Case Study: Brain Injury
AAPB and ISNR have established standards for Neurofeedback research [Moss & Gunkleman (2002)] that confer a status of Probable Efficacy for Brain Injuries. Neurofeedback provides evidence-based practices on par with health care establishment demands (Gemon, Devon & Ramsey (2000), Sacket et al, (2000). Levels of evidence include: case reports, observational studies, randomized clinical trials, fMRI scans (Andrasik & Rime (2007), and so on. “Efficacy” determination of training or treatment effect is derived from systematic evaluation in controlled clinical trial (La Vaque et al (2002).
Case A
This case involved a twenty-two year old female who was a very bright, full-time college student and scholarship award winner. The woman had a history of asthma and also had struggled with anxiety/OCD tendencies, but otherwise, was leading a fairly "normal" life. A serious automobile accident caused severe injury to the right frontal orbital area on impact, requiring hospitalization and surgery. Thereafter the woman was unable to sleep (managed five to ten minute naps all day and night, off and on), and she was jittery and constantly restless. She had lost all concentration, had become under-motivated, was experiencing a diminished appetite and was plagued with recurring panic attacks. Cognitive changes included some Anomia/syntactical errors, hypolexia and laconic speech. In addition, she was experiencing facial skin eruptions/lesions, migraine headaches and intermittent diffuse pain (from inflamed nerves and muscle aches through out her body). The woman had dropped out of school, and prescribed medications did not improve her condition.
After completing her initial Neurofeedback training session the woman reported feeling more relaxed then she had "in a very long time". Several trainings later the woman reported she was able to nap for a full hour. Shortly thereafter she reported that her appetite was returning, if only slightly, and that she was falling asleep more easily, and, though still waking up a lot, she was feeling more rested and calmer overall. In the still early stages of her training the woman reported superseding an asthma attack without hospitalization, which always was required in past. She reported having slept six hours in a row uninterrupted without a sleeping aid. She continued to report sleeping up to six hours without sleeping aids, and was feeling “calmer overall”. Her cognitive issues began to improve, and she reported that reading had become pleasurable again in a cadence of speech that was more flowing and relaxed then previously. Her skin eruptions decreased dramatically as her training progressed, and the woman reported that her self-confidence was returning, and that she was feeling ready to try going back to school and/or looking for work. By mid-program the woman reported that her mood was consistently "good", sleep was much improved and dreams had returned. She had ceased all prescribed sleep and anti-anxiety medications (under physician supervision). Later, the woman reported being invited for a second interview as an applicant for an exclusive scholarship intern program, and was one of twenty accepted applicants among hundreds. She continued to report sleeping seven hours a night, reported that her body remained “mostly pain free”, and that she was less anxious overall, despite the challenges of re-entry to work and scholastic environments. At discharge the client had a full time job and was ready to transition to home training.
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Case B
This case involved an under-employed twenty-eight year old female who had a history of head injuries. When she was nine years old she sustained a substantial blow above her left eye from a baseball accident in which she lost consciousness and received fifteen stitches. She had struggled with alcoholism from age fifteen and had frequent alcohol-related blackouts until she quit drinking at age twenty-six. She had been “dry” for two years when she was involved in a serious equestrian accident in which she sustained a concussion with loss of consciousness and subsequent temporary amnesia. Thereafter she was plagued with short term memory loss, recurring headaches, sleep-disruption, diminished ability to taste, hypersensitivity to light, diminished dexterity, bouts of dizziness and disturbances to her sense of balance. She reported diminished self-expression; had difficulty with speech articulation and could not “think clearly”. She described saying things “backwards from what I mean all the time”; was experiencing oral dyslexia. She reported feeling very depressed and unable to focus enough to return to work. A physician prescribed antidepressant was not helping her symptoms to improve.
Early after commencing Neurofeedback training the woman reported sleeping better then she had in years. After completing subsequent sessions she reported improved focus and motivation, a renewed interest in food and eating, and also reported that her headaches were less frequent and of a lower intensity. After more training the client reported decreased sensitivity to environmental stressors such as light and noise, and continued to report normal sleep patterns. She slowly regained her balance, experienced fewer and fewer bouts of dizziness, and regained her dexterity. The woman also noted that her speech and thinking were “so much better”: congruent, consonant and coherent. Her short term memory improved dramatically, and toward the end of training she had started to look for work and spoke of experiencing a renewed hope for her future.
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