel and bladders control which the child did not improve.

52. Report of the week 10th March, 2013
Unwanted Symptoms: Reduced
 Urination-almost same before at home
 Waking up early in the morning-sound 6.00 am
(sleep disturbance less?)
 Frequent Hand flapping (compulsion)-several
times a weeks (reduced)
 Jumping on both legs together (hop) – not seen this
week
 Agitation-much less this week .
 Seeking for verbal prompt-same/little reduced.

53. Positive Observations
 The range of ‘Choice of food’ has been increased
 Communication-Providing small answers in one o two
words 2/3 times this week (new improvement).
 Paying Salam when asked to perform. (more spontaneously
than before).
 Cooperation: Carrying order more than 1st week of NF, but
less than the time before starting NF- better.
 Helped mom to carry grocery in his back pack. More
cooperative.
 Response to conversation and counseling improved.

54.  Showed very much happiness while eating; (laughed loudly
after finishing eating and said complementary words
 Tolerance on sisters crying seems to be improved. – same.
 Refused the RDI (relationship development Intervention)
program saying “RDI finish” –so mom did not create
pressure and let him get away.
 Choosing Food: Asked for Khichuri, Dale halua etc. Was
very happy to get.
 Joined in morning walk with mom this morning.
 Teacher from school said today, urination and obsession
problems are reduced. Speech is less but more meaningful.
Positive Observations

55. Case 2: Trend analysis of frequency amplitude
Figure-8b: Trend Analysis of EEG frequency amplitude of Shimana (Autism).

56. Case 2: Trend analysis of frequency amplitude
Figure-8a: Trend Analysis of EEG frequency amplitude of Shimana (Autism).

57. Scope of Neurofeedback in Bangladesh
 Bangladesh is a low income country but some are very rich and afford
Neurofeedback.
 Going abroad is time consuming and NF is long therapy, they will be
interested if it is provided at home.
 Bangladesh government has given emphasis on child development
disorder mostly on Autism.
 There is an opportunity to integrate Neurofeedback with other
services.
 Many National and international NGOs are also working in Autism and
other developmental disorder,
 Neurofeedback It can be a new HOPE

58. Challenges
 If Neurofeedback available children would be
highly benefited
 The major limitations whole population including
health professionals unaware of Neurofeedback
 The therapy is quiet expensive and unaffordable
by most of the population.
 People will be interested who is going to inform

59. Conclusion
 I believe Neurofeedback will be applied in
treating many Neurological Diseases in
future.
 I expect more of suggestions to improve on
and support to Develop Neurofeedback in
Bangladesh.

60. ACKNOWLEDGEMENTS
I must acknowledge my heart felt gratitude to Dr. Kenneth
Kang from whom I learned Neurofeedback and who gave much
time answering many of my questions and clarify many of
understandings. He also reviewed my cases and suggested the
treatment. I also thank the staffs of Spectrum Learning, especially
Kathy, Stacy and Ting Ming on whom I really practiced
my first sessions. I am also grateful to my first three cases
who volunteered in taking up the therapy without knowing much
about it and in confidence on me.