Treatment Results for Mild/Moderate Traumatic Brain Injury Using EEG Data Provides Quantitative Information with Predictive Value for Rehabilitation Outcomes and Treatment Planning
Mary Lee Esty, LCSW-C, Ph.D.
Neurotherapy Center of Washington
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Mary Lee Esty, LCSW-C, Ph.D., is president of the Neurotherapy Center of Washington, Inc. in Chevy Chase, MD. Her work focuses on using EEG stimulation biofeedback in the treatment of fibromyalgia, brain injuries, PTSD and learning disorders. She was co-principal investigator in a study funded by a NIH block grant looking at the effect of EEG-drive stimulation on Mild/Moderate Traumatic Brain Injury. The study was published in 2001 in The Journal of Head Trauma Rehabilitation, Vol. 16, #3.

Dr. Esty is also a co-principal investigator with Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL, in a privately funded placebo-controlled, double blind study of the effects of EEG-drive stimulation upon symptoms of fibromyalgia patients. Dr. Esty is also a consultant on this treatment for fibromyalgia to the Oregon Health Sciences University, Portland, OR, and a pending study at McLaren Hospital in Flint, MI.

ABSTRACT

The addition of brain wave amplitude and standard deviation data to standard neurological and neuropsychological evaluation of traumatic brain injury (TBI) provides quantitative information that has predictive value for rehabilitation treatment planning and outcomes. Electrical activity of the brain is a reflection of brain chemistry and gives quantitative information about cognitive, behavioral, mood and social functioning problems, presenting a new tool for the field of rehabilitation. Simultaneous changes occurred in the areas of cognitive, energy, mood, pain, irritability, dysautonomia and sleep problems in persons with Mild/Moderate TBI even 7 – 10 years after trauma. The results of the study are in the Journal of Head Trauma Rehabilitation, (16) 3, June 2001. Study participants received 25 treatments that delivered a gentle stimulation. Outcome data comparing two treatment groups showed significant differences between treatment and non-treatment. Seven of the 12 subjects were able to return to pre-trauma level of employment. Length of time post-trauma for these people was an average of 7.7 years (the range was from 3 to 15 years). There has been no relapse among these people in the 4 years since completion. Study results suggest that inclusion of this treatment in rehabilitation programs would provide an efficient and complementary dimension to the services now available to those with TBI.

INTRODUCTION

Traumatic brain injuries (TBI) affect as many as 500,000 Americans each year, causing chronic problems that interfere with physical, occupational and social functioning. Though rehabilitation programs provide a variety of services and benefits, restoration of brain function is often limited and focus is placed on addressing symptoms and functional problems. This study investigated an innovative therapy, EEG Stimulation Neurofeedback, which attempts to alleviate injury caused by brain trauma, thereby improving functioning and quality of life.

Using a form of biofeedback that was designed to combine conventional EEG biofeedback and Photic stimulation, the EEG Stimulation Neurofeedback alters the EEG patterns associated with cognitive dysfunction and ultimately to improve functioning. Though based in principles of conventional EEG biofeedback, this system differs from conventional treatments in that there is no attempt to consciously control EEG activity. The feedback system produces changes in the patterns without clients’ efforts.

After receiving Institutional Review Board (IRB) approval, 12 participants were recruited from clients seeking treatment from Dr. Mary Lee Esty (Neurotherapy Centers’ president and founder), and from referrals by local area neurologists and rehabilitation specialists. Exclusions included: penetrating head injuries, pre-injury substance abuse or dependence, pre-injury diagnosis of psychotic illness, pre-injury or post-injury seizure disorder, and/or women that were pregnant or trying to conceive. Selected participants included two men and ten women, aged 21 to 53, who experienced mild to moderate severe closed head injury 36 months to 21 years prior to the study. Following pretreatment assessments, participants were assigned to one of two conditions: immediate treatment or wait-list control group. To insure that all procedures were consistent, the neuropsychologist was not aware of the participants’ assignment to treatment or waitlist assignment.

Participants received 25 treatment sessions of EEG Stimulation Neurofeedback administered over a 5 to 8 week period. Treatment required that participants sit comfortably with their eyes closed, wearing LED imbedded glasses, without engaging any specific activity. Although we attempted to standardize stimulation provided during treatment sessions, duration varied based on each participants’ sensitivity to neurofeedback. Therefore, duration of stimulation per session ranged from 5 seconds to 20 minutes.

Prior to coming to the Neurotherapy Center and received EEG Stimulation Neurofeedback, each of the participants had been told that her/his condition would not improve, that all medical avenues had been exhausted. Each was receiving other forms of treatment(s) that focused on accepting and working within the limitations of her/his current state/condition. However, following EEG Stimulation neurofeedback 9 of the 12 participants reported significant improvement. The brainwave patterns of the other 3 participants have specific characteristics that we now know are not likely to be substantially improved by EEG Stimulation Neurofeedback. This information has improved our screening/evaluation process, enabling us to predict with greater accuracy who will benefit from this form of treatment.

Additionally, of the 9 that reported significant improvement, 7 returned to employment at the same level as pre-trauma, despite the fact that there was no expectation that they would ever regain such functioning. Furthermore, the data and follow-up contacts document that these 9 participants have maintained or continued to improve upon their post treatment condition. The follow-up data confirms what other Neurotherapy Center patients have been reporting, that after completing treatment functioning continues to improve, not decline.

We have included some graphics that demonstrate the improvements realized by the participants.

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