The The Road Less Traveled: Integrating Neurotherapy with Holistic Neuropsychological Rehabilitation After Severe Head Injury

Authors

  • Mohammed Afsar National Institute of Mental Health Neuro Sciences, Bangalore, India
  • Nishita Choudhari National Institute of Mental Health and Neuro Sciences, Bangalore, India
  • Dhaval Shukla National Institute of Mental Health and Neurosciences, Bangalore, India
  • Jamuna Rajeswaran National Institute of Mental Health and Neurosciences

DOI:

https://doi.org/10.15540/nr.8.1.57

Keywords:

EEG Neurofeedback Training, Neuropsychological Rehabilitation, Holistic Neuropsychological Rehabilitation, Severe Traumatic Brain Injury, Neurotherapy

Abstract

Introduction: Traumatic brain injury (TBI) is associated with physical, cognitive, emotional, and behavioral disturbances.  The cognitive deficits are common after TBI, and a holistic approach to neuropsychological rehabilitation is recommended in these patients.  EEG neurofeedback training (EEG-NFT) is a state-of-the-art technique for neuropsychological rehabilitation.  There is a paucity of studies exploring the use of EEG-NFT integrated with holistic neuropsychological rehabilitation.  Method: Single case design was adopted for the present study.  A 25-year-old single male, diagnosed with severe TBI, presented with physical, cognitive, and emotional-behavioral disturbances after 17 months of injury.  A comprehensive neuropsychological assessment was carried out.  The neuropsychological rehabilitation using EEG-NFT along with psychosocial interventions with the patient and the parents was carried out for 9 months.  Results: The patient showed significant improvement in cognitive deficits such as attention, executive functions, and visuospatial ability.  Emotional-behavioral problems such as irritability, sadness, and overall dysfunction also improved significantly.  Conclusion: The present case study highlights that integrating EEG-NFT along with holistic neuropsychological rehabilitation helps to improve cognitive, emotional, and behavioral disturbances after TBI.

References

Ahmed, S., Venigalla, H., Mekala, H. M., Dar, S., Hassan, M., & Ayub, S. (2017). Traumatic brain injury and neuropsychiatric complications. Indian Journal of Psychological Medicine, 39(2), 114–121. https://doi.org/10.4103/0253-7176.203129

Albrecht, J. S., Barbour, L., Abariga, S. A., Rao, V., & Perfetto, E. M. (2019). Risk of depression after traumatic brain injury in a large national sample. Journal of Neurotrauma, 36(2), 300–307. https://doi.org/10.1089/neu.2017.5608

Bédard, M., Felteau, M., Marshall, S., Dubois, S., Gibbons, C., Klein, R., & Weaver, B. (2012). Mindfulness-based cognitive therapy: Benefits in reducing depression following a traumatic brain injury. Advances in Mind-Body Medicine, 26(1), 14–20.

Benedictus, M. R., Spikman, J. M., & van der Naalt, J. (2010). Cognitive and behavioral impairment in traumatic brain injury related to outcome and return to work. Archives of Physical Medicine and Rehabilitation, 91(9), 1436–1441. https://doi.org/10.1016/j.apmr.2010.06.019

Bennett, C. N., Gupta, R. K., Prabhakar, P., Christopher, R., Sampath, S., Thennarasu, K., & Rajeswaran, J. (2018). Clinical and biochemical outcomes following EEG neurofeedback training in traumatic brain injury in the context of spontaneous recovery. Clinical EEG and Neuroscience, 49(6), 433–440. https://doi.org/10.1177/1550059417744899

Bennett, C. N., Rajeswaran, J., Sampath, S., & Christopher, R. (2013). The right to write: EEG neurofeedback training in frontal lobe agraphia—A case report. Journal of Neurotherapy, 17(3), 162–165. https://doi.org/10.1080/10874208.2013.813174

Bennett, C. N., Sampath, S., Christopher, R., Thennarasu, K., & Rajeswaran, J. (2017). Effect of electroencephalogram neurofeedback training on quality of life in patients with traumatic brain injury: In context of spontaneous recovery. Indian Journal of Neurotrauma, 14(02/03), 129–134. https://doi.org/10.1055/s-0038-1649280

Ben-Yishay, Y., & Diller, L. (2011). Handbook of holistic neuropsychological rehabilitation: Outpatient rehabilitation of traumatic brain injury. New York, NY: Oxford University Press.

Blake, H. (2008). Caregiver stress in traumatic brain injury. International Journal of Therapy and Rehabilitation, 15(6), 263–271. https://doi.org/10.12968/ijtr.2008.15.6.29878

Burton, A. (2016). A key traumatic brain injury initiative in India. The Lancet Neurology, 15(10), 1011–1012. https://doi.org/10.1016/S1474-4422(16)30131-4

Byers, A. P. (1995). Neurofeedback therapy for a mild head injury. Journal of Neurotherapy, 1(1), 22–37. https://doi.org/10.1300/J184v01n01_04

Cicerone, K. D., Goldin, Y., Ganci, K., Rosenbaum, A., Wethe, J. V., Langenbahn, D. M., ... Harley, J. P. (2019). Evidence-based cognitive rehabilitation: Systematic review of the literature from 2009 through 2014. Archives of Physical Medicine and Rehabilitation, 100(8), 1515–1533. https://doi.org/10.1016/j.apmr.2019.02.011

Cicerone, K. D., Mott, T., Azulay, J., Sharlow-Galella, M. A., Ellmo, W. J., Paradise, S., & Friel, J. C. (2008). A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 89(12), 2239–2249. https://doi.org/10.1016/j.apmr.2008.06.017

Cole, M. A., Muir, J. J., Gans, J. J., Shin, L. M., D'Esposito, M., Harel, B. T., & Schembri, A. (2015). Simultaneous treatment of neurocognitive and psychiatric symptoms in veterans with post-traumatic stress disorder and history of mild traumatic brain injury: A pilot study of mindfulness-based stress reduction. Military Medicine, 180(9), 956–963. https://doi.org/10.7205/milmed-d-14-00581

Dewan, M. C., Rattani, A., Gupta, S., Baticulon, R. E., Hung, Y.-C., Punchak, M., ... Park, K. B. (2018). Estimating the global incidence of traumatic brain injury. Journal of Neurosurgery, 130(4), 1080–1097. https://doi.org/10.3171/2017.10.jns17352

Dikmen, S. S., Corrigan, J. D., Levin, H. S., Machamer, J., Stiers, W., & Weisskopf, M. G. (2009). Cognitive outcome following traumatic brain injury. The Journal of Head Trauma Rehabilitation, 24(6), 430–438. https://doi.org/10.1097/htr.0b013e3181c133e9

Dikmen, S. S., Machamer, J. E., Powell, J. M., & Temkin, N. R. (2003). Outcome 3 to 5 years after moderate to severe traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 84(10), 1449–1457. https://doi.org/10.1016/s0003-9993(03)00287-9

Doornhein, K., & De Haan, E. H. F. (1998). Cognitive training for memory deficits in stroke patients. Neuropsychological Rehabilitation, 8(4), 393–400. https://doi.org/10.1080/713755579

Foulkes, M. A., Eisenberg, H. M., Jane, J. A., Marmarou, A., & Marshall, L. F. (1991). The Traumatic Coma Data Bank: Design, methods, and baseline characteristics. Journal of Neurosurgery, 75(Suppl.), S8–S13. https://doi.org/10.3171/sup.1991.75.1s.00s8

Frasca, D., Tomaszczyk, J., McFadyen, B. J., & Green, R. E. (2013). Traumatic brain injury and post-acute decline: What role does environmental enrichment play? A scoping review. Frontiers in Human Neuroscience, 7, 31. https://doi.org/10.3389/fnhum.2013.00031

Gupta, R. K., Afsar, M., Yadav, R. K., Shukla, D. P., & Rajeswaran, J. (2020). Effect of EEG neurofeedback training in patients with moderate–severe traumatic brain injury: A clinical and electrophysiological outcome study. NeuroRegulation, 7(2), 75–83. https://doi.org/10.15540/nr.7.2.75

Hammond, D. C. (2007). Can LENS neurofeedback treat anosmia resulting from a head injury? Journal of Neurotherapy, 11(1), 57–62. https://doi.org/10.1300/J184v11n01_06

Heinemann, A. W., & Whiteneck, G. G. (1995). Relationships among impairment, disability, handicap, and life satisfaction in persons with traumatic brain injury. The Journal of Head Trauma Rehabilitation, 10(4), 54–63. https://doi.org/10.1097/00001199-199508000-00006

Keller, I. (2001). Neurofeedback therapy of attention deficits in patients with traumatic brain injury. Journal of Neurotherapy, 5(1–2), 19–32. https://doi.org/10.1300/J184v05n01_03

Kersel, D. A., Marsh, N. V., Havill, J. H., & Sleigh, J. W. (2001). Neuropsychological functioning during the year following severe traumatic brain injury. Brain Injury, 15(4), 283–296. https://doi.org/10.1080/02699050010005887

Leclercq, M., Couillet, J., Azouvi, P., Marlier, N., Martin, Y., Strypstein, E., & Rousseaux, M. (2000). Dual task performance after severe diffuse traumatic brain injury or vascular prefrontal damage. Journal of Clinical and Experimental Neuropsychology, 22(3), 339–350. https://doi.org/10.1076/1380-3395(200006)22:3;1-v;ft339

Madigan, N. K., DeLuca, J., Diamond, B. J., Tramontano, G., & Averill, A. (2000). Speed of information processing in traumatic brain injury: Modality-specific factors. The Journal of Head Trauma Rehabilitation, 15(3), 943–956. https://doi.org/10.1097/00001199-200006000-00007

Majid, M. J., Lincoln, N. B., & Weyman, N. (2000). Cognitive rehabilitation for memory deficits following stroke. Cochrane Database of Systematic Reviews, 3, CD002293. https://doi.org/10.1002/14651858.CD002293

May, G., Benson, R., Balon, R., & Boutros, N. (2013). Neurofeedback and traumatic brain injury: A literature review. Annals of Clinical Psychiatry, 25(4), 289–296.

McAvinue, L., O’Keeffe, F., McMackin, D., & Robertson, I. H. (2005). Impaired sustained attention and error awareness in traumatic brain injury: Implications for insight. Neuropsychological Rehabilitation, 15(5), 569–587. https://doi.org/10.1080/09602010443000119

Menon, D. K., Schwab, K., Wright, D. W., & Maas, A. I. (2010). Position statement: Definition of traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 91(11), 1637–1640. https://doi.org/10.1016/j.apmr.2010.05.017

Millis, S. R., Rosenthal, M., Novack, T. A., Sherer, M., Nick, T. G., Kreutzer, J. S., ... Ricker, J. H. (2001). Long-term neuropsychological outcome after traumatic brain injury. The Journal of Head Trauma Rehabilitation, 16(4), 343–355. https://doi.org/10.1097/00001199-200108000-00005

Munivenkatappa, A., Rajeswaran, J., Indira Devi, B., Bennet, N., & Upadhyay, N. (2014). EEG Neurofeedback therapy: Can it attenuate brain changes in TBI? NeuroRehabilitation, 35(3), 481–484. https://doi.org/10.3233/nre-141140

Qadeer, A., Khalid, U., Amin, M., Murtaza, S., Khaliq, M. F., & Shoaib, M. (2017). Caregiver’s burden of the patients with traumatic brain injury. Cureus, 9(8), e1590. https://doi.org/10.7759/cureus.1590

Rabinowitz, A. R., & Levin, H. S. (2014). Cognitive sequelae of traumatic brain injury. Psychiatric Clinics of North America, 37(1), 1–11. https://doi.org/10.1016/j.psc.2013.11.004

Rajeswaran, J. (Ed.). (2012). Neuropsychological rehabilitation: Principles and applications. Oxford, UK: Newnes.

Rao, S. L., Subbakrishna, D. K., & Gopukumar, K. (2004). NIMHANS neuropsychology battery manual. Bangalore, India: National Institute of Mental Health and Neurosciences.

Rao, S. L. (2004). Home-based cognitive retraining. Paper presented at the II Workshop on 369 Continuing Education in Neuropsychology. Bangalore, India: National Institute of Mental Health and Neurosciences.

Rassovsky, Y., Satz, P., Alfano, M. S., Light, R. K., Zaucha, K., McArthur, D. L., & Hovda, D. (2006). Functional outcome in TBI II: Verbal memory and information processing speed mediators. Journal of Clinical and Experimental Neuropsychology, 28(4), 581–591. https://doi.org/10.1080/13803390500434474

Reddy, R. P., Jamuna, N., Indira Devi, B., & Thennarasu, K. (2009). Neurofeedback training to enhance learning and memory in patient with traumatic brain injury: A single case study. The Indian Journal of Neurotrauma, 6(1), 87–90. https://doi.org/10.1016/S0973-0508(09)80037-3

Reddy, R. P., Rajeswaran, J., Bhagavatula, I. D., & Kandavel, T. (2014). Silent epidemic: The effects of neurofeedback on quality-of-life. Indian Journal of Psychological Medicine, 36(1), 40. https://doi.org/10.4103/0253-7176.127246

Reddy, R. P., Rajeswaran, J., Indira Devi, B., & Kandavel, T. (2013). Neurofeedback training as an intervention in a silent epidemic: An Indian scenario. Journal of Neurotherapy, 17(4), 213–225. https://doi.org/10.1080/10874208.2013.847139

Reddy, R. P., Rajeswaran, J., Indira Devi, B., & Kandavel, T. (2017). Cascade of traumatic brain injury: A correlational study of cognition, postconcussion symptoms, and quality of life. Indian Journal of Psychological Medicine, 39(1), 32–39. https://doi.org/10.4103/0253-7176.198940

Ruff, R. M., Young, D., Gautille, T., Marshall, L. F., Barth, J., Jane, J. A., ... Foulkes, M. A. (1991). Verbal learning deficits following severe head injury: Heterogeneity in recovery over 1 year. Journal of Neurosurgery, 75(Suppl.), S50–S58. https://doi.org/10.3171/sup.1991.75.1s.0s50

Scholten, A. C., Haagsma, J. A., Cnossen, M. C., Olff, M., van Beeck, E. F., & Polinder, S. (2016). Prevalence of and risk factors for anxiety and depressive disorders after traumatic brain injury: A systematic review. Journal of Neurotrauma, 33(22), 1969–1994. https://doi.org/10.1089/neu.2015.4252

Serino, A., Ciaramelli, E., Di Santantonio, A., Malagù, S., Servadei, F., & Làdavas, E. (2006). Central executive system impairment in traumatic brain injury. Brain Injury, 20(1), 23–32. https://doi.org/10.1080/02699050500309627

Stéfan, A., & Mathé, J.-F. (2016). What are the disruptive symptoms of behavioral disorders after traumatic brain injury? A systematic review leading to recommendations for good practices. Annals of Physical and Rehabilitation Medicine, 59(1), 5–17. https://doi.org/10.1016/j.rehab.2015.11.002

Sternbach, G. L. (2000). The Glasgow Coma Scale. The Journal of Emergency Medicine, 19(1), 67–71. https://doi.org/10.1016/s0736-4679(00)00182-7

Thornton, K. (2000). Improvement/rehabilitation of memory functioning with neurotherapy/qEEG biofeedback. The Journal of Head Trauma Rehabilitation, 15(6), 1285–1296. https://doi.org/10.1097/00001199-200012000-00008

Tinius, T. P., & Tinius, K. A. (2000). Changes after EEG biofeedback and cognitive retraining in adults with mild traumatic brain injury and attention deficit hyperactivity disorder. Journal of Neurotherapy, 4(2), 27–44. https://doi.org/10.1300/J184v04n02_05

von Bernhardi, R., Eugenín-von Bernhardi, L., & Eugenín, J. (2017). What is neural plasticity? In R. von Bernhardi, J. Eugenín, & K. Muller (Eds.), The Plastic Brain, Advances in Experimental Medicine and Biology (vol. 1015, pp. 1–15). Switzerland: Springer Nature. https://doi.org/10.1007/978-3-319-62817-2_1

War, F. A., Jamuna, R., & Arivazhagan, A. (2014). Cognitive and sexual functions in patients with traumatic brain injury. Asian Journal of Neurosurgery, 9(1), 29–32. https://doi.org/10.4103/1793-5482.131061

Wilson, B. A. (2008). Neuropsychological rehabilitation. Annual Review of Clinical Psychology, 4, 141–162. https://doi.org/10.1146/annurev.clinpsy.4.022007.141212

Yeates, K. O. (2010). Mild traumatic brain injury and postconcussive symptoms in children and adolescents. Journal of the International Neuropsychological Society, 16(6), 953–960. https://doi.org/10.1017/S1355617710000986

Zorcec, T., Demerdzieva, A., & Pop-Jordanova, N. (2011). QEEG, brain rate, executive functions and neurofeedback training in patients with traumatic brain injury. Acta Informatica Medica, 19(1), 23–27.

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Published

2021-03-29

Issue

Vol. 8 No. 1 (2021)

Section

Clinical Corner

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