Neurofeedback Impact on Chronic Headache, Sleep and Attention Disorders Experienced by Veterans with Mild Traumatic Brain Injury.

战争给我们的退伍军人带来了许多致残性的健康挑战。一个非常重大的挑战是 创伤性脑损伤（TBI）是由退伍军人暴露于简易爆炸装置（IED）造成的 在伊拉克和阿富汗冲突期间。尽管大多数轻度（m）TBI的影响在几天或几周内消退， 我们有相当数量的退伍军人，估计为23- 48%，具有与他们的mTBI相关的持续症状， 影响日间功能、工作能力、身心健康和生活质量。由于治疗 对于这种疾病及其持续症状的选择是有限的，需要新的可行的治疗策略 研究了神经反馈（NFB）已被证明会影响皮层神经可塑性，并有助于神经功能的恢复。 通过改变可能受损的大脑特定区域的连通性来进行神经元康复 这些变化似乎是永久性的。超过25个案例和小型研究提供了证据， NFB通过游戏模拟使用脑电波反馈策略，已经导致了各种改进的mTBI 成果。下一个合乎逻辑的步骤是进行临床试验，以提供进一步的支持，NFB可以影响 退伍军人经历的持续性脑震荡后症状。 这项研究的目的是评估NFB训练作为一种低风险，非侵入性，有效的治疗方法， 退伍军人谁有mTBI，也被称为脑震荡，而在军队服役。特别的慢性 目标脑震荡后症状将是头痛、失眠和注意力困难。感知质量 还将在干预前后评估生命的价值。据推测，与对照组相比， 接受常规标准护理的群体，那些接受NFB培训的退伍军人，沿着接受常规标准护理 护理，将有：1）更大的减少频率，持续时间，和/或头痛的严重程度; 2）更大的 睡眠效率和/或睡眠质量感知的改善; 3）注意力的改善;以及4） 改善对生活质量的看法。 具体目标是比较NFB治疗组（接受20次，1小时的治疗加常规护理）与 对照组（仅接受常规护理）的临床症状（失眠，头痛， 注意力困难和生活质量），如通过研究工具（测量临床 在基线、中点、治疗结束和2个月随访时的症状）评分。 研究设计：本研究将采用随机对照组设计，包括延迟后对照 干预组，以评估NFB对头痛，失眠，注意力困难和 生活72名患有部署相关mTBI的退伍军人，他们正在经历头痛，失眠， 将入组注意力困难患者，NFB治疗组36例，对照组36例。控制后 小组成员完成最后的评估，他们将被提供NFB。共有72名退伍军人 （干预和后控制）谁完成了所有的NFB会议和评估将是样本， 项目将在组间（干预组和对照组）和干预组内分析数据。 影响：头痛，失眠和注意力困难的经历可能导致身体各方面的衰弱。 退伍军人的生活本研究将为退伍军人使用NFB以减轻他们的慢性疾病提供证据 改善症状，提高生活质量。如果得到支持，NFB将为我们的退伍军人提供一个有效的和非- 侵入性治疗选择。NFB是一个以病人为中心的干预，使退伍军人有机会自我- 健康管理。

War has led to many disabling health challenges among our Veterans. One very significant challenge is traumatic brain injury (TBI) which resulted from Veterans’ exposure to improvised explosive devices (IEDs) during the Iraq and Afghanistan conflicts. Although the effects of most mild (m)TBIs resolve in days or weeks, a significant number of our Veterans, estimated at 23-48%, have persistent symptoms relating to their mTBI that impact daytime functioning, ability to work, mental and physical wellness and quality of life. Since treatment options are limited for this disorder and its persistent symptoms, new viable treatment strategies need to be studied. Neurofeedback (NFB) has been shown to affect cortical neuroplasticity and contribute to neuro- neuronal rehabilitation by changing connectivities of specific areas of the brain that may have been impaired and these changes appear to be permanent. Over 25 case and small studies have provided evidence that NFB, which uses brain wave feedback strategies via gaming simulations, has led to a variety of improved mTBI outcomes. The next logical step is to conduct a clinical trial to provide further support that NFB can impact persistent post concussive symptoms that are experienced by Veterans. The study’s objective will be to evaluate NFB training as a low risk, non-invasive, effective treatment for our Veterans who had an mTBI, also referred to as concussion, while serving in the military. The particular chronic post-concussive symptoms targeted will be headache, insomnia, and attentional difficulties. Perceived quality of life will also be assessed pre and post intervention. It is hypothesized that when compared to the control group that receives usual standard care, those Veterans who receive NFB training, along with usual standard care, will have: 1) greater reduction in the frequency, duration, and/or severity of headaches; 2) greater improvement of sleep efficiency and/or perceptions of quality of sleep; 3) more improved attention; and 4) improved perceptions of quality of life. Specific aims will be to compare the NFB treatment group (receiving 20, 1-hour sessions plus usual care) with a control group (receiving only usual care) on improvement in clinical symptoms (insomnia, headaches, attention difficulties and quality of life) as ascertained by the study instruments’ (that measure the clinical symptoms) scores at baseline, midpoint, end of treatment and 2-month follow-up. Study Design: This study will utilize a randomized control group design that includes a delayed post-control intervention group to assess the impact of NFB on headaches, insomnia, attention difficulties, and quality of life. Seventy-two Veterans with a deployment related mTBI who are experiencing headaches, insomnia, and attention difficulties will be enrolled, 36 in the NFB treatment group and 36 in the control group. After control group members complete the final assessment, they will be offered NFB. Thus, a total of 72 Veterans (intervention and post-control) who complete all NFB sessions and evaluations will be the sample for this project. Data will be analyzed between groups (intervention and control) and within the intervention groups. Impact: The experience of headaches, insomnia, and attention difficulties can lead to debilitation in all areas of Veterans’ lives. This project will provide evidence for the use of NFB with Veterans to alleviate their chronic symptoms and enhance their quality of life. If supported, NFB will offer our Veterans an efficacious and non- invasive treatment option. NFB is a patient focused intervention that enables Veterans the opportunity for self- health management.