A traumatic brain injury (TBI) occurs when there is damage done to the head, causing either short or long-term dysfunction. Brain matter has a soft consistency, and although protected by the skull, damage can occur if it is moved vigorously. Craniocerebral traumas frequently result from a car accident, sporting incident or blunt force injury, like an assault. Falls are quite common in the elderly and can also produce damage to the brain. Most TBI’s are classed as mild, and usually show no damage on a standard MRI or CAT scan. However, on a neuronal level, white matter connections between brain regions and structures can still shear, causing a deficit in production, transference and processing of information. Symptoms like confusion and weakness, blurred vision and/or speech, vomiting and persistent headache can happen quickly after the incident, or can develop over time.

In mild TBI cases, the changes may be subtle and are not always obvious for the patient, but noticeable by others. For example, a loved one might recognize a change in personality, or a work colleague see a drop in performance. A clinical diagnosis is often then sought, but sometimes it goes undiagnosed. Many TBI’s do resolve in the weeks and months after the injury, but unlike most other parts of our anatomy, healing does not completely fix or repair the damage. The brain has to reorganize when neurons shear or die, and the resulting compensatory arrangement can be inadequate. When changes in memory, executive functioning, sleep and often personality persist, this is termed Chronic Traumatic Encephalopathy (CTE). Besides cognitive decline, CTE has been linked to an increased risk of late onset dementia and can also trigger Anxiety, Depression and other mental disorders.

From a QEEG perspective, Traumatic Brain Injuries have been shown to play havoc with electrical activity in the brain. A recent study was carried out on 150 American footballers who sustained multiple concussions in their playing careers. The study concluded that although only one third of the subjects had damage visible on imaging, all reported neurocognitive deficits (Merritt, J.L. 2023). Abnormalities in QEEG power maps and Theta/beta ratios were frequent, as were differences in brain areas involved with visual and auditory processing, cognition and working memory.

How QEEG and Neurofeedback can help

A QEEG examination provides personalized results which identify the activity most likely to be contributing to headache, migraine, and deficits in cognitive function and memory. The brain maps display the frequencies which may be lacking, as well as those that are elevated. Presence of increased slow wave activity and altered connectivity are two typical EEG signatures seen in a person with a traumatic brain injury. When slow wave and coherence are moderated by the training, there can be widespread improvements in brain function. In some TBI cases, significantly deviant electrical activity is concentrated at one or more electrode sites. This is usually identified in power and coherence maps and may represent under-performing neural circuitry or a compromised brain region. These can then be targeted in the Z-score swLORETA Neurofeedback program to reduce the negative effects of the TBI. The Neuroguide training software discourages the dysfunctional pattern in terms of coherence, intensity/power and speed/frequency. Over an undefined number of sessions, reduction in the deviant electrical activity usually occurs.

In addition to training atypical patterns seen in the individualized QEEG, the US based Neuroguide software offers more general TBI protocols to trial. Neuroguide developer, Robert Thatcher, utilizes metrics such as phase, coherence and Brain function index (BFI) which have been specifically introduced to help with assessment of functional deficits related to TBI (Thatcher et al. 2001; Hanley et al. 2018).