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令人伤残的健康挑战。一个非常重大的挑战是 退伍军人接触简易爆炸装置(IED)导致的创伤性脑损伤(TBI) 在伊拉克和阿富汗冲突期间。尽管大多数轻度(M)脑损伤的影响在几天或几周内消失，但 我们的退伍军人中有相当数量的人，估计有23%-48%，有与他们的mTBI有关的持续性症状 影响日间功能、工作能力、身心健康和生活质量。自治疗以来 对于这种疾病及其持续症状的选择是有限的，新的可行的治疗策略需要 学习。神经反馈(NFB)已被证明影响皮质神经可塑性，并有助于神经- 通过改变大脑中可能受损的特定区域的连接性来实现神经元康复 而这些变化似乎是永久性的。超过25个案例和小规模研究提供了证据 NFB通过游戏模拟使用脑波反馈策略，已经导致了各种mTBI的改善 结果。下一个合乎逻辑的步骤是进行临床试验，以提供NFB可以影响的进一步支持 退伍军人经历的持续性脑震荡后症状。 这项研究的目标将是评估NFB训练作为一种低风险、非侵入性、有效的治疗方法 在军队服役期间患有mTBI的退伍军人，也称为脑震荡。特殊的慢性病 脑震荡后的症状将以头痛、失眠和注意力障碍为目标。感知质量 还将在干预前后对生活质量进行评估。假设当与对照组相比时 接受通常标准护理的组，那些接受NFB培训的退伍军人，以及通常的标准 护理，将有：1)头痛的频率、持续时间和/或严重程度的更大程度的减少；2)更大 提高睡眠效率和/或对睡眠质量的感知；3)更多的注意力；和4) 改善人们对生活质量的看法。 具体目标将是将NFB治疗组(接受20次、1小时的治疗加上通常的护理)与 对照组(只接受常规护理)改善临床症状(失眠、头痛、 注意力、困难和生活质量)由研究仪器(测量临床 症状)在基线、中点、治疗结束和2个月随访时的评分。 研究设计：本研究将采用包括延迟后控制的随机对照组设计 干预小组评估NFB对头痛、失眠、注意力障碍和生活质量的影响 生活。72名患有与部署相关的mTBI的退伍军人，他们经历了头痛、失眠和 注意困难将被纳入，36人在NFB治疗组，36人在对照组。控制后 小组成员完成最终评估后，将获得NFB。因此，总共有72名退伍军人 (干预和后控制)谁完成了所有NFB会议和评估将是这方面的样本 项目。数据将在组之间(干预和对照)和干预组内进行分析。 影响：头痛、失眠和注意力障碍的经历会导致身体各个部位的虚弱 退伍军人的生活。该项目将为退伍军人使用NFB缓解慢性疾病提供证据 并提高他们的生活质量。如果得到支持，NFB将为我们的退伍军人提供有效和非 侵入性治疗选择。NFB是一种以患者为中心的干预措施，使退伍军人有机会 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.