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Neurofeedback for Concussions

By Siegfried Othmer, PhD

collision-movieOn the occasion of the release of the film ‘Concussion‘ it is only appropriate that we add our voice to those that have already been raised on this issue. The reason is that neurofeedback is really the only remedy currently available for concussions. The plain truth of the matter is that the medical cupboard has always been bare when it came to concussions, and that remains true to this day.

There are the usual remedies on offer for symptom suppression—for headaches, nausea, dizziness, and edema. But these do not address the underlying issue. When it comes right down to it, the only recovery mechanism we know of for concussions is self-recovery. And it is even true that all we can do with neurofeedback is to facilitate and accelerate that process.

Neurofeedback is not anything that is done to the brain. Rather, it simply illuminates the path for the brain to find its way to its own recovery. It is best thought of as a rehabilitation technique—-as brain rehabilitation in this case. The difference between this and physical rehabilitation is that the brain does all the work! We are simply providing it with information. Another model for neurofeedback is brain exercise. But again, the trainee is not doing the heavy lifting here. It is the brain that is doing the work.

Concussions have been successfully remediated with neurofeedback since 1975. That this is still not generally known is of course scandalous, but then so is the fact that the entire topic of concussions has been off the agenda within medicine for the entire twentieth century. Medical professionals do not like to talk about conditions where no medical remedies are available.

This disagreeable fact is shaping the discussion even now. After all, when we use the term concussion we are referring to a condition where ultimate recovery is typically expected, even if we have no choice but to wait for it. But concussions are really only a subset of a much larger class of conditions labelled minor traumatic brain injury, by which is meant all those cases of head trauma where there has been no skull fracture. That actually covers a whole range of conditions that would never be labelled a mere concussion.

These can leave people permanently dysfunctional, and after the usual period of ‘self-recovery’ that might take up to eighteen months, they are deemed to be in a stable state and no further help is on offer. After all, there is nothing one can do…! There is, however, neurofeedback, and even after decades of dysfunction, function may still be recovered. The capacity for functional recovery is never lost.

Let me be utterly clear here: We are not talking about subtle change at the margins. We are talking about global functional recovery. We have ourselves worked with someone who was functionally blind after a head injury, having nothing more than blurry tunnel vision, and after seventeen sessions vision was restored to the point where the person could drive again. We have taken a stroke victim from the point where they were on crutches to where they were skiing once again. This transpired after all medical care and all other rehabilitation efforts had ceased.

The effectiveness of neurofeedback in facilitating recovery for minor traumatic brain injury (mTBI) has been a fact for forty years now, and it has been totally ignored by the field of medicine. This scandal is only eclipsed by the even worse scandal that the field of medicine has been in denial about the entire business of so-called minor traumatic brain injury.

Consider the PBS Frontline program “League of Denial” that first aired two years ago (and is being re-broadcast presently). The denial of the issue of head trauma is being blamed on the NFL, when in fact they were backed up in their stance at every step of the way by their medical advisers! If the NFL was in denial, then so were the medical authorities advising them. It was not the NFL that ruined the career of Dr. Bennet Omalu for discovering the physical evidence for chronic traumatic encephalopathy (CTE). It was the medical brain trust.

Consider also the fact that the medical field was caught entirely flat-footed by the flood of cases of blast injury out of Iraq. In many of these cases, there had been no direct brain insult. And yet all the dysfunctions associated with minor brain injury presented themselves. Was there really no precedent for this? Of course there was! After all, we had been driving automobiles for a hundred years already. In the US we encounter more than a million cases of minor traumatic brain injury per year, a much larger caseload than was now presenting itself within the military.

The difference was that the automobile injuries were all individual cases that could be dismissed one at a time. The military presented a very different kind of problem. Cases were now arriving in droves. The matter could not be ignored quite so easily.

Throughout our collective experience with the automobile there had been countless cases where the severity of the complaints seemed out of line with the severity of the original brain insult:
“But the airbag didn’t even deploy.”
“But you didn’t even lose consciousness.”
“But you were able to drive home after the accident.”

Doctors did what came naturally. They took issue with what the patient was reporting. Their complaints were simply dismissed. Of course the docs were very much encouraged in this course by insurance company lawyers.

They also had their own evidence, or rather a lack thereof. And this turns out to be a crucial part of the story. Matters were caught on the cusp of the structure/function dichotomy. For decades now we have had CT scans that allowed us to take a look at the brain. Problem was, these tended not to support the claims in most cases of minor traumatic brain injury. There was no structural injury—hence there was no medical issue! People were sent home with all of their complaints. Whatever they were, they were not a medical issue.

This lack of supportive evidence from brain imagery solidified the position that minor traumatic brain injury was not a medical problem, by and large. This posture fit hand-in-glove with the insurance companies who would otherwise be stuck with potentially large payouts.

In the neurofeedback field, we had been seeing the evidence of functional injury all along in the course of tracking EEG measures through the training process. And if the brainwave activity was wildly irregular at the outset, there was an obvious tendency for it to approach typical values with the training. Insurance companies moved heaven and earth to discredit the new evidence, because if neurofeedback could actually be helpful, then ethically it had to be made available to head-injured people. The best way to discredit neurofeedback was to call the evidence into question—the same process to which Dr. Bennet Omalu was subjected.

The failure mechanism involved in minor traumatic injury was plainly the “scrambling of the brainwaves,” to quote the pungent metaphor of former NBA player and basketball commentator Bill Walton. The loss was in the functional domain, and is presently modeled in terms of alterations of functional connectivity. These leave no evidence in CT scans. After all, CT scans cannot tell the difference between a living brain and a dead one. How could they possibly tell the difference between a functional and a dysfunctional one? Nevertheless, it suited the purpose of the moment to deny the new evidence. We had a pact of the devil between medicine and insurance company lawyers, just as there was such a pact between medicine and the NFL.

Insurance companies have had yet one other ace up their sleeves. It is to argue that the injury is not so much due to the event at issue, but rather to the fact that the victim was bringing a vulnerable brain to the incident. The victim was already vulnerable, and now just wants to blame everything on this particular brain insult in order to obtain recovery. They call these ‘egg-shell’ cases.

In fact, the insurance companies nailed it! It is indeed impossible to explain the severity of injury and the subsequent rate of recovery, or lack thereof, until the person’s prior history is taken into account. To resort to Bill Walton’s metaphor again, these people came to the critical incident with brainwaves that were already scrambled. Functional connectivity was already compromised at some level. There is absolutely no doubt that this holds true. The best predictor of recovery is the history of the patient prior to the injury. Many of them had histories of earlier trauma—psychological or physical, and it did not matter much which one. Both succeed in ‘scrambling the brainwaves.’ Nevertheless, it was this particular injury that sent this particular patient over the cliff into obvious dysfunction.

So where are we presently? We are just where we started:
There is only one remedy for the persistent symptoms of minor traumatic brain injury, and it is neurofeedback.
But if we take the lesson of prior vulnerability to its logical conclusion, we should be offering neurofeedback to all those who are trying to function with scrambled brainwaves throughout their lives, even well before a minor head injury makes that deficit obvious by making it even worse. People need training in resilience, and the method is neurofeedback. Who would benefit? Well, just about all of us, frankly.

Siegfried Othmer, PhD
drothmer.com

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5 Responses to “Neurofeedback for Concussions”

  1. Hanno Kirk says:

    I have dealt with a number of persons with repetitive concussion damage. One was a military bomb disposal specialist who was thrown about 26 times by IED explosions.

    I have one young man right now who has noticeable cognitive deficits from concussions— first from playing high school and then from playing collegiate football. When he took a hit that ‘rang his bell’ he would take pride in getting back on the field. He didn’t want to be seen as weak. He also had an ill-fitting helmet, but he didn’t want to be a complainer.

    I have found that some of the persons with concussion damage are either in denial or don’t recognize how damaged they are. It took the threat of divorce by the wife of the bomb disposal expert to get him to come in for treatment. The young man with the repetitive football hits is still dithering around. He keeps forgetting his appointments.

    Reply

  2. Terry Moore says:

    I can attest to the dearth of therapeutic options available to doctors who evaluate and treat persons with head injuries. As a neurologist I have seen brain injuries of all sorts in over 30 years of practice. The main medical treatment for acute concussion is tincture of time as they say. Prevention here is truly the best medicine, but that will not be the case with young men (and women) who play contact sports.

    I would like to echo Siegfried’s statement of the abundance of minor traumatic brain injury (mTBI), the incidence of which is very likely underestimated. Current evidence, which is intuitive, indicates that multiple sub-concussive brain injuries may lead to symptoms of dementia that some have labeled chronic traumatic encephalopathy (CTE). The limited pathological data available on such brains demonstrates a similar, yet distinctive, pattern of abnormalities that includes neurofibrillary tangles found in Alzheimer’s disease.

    In addition to the substantial memory deficits these individuals have, they are prone to severe emotional instability and have a disproportionate rate of suicide.

    In my opinion, currently available medical therapy for dementia of any cause leaves much to be desired and has been more or less static for decades. Neurofeedback offers huge risk-benefit advantage. Why it has not been more fully studied and utilized I leave for the reader to discover.

    I agree with Siegfried that a serious pro-active stance should be taken by parents, schools and other organizations involved in contact sports known to be associated with recurrent sub-concussive injury. Baseline testing should be part of every program with monitoring as needed by experienced individuals. Neurofeedback could well be viewed as a form of rehab therapy much as any other therapy that athletes receive for other injuries. I suggest that its utility in preventing the effects of cumulative mTBI be investigated as well.

    With the recent publicity that the long term effects of concussion is receiving, now is the time to spread the word of good hope regarding mTBI, CTE and neurofeedback.

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  3. I agree with Dr. Othmer. Neurofeedback can be so valuable when it comes to relieving symptoms due to concussion or any other type of brain injury. I have been seeing a client who suffered a traumatic brain injury (TBI) 18 years ago due to an automobile accident. He had severe cognitive impairment, physical impairments, among a multitude of other issues. After working with him for a few months now he is in a much more functional and regulated state. His speech pacing has improved dramatically, his vocabulary and memory has made major strides, his walking gate and mobility has improved, his ability to think abstractly and hypothetically has improved, his impulsivity has improved and his lack of social inhibition has improved. His physician was floored when he saw him for a check-up and he was so dramatically different from the prior 18 years. So much so he asked the parents what they had been doing and wanted as much information regarding Neurofeedback and available research. We are continuing to make progress when no one in the medical field gave him any other option or any hope for further recovery. He now has hope and continues to strive for better functionality and regulation within his body and brain. Something that wouldn’t have been possible without Neurofeedback. The fact that the medical community doesn’t recognize its effectiveness in these situations is indeed scandalous. One can only hope that eventually the medical field can catch up to the times and recognize Neurofeedback for what it is and its effectiveness.

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    Terry Moore Reply:

    Justin, would you be able to provide me with records about your client? I am trying to generate interest in NF for persons with traumatic brain injuries, both acute and chronic. If he is willing, I would like to review what has changed neurologically. This may involve getting records from his treating physician as well.

    You can reach me through the list serve. Send your email or contact me at my office 972-272-6558.

    Sincerely,

    P. Terrence Moore, MD
    Diplomate American Board of Psychiatry and Neurology

    Reply

  4. Ivy Baker says:

    This is some really good information about neurofeedback. I like what you said about how you can use this when you need to get help with a brain injury. That is a good thing to be aware of when you need to recover from a bad injury.

    Reply

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