Traumatic Brain Injury

iStock_000023595907Small-277x300A lot of people get traumatic brain injury, estimates are 600,000 per year in this country. Often this happens from car accidents, including relatively “minor” accidents. The most common result is that you have lower concentration, trouble reading, mental slowness, often sleep disruption. Often vision is “not right,” with sudden loss of reading speed, comprehension or comfort; depth perception may be dramatically worsened. Getting poor sleep because of sore muscles from whiplash injuries makes the effects of any mild brain injury much worse. The hard part is that you look normal to friends, family and your doctor.

What is it that we are doing to help Traumatic brain injury (TBI)?

Traumatic brain injury (TBI) typically occurs when the head is suddenly accelerated and/or decelerated during an accident of some type. There may or may not have unconsciousness, or even a blow to the head. A severe whiplash situation can cause the same kinds of twisting and shearing forces on the brain’s axons – the nerve fibers connecting one part of brain to another – as does a blow to the head. It is thought that these forces damage the connections between nerve cells and possibly the conducting fibers themselves, resulting in impairment of function.

Damage to the networks of connections in the brain also occurs with a stroke or surgery. A “stroke” means that either there was a blockage in a blood vessel feeding a particular region of brain, or a blood vessel broke open and bled (aneurism). There will be a local area of damage from the cells not getting enough bloodflow. The piece of brain that is directly damaged by the stroke will be impaired, at least for a while, and won’t be able to serve its normal function. Beyond that there can be effects in regions the local area of damage is supposed to communicate with. Many regions of brain perform regulation of other regions, so if an area is damaged by a stroke or surgery other areas – not necessarily nearby – can lose function because they’re not being regulated properly.

Brain can also be injured if a person is unable to breath for long enough, or if the heart stops for too long. This happens from lack of oxygen and blood sugar getting to the brain cells. This is why it is so important to provide emergency CPR at the scene, immediately. If you do not know how to administer CPR, you should learn. Contact a local hospital, fire department or medical clinic and ask how to get basic first aid training including CPR. Even when the person is revived, the brain may have suffered widespread damage, since all the cells need oxygen and glucose to survive. Some are tougher than others in the face of oxygen deprivation. The cells in the hippocampus, which is vital for memory formation, are unusually sensitive to being deprived of oxygen, so loss of ability to store new memory is very common in “anoxic” (without oxygen) brain injuries.

Traumatic Brain Injury patients often show emotional instability, which may be from the emotional regulation regions having been injured, or from the incredible frustration of everyday life with a brain injury, or both. Brain injuries from many causes create impaired concentration and memory and reductions in the ability to “multi-task,” that is, to keep on top of several things at once. Patients with brain injury (particularly from traumatic injury) often show a dramatic drop in their visual processing ability. This is measured by a relative failure of the eyes to converge and/or diverge rapidly and accurately. This results in decreased reading skill and decreased depth perception. Patients often have further accidents, and tell us they feel “clumsy,” disoriented in space. In traffic for example, they feel confused about where the other cars are relative to their car. This is obviously dangerous and predisposes to further injuries. The impaired attentiveness coupled with the visual problems and emotional instability probably contributes to the finding that a person with a head injury is six times more likely to have another one. We’ve had great results correcting this problem with binocular vision training.

Neurofeedback’s Impact on Traumatic Brain Injury

Approximately five million people in the United States live with some type of disability resulting from traumatic brain injury, or TBI. Sadly, it is reported that an additional 1.5 million annually will experience some degree of TBI. Of those, about 80,000 end up on long-term disability and 50,000 die. Most brain injuries are directly related to car accidents, although serious falls are also a potential risk. Because of these vast numbers, experts estimate that some $49 billion are spent every year for treatment.

Although the consequences of traumatic brain injury would depend on the situation and person, the most common effects involve psychological and cognitive functioning. This means that the person’s ability to reason, solve problems, or concentrate become challenged. Along with these, other problems develop, including depression, fatigue, irritation, and lack of motivation, which is understandable. Not only has the life of the person with TBI been disrupted, but family members and friends are also affected.

Because traumatic brain injury is a serious and growing problem, new studies are continually being conducted to try to gain a better understanding of how the brain is impacted, as well as what new treatments or therapies are available to help. One that has gained serious focus is neurofeedback, specifically the QEEG, which stands for Quantitative Electroencephalogram. QEEG is a diagnostic tool that has taken the traditional EEG signal and digitized it. Therefore, rather than having the findings of the assessment being printed on paper, information is captured electronically and saved where it can then be analyzed via computer.

The benefit of using QEEG specifically for traumatic brain injury is that the patient’s brainwaves can be replicated at a future date and then reviewed but also compared to a database of other people without brain injury to determine weaknesses or areas of the brain that are not responding or processing normally. This information is valuable for neurofeedback therapists in that they can then zero in on the type of training the patient needs so the connection between mind and body can be reestablished.

To accomplish this, neurofeedback therapists use two different types of QEEG measures. First, brain activity from many different locations on the scalp that have had electrodes applied would be looked at to determine the brainwave activity for each location according to a particular frequency. Second, variables would be analyzed, to understand connectivity patterns of the brain between the locations on the scalp. This looks at what is known as the brain’s white matter, or activity between myelinated fibers that connect different parts of the brain.

All of the values that are identified using the QEEG can help the therapist provide the best training so the patient ultimately receives the best therapy and results. During testing, the patient would be asked to focus on specific tasks with the eyes closed, which enhances the signal produced by Neurofeedback QEEG. Typically, this type of testing and retesting might occur over a seven-day period, which increases level of accuracy.

Taking information from the strategically placed electrodes on the scalp, information, or brainwave activity is sent to the neurofeedback machine. Then, with a software interface, selected feedback is provided to the patient using visual or audio signals. These signals are used to help the patient recognize activity in the brain to avoid and when done, responses from the body would improve.

Neurofeedback can be a long process, especially when it comes to therapy for people with a traumatic brain injury, but in time and with hard work, the brain may be supported so that the mind – body connection is retrained positively. Neurofeedback therapy is not complicated, however, and it appears to have had great success for helping people with traumatic brain injury. With time, the individual may regain the ability to read, concentrate, follow through on tasks, and prevent or control symptoms that often go along with TBI such as headaches, pain, and depression.

EEG Biofeedback Training for Minor Traumatic Brain Injury

The long-term consequences of Minor Traumatic Brain Injury (MTBI) have recently become more widely acknowledged. Persons suffering loss of function due to minor head injuries were usually given CAT scans and MRI scans, which might not reveal any organic injury. As a result, victims were often not taken seriously, and accused of fabricating their symptoms and malingering. More recently, tests of brain function have demonstrated a basis for the symptoms which are described. Such tests include PET scans, topographic brain mapping of EEG activity, and evoked response measurements. These functional tests reveal changes in cortical activation, anomalous EEG activity traceable to head injury, and slowed response.

The symptoms which accompany minor head injury include principally loss of energy; headaches and chronic pain; dizziness and vertigo; memory impairment; difficulty concentrating; anxiety, depression, and mood swings; sleep disturbances; irritability; visual perception problems and dyslexia; and even apparent personality changes. Seizures may also be observed, or seizure-like activity such as auras. If persons exhibited certain weaknesses before the accident, such as attention deficit disorder, migraine headaches, or sleep difficulties, then such symptoms might be considerably exacerbated by the head injury. The apparent severity of the injury, including the length of period of unconsciousness (if any), has little to do with the severity of subsequent symptoms. New symptoms may arise months or even years after the head injury.

We know of no published literature on the use of EEG biofeedback for head injury. We are aware only of clinical work in this field in a number of settings. Over the past six years, we have obtained considerable clinical evidence for the effectiveness of EEG biofeedback training as an adjunct modality for remediating the symptoms of minor closed head injury. By September of 1992, we had accumulated a clinical history of EEG training for 88 cases of (mostly minor) traumatic brain injury. The training appears to be effective even years post-injury, when spontaneous remediation is no longer expected. The training can impact favorably on all of the symptoms listed above.

By means of EEG training, we have been able to restore to productive life a number of individuals who had been totally disabled for a number of years due to head injury. The training is not always that effective. However, essentially everyone who undertakes the training for head injury derives significant benefit. The training needs to be undertaken for a minimum of ten training sessions in order to be able to make a meaningful assessment of whether the training is worthwhile. Completion of training may take anywhere from 25 to more than 100 sessions. Of course, anyone continuing for 100 sessions would only be motivated to do so if there were continuing benefit. The gains made in the training appear to hold for the long term. That is, once the brain is taught again how to regulate itself, it does not relinquish that capability.

When clients are seen within the first six months after head injury, there is a concern about new symptoms continuing to emerge post-injury. Clients must be aware that this may happen despite the biofeedback training, since the latter takes effect gradually. If this understanding exists, and the client is willing to proceed, there may be additional benefit if the training is undertaken soon after injury.