Semi-Automated Neurofeedback Therapy for Persistent Postconcussive Symptoms in a Military Clinical Setting: A Feasibility Study

Abstract

Introduction Neurofeedback therapy (NFT) has demonstrated effectiveness for reducing persistent symptoms following traumatic brain injury (TBI); however, its reliance on NFT experts for administration and high number of treatment sessions limits its use in military medicine. Here, we assess the feasibility of live Z-score training (LZT)—a variant of NFT that requires fewer treatment sessions and can be administered by nonexperts—for use in a military clinical setting. Materials and Methods A single group design feasibility study was conducted to assess acceptability, tolerance, treatment satisfaction, and change in symptoms after a 6-week LZT intervention in 38 Service Members (SMs) with persistent symptoms comorbid with or secondary to mild TBI. Acceptance and feasibility were assessed using treatment completion and patients’ satisfaction with treatment. To evaluate changes in symptom status, a battery of self-report questionnaires was administered at baseline, posttreatment, and 3-month follow-up to evaluate changes in psychological, neurobehavioral, sleep, pain, and headache symptoms, as well as self-efficacy in symptom management and life satisfaction. Results Participants tolerated the treatment well and reported a positive experience. Symptom improvement was observed, including depressive, neurobehavioral, and pain-related symptoms, with effects sustained at 3-month follow-up. Conclusion LZT treatment appears to be a feasible, non-pharmacological therapy amenable to SMs. Results from this pilot study promote further investigation of LZT as an intervention for SMs with persistent symptoms following TBI.

The analgesic effect of electroencephalographic neurofeedback for people with chronic pain: A systematic review and meta‐analysis

“…Elbogen et al [14] ( n = 41), reported the number of participants who experienced different side effects such as headset discomfort ( n = 14), drowsiness ( n = 13), irritability ( n = 6), headache ( n = 3), dizziness ( n = 1), vibrating/buzzing ( n = 1), and muscle twitching ( n = 1). Finally, two (out of 38) of the participants in Hershaw et al [18] dropped out due to nausea and intensification of their pre‐existing headache, and two more were pulled out by the investigators due to an increase in their pre‐existing migraines.…”

“…The targeted frequency bands are extracted and processed in real time, then their calculated power is presented to the individual as a form of positive or negative reinforcement [11,17]. Examples of such reinforcement include advancement or setbacks in a video game, and positive/negative visual and auditory feedback [18,19]. Different EEG neurofeedback techniques train individuals with chronic pain to gain control over their abnormal brain activity, which ultimately leads to pain reduction [20,21].…”

Language Rehabilitation of Traumatic Brain Injury Patient by LORETA Z-Score Neurofeedback: A Single-Case Study

“…Ayers (1989) was the first to report positive effects of NF on TBI-related symptoms, finding improvements in a number of postconcussive symptoms experienced by patients, including decreased energy, depression, irritability, photophobia, attention deficit, dizziness, headache, and short-term memory loss. The role of NF in improving cognitive, behavioral, and physical dysfunctions among patients with TBI has been confirmed in previous studies (Bennett et al, 2018;Brown et al, 2019;Gray, 2017;Gupta et al, 2020;Hershaw et al, 2020;Kaser, 2020;Koberda, 2015a).…”

Neurofeedback for Chronic Pain

“…Most of the neurofeedback studies have measured changes in pain immediately following neurofeedback [39,43,52,55,56]. Furthermore, pain reduction has been reported to be sustained even at follow up of 3-6 months after completion of neurofeedback training [28,36,41,[49][50][51]54]. However, these studies do not report whether the corresponding change in brain rhythm which were measured following completion of training were also sustained at long-term follow-up.…”

“…It has been shown that neurofeedback not only leads to reduction in pain but leads to improvement in a number of pain associated symptoms such as depression [27,39,41,54,[57][58][59][60], anxiety [27,41,54,57,59], fatigue [27,29,41,49,51], and sleep [36,39,[49][50][51]57]. These symptoms have been known to co-exist with pain in chronic pain conditions and also known to exacerbate the individual's pain on a dayto-day basis [61][62][63].…”