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Concussions

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What is a Concussion?
A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.
Health care professionals may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, their effects can be serious.

Research has demonstrated that concussions represent a large percentage of injuries sustained by athletes, including increasing number of children and adolescents, while participating in sports. For example, years ago approximately 20% of reported injuries in football players from were concussions. That estimate has significantly increased in the past 5 years as the ability to diagnosis concussions has improved and our awareness of the long-term effects has increased. In fact, concussions are now commonly assessed in all major sports and most sports have developed guidelines for assessment and return to play criteria (RTP). Cerebral concussion is defined as a closed head injury (CHI) that produces an alteration in normal consciousness and brain processes.

What are the Signs and Symptoms of Concussion?
Most people with a concussion recover quickly and fully. But for some people, symptoms can last for days, weeks, or longer. In general, recovery may be slower among older adults, young children, and teens. Those who have had a concussion in the past are also at risk of having another one and may find that it takes longer to recover if they have another concussion.

Symptoms of concussion usually fall into four categories:

  • Thinking/Remembering
  1. Difficulty thinking clearly
  2. Feeling slowed down
  3. Difficulty concentrating
  4. Difficulty remembering new information
  • Physical
  1. Headache; Fuzzy or blurry vision
  2. Nausea or vomiting (early on)
  3. Dizziness
  4. Sensitivity to noise or light
  5. Balance problems
  6. Feeling tired; having no energy
  • Emotional/Mood
  1. Irritability
  2. Sadness
  3. More emotional
  4. Nervousness or anxiety
  • Sleep
  1. Sleeping more than usual
  2. Sleep less than usual
  3. Trouble falling asleep

Some of these symptoms may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them. Sometimes, people do not recognize or admit that they are having problems. Others may not understand why they are having problems and what their problems really are, which can make them nervous and upset.

The signs and symptoms of a concussion can be difficult to sort out. Early on, problems may be missed by the person with the concussion, family members, or doctors. People may look fine even though they are acting or feeling differently.

People are having more frequent concussions than ever before. Concussions commonly occur from automobile accidents or sport injuries. Often the negative effects of concussions do not occur immediately after the head injury. In addition, post-concussion problems may not appear in the usual recommended MRI or CAT scan tests. QEEG (Quantitative Electroencephalography) Mapping uses a statistical analysis of EEG brainwaves to assess amplitude, instabilities and connectivity abnormalities in specific locations where the injuries occur. A neurologist also reviews each EGG for neurological deficits such as seizures. Attention Performance Center uses the results of QEEG Mapping to develop ndividualized protocols for a treatment called Neurofeedback or EEG Biofeedback. Research on the use of QEEG with patients with Head Injuries indicated (Duff, 2004) indicated that the QEEG Map was the most sensitive type of brain imaging test for identifying postconcussion syndrome.

What are the Potential Effects of TBI?
The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness, to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury.
TBI can cause a wide range of functional short- or long-term changes affecting thinking, sensation, language, or emotions.

  • Thinking (i.e., memory and reasoning);
  • Sensation (i.e., touch, taste, and smell);
  • Language (i.e., communication, expression, and understanding); and
  • Emotion (i.e., depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).1

TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more prevalent with age.1

About 75% of TBIs that occur each year are concussions or other forms of mild TBI. 2
Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.3

For more information and resources, visit www.cdc.gov/concussion

QEEG and Neurofeedback for Assessment and Treatment of Concussions & Traumatic Brain Injuries (TBI)

The understanding of concussion is now widely accepted as metabolic with neurophysiological pathology being at the root of symptom presentations in addition to the structural damage that is often associated with moderate or severe brain injury. As a result, conventional structural
neuroimaging studies such as computerized tomography (CT) and magnetic resonance imaging (MRI) routinely produce unremarkable findings in sport-related concussion and mTBI.

Within the sport concussion literature, there is a call for a more precise and accurate methods for diagnosing an injured athlete who may have suffered a concussion during competition or off -field activities. Given the work that researchers have done in demonstrating the pathophysiological EEG changes that follow sport-related concussion, the latest QEEG techniques can be used to demonstrate reliable and measurable physiological markers that are associated with sport-related concussion.

Abnormal EEG & QEEG

This is an abnormal EEG with frequent paroxysmal sharply contoured theta discharges predominantly seen in frontal leads with a right predominance. This suggests impairment of frontal cortical function, greater on the right. These findings are considered consistent with a history of concussive injury.

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  concussioncoherence-300x225

Neurofeedback

Neurofeedback for concussions and TBI can be individualized for each person and each specific head injury based on the brain location and brain imbalance (frequency (speed), amplitude (energy) and coherence (connectivity). The standard treatment for concussions is primarily rest and drinking liquids; a very passive non-direct approach. Neurofeedback is one of the only active treatments whole goal is not only to quicken recovery time and return to play, but also to improve brain functioning in terms of attention, memory, learning, reaction time and remaining calm under pressure.

There have been studies showing that neurofeedback can remediate symptoms of concussions and closed head injury. Current research suggest that Neurofeedback interventions aimed at improving QEEG can be effective in reducing recovery time, return to play (RTP) and improving successful recovery for concussions.

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Click here for The Effects of QEEG Guided Neurofeedback on Post-Concussion Syndrome: Case Study

A New Neurofeedback Treatment for ADD, Learning Disabilities, Autism and Brain Injuries

Smartmind is a new, state of the art treatment that combines the effectiveness of neurofeedback with the capability of computerized cognitive training. SmartMind joins forces with the Captain’s Log Mental Gym to simultaneously access the capabilities of both cognitive systems. Brainwave patterns are shaped through neurofeedback while Captain’s Log cognitive training system is utilized to improve their attention, working memory, hand-eye coordination, patience, and mental processing speed.

Attention Learning Center is proud to be one of the first centers to offer the SmartMind system. Dr. Michael Linden, the director of Attention Learning Centers has helped develop some of the Neurofeedback software for this system and has worked with Dr. Joseph Sanford, director of Braintrain and the developer of the IVA CPT test, Captains Log and Smart Mind for more than 15 years.

A published research study that explored the effectiveness of a training protocol that simultaneously presented neurofeedback with the Captain’s Log exercises (Tinius & Tinius, Journal or Neurotherapy, 2000) found significant improvements for both auditory and visual attention and response accuracy for adults diagnosed with ADHD and mild traumatic brain injury (mTBI) in only 20 training sessions.

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REFERENCES

Aubry, M. et al. (2002). Summary and agreement statement of the 1st International Conference on Concussion in Sport, Vienna 2001. British Journal of Sports Medicine, 36, 6 – 10.

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

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.

Folmer, R.L. et al., (2011). Electrophysiological assessments of cognition and sensory processing in TBI: Applications for diagnosis, prognosis and rehabilitation, Int. J. Psychophysiol.

Gerberich, S. G., Boen, J. R., Straub, C. P., & Maxwell, R. E. (1983). Concussion incidences and severity in secondary school varsity football players. American Journal of Public Health, 73, 1370–1375.

Gunkleman, J. (2102). QEEG Assessment of Concussion with Athletes. Presentation at Annual Meeting of ISNR, Orlando, Fl.

Lechuga, D. (2012). Current Challenges in concussion management of amateur and professional athletes. Presentation at Argosy University, Orange, CA.

Linden, M. QEEG and Neurofeedback with Concussions (2010). In Applications of Biofeedback & Neurofeedback, AAPB, Wheat Ridge, Colorado.

McCrory, P. et al. (2005). Summary and agreement statement of the 2nd international conference on concussion in sport, Prague 2004. British Journal of Sports Medicine, 39, 196 – 204.

Tinius, T.P. (2003). The Integrated Visual and Auditory Continuous Performance Test as a neuropsychological measure. Archives of Clinical Neuropsychology, 18, 199-214.

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.

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.