Brain Balance Centers: An insider’s perspective

I’ve written before about Brain Balance Centers; an ever-expanding network of franchise operations in the USA that offer treatment programs for a variety of developmental disorders based on an utterly made-up theory of brain function, and founded by a chiropractor with dodgy credentials. My opinion about Brain Balance has always been that it’s pretty much an outright scam, but I’ve never been able to dig up any real details about their treatment program; the information on the website is very vague.

However, that’s recently changed. A reader of this site who briefly worked for Brain Balance got in touch with me, and kindly gave me some detailed impressions of the practices, staff, and treatment sessions at one of their franchise locations.

So, parents reportedly pay around $6000 for 36 sessions; that’s around $167 per session. The first session lasts for 2-4 hours and the kid is assessed to see which side of their brain is ‘weaker’. Although they advertise a customised service, apparently the treatment programs are fairly standard and originate with the central Brain Balance organisation (the BB Centers are franchise operations). At the beginning of each appointment, shoes and one sock is removed, in order to ‘stimulate one side of the brain’, and a session in the ‘sensorimotor room’ follows. This might be some simple motor (walking on a balance beam, jumping on a trampoline) or cognitive (clapping to a regular beat, doing simple games on a computer) exercises. Sometimes these are done with an eye-patch over one eye, again to ‘stimulate one half of the brain’. The second half of each session is in the ‘cognitive room’ where remedial maths or English work is done; spelling, grammar, arithmetic; whatever the particular child is weakest on.

None of this was very surprising; I always strongly doubted that Brain Balance had found some revolutionary instructional method, and this all sounds very, very standard and boring. What did surprise me was what this reader said about the staff. Apparently, most are very young (21/22 on average), with no real relevant qualifications, and there’s a high turnover; most don’t stay longer than a few months. That could be partly because of the awful wages; $10 an hour. That’s particularly ridiculous when you consider that a typical session includes one coach and two kids. Brain Balance rakes in over $300 per session, but only pays their coaches $10. This reader also mentioned that parents frequently complained about the lack of any nutritional guidance as part of the program; Brain Balance make a big deal out of this in their promotional information, but apparently it never materialised.

They did mention one positive aspect; that there are so few specialist programs for kids with special needs in their local area that parents need something that will at least give them some hope. This jibes with my opinion of these things – individualised attention for an hour a week is probably a good thing for a lot of kids, and may well have some positive effects for many of them. My problem with it is the bullshit pseudo-science and outrageous claims for effectiveness in their marketing.

Now, clearly this is the experience of just one coach, at one particular Brain Balance location, so I have no idea how much it generalises to any of the others. The reader mentioned that some high pressure sales-techniques were often used to get parents to sign on the dotted line, but that might be peculiar to this particular BB Center. Overall, it doesn’t paint a pretty picture though; unqualified, poorly-trained staff on minimum-wage, leading kids through pointless exercises and standard spelling tests. A far cry indeed from the hysterically positive promotional material that promises cures for ADHD, Asperger’s, and other serious developmental disorders. The reader’s general verdict? The Brain Balance program is “fraud”.

You keep using this word ‘neuroplasticity’. I do not think it means what you think it means.

So, I wanted to write a post about how the word ‘neuroplasticity’ is  the current neuro-bullshitter’s favourite big sciencey-sounding word to throw around these days. I was going to explain how it was actually such a broad umbrella term as to be pretty meaningless, and talk about some things like LTP and synaptogenesis in the hippocampus which (in contrast) are precise, well-defined terms, and fascinating processes, and how your brain is changing in a ‘plastic’ manner even as you read these words. It was really going to be a great post.

Unfortunately (as so often seems to happen), it turns out that the mighty Vaughan Bell beat me to it by a scant three years with this typically outstanding post on mindhacks.com. So. I guess you should all just go and read that instead, and I’ll have to be content with my standard operating procedure and take the piss out of some quacks instead.

The ‘About the Science’ section of the Brain Balance Centers main website has some awesomely meaningless language, that manages to work in some other big sciencey-sounding word too:

“It was once thought that the brain was static, unable to grow or change. But extensive research and in depth study of epigenetics has shown that it’s remarkably adaptable, able to create new neural pathways in response to stimulus in the environment, a branch of science called neuroplasticity.”

Ooh – epigenetics, and neural pathways. Fans of meaningless brain cartoons should definitely check out that site too, their disconnected vs. connected diagram is fabulous.

The Lumosity website (a brain-training company) has some pretty choice language too:

“But when neuroplasticity’s potential is thoughtfully and methodically explored, this physical reorganization can make your brain faster and more efficient at performing all manner of tasks.”

There are lots of other examples I could paste in here. I spend a fair amount of time looking at these companies’ sites and I’ve come to the conclusion that any mention of the word ‘neuroplasticity’ is basically a massive red-flag. People are very fond of using it to promote these things, but mostly their arguments boil down to “Because: neuroplasticity!”, which as Vaughan explained so eloquently, doesn’t mean anything at all without a whole additional layer of explanation, refinement and qualification.

So – a top tip, when you see the word ‘neuroplasticity’ think ‘bollocks’ instead.  99% of the time you’ll be absolutely dead-on.

Can playing video games improve general cognitive function?

There’s been a lot of discussion this week about a new article in Nature by Anguera et al. titled “Video game training enhances cognitive control in older adults”. This paper appears to demonstrate what a lot of brain training programs promise, but few seem to deliver; genuine cognitive benefits that generalised to additional untrained cognitive domains/abilities, in older adults.

The positive effects seen are quite large, and as such, the results appear to be quite promising. There are still some reasons for scepticism though. Firstly, this result stands in contrast to other research which shows no effect of similar training programs (including another study by Adrian Owen et al., also published in Nature a few years ago). Secondly, the number of subjects in this study is pretty small, with only 15 per group. As Button et al. (2013)  have pointed out recently, small sample sizes can lead to an inflation of the estimates of effect sizes.

There are several other issues with the paper, but they have been most ably covered by others, notably Christian Jarrett on the BPS Research Digest, and Daniel Simons on his own blog, so I encourage interested readers to go and check out those sources rather than repeat them here. It would be wonderful if such a simple intervention could halt or slow cognitive decline in older adults, however (as usual) more work is needed with larger groups of people before we’ll know for sure if that’s the case.

A short video from Nature that explains the study is embedded below:

Neuro-Linguistic Programming – the 1970s neurobollocks that just refuses to die

I’d prefer to spend two days in a Siberian gulag than with these two smug bullshitters.

Neuro-Linguistic Programming (NLP) was invented in the mid-70s by Richard Bandler (a psychology and philosophy graduate) and John Grinder (a linguist). It originally grew out of observations made in therapy, and a metaphorical extension of some of the concepts of Chomsky’s transformational grammar. In the fertile grounds of the 70s Californian therapy and self-help movement, it soon blossomed into a multi-faceted set of techniques and philosophies. By the 80s it was being widely touted as a novel therapy technique and attracted some serious attention from researchers. However it was relatively quickly understood that there was no empirical basis for its key claims, and as its practitioners began to make ever more outlandish claims, serious interest from professionals waned.

This didn’t stop the NLP-faithful though. People like Tony Robbins (who studied with Bandler) made incredibly successful careers out of the motivational speaking/books circuit.  Despite this undeniable popular appeal, NLP is nowadays widely-regarded as pseudo-scientific bollocks of a particularly refined and rarefied strain.

It’s actually quite hard to pin down exactly what the key principles of NLP are. This is partly because its founders and practitioners use such vague and amorphous language, full of metaphors and pointless jargon, but also because of the diversity of its supposed applications; from ‘traditional’ therapeutic settings, to sports coaching, to corporate training seminars, to (creepily) seduction. It aspires to include something for everyone; the best way to maximise the market and therefore the potential profit. One relatively common theme is focused on teaching communication skills in order to facilitate the learner’s personal and professional relationships. On the surface this sounds reasonable, but the communication theory that its based on has absolutely zero empirical support. The wackier variants incorporate all kinds of other bollocks like hypnosis, and many NLP-whackos talk about being able to ‘reprogram’ their own (and other’s) brain, often by claiming to influence the subconscious mind in some way.

Despite being nearly 40 years old, and a ridiculous, facile hodge-podge of concepts from psychology, philosophy, linguistics and new-age twaddle with absolutely no support from any reputable sources, amazingly, NLP is still very much alive and kicking. Bandler has kept on developing (and ruthlessly trademarking) a load of new techniques including ‘Design Human Engineering™’, or ‘Charisma Enhancement™’. A lot of his recent work also appears to include hypnosis. His website is essentially one big advertisement for his books, CDs and speaking gigs; and there are literally thousands of individuals, businesses, and ‘institutes’ offering NLP training for a bewildering variety of purposes and people. Bandler has even latterly jumped on the ‘Brain training’ trend with a new company called ‘QDreams‘ (‘Quantum brain training!’; ‘Success at the speed of thought!’ FFS…). Searching on Twitter turns up many, many people earnestly tweeting away about the benefits of NLP. Why is it so persistent? Partly this is because of Bandler’s clear talent for slick marketing, re-invention and dedication to innovative bull-shittery, and partly because NLP was never really clearly defined in the first place, which makes it highly malleable and adaptable to any pseudo-scientific new-age trends that come along. Despite a hiccup in the mid-90s (when Bandler tried to sue Grinder for ninety million dollars) it seems to be as popular as ever, and to be attracting new adherents all the time.

In my opinion the real stroke of genius in NLP, and perhaps the reason why it’s been so successful, is simply the name. These days we’re used to putting the ‘neuro-‘ prefix in front of everything, but back in the ’70s, this was way ahead of its time. Obviously there’s nothing remotely ‘neuro’ about it, though. Plus the ‘programming’ bit has a deliciously Orwellian appeal; promising the potential to effect change in oneself or others, if you just know the right techniques.

But effecting genuinely meaningful behavioural change in yourself is hard work. NLP derives from the quick-fix mentality of the self-help movement and is doomed to failure because of it. Does it actually help people? Perhaps, on some level, but any anecdotal results are almost certainly derived from a version of the placebo effect. Because of its vague nature, it’s not even really clear how its effectiveness would be meaningfully assessed anyway. Until we discover the genuine low-level programming language of the human brain we’ll probably always have to put up with this kind of bollocks being peddled.

There’s another really good article on NLP at the Skeptics Dictionary.

Interactive metronome treatment for ADHD/ADD; swing your arms about, cure your brain

Ian Dury. Because… any excuse.

One of the best things about starting this blog was several e-mails I got from like-minded people saying nice things, and often, pointing me towards interesting bits of neurobollocks that I wasn’t aware of. Such was a series of e-mails from Deborah Budding and Michael Thaut (who must be one of only a few people in the world who holds posts as Professor of Music, and Professor of Neuroscience – cool) about the ‘interactive metronome’ technique. Michael’s research (unsurprisingly) focuses on the interplay between the brain and music, and in particular, the processing of temporal information as it relates to rhythmicity, so it’s probably fair to say he certainly knows his way around a metronome.

But what’s this interactive metronome business? Well, as you can see in this video on the hypochondriac’s website of choice (WebMD), it’s basically waving your arms about and moving your feet in time to a regular beat. So, it’s basically dancing then, but much more boring.

Surprisingly, given it appears to be such a simple technique, some people are claiming that it can have profound effects, and assist with various disorders such as ADHD, Parkinson’s, MS and even post-brain injury and stroke. The usual bunch of jokers with slickly-designed websites have sprung up offering treatment for all these things and more. The ‘How it works’ section of that website claims that the underlying deficit in a variety of disorders, claiming that the underlying dysfunction in ADHD, autism, dyslexia, Parkinson’s and others is just a ‘neural timing deficit’. The exercises used in IM correct the timing deficit, and therefore (supposedly) treat the disorder.

To say this is startlingly simplistic would be a massive understatement; it’s just plain wrong. The precise neurological issues in many of these disorders are difficult to pin down and are the subject of active investigation but, to take a simple example, we know exactly what the problem is in Parkinson’s; neuronal depletion in the substantia nigra. To claim that it’s some vague neural ‘timing’ issue goes well beyond disingenuousness and into the realm of outright deception.

There’s even a home-based version of IM therapy, that can be run on any computer – however the basic equipment (wiresless button boxes, tap mats for the feet etc.) and the software licence cost $800.

A PubMed search for ‘interactive metronome adhd’ actually produces five hits! However, on closer inspection, all five articles are seriously compromised in some way – studies with no control group, or with very low numbers. Interestingly, one of the papers that pops up is one I’ve discussed before in reference to Brain Balance Centers. So, IM appears to form a cornerstone of what the Brain Balance guys (chiropractic, with a thin layer of neuro-woo laid on top) are pushing too. The IM guys have gone to a lot of trouble to make their approach appear scientific – there’s a well-populated ‘Science’ section on the website, that contains links to lots of articles, however, many of them are ‘white papers’ of uncertain provenance, and the rest are articles from obscure journals, or on barely relevant topics.

Another problem with IM is that it gets conflated with serious interventions. There’s a large field of study focussed on the use and effectiveness of musical-type interventions for a variety of neurological disorders (broadly, called Neurologic Music Therapy, or NMT) that has some solid research behind it. The slick marketing of IM seeks to conflate their approach with much more high-standard music-based therapy approaches.

In Prof. Thaut’s words (my emphases added):

First, where is the research? Studies that back up the clinical effect of IM directly, are very rare or nonexistent. A small study from 2001 is one that comes up repeatedly. One small study does not build clinical evidence. IM seems in general a well marketed but unresearched application. From a research point I see no evidence for the therapeutic benefit of IM.

Second, brain mechanisms in therapy work differently. Possibly to fill the research void IM generously includes ‘borrowed’ research that has nothing to do with their device. Since I am one of the authors they use I have to clearly  state that my brain research in music and rhythm does not address IM and our results do not support IM applications, neither with patients nor physiologically in explanatory brain mechanisms. The only forms of therapy in brain rehabilitation that work are active and specific exercises based on functional learning and training paradigms, not machine tapping. 

Last, rhythm has its own life. The claim that tapping to a metronome improves timing in patients which in turn transfers to all kinds of cognitive and motor improvements is not only unsupported by research but seems based on a misunderstanding. Rhythmic synchronization is a very complex process that fluctuates continuously on a millisecond level and is inherently unstable and variable. This time flexibility is the actual hallmark of functional entrainment. Therefore the IM definitions and measurements of what constitutes rhythmic improvement seem physiologically and functionally meaningless.

So, there you have it. If you’re concerned about your child’s sense of rhythm (for some reason?) you’d probably be much better off signing them up for dance classes, or piano lessons. It’ll almost certainly be cheaper, and they’ll likely have a lot more fun too.