Hey everybody, Kurt Othmer here back with the 2017 Clinical Summit
and I have invited these two amazing experts along with me to talk to you about the combination sensor
This is Roxanna Sasu
she's been a clinician with us for nine years now
Over nine years now
and she is an instructor for us
teaches the assessment and what is it it's synchrony now
and then also the intro class
oh that's right that's right you're half the intro class now
oh how time flies
oh yes
and Meike Wiedemann you do the intro class in Europe
and you're a University instructor, you teach at a University
and in the advanced class over there
and you also just got off an airplane
and I dragged you into this to help us with the combination Sensor
well because I really want your voices as we get into not just the technical details of how does this work but the specifics
of you know well sorry the specifics of how it works
but the more general of how do we interpret the results what is meaningful
here what is not meaningful and you know when does the result differ from from
what we think and so I kind of want to pick both of your brains on that but
first just the technical how to how do we plug it in because this is a little
techie it isn't as simple as some of the other steps it is a little bit a little
bit techie arm so all it takes is for the combination sensor to be plugged
into the neural amp and we need to make sure to plug it into the far right board
we don't plug it into the other port that just only goes into the chest so
far all right the other three can be used for the tectile okay so then this
is designated for the amplifier for the combination sensors or I do those at the
same time yeah the examination sensor and they're right and the bear goes into
one of the other one exactly exactly so let me do that now
plug it in the flat surface upwards just like you do it with the tech tile it
doesn't go all the way in but far enough so just once it sometimes it doesn't
like click or anything but it's no but yeah it's good
you can't go any further than that that's it okay and then what you have to
do is enable the sensor and what you need to do for that is go
into the settings yeah on the main screen and scroll down to combination
center and it will show you that it's disabled disabled is checked then what
you need to do is enable it once you've done that there's two more steps that
you need to do you need to reset signal types and that's done on purpose so if
you really use the combination sensor then you go to all those steps once you
enable it if you don't turn the system off and you don't turn the meter off it
should work for all the subsequent sessions okay so I don't have to do that
every every time it's one time setup and we reset twice right and that tells it I
really am serious about using the company but a sensor it's not just
make-believe it's not a bear it's actually the combination sensor so
enable reset twice okay right plug I'm learning okay actually and then so we
reset once reset again excellent and an event it will be ready to go and you can
see this red light will pop up here as soon as we start using it so in the
right panel a little light there and then should I put this on oh sure let me
help you there let you be the therapist will use the index finger and I've seen
like Sam in his office he just has the the velcro closed and then with the
velcro closed the client can just sort of sneak in there and slide their finger
in under the velcro or you can undo it and so then in the right panel under
grabs if you click on it you'll have the measurements great
so I see in there what you're seeing is well a few things the amplitude trends
that's something that has nothing to do with the combination sensor that's our
graph in the session report as well and in the history graph so that's something
that you all know about the EMG that muscle tension picked up actually by D
like to it so the first two graphs have nothing to do they don't
anything that the combination sensor is picking up but then the next few graphs
for the EMG that's actually pulling like from the EEG sensors and it's telling
you this is muscle tension so it's giving you muscle tension for the aging
such as bad as a cool trick it is like well I think about muscle tension it's a
much bigger signal than you actually EEG so then that's probably easier to
measure I love it I love so easy for them to pull that out and put it there
it's in a graphite oh your client has muscle tension there's a graph and we're
getting it from the EEG electrodes right that's me and then the next thing we see
is the heart rate and then we have GSR so that galvanic skin response and we
have temperature measurements and then the last piece here is a stress index so
what the software does is it calculates the stress index based on those
measurements telling you whether you're pretty calm or pretty stressed so it's
an overall kind of measurement and oh that actually doesn't show anything
right now because it needs 120 seconds you guys to get started take this a
little bit here oh just just that better comfortable so talk to me a little bit
so heart rate and IC h RV right that has heart rate variability okay so there's a
number next to it so that's the variability between you know the heart
rate when you're reading in and when you're breathing out and that should
very that that should should be nicely varying and oh so that's another way of
measuring how the system responds to certain stressors and stimuli in real
life and of course what we're getting here is basically reflective of how that
nervous system responds to what we're doing for the training which is really
helpful when the client is not giving you much information or when the client
is trying to be nice right well that's just that is really what I want to delve
into right I mean first I'd like to understand these numbers just a little
bit better what is heart rate what is GSR was heart rate variability what is
temperature what does it mean and the stress
index but I really what I really want to delve into with you guys is how do we
under interpret or over interpret these numbers I mean how do we use the stress
index to say boy there might be something meaningful here from the
client but how do we also say well there must be something meaningful and then
it's not well so first let me delve into the numbers what is it so heart rate is
this is what am I suppose okay right pulse so you get the number here and it
varies right so then you get the heart rate variability which is the difference
between your heart rate that's going up and down with your breathing okay and
that's that difference is that is reflected in that number okay and then
the skin responds to galvanic skin response that's basically sweating which
I'm doing more of being on camera and I actually know I'm never nervous never at
all it's live live live I don't look nervous on camera this is not true at
all okay so my GSR is climbing through the roof and while you're on camera and
we would expect that to go down if we're calming the nervous system down okay so
we're doing the opposite with you right now and then or at least this is what
the measurement is say this is exposure therapy and then what we also have below
is the temperature measurement and that goes up because as muscle tension is
decreasing you have increased blood flow to your body and then that's being
measured right the temperature is rising a nice warm hand yeah yeah maybe Green
Sun I must have done a lot of biofeedback in my youth your mother
tells me my mom tells this story but she did so much hand warming because she
didn't like getting on airplanes and so she did so much hand warming then she
gets on an airplane her hand like just like being there yeah just her hands
were like right this conditioned response right she's done it so many
times in hand warming when she gets on a plane but boomer hands just get hot when
she does it an airplane conditioned response
so apparently okay so my hands are nice and warm and my stress index is
interestingly all over the place it kind of went up with my GSR there right it
did and then now it's go sounds now you're moving a lot and you're talking a
lot with a client and training with us wouldn't really
happen much so the talking sure but not the moving right the flailing around
ending on stage okay that kind of thing but we're picking that up and then you
know if you would be hooked up we're not getting an EEG signal now so don't have
amplitude plants so we're not really getting the entire information that we
would normally collect but a client that's training with us um and this
little green light that's my heart rate that's your yeah that's your pulse
how cool okay and what it's nice about the grass is that you can adjust them so
you can move them up and down to move the you know the baseline up and down
and then you can blow up the information you know the signal make it bigger make
it smaller whatever works and then what you're seeing here is a time a time
frame is five minutes okay but then you can actually at the end of the session
you can see the entire information thirty minute recording you can replay
it in replay mode for each client if you collected the data and it's interesting
I find it really interesting having this additional information with clients not
that we're going to I'm not basing my clinical decisions on that measurements
but it's it's more information about that brain and it's interesting to see
how it correlates with what we hear from the client your regulation and how are
you using it with say alpha theta and synchrony are you seeing are using it
there at all yes we do we do um and it's interesting again because it's a
different kind of training so the expectations are different we're
achieving more maybe more calming with the synchrony training we're achieving a
different deeper kind of calming with the with the Alpha Theta but sometimes
for instance an alpha theta people might have a very informational experience
which doesn't have to necessarily be a good one and then uh you will see that
Wow in the measurements because you know then the heart rate is going to go up so
it's it's being of stress right distress signal from the body and that's what
we're seeing right so somebody had some really profound experience twenty
minutes into their alpha theta session they're like oh boy be able to
exactly see that just that moment in the heart rate right here's our and the temp
and everything wow that's really fine to discuss with Clyde's
after the session yeah you know they always want to see something the lines
that they don't see in the EEG but we might see a lot of in the special
stuff and then you can say well in the middle of the session we see something
here what happens there is oh well I feel that I had this experience or I
reappearance and they are really impressed to see that symbol in the line
graphs them well it's also what I really like about the quick test is that it
gives you those numbers that they're craving with and the clients are craving
to see those numbers in EEG and doc and I better kill me if I do that better
than my AG and it's like well you're better on your quick test and these
graphs are interest so I love that that gives you something and so are you using
this usually we've been using combination sensor yes I'm usually with
most people that don't new in the training so when they are not really
trained what we are asking them for so they tend to look at the screen and said
well how do you feel well the screen is getting darker or brighter or whatever
level but how do you feel inside top for a lot of people so if you have this in
the beginning and then you train them over time it's not that I needed over 30
or 40 sessions using the sensor but for the first five six seven sessions I
always use it especially with adult people not necessarily with the kids
that move around a lot because then we grab a lot of movement artifacts then
it's more difficult to interpret but also useful yeah so we get those
artifacts oh that's B that's the sort of over interpreting of it we can read too
much into it that's wiggling and then under
interpreting it well and so you can you thing I think yes absolutely and it's
really interesting I have this one client that comes to mind he was
watching documentaries nature documentaries which are really beautiful
but every once in a while you know an animal gets killed and doing one of
those scenes although he was reporting that he was feeling nice and calm I
could see that he was actually stressed out at the end of decision I asked was
that scene disturbing and he said you actually it was yeah well I could tell
so that's that's that's how you use it that's how you use that piece of
information it's just additional information about that
nervous system it's not going to be the court it's not going to tell you which
weakness Ian Ervin is the needs so not it's not going there what we're hoping
for is that this is you know a tool that we can then develop into maybe about a
feedback tool and I think that's you know this is just a platform yeah and
possibilities we've got the citing why not use it with with biofeedback just
run the games directly with this and do it for biofeedback there's also just so
many great biofeedback toys out there so people can just get mine wave
photographs yeah that's perfect thank you both so much for taking the time
with me entire body we appreciate it this was fun Thanks yes