With the new year I have reorganized my new client evaluations to include both the Qik CPT (replacing the TOVA) and Symptom Tracking on EEG Expert. The idea of tracking relevant symptoms every session or every few sessions is an attractive one. But implementing this change takes some thought and preparation. EEG Expert makes the data collection and display easy. I needed to think about exactly how to fold this into the evaluation and into subsequent sessions.
I now find that the Symptom Tracking setup works well for me near the end of the evaluation. I start with the interview, then the Qik CPT, then the neurofeedback session. After the session, we discuss the CPT results and training results. Then, before a discussion of how to proceed with neurofeedback, I suggest that it would be helpful to choose five to ten primary symptoms that we can track every five sessions as we proceed with training. I have by then reviewed my interview notes and summarized reported symptoms during the CPT. I also have a print-out of all the available symptoms from EEG Expert, on which I have highlighted what I think might be useful symptoms to track.
The discussion of which symptoms to track is proving very helpful. We go back over which symptoms are most important and which symptoms will be useful for us to track. Some of the symptoms we like to pay attention to as early indicators of change, such as bruxism or sleep onset problems, might be covered up by the use of night guards or medication. Or maybe no one is around to report on snoring or bruxism during sleep. This also sets the expectation that changes will be observable and reportable. I am expecting to see results and I am expecting the client to participate in the process by noticing and reporting changes.
After choosing symptoms to track, I do the setup on EEG Expert – still during the evaluation session. We select or write in symptoms and then give each symptom a starting value. I like to let clients rate each symptom based on severity and frequency. I am finding that people do this quite easily. Then I print out a copy of the form with the initial values plus four more copies of the blank form. I write session number 5, 10, 15 and 20 on the blank forms and put them into the client’s chart.
I decided that I didn’t want to rate symptoms every session because I didn’t want to crowd out a more fluid discussion of how the client is responding to training and what to do next. Every five sessions is working well as a time to take stock of where we are with symptoms defined as significant at the evaluation. Of course, some symptoms may have faded away entirely by five sessions, and it is useful to acknowledge that. It is interesting how powerful and validating it is to simply give something a number and write it down. I fill in the form in discussion with the client and then later I can enter the data into EEG Expert.
By the time I sit down with clients after twenty sessions, I have five data points – sessions 0, 5, 10, 15 and 20. That is enough for interesting and useful graphs of symptom changes. Along with the pre and post CPT results, it helps to focus the discussion on how to proceed with neurofeedback or other interventions.
EEG Expert Symptom Tracking is a flexible system that can be used differently by different clinicians. I have found a process that works well for me. I encourage others to experiment with it and give us your feedback and suggestions. Since this is all web-based, the program can develop as we use it.