Practice in Clinical & Health Psychology
Brain Injury
Advanced Therapies

 

 

MILD TRAUMATIC BRAIN INJURY

Our brain is the consistency of Jell-O™, suspended in a thick glycerin-like fluid, wrapped in a thin, rubber inner tube-like material, and enclosed in the skull, a rigid, hard case. Nature has done an awesome job of protecting our most valuable asset.

Unfortunately, even Nature's best design has limits: Hit your head with enough force to overcome these protective barriers, and the price is horrendous.

Most mild head injuries (Mild Traumatic Brain Injury or MTBI) are caused by motor vehicle accidents, work related injuries, or "slip and fall" accidents. 

Striking the head with sufficient force damages the brain at the site of impact. To make a very bad situation even worse, the blow may cause the brain to bounce off the other side of the skull. Damage is doubled -- the potential for loss of mental, physical and emotional capacity and flexibility is multiplied.

Axons -- Our brain's vital links.

A heavy blow to the head causes a rapid acceleration and deceleration of the brain. The head whips forward, stops suddenly, and then violently whips back. Because the white matter (the brain's bulk) and the grey matter (the brain's thin outer layer) are of different densities, they move at different speeds. As the two types of tissue slip against each other, billions of axons are damaged, some even severed (called axonal shearing).

Axons are slender, thread-like filaments that connect nerve cells in the brain and throughout the body. Their job is to send communication signals from one area of the cortex to another, from the cortex to the brain's deep structures, and to all parts of the body.

When injured, the axons are not able to efficiently carry the brain's communication signals. If sheared, signals will not be able to transmit at all. Brain performance is hampered, and symptoms such as confusion, headaches, visual disturbances, speech problems, incoordination, spastic limbs, and even paralysis occur.

The slow brain waves of Traumatic Head Injury.

Those suffering from the effects of a Traumatic Brain Injury often show generalized (all over) and focal (one or more areas) of slow Delta and Theta brain wave activity when examined by EEG. The slow waves are a cardinal sign the brain is damaged and not able to do its job efficiently.

The "fused" brain -- Locked and in a box.

Our brain does much of its work by communicating with itself -- by rapidly connecting, disconnecting, and then reconnecting its many specialized areas. In those with head injury, the brain's coherence may become excessive, locking the brain into inflexible thinking and behavior patterns.

Other mental problems, fuzzy thinking and confusion, for example, and physical symptoms, such as dizziness and headaches, are common.

Common Symptoms of Brain Injury

The most common symptoms reported by patients are:

     Fatigue

      Headache

      Short-Term Memory Problems

      Difficulty Concentrating

      Difficulty Multi-Tasking

      Trouble Finding the Right Word

      Transposing Numbers or Words

      Difficulty with Organization

      Sleep Disturbance

      Forgetful and Losing Things

      Depression

      Anger, Irritability and Impatience

      Disorientation and Getting Lost

      Roller Coaster Moods

      Overwhelmed by Light, Noise or Too Much Stimulation

      Ringing in The Ears

Recovery

Head injuries recover slowly.  Eighty percent of improvement comes within the first six months, with the other 20% taking up to another 18 months.  Two thirds of patients will spontaneously recover with time alone, but they must be patient.  If improvement is not noted within the first six months, or it plateaus at a point where there is still cognitive disruption, then further intervention is necessary.

Diagnosis

Traditionally mild head injuries are diagnosed by reviewing the history, mental status examination (testing how your brain works by asking about 10 minutes of questions on memory, etc.) and neuropsychological testing. There are pros and cons to this testing.  While it is helpful in determining how the brain performs cognitive tasks, some say it is not sensitive enough for the mild cases or in people with high IQs. In almost every case, litigation is involved. When neuropsychological testing is used, invariably two different neuropsychologists will offer the opposite professional opinions based on the same data. This suggests there is a lot of subjectivity to the interpretation of the results.

Cognitive Compensatory Skills Retraining

While not treating the underlying problem, learning "tricks" to help maneuver around the deficits can make a huge difference for those patients who practice and use the compensatory skills. Examples include how to slow down your processing speed to gain accuracy or writing down and organizing things that need to be done and remembered. Many hospital-based brain injury rehabilitation programs offer this type of training for individuals with brain injuries.

Advanced Testing and Treatment

If the traditional strategies are not helping, the use of more cutting edge diagnostic and treatment modalities should be attempted.

A quantitative EEG (QEEG) recording and comparison to both normative and brain injured EEG databases can help determine the nature and extent of any axonal injury and if there are the characteristic slow waves of focal brain damage.

EEG Neurofeedback

This may be one of several treatment options, depending upon the results of the QEEG assessment and neurometric analysis. If applicable, and chosen as a treatment by the patient, EEG Neurofeedback is used to retrain the brainwaves back to a more normal pattern. The patient sits, with sensors on the scalp, in front of a computer screen. The sensors monitor the brain's electrical activity and transmit it to the computer where moment-to-moment changes in brainwave activity are displayed on the screen in a way that the patient can easily understand. The patient uses this feedback to learn ways to manipulate the brainwaves in whatever way is desirable. Throughout the training process the brain is challenged until it plateaus, thereby refocusing and reshaping the brainwaves into the desired patterns and ameliorating the patient's symptoms.  This learning process is similar to what the brain has to do when it first learns to ride a bicycle.  

Although still quite limited, current clinical reports and initial published research on the use of EEG neurotherapy to treat mild-moderate brain injury is promising… suggesting  that a majority of patients can obtain significant improvement in their symptoms and functioning with appropriate EEG neurofeedback based on QEEG neurometric assessment findings. The length of treatment and number of training sessions required is quite variable between individuals based on the severity and chronicity of the brain injury.