Transcript The Efficacy of Neurofeedback for Mild Traumatic Brain Injury

Treating Dementia and
Traumatic Brain Injury with
EEG Biofeedback and
1072nm IR Stimulation
Combat Veterans and TBI
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2/3 of injuries caused by
IEDs
TBI afflicts
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>25% of bomb blast
survivors (Walter Reed
Army Medical Center)
2/3 of IED survivors
(Veterans Administration)
40% of injured soldiers
(Defense and Veterans
Brain Injury Coalition)
Combat Veterans and TBI
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“Evidence-based guidelines for diagnosis and
treatment are limited.”
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Roughly half of severe TBI “will regain some
function, but will be left with significant
disability.”
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Half may be left in a permanent vegetative state
Annals of Neurology
Combat Veterans and TBI
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Mild TBI Symptoms can include
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depression, ADHD-like symptoms, headaches,
anxiety, fatigue, irritability, temper outbursts
and aggression, problems with memory,
problems with memory, sleep disorders, and
sexual dysfunction.
 Defense & Veterans Head Injury Program
Report (1998) showed no effect of cognitive
rehabilitation.
Biofeedback/Neurofeedback
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A method of training increased conscious
awareness and control of physiological processes
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e.g., pulse oximeter, GSR, EMG or thermometer
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Mechanism of Action: operantly rewarding EEG
phase, amplitude and/or coherence.
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Measurement/Intervention technologies:
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1072nm IR + EEG, surface cortical oxygenation
Adjunctive Tools: ROSHI A-V Entrainment, HBOT
ROSHI A-V Entrainment
Neurofeedback for TBI
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Ayers, 1987
250 head injured clients
 Decrease 4-7 Hz, Increase 15-18 Hz, 24 sessions
 A return to premorbid function in most clients
 Normalization of phasic spikes, 4-7 Hz activity
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Neurofeedback for TBI
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Ayers, 1991
12 right-hemisphere CHI cases
 Six received NF + psychotherapy
 Decrease 4-7 Hz, Increase 15-18 Hz, 24 sessions
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Showed significant improvement in symptoms
Six controls received psychotherapy alone
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no improvement
Neurofeedback for TBI
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Hoffman et al. (1996a; 1996b)
treated 50 patients with mild TBI
 average of 40 sessions
 observing a clear trend of significant improvement in
24 physical, emotional, and cognitive symptoms
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Neurofeedback for TBI
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Ingo, 2001
Twelve moderate TBI patients received NF
 Rewarded increased 13-20 Hz amplitude
 Ten sessions
 Nine control patients received computer based
attention training (CBT)
 NF group > improvement in attentional tasks
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Neurofeedback for TBI
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Tinius and Tinius (2000)
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16 MTBI patients, 15 controls
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rewarded normalizing QEEG abnormalities:
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Theta and SMR over C3, Cz, and C4
Coherence
Significant improvement was observed in
Attentional measures (IVA)
 Neuropsychological symptoms (NIS)
 Wisconsin Card Sorting Task
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Areas of Positive Impact
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Modulation of arousal levels
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Regulation of sleep/wake cycle
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Organization of cognitive processes
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Normalization of sensory processing
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Inhibiting inappropriate motor responses
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Management of mood and emotions
Athletic Performance Enhancement
Kaman is enjoying a
breakout season, in
this his fifth year in
the NBA. He ranks
among the league
leaders in rebounds,
blocked shots and
double-doubles, and
is one of the leading
candidates for the
league’s most
improved player
award.
“It’s definitely
from the
neurofeedback
I’ve been doing,”
Mind Games:
Several members of
Italy's World Cupwinning team,
including Andrea
Pirlo, second from
lower left, did
extensive
neurofeedback
in the runup to the
tournament.’
WSJ,July 29, 2006
QEEG
e.g, Trudeau et al
(1998) showed
high discrimant
validity for
evaluating combat
veterans with a
history of blast
injury
The female brain
The male brain
Epilepsy
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Sterman conducted a meta-analysis of 30 years on
neurofeedback efficacy with epilepsy
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82% of studies showed clinical improvement
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66% showed positive changes to the EEG
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There was an average of 70% seizure reduction for
both intensity and frequency
Coma Recovery
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Ayers, 1999
32 clients in a level 2 coma for > 2 months
 Green light brightened as 4-7 Hz decreased
 Speakers beeped when both 4-7 Hz decreased and
15-18 Hz increased
 25 of 32 clients came out in one or two sessions
 2 of 32 came out after additional sessions
 5 were unresponsive to six sessions
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Neurofeedback for TBI
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Bounais et al. (2001; 2002)
Classified 27 cases in to seven symptom groups
 Treatment mode depended on pre-treatment QEEG
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Trained to normalize statistically abnormal measures
Groups’ improvement ranged from 59 to 87%
 Improvement correlated significantly to # sessions
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Neurofeedback for TBI
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Walker et al. (2002) MTBI patients
Rewarded normalizing abnormal coherence
deviations from the QEEG
Up to 40 sessions
>50% improvement in 88% (mean 72.7%).
All patients returned to work.
Other Studies: PTSD
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Peniston et al. (1993) reduced symptoms of
combat-related posttraumatic stress disorders
and alcohol abuse
Training alpha-theta synchronization
 Six months of group therapy
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DSM-IV Criteria for Post
Concussive Disorder
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Head trauma hx of significant cerebral
concussion.
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Evidence quantified cognitive assessment of
difficulty in attention (concentrating, shifting
focus of attention, performing simultaneous
cognitive tasks), or memory (learning or recalling
information).
Three or more occur shortly after
trauma and last > 3 months:
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Becoming fatigued easily
Disordered sleep
Headache
Vertigo or dizziness
Irritability/aggression w/o provocation
Anxiety, depression, or affective lability
Changes in personality (eg, social or sexual
inappropriateness)
Apathy or lack of spontaneity
DSM-IV Post Concussive
Disorder (cont.)
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Symptom onset follows head trauma or
represent a substantial worsening of preexisting
symptoms.
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The disturbance causes significant impairment in
social or occupational functioning and
represents a significant decline from a previous
level of functioning.
DSM-IV Post Concussive
Disorder (cont.)
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The symptoms do not meet criteria for dementia
due to head trauma and are not better accounted
for by another mental disorder (eg, amnestic
disorder due to head trauma, personality change
due to head trauma).
Clinical Applications
Quietmind Foundation
Research Agenda

ICAD (2009) studied impact of 40 sessions of
EEG biofeedback on executive functioning (N=27).
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1072nm IR stimulation for treating dementia
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1072nm IR stimulation for Parkinson’s Disease
Prevention Gains Priority
 “we can’t wait to try to do prevention
until we are absolutely certain what causes
the disease. This public health emergency is
just going to get out of control if we don’t
do something.”
Neil Buckholtz,
Chief of Dementias of Aging,
National Institute on Aging.
New York Times, June 2, 2010
Literature Cited
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head injury. Paper presented at the National Head Injury Foundation, Los Angeles, 1991.
Ayers, ME (1999) Assessing and treating open head trauma, coma, and stroke using real-time digital EEG neurofeedback.
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