successful neurofeedback treatment of post- concussion ... · 5/20/2016 · 5/12/2016 1 successful...

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Successful Neurofeedback Treatment of Post-Concussion Syndrome and Other Head Injuries

BCIA Webinar 16-07,

Dennis A. Romig, Ph.D., BCN

Austin, Texas

[email protected]

(512) 288-0416

May 20, 2016 With Appreciation to:

Angelo S. Bolea, Ph.D. Clinical Neuropsychologist

Originator of the Quadrant Brain Theory

Annapolis MD | Dr. [email protected]

Dennis Romig, PhD, BCN [email protected] 1

Jim McMahon: Chicago Bears Super bowl wining Quarterback – Loss of

Immediate Memory Now

Dennis Romig, PhD, BCN

[email protected] 2

mailto:[email protected]

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Dennis A. Romig, PhD, BCN Brain Improvement Center.com

[email protected] Austin, Texas

• Psychologist and Director of the Brain Improvement Center, Group private practice treating clients using Neurofeedback, other Biofeedback, and cognitive behavioral treatment (CBT):

Traumatic Brain Injury (TBI) and Post-Concussion Syndrome (PCS)

Depression; Anxiety; Attention Deficit Disorder (ADD) and other problems

• Current President of the Biofeedback Society of Texas

• Co-Program Chairman of the Association of Applied Psychophysiology and Biofeedback (AAPB) 46th Annual Scientific Meeting in Austin, Texas in March, 2015

• How Texas Veterans Benefit from Neurofeedback. Invited to give a presentation and demonstration at the Texas Capitol to the Texas Governor’s Staff, Texas House Staff, Texas Senate Staff, Austin, TX. 2012 (Resulted in additional state appropriations for neurofeedback treatment of military veterans)

• Bolea, A., Romig, D. & Romig, L. (2012). Heal Your Brain and Body: Think and Speak the Positive. Performance Research Press: Austin, TX. And Bolea, A., Romig, D. & Romig, L. (2012). How to Have Brain Healing Sleep. Performance Research Press: Austin, TX. Brainimprovementcenter.com

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BCIA Webinar Objectives Participants will learn:

1. Definition of Post-Concussion Syndrome and its relation to Traumatic Brain Injury(TBI) 2. Key Symptoms of Post-Concussion Syndrome: Sleep Disorders, Irritability, Focus Issues, Depression,

Anxiety, and Headaches 3. Key Assessment Methods for starting treatment 4. Neurofeedback, Biofeedback, and Cognitive Behavior Treatment Methods for each of the above symptoms 5. All of the above with two case studies from the study of 30 consecutive clients


[email protected] 4

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Traumatic brain injury (TBI) Traumatic brain injury (TBI) is a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or

temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of

consciousness.

Post-Concussion Syndrome (PCS) 2016 ICD-10-CM Diagnosis Code F07.81

The organic and psychogenic disturbances observed after closed head injuries (head injuries, closed). Post-concussion syndrome includes subjective physical complaints (i.e. Headache, dizziness), cognitive, emotional, and behavioral changes. These

disturbances can be chronic, permanent, or late emerging.

Old definition of PCS was 3 or more symptoms : Head

aches, depression, anxiety, focus problems, sleep disorders, etc.


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Human Costs of the Symptoms of

Concussions and Head Injuries (Post-Concussion Syndrome):

• Poor Employability

• Unemployment

• Occupational Disabled (Military Veterans and Others)

• Poor and Unacceptable School/Work Performance

• Destructive Family and Other Interpersonal Relationships

• Suicide


[email protected] 6

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Presentation Outline

• Angelo Bolea’s Quadrant Brain Model to Neurofeedback produces 98% success with 30 Clients

• Post-Concussion Success Case Study- Client “A”

• Symptom Model to Set Treatment Priorities

• Green House Interpersonal Environment to Nurture Healing

• Concurrent Use of Three Sets of Therapy Tools: Neurofeedback; Biofeedback; Cognitive Behavior Therapy

• EEG Quadrant Brain Neurotherapy Prototypes:

Depression, Sleep Disorders, Focus Problems, Anxiety, and

Irritability


[email protected] 7

Study 1: Quadrant Brain Theory Success with Inpatient Chronic Schizophrenic Patients

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Study 2. Quadrant Brain Theory Based Neurofeedback 95% Successful Suicidal and

Severe Depression Clients

(20 Consecutive, Sequential Clients)

Average Number of Total Treatment Sessions for Depression: 12.6

• All Clients able to return to work, education, and/or family responsibilities

• 19/20 Depression symptoms gone at conclusion of treatment. Off of all psychotropic medicine 95% Success

Angelo Bolea and Dennis Romig. Immediate and Follow-up Success of Neurofeedback Treatment for 20 Severely Depressed Clients: Quadrant Brain Theory and Application,

International Society of Neurofeedack Research Annual Conference, Carrolton, Texas 2013 (Video available from ISNR)

Audio Presentation and PowerPoints available from BCIA Webinar 15-8:

November 6. 2015 Presented by Dennis A. Romig, PhD, BCN

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Study 3: Success Treating Head Injuries

and Concussions

95% rehabilitation success with 25 clients with Post-Concussion Syndrome (PCS) symptoms from head injuries and concussions. • Dennis Romig, Ph.D., and Angelo Bolea, Ph.D., Proceedings of the

International Society of Neurofeedback and Research 2014 Conference, San Diego, California, Successful Treatment of 25 Consecutive Clients with Post-Concussion Syndrome using Neurofeedback and a Variety of Adjunctive Interventions. NeuroRegulation Vol. 1(3-4):278-279 2014 doi:10.15540/nr.1.3-4.273 http://www.neuroregulation.org


[email protected] 10

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Study 4: Follow-up Study including Five additional PCS Clients (n=30 consecutive

clients) Life Improvements

Pre- Treatment Post-Treatment

10 Disabled and/or Dependent 10 Employed or Student

5 Semi-Disabled 5 Employed or Fully Engaged

7 Poor Job Performance 7 Good job performance

4 Medical Problems 4 Healthier

2 Poor School Performance 2 Honor Student

1 Marriage Conflicts 1 Happy Marriage

2 Lost Driving 1 Lost Driving

29/30 client Life Improvement and Symptom removal

24 month follow-up 27/ 30 still symptom free (90% success)



Life Improvement

Pre Status Post Status

Disabled Employed –Continuous Promotions

Disabled Employed

Disabled Employed

Poor concentration Continuous promotions and work bonuses

Distracted, Unproductive Successful business

Unable to engage life Social butterfly

Disabled Full-time graduate student, All A's

Poor sleep, Distracted Better sleep, Concentration

Poor concentration, Marriage problems Job success, Happy family

Semi-disabled Student, Employed

Getting Lost Driving Part-time employed, still getting lost driving

Low job performance Good job performance

Low job performance Superior job performance

Anger, Anxious, No direction Law school

Social Anxiety, Intestinal problems Symptom free

12 Dennis Romig, PhD, BCN

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Life Improvement

Pre Status Post Status Depressed Happier

Unemployed, Dependent Employed, Independent

Poor sleep, Pain Great sleep, Less pain

Disabled, Poor sleep Successful business owner, Great sleep

Focus problems at work, Impulsive Improved focus and work performance

Disabled, 3 grand mal seizures per day Managed Calmness, Part-time employment

Disabled Functioning homemaker

Poor memory, Agitated Calm, Improved memory

Incapacitated World Traveler and Volunteer Mentor

Medical Leave Full-time work

Unable to concentrate on school work Honor Role

Poor work performance (Irritability) Improved work performance -Calm

Dependent, Poor life decisions Enrolled in college and good life decisions

Poor sleep, Irritable, trouble focusing Improved sleep, calmness, and focus

Poor School performance, headaches Top 1% school performance, No headaches


[email protected]

Pre-Post Improvement of Theta (2-5 Hz)- Beta –SMR (13-15Hz) Ratio at FP1 (Left Forehead)

ID# FP1 DT

Pre FP1 SMR

Pre FP1 DT/SMR

Pre FP1 DT

Post FP1 SMR

Post FP1 DT/SMR

Post Pre-Post

Difference 2 64.90 8.50 7.6 45.80 12.90 3.6 4.0

3 30.80 4.00 7.7 14.00 2.30 6.1 1.6

4 23.10 4.90 4.7 21.40 4.40 4.9 -0.2

5 38.30 6.90 5.6 9.70 3.30 2.9 2.7

6 30.00 6.20 4.8 6.90 3.80 1.8 3.0

7 26.40 6.20 4.3 6.10 9.40 0 4.3

8 20.44 4.32 4.7 14.10 4.10 3.4 1.3

9 17.60 2.90 6.1 12.20 4.00 3.1 3.0

10 13.80 2.40 5.8 13.60 2.30 5.9 -0.1

11 28.00 3.30 8.5 20.00 5.00 4.0 4.5

12 9.40 3.20 2.9 12.60 6.10 2.1 0.8

13 20.90 4.00 5.2 7.00 1.90 3.7 1.5

14 19.30 4.90 3.9 12.80 2.50 5.1 -1.2

15 27.10 5.90 4.6 5.90 3.30 1.8 2.8

16 25.20 4.30 5.9 13.60 3.40 4.0 1.9

17 9.20 2.90 3.2 8.30 2.80 3.0 0.2

18 26.40 7.20 3.7 14.40 8.90 1.6 2.1

19 88.00 5.80 15.2 7.10 4.50 1.6 13.6

20 17.90 4.20 4.3 6.10 2.10 2.9 1.4

22 62.58 8.09 7.7 22.60 4.00 5.7 2.0

23 90.00 7.90 11.4 22.70 6.10 3.7 7.7

24 10.30 4.50 2.3 5.40 2.60 2.1 0.2

25 27.70 6.60 4.2 8.40 4.90 1.7 2.5

26 4.80 2.30 2.1 12.20 4.00 3.1 -1.0


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ID# FP1 DT

Pre FP1 SMR

Pre FP1 DT/SMR

Pre FP1 DT

Post FP1 SMR

Post FP1 DT/SMR

Post Pre-Post

Difference

27 29.80 3.70 8.1 23.00 3.70 6.2 1.9

28 16.70 2.40 7.0 7.70 1.70 4.5 2.5

29 82.20 7.10 11.6 27.20 6.50 4.2 7.4

30 117.40 7.30 16.1 27.10 2.50 10.8 5.3

31 12.90 1.90 6.8 13.30 2.40 5.5 1.3

Average 34.2 5 7.8 13.8 4.5 3.5


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Pre-Post Improvement of Theta (2-5 Hz)- Beta (13-15Hz) Ratio at FP1 (Left Forehead)

Theta/Beta Ratio Improvement at FP1 after Neurotherapy

with Adjunctive Interventions

FP1 DT/SMR Pre

FP1 DT/SMR Post

7.8 : 1

3.5 : 1

Analysis of Variance F> 15 Significant p < 0.001


[email protected]

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First Post-Concussion Syndrome Case

Presentation Outline of “A”

• Presenting Post- Concussion Symptoms and

Situation of “A”

• Interview Assessment Summary

• Quadrant Brain Spectral Assessment Summary

• What I did and Why I did it

• A’s Treatment Results



Head Injury and Other Health History: “A” Form completed before or at first appointment

• Age : 55 Education and Training: 3 years of college

• Occupation: Unemployable (Past- General contractor)

• Head Injuries:

Several falls off of bicycle and horse as a child,

In 2009 slammed against wall, knocked unconscious (Loss of

Consciousness, LOC )

• Serious Illnesses like Strep Throat, Mono, Epstein-Barr’s, Serious Sinus:

History of serious sinus infections for almost 25 years

• Interests and Hobbies: Swimming, scuba, hiking, snow skiing, sailing , yoga , weight lifting, walking



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“A”s Presenting Symptoms and Situation

“A”, 2011-2015 abusive marriage where husband frightened her, Unable to think, No one knows why she married abusive man. Continues to care for him in spite of his alcoholism and abuse. Self-report-- uncontrollable emotions

Presenting Symptoms:

1. Depressed,

2. Sleep interruption,

3. Poor memory,

4. Unable to make decisions,

5. Poor concentration and focus

6. Poor or no decisions



Client Education and Assessment 1st Meeting Agenda (2 Hours)

My Interaction Style – Teaching, Respectful, Side by Side

1. One or two stories of my past Successful Clients

2. Overview: parts of the brain have different functions

3. Brain Wave Frequencies and Desired Amplitudes of

frequencies (microvolts)

4. Interview of Client “What would you like to be

improved?” - Client Goals and other useful

information

5. Review Head Injury History and traumatic events



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Client Education and Assessment 1st Meeting Agenda (2 Hours) Continued

6. Any questions?

7. Assessment at 10 brain Sites. Print out assessment at each

site and go over average scores. Client sees brain wave

imbalances that correspond to Client Goals. Ex. Client’s DT

2-5 at FP1 is 30mv. Should be less than 8-10

8. Do abbreviated Neurofeedback Training on right side, left

side, and right side

9. Write down results and show client results

10. Any Questions? And Schedule Next Session



Angelo Bolea, PhD, BCN 22

Critical Clinical Conditions Successfully Treated with Select Biofeedback Modalities

Skill Stream

Emotional Ridge

Associations – must be

some connection

Associations – what is it

connected to

Something is

Happening

Energized High

Arousal

Remembering how it feels to

do it

Supplementary motor:

get ready for movement

Motor: movement

SENSORY Leg & Foot

Shoulder

Hand

Face

Jaw

Abdomen

Neck

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Brain Training Assessment Summary- “A”

1. What would you like to have improved? “Memory, fear of husband, manage stress, improve staying asleep, clear thinking, better focus and concentration”

2. What challenging life events or psychological difficulties have you had? “Husband drugged me and had me arrested 3 times. Current marriage violent”

3. Any substance abuse? “Drink alcohol 3 times/week”

4. Who are some of your relatives or friends who have had a positive impact on you ?

“Adult children, father, brothers, and sister-in-law”

5. What would you like to do when your brain is trained the way you want? “Focus better and Become a Nurse”



Brain Wave Training Frequencies for Assessment - Table 1

Name of Frequency Frequency Settings

Herz (Hz)

Usual Training Goals

with One Sensor (in

microvolts)

Delta/Theta Brain Waves

“Foggy Brain Waves.”

Sleep and Twilight brain waves.

2-5 Hz

Less than 10-12

Less 3:1 theta/ beta/smr

ratio

Right Side Brain Alpha Brain

Waves

Calming and Optimism brain

waves

8-12 More than 4

Left Side Brain Alpha Brain

Waves

Worry and Distractibility brain

waves

8-12 Less than 4-5

Less than left side Beta in

frontal area.

Equal to Beta in left side

parietal

SMR (Sensory Motor Rhythm)

Brain Waves

“Get up and go” brain waves

12-14 Right Side

13-15 Left Side

More than 3

Beta Brain Waves

Clear thinking

16-22 More than 3

High Beta

Highly vigilant,

Anxious (Inflammation?)

25-35 4-5 or Less



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Landmarks of the Brain – Quadrant Brain Theory

Angelo S. Bolea, PhD, BCN 26

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Brain Improvement Center, Austin, Texas

EEG Brain Wave Assessment Summary Name:__________A_______________ Date:______________________

Average Levels of Brain Waves in Microvolts

Improvement Goals

Right Side of the Brain FP2

DT 68.7 B 9 A 16.4 BF 13.9 SMR 6.9

O-2

DT 8.4 B 5.4 A 5.1 BF 6.5 SMR 3.2

T4

DT 12.9 B 6.8 A 4.2 BF 6.5 SMR 2.2

P4 DT 19 B 6.6 A 7.4 BF 4.7 SMR 4

CP4

DT 20.5 B 6.7 A 7.7 BF 4.5 SMR 4.2

Lower DT: SMR Ratio



Brain Improvement Center, Austin, Texas

EEG Brain Wave Assessment Summary Name:__________A_______________ Date:___________________


Improvement Goals

Left Side of the Brain

FP1

DT 82.2 B 11.3 A 21.2 BF 13.8 SMR 7.1

Note high DT= Poor immediate memory and poor decision-making

F3

DT 33.6 B 8.6 A 10.8 BF 8.8 SMR 5.1

Must lower DT here and at Fc3 before going to FP1

O1

DT 11.5 B 9.7 A 10.3 BF 14 SMR 5.6

P3 DT 17.6 B 7.9 A 6.9 BF 5.6 SMR 4.2

FC3

DT 21.9 B 7.7 A 6.9 BF 5/9 SMR 4.5



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Improve Sleep (Sleep Disorders)

Cognitive Behavior Therapy Biofeedback Neurofeedback



Cognitive Behaviors Biofeedback Neurofeedback (EEG)

• 30 minutes

movement -outside

• Rest 2 hours before bed

• No screen time 2 hours before bed

• Warm bath or shower 30 minutes begore bed

• No conflicts when tired, hungry, or sick

Ex . Mark B.

• Heart Rate Variability

Biofeedback (HRVB)

• Paced Breathing, 5-6 breaths per minute, eyes closed http://www.amazon.com/ RESPeRATE-Ultra-Pressure Hypertension-Reduction

Smart phone ap-

Breathe2Relax

• Interrupted sleep: Reduce anxious brain waves, increase optimistic brain waves, eyes open and eyes closed CP4, P4, PO4, 02

• Sleep onset problem:

Reduce sleep brainwaves (DT 2-5 Hz), Increase get-up-and-go brain waves (SMR 13-15 Hz)

Neurotherapy Protocol to Improve Interrupted Sleep

Slow Down Breathing Rate to 9 Breaths per minute or less before start.

Phase 1. Extreme Interrupted Sleep

Site Inhibit Reward Eyes Open Eyes Closed

CP4 BF 25-35 hz Alpha 8-12 hz 2 minutes 2 minutes

DT 2-5 SMR 12-14 4 minutes

P4 BF 25-35hz Alpha 8-12 hz 2 minutes 2 minutes

PO4 BF 25-35 hz Alpha 8-12 hz 2 minutes 2 minutes

O2 BF 25-35 hz Alpha 8-12 hz 2 minutes 2 minutes

FC3 Alpha 8-12 Beta 16-21 4 minutes

P4 BF 25-35 Alpha 8-12 hz 2 minutes 2 minutes

Phase 2. Continue above at cp4, p4, Fc3 and other sites for other symptoms


[email protected]

http://www.amazon.com/RESPeRATE-Ultra-Predssure








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Improve Focus and Concentration (ADD)





• Drawing • Mindfulness exercises

Movement (Exercise) • See John Ratey book,

Spark

• Heart rate variability

biofeedback http://www.somaticvision .com/products/alive • Paced Breathing

• Reduce the Theta-Beta

ratio (DT/SMR) • Lower the Distractible

Alpha brain waves (Left Side Frontal: Alpha 8-12 Hz) so Beta is greater than Alpha

Neurotherapy Protocol to

Improve Focus and Concentration Phase 1: One Sensor Right Brain Work: Calming and Grounding

Site Inhibit Reward Time

CP4 BF 25-35 hz Alpha 8-12 hz 4-5 minutes

DT 2-5 hz SMR 12-14 hz 4-5 minutes

Left Brain Work: Increasing Focus and Energy

FC3 DT 2-5 hz SMR 13-15 hz 4-5 minutes

Alpha 8-12 hz Beta 16-22 hz 4-5 minutes

F3 DT 2-5 hz SMR 13-15 hz 4-5 minutes

Alpha 8-12 hz Beta 16-22 hz

Right Brain Work: Grounding and Sealing In All Brain Wave Improvements


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Improve Focus and Concentration Phase 2 : One Sensor Right Brain Work: Calming and Grounding



DT 3-6 hz SMR 12-14 hz 4-5 minutes

Left Brain Work: Increasing Focus and Energy (leave below unbolded) FC3 DT 3-6 hz SMR 13-15 hz 4-5 minutes


F3 DT 3-6 hz SMR 13-15 hz 4-5 minutes


FP1 DT 2-5 SMR 13-15 Start with 1-2 mins. Work up to 4 mins.

Right Brain Work: Grounding and Sealing In All Brain Wave Improvements


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Improve Focus and Concentration

Phase 3: Two Sensors If Needed Right Brain Work: Calming and Grounding


CP4 & P4 BF 25-35 hz Alpha 8-12 hz 4-5 minutes

DT 2-5 hz SMR 12-14 hz 4 -5minutes

Left Brain Work: Increasing Focus and Energy

FC3 & F3 DT 2-5 hz SMR 13-15 hz 4-5 minutes


FP1 & F3 DT 2-5 hz SMR 13-15 hz 4-5 minutes


Right Brain Work: Grounding and Sealing in All Brain Wave Improvements

CP4 & P4 BF 25-35 hz Alpha 8-12 hz 2-5 minutes

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Initial Therapy Training Session () Initial Assessment

For one or more microvolts of improvement from previous level

Date Brain Sites

Inhibit/ Lower

Ave. Microvolt

Reward/Raise

Ave. Microvolt

Notes

10/7/ As. Cp4 Bf 4.3 Alpha 8.1 EO/EC

FC3 DT 19.6 SMR 4

CP4 Bf 4.4 A 8.5 EO/EC

10/14 HRVB Ave. 50%

Cp4 Bf 6.3 A 10.6 EO/EC

DT 17.8 SMR 4.2

Fc3 DT 18.5 SMR 4.5

A 8.9 B 9

F3 DT 25.6 SMR 4.5

Cp4 Bf 5.5 A 11.6 EO/EC



“A”’s Neurotherapy Results • After 2 hour Assessment and first neurofeedback

client went home and did her income tax.

• After second session reported, “Memory better, more energy, calmer, more organized “

• Sleep improved, Focus better, “Memory is like it was in college” Started exercising

• Getting along better with adult daughters and family

• Enrolled in nursing program in college. Calmly working through divorce.

• At Fp1 Dt decreased from 82.2 mv to 27.2 mv at completion of treatment (15 sessions total)



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Symptoms of concussions and Head Injuries (Post-Concussion Syndrome)

• Depression

• Stress

• Anxiety

• Irritability (conflicts with health care workers)

• Fatigue (Low Energy and “Low Get up and Go “)

• Lack of Concentration and Focus

• Poor Sleep (Sleep Disorders)

• Headaches

• Poor Memory

• Dizziness and/or Vertigo

• Bad Decision Making

• Pain ( Neck, back and/or other injured parts of the body) Dennis Romig, PhD, BCN


Interconnections of Post-Concussion Syndrome Symptoms

• Poor Sleep >Depression

• Poor Sleep, Stress, and Anxiety > Irritability

• Poor Sleep and Anxiety >Fatigue

• Poor Sleep >Lack of Concentration and Focus

• Poor Sleep, Stress, and Fatigue >Headache

• Poor Sleep and Anxiety > Poor Memory

• Poor Sleep and Anxiety >Dizziness and/or Vertigo

• Stress, Pain and Anxiety>Poor Sleep

• Depression > Poor Sleep, Anxiety and Poor Memory

• Stress, Anxiety, and Poor sleep > Pain



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Symptoms Caused by Poor Sleep Depression

+Stress and Fatigue=

Irritability

+ Anxiety =Fatigue

Lack of Concentration

and Focus

+Stress and Fatigue =

Headache

+ Anxiety =

Poor Memory

+Anxiety = Dizziness and/or Vertigo



Symptoms Caused by Anxiety +Poor

Sleep and Stress =

Irritability + Poor Sleep

= Fatigue

+ Poor Sleep =

Poor Memory + Poor Sleep =

Dizziness and/or Vertigo

+ Stress and Pain = Poor

Sleep

+Stress and Poor Sleep =

Pain



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Symptoms Caused by Stress

+ Poor Sleep and Anxiety =

Irritability

+ Anxiety and Poor Sleep =

Pain

+ Poor Sleep and Fatigue =

Headache

+ Pain and Anxiety =

Poor Sleep



Symptoms Caused by Depression

Poor Sleep

Anxiety

Poor Memory

Lack of Motivation



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Two Major Principles of Biofeedback Success

1. The client understands how their

biofeedback works (Table 1, Slide 24 and

their EEG spectral Assessment)

2. The client is motivated to do the

biofeedback training (their success and

other success stories)



Second Case, “B””s Presentation Outline: Post Concussion Syndrome

• Presenting Symptoms and Situation

• History of Head injuries

• Quadrant Brain Spectral Assessment Summary

• What I did and Why I did it

• “B” ‘s Treatment Results



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Presenting Situation and Symptoms

• Poor memory, poor focus and concentration, fatigue/low energy, morning fogginess, panic attacks, can only read for 5-10 minutes

• Unemployed and disabled after being a CEO

• Put on three different anti-depressants – no improvement.

• Put on bipolar medication- No improvement

• Put on anti-psychotic medicine- no improve.



History of “B” Head Injuries

• Multiple childhood head injuries (dare devil)

• Hear with baseball bat and golf club

• 2009 three head injuries almost unconscious

• Summer 2012 Head bump

• Summer 2012 Another head bump, almost unconscious

• 2012 noticed depression symptoms

• Did not think head bumps were serious because there was no loss of consciousness (LOC)



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EEG Brain Wave Assessment Summary - Head Injury

Name:_______”B”_________________ Date:____________________________


Improvement Goals

Right Side of the Brain

FP2 DT 33.5 B 4.5 A 7.3 BF 11 SMR 3.3

O2 DT 10.9 B 13.5 A 8.5 BF 15.4 ˅ SMR 6.3

T4 DT 3.8 B 2.5 A 2.5 BF 3.6 SMR 1.6

P4 DT 7.2 B 10.9 A 4.8 BF 12.4 SMR 2.9

CP4 DT 7.7 B 3.8 A 5.3 BF 6.3 SMR 2.8

Dennis Romig, PhD, BCN [email protected]

47

Left Side of the Brain

FP1 DT 26.4 B 8.6 A 8.0 BF 20.4 SMR 6.2

F3 DT 16.7 B 7.6 A 7.4 BF 15.4 SMR 6.2

T3 DT 16.1 B 17 A 13.2 BF 22.2 SMR 11.2

P3 DT 6.9 B 6.4 A 8.7 BF 6.9 SMR 4.0

FC3 DT 8.7 B 3.9 A 5.3 BF 7.3 SMR 3.5

Dennis Romig, PhD, BCN [email protected]

48


Improvement Goals

EEG Brain Wave Assessment Summary - Head Injury Name:_______”B”_________________ Date:____________________________

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Treatment Planning for Post-

Concussion Syndrome • Mayo Clinic treatment protocol recommends to treat the

symptoms of Post-Concussion Syndrome individually

• Begin treatment with the symptoms most important to the client’s goals for improvement

• Use improvement language versus the negative language of the symptom

• If sleep problems are present, initially focus on that issue

• Once per week schedule should be the default schedule option so there is needed rest in between brain wave treatments unless the client has acting out irritability or suicidal depression



Improve Positivity and Energy (Depression)





• Think 4 positive thoughts after 1 negative thought

• Do activities that are fun

• Be around positive people

• Exercise 30 minutes, John Ratey, Spark

• get a good night’s sleep

• Paced Breathing • Heart rate

variability biofeedback

• Increase optimistic brain waves (A 8-12 Hz at CP4, P4, P6) and

• Reduce anxious brain waves (BF 25-35 Hz)

• Increase get-up-and-go brain waves (SMR 13-15 Hz)

• Reduce sleep brain waves (DT 2-5 Hz at CP4, FC3, and FP1)

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Neurotherapy Protocol to Improve Optimism and Get-Up-and-Go

Phase 1. One Sensor

Site Inhibit Reward Time CP4: BF: 25-35 hz Alpha: 8-12 hz 4-5 minutes

DT: 2-5 hz SMR: 12-14 hz 4-5 minutes

FC3: A. BF: 25 -35 hz SMR: 13-15 hz 4-5 minutes

B. DT: 2-5 hz SMR: 13-15 hz 4-5 minutes

C. Alpha: 8-12 hz Beta: 16-22 hz 4-5 minutes

CP4: BF: 25-35 hz Alpha: 8-12 hz 3-5 minutes

One Sensor first then shift to two Sensors using protocol on next page when there has been 80% improvement towards microvolt goal

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Phase 2: Two Sensors

Do only following sessions where improvement is needed


CP4 P4 BF: 25-35 hz Alpha: 8-12 hz 4 – 5 minutes

FC3 F3 A. BF: 25 -35 hz SMR: 13-15 hz 4 – 5 minutes

B. DT: 2-5 hz SMR: 13-15 hz 4 – 5 minutes

C. Alpha: 8-12 hz Beta: 16-22 hz 4 – 5 minutes

F3 FP1 A. DT: 2-5 hz SMR: 13-15 hz 4 – 5 minutes

B. Alpha: 8-12 hz Beta: 16-22 hz 4 – 5 minutes

CP4 P4 BF: 25-35 hz Alpha: 8-12 hz 3 – 5 minutes


[email protected]

Neurotherapy Protocols to Improve Optimism and Get up an Go

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Be Calm (Anxiety and Irritability)





• Think gratitude • Do Physical Exercise 30

minutes/day. See John Ratey book, Spark

• Contemplate nature • Do daily, weekly, yearly

recovery activities • Stretch muscles

• Warm hands http://www.amazon. com/Stress- Thermometer-stress-reduction-biofeedback/

• Heart rate variability

biofeedback http://www.somaticvision .com/products/alive • Paced Breathing

• Reduce anxious brain waves (BF 25-35 Hz)

• Reduce worry

distractible brain waves (Left Side Frontal: Alpha 8-12 Hz)

• Irritability: (BF 25-35 Hz, Increase Alpha P4, PO4, O2)

Neurotherapy Protocol to Improve Calmness


CP4 BF 25-35 hz Alpha 8-12 hz 4 minutes

P4 BF 25-35 hz Alpha 8-12 hz 4 minutes

FC3 BF 25 -35 hz SMR 13-15 hz 4 minutes

Alpha 8-12 hz High Beta 16-22 hz 4 minutes

F3 BF 25 -35 hz SMR 13-15 hz 4 minutes

Alpha 8-12 hz High Beta 16-22 hz 4 minutes

FP1 DT: 2-5 hz SMR 12-14 hz 4 minutes

P4 BF: 25-35 hz Alpha 8-12 hz 3-4 minutes

Stay with single sensor


[email protected]

http://www.amazon/

http://www.amazon/

http://www.somaticvision/

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Neurotherapy to Reduce Irritability and/or Aggressive Behavior

Phase 1:


CP4 BF 25-35 hz Alpha 8-12 hz 4 minutes

P4 BF 25-35 Alpha 8-12 hz 4 minutes

PO4 BF 25-35 hz Alpha 8-12 hz 4 minutes

O2 BF 25-35 hz Alpha 8-12 hz 4 minutes

FC3 BF 25-35 hz SMR 13-15 hz 4 minutes

F3 BF 25-35 hz SMR 13-15 hz 4 minutes

P4 BF 25-35 hz Alpha 8-12 hz 2-4 minutes

Note: O2 is close to cerebellum (modulates brain). Has most branching possibilities and therefore most impact on improvement.

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[email protected]

Initial Therapy Training Session “B”

For one or more microvolts of improvement from previous level

Date Brain Sites

Inhibit/ Lower

Ave. Microvolt

Reward/Raise

Ave. Microvolt

Notes

12/31 Cp4 Bf 4.4 Alpha 4.7

DT 7.5 SMR 2.8

P4 Bf 6.8 A 6.8

Bf 5.2 A 4.9

Fc3 DT 7.1 SMR 3.2

P4 Bf 6.3 A 5.7



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“B”’s Neurotherapy Results • After one week of treatment, spouse remarked,

“Thank you for giving my husband back. He has a twinkle in his eyes and is paying attention to the family.”

• Concentration improved, sleep improved

• Entered and completed a Master’s degree program

• Tapered off of most medications

• Fully employed as a CEO again

• Two year follow-up – no relapse



Neurofeedback Treatment

• Quadrant Brain Model –Start in right back quadrant – Home

Base

• Provide EEG feedback to balance Within a quadrant before across two quadrants.

• Provide EEG feedback to balance a hemisphere before going across the two hemispheres

• Keep sensor placements off of the midline (z sites) and off the right and left central sulcus (C4 and C3). Instead place sensors at CP4 and FC3.

• When using neurofeedback treatment, avoid T3, T4, or right frontal and prefrontal (F4 and FP2) to prevent an abreaction



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Neurofeedback Treatment

Continued • Starting prototypes for the major symptoms –

Depression and Interrupted Sleep

• 4 – 5 minutes of feedback per site with high level of reward most of the time- 98%-100%

• For low levels of client SMR (below 3 mv.) set threshold to reward where the sound feedback only needs to be provided for 3 seconds to avoid fatigue

• Four words or less verbal feedback for improvement in amplitude changes in the desired direction

• Begin and end treatment sessions at right back quadrant (parietal) of the brain



Cognitive Behavior Therapy

Adjunctive Interventions • Before beginning neurofeedback session have client stretch

muscles in shoulders and neck as well as jaw muscles

• Watch jaw muscles during treatment and give feedback to relax them when they appear to tighten

• Practice abdominal breathing at beginning and during sessions

• Use sketching, tracing, and drawing when balancing the right side of the brain

• Use reading and/or writing when balancing the left side of the brain

• Encourage visualizations: Have the client visualize themselves in the healed brain state they want. Have them describe and amplify on their imagery.



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Breath Work and Heart Rate Variability Biofeedback HRVB

• Successful treatment option for the Irritability

and Stress symptoms of PCS

• Useful as a warm up for all neurofeedback treatment each session for clients with post-concussion syndrome

• Assign abdominal breathing as homework practice and to do before sleep



Client Homework for Faster Improvement

• Assign abdominal breathing especially for sleep disorder and irritability symptoms to shift from the sympathetic (stress) nervous system to the parasympathetic (recovery) nervous system

• Provide the medical literature on the value of high doses of Omega 3 with a high ratio of EPA/DPH http://www.brainhealtheducation.org/omega-3-protocol/

Michael Lewis, M.D.

• Provide summary of literature on value of mild exercise for different symptoms ( 30 minute walks – 5 times a week,)

• Assign checklist for preferred sleep preparation habits and routine

• Do Brain Healing Journal writing

• Eat Healthy Food



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Innovative Treatments of Concussions and Head Injuries Combined into a

Methodology:

1. Client Education of the Brain Wave Imbalances in Concussions and Head Injuries

2. Identification and Assessment of Post-Concussion Syndrome

3. Treatment Planning for Post-Concussion Syndrome



Methodology, Continued:

4. Green House Model of Treatment :

Therapist’s Talk and Attitudes for Success / Interpersonal

Respectful and Non-judgmental Green House

5. Multiple Sets of Treatment Tools Concurrently

a. Cognitive Behavior Therapy Interventions

b. Biofeedback : Breath Work ; Heart Rate Variability

Biofeedback; Hand Warming

c. Neurofeedback Treatment

6. Client Homework for Faster Improvement



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Psychological and Behavioral Functions of Each Quadrant




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• Right Back (Parietal) CP4, P4, PO4 – Sense of grounding, security, trust

– Sense of spatial and interpersonal relationships

– Sense of connection, meaningfulness, purpose

– Sense of physical sensations; especially touch-distance


EEG Dominant: Alpha 8-12Hz

Low: Fast (High) Beta 25-35Hz



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• Left Back (Parietal) P3, PO3, CP3 – Organizing in sequential process of thought and self

prepare for expression

– Directions and calculations in linear logic

– Mindful awareness of time and self moving forward


EEG Dominant: Beta 13-15Hz and 16-19Hz

Low: Fast (High) Beta 25-35Hz



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• Left Frontal FC3, F3, AF3, FP1 – Recalls information

– Determines relevance – “forgets” irrelevant

– Organizes motor – motion system for expression

– Determines when (timing) of what is to be expressed


EEG Dominant: Beta 16-19Hz and 16-21Hz

Low: Alpha 8-12Hz and Delta-Theta

Quadrant Brain Theory

Major Principle: Match The Brain Area, with The Brain Frequency, with the Brain Activity

Alignment of:

•Psychological (Cognitive, Affective)

•Functions of the Quadrant Brain Areas of Treatment

•Brain EEG Frequency Band Width Pattern of Balance

•Dynamic Activity of Therapist and/or Person

– Verbal Expression

– Gestural Expression

– Pictorial (symbols) Expression

– Grapho-motor (writing, numerical) Expression


Brain Area, Frequency, Activity must match

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Contact : Dennis A. Romig, PhD

Psychologist Brain Improvement Center

9506 San Diego Road Austin, Texas 78737

(512) 288-0416

[email protected]

Angelo S. Bolea, PhD Clinical and Consulting Neuropsychologist

Annapolis, Maryland Dr. [email protected]



mailto:[email protected]

successful neurofeedback treatment of post- concussion ... · 5/20/2016 · 5/12/2016 1 successful...

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