Can Neurofeedback work for Traumatic Brain Injury, Stroke ?
NFB for Traumatic Brain Injury
‘Traumatic Brain Injury’ (TBI) refers to brain injury that is "externally caused". It is categorised into mild, moderate or severe. These categories refer to how long consciousness was lost at the time of the injury, and don’t necessarily relate to the severity of the symptoms experienced afterwards.
The external force either directly damages the brain by penetrating the skull, or rapid acceleration/deceleration and impact with the skull causes lesions (bruising) to the brain’s surface as it hits the uneven inner surface of the skull or nerve cell fibres to be stretched, strained or torn; this damage although microscopic can severely disrupt the regulation of the brain, hence, impact brain function or behaviour.
Even so-called mild TBI can result in debilitating ‘post concussion syndrome’ symptoms including depression, ADHD-like symptoms, headaches, anxiety, fatigue, irritability, temper outbursts and aggression, memory problems, sleep disorders and sexual dysfunction, depending on which part of the brain was damaged.
Neurofeedback cannot repair physical damage to the brain’s physical structure, but it can use neuroplasticity to exercise and develop new neural pathways and restore brain function. In the early stages after a traumatic brain injury, neurofeedback can be helpful with the head pain that is often experienced, as well as with nausea, irritability, mental confusion, and sleep difficulties.
Margaret Ayers was an early neurofeedback practitioner who treated hundreds of traumatic brain injury patients and achieving remarkable results particularly with recovery from coma in the 80s. Dr. Jonathan Walker, a Dallas neurologist, observed significant improvement in 88% of a group of 26 patients with mild closed-head traumatic brain injury. All of them who had held a job prior to their injury was able to resume productive employment after neurofeedback. The average number of neurofeedback sessions was 19. These results were obtained with techniques that are more than ten years old and significant improvements in training methods have been made within the last decade. The result is that head injury symptoms showing themselves to be resistant to remediation may be targeted more specifically.
Neurofeedback for Non-traumatic Brain Injury (Stroke)
There are three aspects of stroke that NF can help with:
- Loss of function associated with the damage – e.g. language (aphasia), movement, vision;
- More diffuse symptoms that may have emerged after the stroke or any associated surgical procedure, including irritability, pain, sleep problems, mood swings, effort fatigue, or cognitive fog;
- Psychological impact of any major loss of function and the acceptance of this – the potential loss of career, relationship issues, reduced social circle.
Logical steps to treatment:
1) the diffuse symptoms, 2) psychological impacts 3) specific loss of function.
Regaining lost function is understood as a two stage process:
- (short term but not immediate) It involves the functional reintegration of neuronal resources that remained structurally sound after the stroke but are no longer functionally integrated. This process is similar to what takes place in other recovery conditions such as Parkinson’s, dementia, and chemical injury. Progress occurs after modest number of sessions, and progress may start to plateau in the range of forty - 60 sessions.
- (long term) Over the longer term, dendritic regrowth may increase opportunity for functional recovery. One can sample this process by training at some interval, like once a month, and that process may continue for years. Also, the gradual reassignment of functions that can occur in the brain can be be reinforced by neurofeedback.
Evidence for Neurofeedback’s efficacy for Brain Injury ?
Late Margaret Ayers was a pioneer who applied Neurofeedback to brain injury. One of her case study collections published in Head Injury Frontiers, describes 250 cases of closed head brain injury she treated. Some of the peer-reviewed studies that have been published showed how Neurofeedback was able to help brain injury. SEE right-->
It is my experience, introducing foot reflexology after 80 sessions helps the progress of TBI.
More studies for your reference:
Ayers, M. E. (1981). A report on a study of the utilization of electroencephalography for the treatment of cerebral vascular lesion syndromes. Chapter in L. Taylor, M. E. Ayers, & C. Tom (Eds.), Electromyometric Biofeedback Therapy. Los Angeles: Biofeedback and Advanced Therapy Institute, pp. 244-257.
Ayers, M. E. (1987). Electroencephalic neurofeedback and closed head injury of 250 individuals. Head Injury Frontiers. National Head Injury Foundation, 380-392.
Ayers, M. E. (1991). A controlled study of EEG neurofeedback training and clinical psychotherapy for right hemispheric closed head injury. Paper presented at the National Head Injury Foundation, Los Angeles, 1991.
Ayers, M. E. (1995a). A controlled study of EEG neurofeedback and physical therapy with pediatric stroke, age seven months to age fifteen, occurring prior to birth. Biofeedback & Self-Regulation, 20(3), 318.
Ayers, M. E. (1995b). EEG neurofeedback to bring individuals out of level 2 coma.Biofeedback & Self-Regulation, 20(3), 304-305.
Ayers, M. E. (1999). Assessing and treating open head trauma, coma, and stroke using real-time digital EEG neurofeedback. Chapter in J. R. Evans & A. Abarbanel (Eds.), Introduction to Quantitative EEG and Neurofeedback. New York: Academic Press, pp. 203-222.
Ayers, M. E. (2004). Neurofeedback for cerebral palsy. Journal of Neurotherapy, 8(2), 93-94.
Bachers, A. (2004). Neurofeedback with cerebral palsy and mental retardation. Journal of Neurotherapy, 8(2), 95-96.
Bearden, T. S., Cassisi, J. E., & Pineda, M. (2003). Neurofeedback training for a patient with thalamic and cortical infarctions. Applied Psychophysiology & Biofeedback, 28(3), 241-253.
Bounias, M., Laibow, R. E., Bonaly, A., & Stubblebine, A. N. (2001). EEG-neurobiofeedback treatment of patients with brain injury: Part 1: Typological classification of clinical syndromes.Journal of Neurotherapy, 5(4), 23-44.
Bounias, M., Laibow, R. E., Stubbelbine, A. N.,Sandground, H., & Bonaly, A. (2002). EEG-neurobiofeedback treatment of patients with brain injury Part 4: Duration of treatments as a function of both the initial load of clinical symptoms and the rate of rehabilitation. Journal of Neurotherapy, 6(1), 23-38.
Byers, A. P. (1995). Neurofeedback therapy for a mild head injury. Journal of Neurotherapy, 1(1), 22-37.
Cannon, K. B., Sherlin, L., & Lyle, R. R. (2010). Neurofeedback efficacy in the treatment of a 43-year-old female stroke victim: a case study. Journal of Neurotherapy, 14(2), 107-121.
Doppelmayr, M., Nosko, H., Pecherstorfer, T., & Fink, A. (2007). An attempt to increase cognitive performance after stroke with neurofeedback. Biofeedback, 35(4), 126-130.
Duff, J. (2004). The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clinical EEG & Neuroscience, 35(4), 198-209.
Ham, L. P., & Packard, R. C. (1996). A retrospective, follow-up study of biofeedback-assisted relaxation therapy in patients with posttraumatic headache. Biofeedback & Self-Regulation, 21(2), 93-104.
Hammond, D. C. (2007). Can LENS neurofeedback treat anosmia resulting from a head injury? Journal of Neurotherapy, 11(1), 57-62.
Hammond, D. C. (2006). Neurofeedback to improve physical balance, incontinence, and swallowing. Journal of Neurotherapy, 9(1), 27-48.
Hoffman, D. A., Stockdale, S., & Van Egren, L. (1996a). Symptom changes in the treatment of mild traumatic brain injury using EEG neurofeedback [Abstract]. Clinical Electroencephalography, 27(3), 164.
Hoffman, D. A., Stockdale, S., & Van Egren, L. (1996b). EEG neurofeedback in the treatment of mild traumatic brain injury [Abstract]. Clinical Electroencephalography, 27(2), 6.
Keller, I. (2001). Neurofeedback therapy of attention deficits in patients with traumatic brain injury. Journal of Neurotherapy, 5(1,2), 19-32.
Laibow, R E., Stubblebine, A. N., Sandground, H.,& Bounias, M. (2001). EEG neurobiofeedback treatment of patients with brain injury: Part 2: Changes in EEG parameters versus rehabilitation. Journal of Neurotherapy, 5(4), 45-71
Putnam, J. A., (2001). EEG biofeedback on a female stroke patient with depression: A case study. Journal of Neurotherapy, 5(3), 27-38.
Rozelle, G. R., & Budzynski, T. H. (1995). Neurotherapy for stroke rehabilitation: A single case study. Biofeedback & Self-Regulation, 20(3), 211-228.
Schoenberger, N. E., Shiflett, S. C., Esty, M. L., Ochs, L., & Matheis, R. J. (2001). Flexyx neurotherapy system in the treatment of traumatic brain injury: An initial evaluation. Journal of Head Trauma Rehabilitation, 16(3), 260-274.
Sterman, M. B., Ayers, M. E., & Goodman, S. J. (1976). Case study: Effects of SMR suppression on EEG and motor patterns in a quadriplegic patient. Biofeedback & Self-Regulation, 1(3), 340-341.
Thatcher, R. W. (2000). EEG operant conditioning (biofeedback) and traumatic brain injury.Clinical Electroencephalography, 31(1), 38-44.
Thornton, K. (2000). Improvement/rehabilitation of memory functioning with neurotherapy/QEEG biofeedback. Journal of Head Trauma Rehabilitation, 15(6), 1285-1296.
Thornton, K. (2001). Electrophysiology of auditory memory of paragraphs towards a projection/activation theory of the mind. Journal of Neurotherapy, 4(3), 45-72.
Thornton, K. (2002) Rehabilitation of Memory functioning with EEG Biofeedback,Neurorehabilitation, 17(1), 69-81
Thornton, K. E., & Carmody, D. P. (2008). Efficacy of traumatic brain injury rehabilitation: Interventions of QEEG-guided biofeedback, computers, strategies, and medications. Applied Psychophysiology & Biofeedback, 33(2), 101-124.
Thornton, K. E., & Carmody, D. P. (2005). Electroencephalogram biofeedback for reading disability and traumatic brain injury. Child & Adolescent Psychiatric Clinics of North America, 14(1), 137-162.
Tinius, T. P., & Tinius, K. A. (2001). Changes after EEG biofeedback and cognitive retraining in adults with mild traumatic brain injury and attention deficit disorder. Journal of Neurotherapy, 4(2), 27-44.
Walker, J. E. (2007). A neurologist's experience with QEEG-guided neurofeedback following brain injury. Chapter in J. R. Evans (Ed.), Handbook of Neurofeedback. Binghampton, NY: Haworth Medical Press, pp. 353-361.
Wing, K. (2001). Effect of neurofeedback on motor recovery of a patient with brain injury: A case study and its implications for stroke rehabilitation. Topics in Stroke Rehabilitation, 8(3), 45-53.
Yoo, S. S., & Jolesz, F. A. (2002). Functional MRI for neurofeedback: feasibility study on a hand motor task. Neuroreport, 13, 1377–1381.