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

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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.