Media attention has highlighted the critical problem of concussion injuries in sport and the challenge of treating and rehabilitating individuals with traumatic brain injury. The authors present a framework for the treatment of traumatic brain injury, using low-resolution electromagnetic tomography Z-score based neurofeedback and heart rate-variability biofeedback. The article advocates a comprehensive assessment process including the use of a 19-channel quantitative electroencephalogram, a heart rate variability baseline, and symptom severity questionnaires for attention deficit/hyperactivity disorder, depression, and anxiety. The initial medical assessment, neuropsychological assessment, and evoked potential studies also have potential for a more precise assessment of deficits in brain activation patterns, which assists the targeting of neurofeedback training.

The present article provides a case study showing the application of neurofeedback and biofeedback training with heart rate variability (HRV) training to a 27-year-old man, Mike, who suffered a severe traumatic brain injury (TBI) in a motor vehicle accident. The study demonstrates the use of single-site neurofeedback training, metacognitive strategies, and low-resolution brain electromagnetic tomography (LORETA) z-score training along with HRV. A review of the initial assessment and subsequent progress updates included an examination of continuous performance tests such as test of variables of attention, integrated visual and auditory continuous performance test, and single-channel electroencephalography results, HRV statistics, and 19-channel quantitative electroencephalogram results. The client demonstrated significant improvements on all measures posttraining with marked improvement in five areas: memory, sleep and energy level, academics, mood and irritability, and mental sharpness. Working with clients such as Mike supports the view that one- and two-channel neurofeedback and LORETA z-score neurofeedback, combined with HRV training, are promising interventions for clients with TBIs.

Impairments that may result from a mild traumatic brain injury (TBI) or concussion can be both severe and longlasting. This article will list some of the common persisting symptoms that may occur and give a brief description of the neuropathological processes that can be triggered by TBI, including diffuse axonal injury and its effects on the mitochondrial Kreb's cycle and the production of adenosine triphosphate, the brain's source of energy. This is followed by a summary of a comprehensive assessment process that includes quantitative electroencephalography, evoked potentials, heart rate variability (HRV) measures, neuropsychological testing, and blood and urine analysis. Details concerning a neurophysiological approach to effective treatment are given. These include conventional singlechannel neurofeedback (NFB), also called brain-computer interface training, low-resolution electromagnetic tomography z-score neurofeedback, HRV training, and counseling on diet, sleep, and exercise. The authors expand the discussion on their treatment approach to include a neuroanatomical explanation of why the practitioner should consider combining the NFB training with HRV training.

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This paper discusses the clinical applications of heart rate variability (HRV) data in the treatment of clients who have experienced traumatic brain injuries (TBIs). In the authors' clinical practice, HRV data is collected at the initial assessment, at progress assessments, and again after the completion of a course of neurofeedback combined with HRV biofeedback treatment. This paper describes HRV seen in healthy individuals compared to HRV in individuals known to have experienced a TBI. Three clinical case examples are discussed that explore the changes in heart rate variability following traumatic brain injury as well as improvements noted during, and following, a course of neurofeedback combined with HRV biofeedback training. The cases illustrated in this paper demonstrate the impressive changes in heart rate variability that can occur following a traumatic brain injury and also highlight how neurofeedback combined with biofeedback training can be used to improve heart rate variability and ameliorate related cognitive symptoms.