Managing Traumatic Brain Injury: Appropriate Assessment and a Rationale for Using Neurofeedback and Biofeedback to Enhance Recovery in Postconcussion Syndrome

Abstract

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.

Heart rate variability interventions for concussion and rehabilitation

“…At the end of treatment, the patient showed greater HRV, and greater LF power, as well as significant reduction in severity of post-concussion headaches and overall post-concussive symptoms. Thompson et al (2013) report the case of an athlete who received a sport-related concussion and was treated with a multi-modal intervention, including both HRV BFB and neurofeedback. Bhandari et al (2013) used both HRV and neurofeedback to treat an adult male with a Severe TBI.…”

Treating Postconcussion Syndrome with LORETA Z-Score Neurofeedback and Heart Rate Variability Biofeedback: Neuroanatomical/Neurophysiological Rationale, Methods, and Case Examples

“…As reviewed in the previous paper (Thompson et al, 2013) information from evoked potentials, also called event related potentials (ERPs) because they are time-locked to a specific event (sight or sound or even touch), can be used Thompson et al following concussion to determine the intactness of cortical pathways and speed of processing within these pathways (De Beaument et al, 2009;Dupuis et al, 2000). ERPs have been shown to be resistant to practice effects and are therefore a hearty diagnostic assessment tool (Mendez et al, 2005) that can be repeated as often as necessary.…”

“…There is a complex cascade of neurochemical and neurometabolic changes that occur after a head injury. These were reviewed in detail in an article entitled ''Managing TBI'' that was published in this journal in 2013 (Thompson, Thompson, Reid-Chung, & Thompson, 2013). The processes of secondary injury to neurons following a concussion can affect neurological functioning so that a person can actually become worse in the days and weeks after the injury than they were immediately after the TBI.…”

Combining LORETA Z-Score Neurofeedback with Heart Rate Variability Training

“…There is also diffuse axonal injury (DAI) that involves stretching and twisting of axons, which can result in a flooding of glutamate into the synaptic junction. This may result in an abnormal increase in sodium and calcium entry into the postsynaptic ending with resulting depression of mitochondrial (Krebs cycle) production of adenosine triphosphate (ATP), which is the energy source for the neurons and, in particular, for active transport across neuronal membranes (Thompson, Thompson, Reid-Chung, and Thompson, 2013). This series of events may be postulated to be part of the reason that there is a decrease in EEG amplitude post injury.…”