0 Preface
Attention Deficit Hy-peractivity Disorder (ADHD) is one of the common behavioral problems in children and adolescents. It is a group of syndromes caused by non-intellectual factors. Usually, children with normal or near-normal intelligence. Its pathogenesis and pathogenesis are still unknown, and it is currently considered to be childhood behavioral, emotional and cognitive abnormalities caused by a variety of biological factors, psychological and social factors. Different cultural backgrounds and different regions have different prevalence rates. Foreign epidemiological data show that the prevalence of AD-HD is 3% to 10%. The prevalence of ADHD in school-age children in China is 6%, and there is a trend of increasing year by year. The male-female ratio is 4:1. ADHD is mainly characterized by inattention, hyperactivity, impulsiveness, cognitive function defects, developmental delay, learning and behavior problems, and often combined with a variety of psychopathological manifestations. The core problem is insufficient self-control ability. Although the level of hyperactivity in children with ADHD decreases with age, many symptoms of ADHD can continue into adolescents and even adulthood, and can lead to low socioeconomic status, low education, work ability, and social ability in adulthood. low. About 10% of AD-HD patients have serious mental illness or antisocial behavior problems in adulthood. With the change of medical models, more and more doctors and parents are paying attention to children's ADHD, especially the performance and outcome of children with ADHD. It is the most concerned issue, so early detection, early intervention and Treatment is necessary.
1 Introduction to existing treatment methods
In general, treatments for attention deficit hyperactivity disorder can be divided into pharmacological and non-pharmacological methods. These two methods are usually used in combination in the clinic.
1.1 drug treatment
At present, 91% of drugs are treated with ADHD, and the course of treatment is more than 6 months. The specific treatment methods are as follows:
(1) Central nervous system stimulant treatment
Referred to as the central stimulant, if the effect is satisfactory, it needs to be maintained for more than 3 months before it can be gradually reduced. Studies have confirmed that the short-term efficacy of these drugs is very significant, the effective rate is 65% to 75%, different doses, high doses can improve cognitive function and attention, low dose can improve behavior, social skills and impulsivity.
(2) tricyclic antidepressants
The behavioral improvement of ADHD alone is the most significant, but the effect on attention is not satisfactory, and cardiovascular and other side effects are large. These drugs can alleviate ADHD and depressive symptoms, and their effects are comparable to those of central stimulants.
(3) a-receptor agonist
Celepine (mean dose 0.2 mg/d) is superior to cognitive improvement in the improvement of ADHD behavior and is commonly used in hyperactive children with tic disorder.
(4) Chinese medicine and traditional Chinese medicine treatment
Including acupuncture therapy, auricular acupuncture and Chinese patent medicine. The effective rate of treatment of children with ADHD is 84.8%, and it is necessary to combine psychological counseling during treatment.
Drug treatment may cause cardiovascular damage, drug addiction; anorexia, abdominal pain, gastrointestinal disorders; dizziness, headache, insomnia, liver damage; suspicious, manic and other mental disorders or even sudden cardiac death.
1.2 Non-pharmacological treatment
Non-pharmaceutical procedures include family, social care education, psychological counseling, traditional behavioral game therapy, and biofeedback therapy. The specific method is as follows:
(1) Family and social care treatment
Parents and teachers can be taught weekly by the therapist to teach them standard behavioral skills and to develop rules for rewards and punishments. Pay more attention to the child's good behavior and intentionally ignore the bad behavior, and ask the teacher and parents to reflect the situation in the form of a report card. The general training time takes 8 to 20 weeks. At the same time, it is necessary to purposefully guide children with ADHD to have more contact with sympathetic partners, so that they can not only complete a certain amount of exercise, but also provide them with a social environment, so that they can learn to deal with interpersonal problems.
(2) psychological counseling treatment
The method improves and corrects children's behavioral problems through language self-direction, role rehearsal, self-reward and self-recognition. The specific operation is carried out by a psychotherapist. The therapist teaches the child some cognitive skills, including verbal self-direction, problem-solving method cognitive model building, self-monitoring, self-assessment, and self-reinforcing. Through role rehearsal, children can use these techniques to control inattention and impulsive behavior in other situations. It is usually treated 1 or 2 times a week for several weeks to several months.
(3) Traditional game therapy
By allowing patients to do similar behaviors, including counting black spots, ping-pong, puzzles; continuous calculations, answering simple questions; ordinary video games to keep patients focused for a longer period of time. However, these games are extremely boring and do not attract the attention of the patient or the game content is not suitable for treatment. Can not inhibit the patient's attention shift, and some games (such as online games) have side effects, easy to turn into other mental illnesses such as Internet addiction, and the treatment effect will be limited.
(4) Biofeedback therapy
Biofeedback therapy refers to the use of various techniques to visually and auditoryly display certain physiological activities in the body. Through guidance and self-training, consciously control these physiological activities, thereby achieving the purpose of controlling certain pathological processes and promoting functional recovery. Its theoretical basis is "operating conditioning". The goal of our research is to use ECG biofeedback technology to improve patients' attention deficit and hyperactivity disorder symptoms.
2 Relationship between ECG feedback and attention deficit disorder
It is widely believed that the heart is the power and hub of the circulatory system, and the function of thinking and emotion is attributed to the brain. however. With the deepening of scientific research, scientists have been able to re-examine the relationship between the mind and brain and the heart's physical and mental health from different aspects. In our bodies, different organs and systems affect our emotions, and the heart plays a particularly important role. The communication system between the heart and the brain is more developed than the communication system between all other human organs and the brain. Every beat of the heart not only outputs blood, but also transmits complex nerves, hormones, pressure and electromagnetic information to the brain and the whole body. It is the node that connects the body, mind, emotion, and spirit. It is the entrance to the complex network of mind and body.
Therefore, the rhythm of the heart does not only achieve a single blood supply function, it reflects and affects the state of the autonomic nervous system. The study found that heart rate variability (HRV) extracted from the rhythm of the heart can be effectively used to examine the effects of emotion on the autonomic nervous system. It is a dynamic window showing the balance of the autonomic nervous system.
In the case of concentration, the two parts of the autonomic nervous system (sympathetic nerve and vagus nerve) are in an excited state, and their effects reach equilibrium after confrontation, and the response is net effect on the heart rate. In the quiet state, it is apparent that the influence of the vagus nerve is dominant, and as the exercise load increases, the activity of the vagus decreases and the excitability of the sympathy increases.
The specific mechanism of ECG feedback therapy is the application of the principle of operational conditioning, with the ECG biofeedback as a means to achieve the desired goal by training the patient's autonomic nerve to reach equilibrium. The process applied to humans is to use the ECG detection circuit to detect and separate the patient's HRV index, and then use ECG feedback technology to pass the indicator to the patient's corrective game program. This indicator will affect the progress of the game program. When the indicator meets the requirements, it will be rewarded to the patient. Otherwise, the reward will stop. That is, the game will go smoothly only if attention is concentrated. In this way, through a period of self-regulation, the patient's autonomic balance state can be changed, thereby achieving the purpose of correcting attention deficit disorder.
3 overall system structure
This system integrates ECG data acquisition, preprocessing, A/D conversion and USB transmission, data browsing (including QRS wave detection, HRV preprocessing, RR interval sequence, NN interval sequence), HRV analysis, game correction procedures, etc. The function is integrated into one, mainly including five major functional modules: data acquisition and preprocessing, A/D conversion and USB transmission, data browsing, HRV analysis, and game correction program, and each module is relatively independent. Different modules can be implemented by configuring these modules into different systems. The overall block diagram of the system is shown in Figure 1. The first two parts are the hardware part, and the last three parts of the software can be written in VB under the Windows XP platform, and the processing part is written in VC.
4 system function
The system consists of real-time ECG data acquisition and display, HRV analysis, and game correction procedures.
4.1 Real-time ECG data collection and display
The ECG signal (ECG) is amplified by the ECG amplifier, filtered, and sent to the A/D converter after 50Hz power frequency notch. Figure 2 shows the ECG data acquisition and preprocessing circuit of the system. The system uses Altai's USB2010AD multi-function interface board to sample the processed ECG signal at a sampling rate of 1000 Hz. At the same time of data acquisition, the ECG waveform is displayed on the screen in real time, the data acquisition time is also displayed on the screen, and the user can control the length of the acquisition time. According to the needs of HRV analysis, the data acquisition time is preferably more than 30 minutes.
4.2 HRV analysis
When extracting parameters that can characterize attention concentration in HRV, first understand the waveform characteristics of the ECG signal. Figure 3 shows the waveform of the ECG signal of the normal human body.
The conventional electrocardiogram shown in Fig. 3 generally consists of P, Q, R, S, and T. In the figure, several waveform parameters valuable for diagnosis are P wave, R wave, QRS complex wave, ST segment, T wave, The QT interval and the TP segment, which respectively reflect changes in a series of integrated vectors in the cardiac cycle from different angles. The heart rate variability analysis measures the change in heart rate by measuring the beat to fluctuation variation (Variance) between consecutive normal QRS complex periods. It is different from the commonly used average heart rate change indicator in time (such as maximum heart rate or minimum heart rate, etc.), and the size of HRV does not reflect the speed of heart rate. Reflecting the sinus heart rate should be the P-P interval. Therefore, more specifically, the HRV analysis is a measure of the difference between successive P-P intervals. However, the P-P interval is currently difficult to measure accurately, and in general, the P-P interval and R -R intervals are equal. Therefore, the current analysis replaces the P-P interval, or N-N interval, with the R-R interval. HRV is clinically used as an indicator of non-invasive response to autonomic nervous system activity.
Specific HRV analysis can be performed using scatter plot analysis. For the R-R interval of adjacent two-heart beats, if the previous R-R interval is the abscissa and the latter R-R interval is the ordinate, the Lorenz scatter plot can be obtained. The scatter plot contains the linear and nonlinear trends of HRV. The scatter plots of ordinary people are mostly concentrated near the 45° ray, and are scattered from the bottom to the top in a comet shape. The occult plot can be used to understand the autonomic function status of the subject.
4.3 Game Correction Program
Through a certain amount of experiments, you can determine the scatter plot distribution range of people with normal concentration of attention and the scatter plot distribution range of patients with attention deficit disorder, and then define a parameter Attention (the type is BOOL type, in the program, When attention is focused, its return value is TRUE, otherwise FALSE), and then the parameter is introduced into the game program, the patient can select different games in the main program interface for corrective treatment. Now take one of the games as an example to illustrate its correction principle.
After the game starts, there will be three cars on the screen, the middle one is controlled by the patient himself, and the other two are automatically run by the computer program settings. When the game level is set, the patient controls the initial speed of the car to be v, and the speed of the other two cars is always 0.8 to 1.2 times v. The specific multiple is generated by the random number formed by the computer in the range. . The patient himself controlled a car including two aspects of its two-handed operation and ECG feedback Attention parameter control. For the roadblocks that appear randomly on the track, the patient uses the manual keyboard to control the car to avoid. Every time the car hits a roadblock, the speed is reduced by 0.1v, and the speed of the car remains unchanged when the roadblock is successfully bypassed. While the patient is manipulating the game, the system can analyze the patient's HRV complexity and output the patient's attention status value. Note that the state increases for 5 s and the speed increases by 0.1v. Note that the speed is reduced by 0.1v for less than 2 s; the original speed is maintained when the state is continuously maintained between 2 and 5 s. The game runs for 30 minutes to count a paragraph and records patient points.
In this way, through long-term continuous treatment, the patient will eventually maintain a certain degree of concentration and eventually overcome the attention deficit hyperactivity disorder.
5 Conclusion
The system has a friendly interface, convenient operation and high integration. The operation interface is composed of a main menu, a sub menu, buttons, icons, and the like. Use the mouse to click on the icon, menu, button representing the actual object to achieve the corresponding function. This system integrates ECG data acquisition, preprocessing, A/D conversion and USB transmission, data browsing (including QRS wave detection, HRV preprocessing, RR interval sequence, NN interval sequence), HRV analysis, game correction procedures, etc. The function is integrated and highly targeted. Because attention deficit hyperactivity disorder patients are mostly in adolescence, the design of this design using computer games for treatment is easy to accept, the treatment effect is better than the traditional medical treatment and other treatment effects.
In addition, the analysis results of this system are intuitive. The system restores the ECG waveform in real time, and can visually see the changes in the patient's ECG waveform. At the same time, you can also see the scattergram obtained after HRV analysis, which is convenient for doctors to make correct and reasonable treatment judgments.
Low Scrap Rate Mask Body Machine,Earband Welding Machine,Automatic Inner Ear Mask Machine,Inner Ear Loop Face Mask Machine
Wuxi Kanghe Medical Consulting Co., Ltd. , https://www.jskanghe.com