Treatment option: neurofeedback training
A practical way to promote neuroplasticity and train the brain
Neurofeedback training involves real-time biofeedback from your own brain activity, which is typically converted into a form of game play to help your brain learn (or re-learns) how to produce healthy and functional brain states—such as the calm and focused states that were easier to experience prior to injury.
So in essence, your brain is retraining itself using cues that trigger neuroplastic change (those cues include necessary points of frustration and failure as well as moments of victory and forward progress).
Neurofeedback training can be localized to specific regions of the brain. For example, you can train areas in the back of the brain to produce certain states (perhaps calm), and separately train areas in the prefrontal cortex to produce different states (perhaps focus).
Neurofeedback has been used to effectively treat ADHD, depression, anxiety, epilepsy, and traumatic brain injuries. (It is also popular with Silicon Valley executives as a means of boosting their cognitive performance.)
So is neurofeedback healing your injury?
No. And yes, from a functional training standpoint.
A brain injury involves some level of neuronal damage or death. That damage may have occurred in a small area, or in several areas of the brain. Neurofeedback training isn’t meant to repair structural damage, so in that sense, it won’t heal your damaged neurons.
Neurofeedback helps you recruit and train other neurons. It also helps different brain regions begin to work in concert again. And it can help you shut off the “car alarm” that’s been blaring in your head since your injury.
After a trauma, there’s a neurological alarm going off. Your sympathetic nervous system (fight or flight) is over-activated. To make matters worse, your injury likely means a loss of top-down (cortical) control over impulses and emotions. Neurofeedback training can give you an internal locus of control to steadily turn the alarm down. Until you do, it will be hard to flexibly shift into different brain states. For someone with a brain injury, this is one thing that makes neurofeedback training vital.
The metaphor of the symphony
Since different brain regions work in concert to produce brain states (for example, the state of paying close attention), it’s helpful to think of your injured brain as a symphony hall that’s been hit by a wrecking ball.
Perhaps the percussion section was taken out. The conductor was seriously injured. Unlike an orchestra, which would simply call it a day and come back after the repairs have been made and new musicians hired, your show must go on 24/7.
So your injured conductor is struggling. And some cellists are now trying to fill in for the percussionists (remaining neurons are trying to the job of the damaged neurons). And all the while, rain is pouring in through the hole in the wall (you’re having to deal with the stressors of life with a damaged nervous system).
Like a symphony, which relies on different sections working together to produce a harmonic result, different parts of your brain can produce varying brainwaves that are meant to work together. Neurofeedback gives you a useful tool for re-establishing that harmony.
Neurofeedback and neurovascular coupling
One hypothesis about the root cause of post-concussion syndrome centers on the disruption of something called neurovascular coupling, which is the term for the push-pull action of cerebral blood flow to different parts of the brain in response to (and in anticipation of) neural activity.
Here’s a definition of neurovascular coupling from Scholarpedia:
Neurovascular coupling refers to the relationship between local neural activity and subsequent changes in cerebral blood flow. The magnitude and spatial location of blood flow changes are tightly linked to changes in neural activity through a complex sequence of coordinated events involving neurons, glia, and vascular cells.
If this “complex sequence of coordinated events” gets disrupted by a head injury, the neurons may be firing, but the process that couples that firing with the delivery of blood flow may be disrupted. (This may be due to damage of the vasculature, or the neurons, or the disruption of the signaling process between neurotransmitters and the vascular system, or some combination of these things.)
It’s theoretically possible that neurofeedback can help restore proper neurovascular coupling. Each electrode attached to your scalp measures activity in a specific region of the brain, and by training different regions, you may be helping the neurovascular coupling in those regions.
If this possibility is real, then we might approach neurofeedback training as form of cardiovascular training that involves the vasculature of the brain. We might, for instance, do some form of cardiovascular exercise or breathing exercise prior to performing neurofeedback training.
Yesterday and today
While neurofeedback is a proven treatment that’s been around for decades, in the past it was really inconvenient, and that’s one reason why it isn’t better known or utilized. Clinical neurofeedback involves a 30 to 60 minute setup where the electrodes are attached to your scalp by a technician. You might go three times a week for a session, a volume that might make progress slow.
Today, you can perform neurofeedback training at home, and there are several new devices on the market for doing so. While these devices aren’t currently as robust as clinical machines, they do make it possible to greatly increase the volume of your training, which is likely to help you make swifter progress.
My experience with neurofeedback
As of this writing, I’ve been doing neurofeedback training nearly every day for four months. I use a Muse headband in tandem with the Myndlift application, under the supervision of a trained and licensed professional who I work with remotely. I see this doctor virtually once a month to review that month’s results and make adjustments for the following month.
If you’re interested in doing the same, I would advise you to work directly with a neurofeedback clinic that offers this remote option through Myndlift, rather than letting the Myndlift app automatically pair you with a random provider. The providers Myndlift might connect you with vary greatly in their qualifications (some are psychiatrists with years of experience, some are chiropractors). You really want someone with deep experience in clinical neurofeedback. Start by searching for a provider (and comparing them) on the Myndlift site.
This process begins with an assessment. I placed an electrode (with paste) on different parts of my scalp to record my baseline activity and brainwaves at rest and during different tasks. These readings were then used (by the doctor) to create a protocol specific to my needs. I started by training two regions of my brain, one in the morning, and one at night.
While I have mixed feelings about the Myndlift app itself (mainly around game play design), it is nice to quantify your progress over time and see your improvement.
I can also feel the improvement. After about two weeks of training, I began to feel myself drop into the focused state I was working on in the training. I started to feel levels of mental clarity and brain states that I hadn’t felt in a long time.
I’ve also noticed a gradual return of my ability to calm myself in the face of startling stressors, though this remains a work in progress at the time of this writing.
Side note: Around the same time that I purchased the Muse headband, I ordered a second device for neurofeedback training on Kickstarter called Mendi, which appears to be designed around strengthening one’s attentional network with sensors that read the prefrontal cortex. I look forward to trying it.
Complementing neurofeedback with TMS
Neurofeedback training can help your brain learn how to produce functional brainwaves—to be alert when you want be alert, to be calm when you want to be calm, for instance.
But in the intervening weeks or months when your brain is still being trained, it can really help to have an external locus of control for symptom alleviation, and that’s where TMS (transcranial magnetic stimulation) can be helpful.
I view neurofeedback and TMS as complementary treatments. Here’s a relevant quote from the Wikipedia page on neurofeedback that mentions a study linking the effectiveness of doing the two treatments in a complimentary way.
In 2010, a study provided some evidence of neuroplastic changes occurring after brainwave training. Half an hour of voluntary control of brain rhythms led in this study to a lasting shift in cortical excitability and intracortical function. The authors observed that the cortical response to transcranial magnetic stimulation (TMS) was significantly enhanced after neurofeedback.
As with neurofeedback, TMS was once something you could only access in a clinical setting that was highly inconvenient. Today, you can do low-power TMS at home with relative ease. The device I’ve used for this purpose is the NeoRhythm. That said, TMS clinics are still available and remain an option if home treatments don’t yield results.
To learn more about TMS, see “Treatment option: transcranial magnetic stimulation (TMS).”
Brainwave is an informational resource for people whose symptoms haven’t resolved after a concussion or mTBI. I endeavor to present this information in a clear and concise way, spelling out what’s backed by science and what remains unknown. Nothing here is meant as a substitute for professional medical advice, diagnosis, or treatment. I am not a physician or a healthcare practitioner of any kind; I’ve simply had a lot of sports-related concussions and had to learn this stuff the hard way. If you found this information helpful or know someone who might benefit from it, please share and subscribe to Brainwave.