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Patients with TBI typically exhibit significant increase in stress immediately after brain concussion, with associated increase of serum cortisol levels. Similarly to established pharmacotherapy, neurofeedback training in these patients has been shown to reliably reduce stress, supporting the spontaneous recovery.

Neurofeedback Training in Traumatic Brain Injury Patients Induces Biochemical Changes that Reduce Stress and Support Natural Recovery 

Clinical evidence indicates that individuals who have suffered from traumatic brain injury (TBI) often exhibit secondary symptoms, such as cognitive, emotional, and behavioural disturbances.

It has been suggested that these post-injury symptoms are associated with abnormal biochemical reactions that, when triggered, may have cytotoxic (undermining the normal functioning of neurons or inducing their death) effects in the brain.

Studies investigating the relationship between post traumatic brain injury (PTSD) and TBI, suggest that these secondary symptoms could be dependent on stress reactions triggered after the mechanical insult, challenging the classic belief that post-concussive symptoms are only the result of neurological damage.

In this respect, there is evidence that addressing stress reactions in patients with TBI may be the most effective therapeutic strategy to treat and manage TBI patients [1]. 

These findings are in line with what other evidence [3] indicating that patients with mild TBI exhibit increased sensitivity to stressful stimuli at least during the first two weeks after injury, which may negatively affect early rehabilitation.are

Head pain Attack, man suffering from brain pain. 3D illustration

Most importantly, these considerations are corroborated by the evidence indicating that increased levels of cortisol are associated with both TBI [2] (Fig.1) and increased levels of stress [3, 4]. Given that cortisol has been shown to inhibit growth factors in the central nervous system (CNS), it is crucial that all neurorehabilitation attempts be aimed at bringing cortisol levels back to normal levels. 

Neurofeedback training research [5] has demonstrated a positive association between increased alpha frequency band levels, and relaxation [6]. For example this has been found in the treatment of patients with alcohol addiction and PTSD, as well as of patients with anxiety disorders [7]The efficacy of interventions using neurofeedback training is well known in TBI. For example, amelioration of cognitive functions have been shown in patients with mild TBI after 20 treatment sessions and cognitive retraining [8].

Other clinical data demonstrate that neurofeedback training induces amelioration of attention in patients with closed head injury [9] and also induces improvement in cognitive functioning associated with changes in the electroencephalogram (EEG) as measured by Q-EEG maps.

cortisol_TBI
Fig 1 Example of raised cortisol levels after Traumatic Brain Injury [2]

The biological basis for neuropsychological rehabilitation is neural plasticity, the ability of neural cells to naturally remodel in response to environmental stimuli. Neural plasticity is key in the spontaneous recovery from TBI, which generally takes place within the first 3 months after the injury [10].

Stress significantly affects normal recovery in patients with TBI and the reduction of post-traumatic stress is often associated with a reduction of Post-concussive symptoms [11], In this context, EEG neurofeedback training is used to develop the appropriate mental resources to cope with stress directly altering the biochemical and physiological underpinnings [12].

A recent study supports this view, showing that the use of alpha-theta neurofeedback training as a relaxation protocol induced a reduction in perceived stress in patients with TBI and, most importantly, a reduction of serum cortisol levels during the early stages after concussion, with implications for the acute recovery phase [13]. 

Alpha/theta training has been extensively used in neurofeedback research as a therapeutic strategy to reduce stress [14, 15] and also in patients with severe depression or anxiety [16, 17]. The ability of this protocol to reduce serum cortisol levels suggests that its effects on stress levels and anxiety/depressive symptoms might be mediated by the modulation of inflammatory reactions in the brain similarly to what has been observed in studies with antidepressants and anxiolytic agents [18].

Summary and conclusions

Patients with TBI typically exhibit significant increase in stress immediately after brain concussion, with associated increase of serum cortisol levels. Similarly to established pharmacotherapy, neurofeedback training in these patients has been shown to reliably reduce stress, supporting the spontaneous recovery.

References

 

  1. Bryant, R., Post-traumatic stress disorder vs traumatic brain injury. Dialogues Clin Neurosci, 2011. 13(3): p. 251-62.
  2. Niederland, T., et al., Abnormalities of pituitary function after traumatic brain injury in children. J Neurotrauma, 2007. 24(1): p. 119-27.
  3. Het, S., et al., Stress-induced cortisol level elevations are associated with reduced negative affect after stress: indications for a mood-buffering cortisol effect. Psychosom Med, 2012. 74(1): p. 23-32.
  4. Seldenrijk, A., et al., Psychological distress, cortisol stress response and subclinical coronary calcification. Psychoneuroendocrinology, 2012. 37(1): p. 48-55.
  5. Thatcher, R.W., et al., QEEG and traumatic brain injury: rebuttal of the American Academy of Neurology 1997 report by the EEG and Clinical Neuroscience Society. Clin Electroencephalogr, 1999. 30(3): p. 94-8.
  6. Nowlis, D.P. and J. Kamiya, The control of electroencephalographic alpha rhythms through auditory feedback and the associated mental activity. Psychophysiology, 1970. 6(4): p. 476-84.
  7. Hammond, D.C., Neurofeedback with anxiety and affective disorders. Child Adolesc Psychiatr Clin N Am, 2005. 14(1): p. 105-23, vii.
  8. Tinius, T.P., The intermediate visual and auditory continuous performance test as a neuropsychological measure. Arch Clin Neuropsychol, 2003. 18(2): p. 199-214.
  9. Simkin, D.R., R.W. Thatcher, and J. Lubar, Quantitative EEG and neurofeedback in children and adolescents: anxiety disorders, depressive disorders, comorbid addiction and attention-deficit/hyperactivity disorder, and brain injury. Child Adolesc Psychiatr Clin N Am, 2014. 23(3): p. 427-64
  10. RS., P., Traumatic Brain Injury and Neuropsychological Impairment: Sensorimotor, Cognitive, Emotional, and Adaptive Problems of Children and Adults. 1990, New York, NY: Springer.
  1. Walter, K.H., S.L. Kiefer, and K.M. Chard, Relationship between posttraumatic stress disorder and postconcussive symptom improvement after completion of a posttraumatic stress disorder/traumatic brain injury residential treatment program. Rehabil Psychol, 2012. 57(1): p. 13-7.
  2. Thompson M, T.L., Principles and Practice of Stress Management, N.G. 3rd ed. New York and Press, Editors. 2007, Leher PM, Woolfolk RL, Sime WE, eds. Guilford Press: New York, NY. p. 249-287.
  3. Bennett, C.N., et al., Clinical and Biochemical Outcomes Following EEG Neurofeedback Training in Traumatic Brain Injury in the Context of Spontaneous Recovery. Clin EEG Neurosci, 2018. 49(6): p. 433-440.
  4. Raymond, J., et al., The effects of alpha/theta neurofeedback on personality and mood. Brain Res Cogn Brain Res, 2005. 23(2-3): p. 287-92.
  5. Gruzelier, J., A theory of alpha/theta neurofeedback, creative performance enhancement, long distance functional connectivity and psychological integration. Cogn Process, 2009. 10 Suppl 1: p. S101-9.
  6. Dalkner, N., et al., Short-term Beneficial Effects of 12 Sessions of Neurofeedback on Avoidant Personality Accentuation in the Treatment of Alcohol Use Disorder. Front Psychol, 2017. 8: p. 1688.
  7. Cheon, E.J., et al., Effects of neurofeedback on adult patients with psychiatric disorders in a naturalistic setting. Appl Psychophysiol Biofeedback, 2015. 40(1): p. 17-24.
  8. Kohler, O., et al., Inflammation in Depression and the Potential for Anti-Inflammatory Treatment. Curr Neuropharmacol, 2016. 14(7): p. 732-42.