The Road Less Traveled: Integrating Neurotherapy with Holistic Neuropsychological Rehabilitation After Severe Head Injury

Mohammed Afsar,Nishita Choudhari,Dhaval Shukla,Jamuna Rajeswaran

doi:10.15540/nr.8.1.57

Abstract

Introduction: Traumatic brain injury (TBI) is associated with physical, cognitive, emotional, and behavioral disturbances. The cognitive deficits are common after TBI, and a holistic approach to neuropsychological rehabilitation is recommended in these patients. EEG neurofeedback training (EEG-NFT) is a state-of-the-art technique for neuropsychological rehabilitation. There is a paucity of studies exploring the use of EEG-NFT integrated with holistic neuropsychological rehabilitation. Method: Single case design was adopted for the present study. A 25-year-old single male, diagnosed with severe TBI, presented with physical, cognitive, and emotional-behavioral disturbances after 17 months of injury. A comprehensive neuropsychological assessment was carried out. The neuropsychological rehabilitation using EEG-NFT along with psychosocial interventions with the patient and the parents was carried out for 9 months. Results: The patient showed significant improvement in cognitive deficits such as attention, executive functions, and visuospatial ability. Emotional-behavioral problems such as irritability, sadness, and overall dysfunction also improved significantly. Conclusion: The present case study highlights that integrating EEG-NFT along with holistic neuropsychological rehabilitation helps to improve cognitive, emotional, and behavioral disturbances after TBI.

Highlights

Traumatic brain injury (TBI) is associated with physical, cognitive, emotional, and behavioral disturbances
EEG neurofeedback training (EEG-NFT) was found to be useful in improving subjective symptom reporting, perceived stress, and quality of life (Bennett et al, 2018; Bennett, Sampath, Christopher, Thennarasu, & Rajeswaran, 2017; Reddy, Rajeswaran, Bhagavatula, & Kandavel, 2014). These findings suggest that EEG-NFT can lead to dual benefit
Munivenkatappa et al (2014) reported a significant increase in the cortical grey matter volume, enhanced white matter integrity, and increased global functional connectivity in two patients with severe TBI who received 20 sessions of EEG-NFT. Another recent study had shown that 20 sessions of EEG-NFT resulted in reduced postconcussion symptoms, reduced delta–alpha, and increased theta–alpha ratio on quantitative EEG (Gupta, Afsar, Yadav, Shukla, & Rajeswaran, 2020). These findings indicate that EEG-NFT can bring about changes in neural functioning and thereby result in clinical improvement

Summary

Introduction

Traumatic brain injury (TBI) is associated with physical, cognitive, emotional, and behavioral disturbances. A 25-year-old single male, diagnosed with severe TBI, presented with physical, cognitive, and emotional-behavioral disturbances after 17 months of injury. Conclusion: The present case study highlights that integrating EEG-NFT along with holistic neuropsychological rehabilitation helps to improve cognitive, emotional, and behavioral disturbances after TBI. TBI has been defined as “an alteration in brain function, or other evidence of brain pathology, caused by external force” (Menon, Schwab, Wright, & Maas, 2010) As a syndrome, it is heterogeneous in its pathophysiology and is classified in terms of differing levels for severity (i.e., mild, moderate and severe) for better understanding and management (Sternbach, 2000). The survivors of TBI, especially with moderate or severe TBIs, often suffer from chronic disability (Burton, 2016)

Methods

Results

Discussion

Conclusion