Preliminary investigation of a multimodal enhanced brain function index among high school and collegiate concussed male and female athletes

Objective: The primary purpose of this study was to examine the longitudinal effects of sports-related concussion (SRC) on a multi-faceted assessment battery which included neuropsychological testing, symptom reporting, and enhanced brain function index (eBFI) among athletes with and without SRC. A secondary purpose was to explore longitudinal sex differences among these measures in athletes with and without SRC. Methods: A case-control, repeated-measures design was used for this study. A total of 186 athletes (concussed group:n= 87 controls:n= 99) participated in the study. A repeated-measures design was used in which each athlete was tested at four time points following an SRC: within 72 h of injury (Day 0; 2.0 ± 0.9 days following injury), 5 days following injury (Day 5; 5.0 ± 0.0), at return to play (RTP; 18.3 ± 13.8 days following injury), and within 45 days following RTP (RTP45; 66.2 ± 19.0 days following injury). All analyses were conducted separately using a 2 (Group: concussed, control) × 2 (Sex: male, female) × 4 (Time:Day 0, Day 5, RTP, RTP45) univariate multi-level model including the random intercept for each participant. A higher eBFI score indicates a better performance. Alpha level was set aprior at .05. This study was registered on clinicaltrials.gov (Objective Brain Function Assessment of mTBI/Concussion in College/high school Athletes NCT02477943, NCT02661633, CAS 13-25 NCT03963804). Results: Concussed athletes exhibited impaired eBFI within 72 h of SRC and at Day 5 compared to controls (p<.001). Analysis of eBFI scores between male and female athletes revealed a main effect of sex (p=.05), with female athletes exhibiting lower eBFI (33.9 ± 30.7) relative to male athletes (40.4 ± 33.0), however, it did not indicate interactions between sex, group, and time (p's ≥ 0.786). Conclusion: The eBFI appears to be a useful tool in determining concussed athletes during the acute stages of an SRC. However, this index may lack the sensitivity to detect sex-related differences between groups at various time points during recovery.

Electroencephalography (EEG) Technology Applications and Available Devices

The electroencephalography (EEG) sensor has become a prominent sensor in the study of brain activity. Its applications extend from research studies to medical applications. This review paper explores various types of EEG sensors and their applications. This paper is for an audience that comprises engineers, scientists and clinicians who are interested in learning more about the EEG sensors, the various types, their applications and which EEG sensor would suit a specific task. The paper also lists the details of each of the sensors currently available in the market, their technical specs, battery life, and where they have been used and what their limitations are.

Sex differences in sport-related concussion long-term outcomes

Approximately 1.6 to 3.8 million recreational and sports-related concussions (SRC) occur each year in the Unites States. Research suggest that female athletes are at a greater risk for a SRC compared to male athletes competing in comparable sports (i.e., soccer, basketball). Moreover, female athletes have reported more total symptoms and greater neurocognitive impairments following a SRC. Female athletes have been found to report greater symptom provocation as measured by the Vestibular/Ocular Motor Screening (VOMS), and increased brain activation compared to males. There is a scarcity of research on long-term effects of SRC in male and female athletes. Therefore, the aim of this review article is to summarize the existing literature on sex differences in acute and sub-acute SRC outcomes.

Upper Alpha Based Neurofeedback Training in Chronic Stroke: Brain Plasticity Processes and Cognitive Effects

In the present study, we investigated the effects of upper alpha based neurofeedback (NF) training on electrical brain activity and cognitive functions in stroke survivors. Therefore, two single chronic stroke patients with memory deficits (subject A with a bilateral subarachnoid hemorrhage; subject B with an ischemic stroke in the left arteria cerebri media) and a healthy elderly control group (N = 24) received up to ten NF training sessions. To evaluate NF training effects, all participants performed multichannel electroencephalogram (EEG) resting measurements and a neuropsychological test battery assessing different cognitive functions before and after NF training. Stroke patients showed improvements in memory functions after successful NF training compared to the pre-assessment. Subject B had a pathological delta (0.5-4 Hz) and upper alpha (10-12 Hz) power maximum over the unaffected hemisphere before NF training. After NF training, he showed a more bilateral and "normalized" topographical distribution of these EEG frequencies. Healthy participants as well as subject A did not show any abnormalities in EEG topography before the start of NF training. Consequently, no changes in the topographical distribution of EEG activity were observed in these participants when comparing the pre- and post-assessment. Hence, our results show that upper alpha based NF training had on the one hand positive effects on memory functions, and on the other hand led to cortical "normalization" in a stroke patient with pathological brain activation patterns, which underlines the potential usefulness of NF as neurological rehabilitation tool.

Effect of neurofeedback and electromyographic-biofeedback therapy on improving hand function in stroke patients

PURPOSE

The aim of the present study was to evaluate the effect of applying electroencephalogram (EEG) biofeedback (neurobiofeedback) or electromyographic (EMG) biofeedback to conventional occupational therapy (OT) on improving hand function in stroke patients.

METHODS

This study was designed as a preliminary clinical trial. Thirty patients with stroke were entered the study. Hand function was evaluated by Jebsen Hand Function Test pre and post intervention. Patients were allocated to 3 intervention cohorts: (1) OT, (2) OT plus EMG-biofeedback therapy, and (3) OT plus neurofeedback therapy. All patients received 10 sessions of conventional OT. Patients in cohorts 2 and 3 also received EMG-biofeedback and neurofeedback therapy, respectively. EMG-biofeedback therapy was performed to strengthen the abductor pollicis brevis (APB) muscle. Neurofeedback training was aimed at enhancing sensorimotor rhythm after mental motor imagery.

RESULTS

Hand function was improved significantly in the 3 groups. The spectral power density of the sensorimotor rhythm band in the neurofeedback group increased after mental motor imagery. Maximum and mean contraction values of electrical activities of the APB muscle during voluntary contraction increased significantly after EMG-biofeedback training.

CONCLUSION

Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT. Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy.

The role of biofeedback in stroke rehabilitation: past and future directions

Biofeedback has been applied to many aspects of stroke rehabilitation, with mixed results. This is largely due to the varying modalities, differences between study designs, and methods of measuring success and progress. How well biofeedback works appears to be inversely related to the direct observability of the function about which information is being provided. The more covert the function (e.g., swallowing muscle activity, attention, cortical functioning, etc.), the more helpful biofeedback is likely to be. However, biofeedback in general can have a very positive impact, even through indirect means. Improvements in self confidence, shifting of locus of control, and instantly being provided information regarding changes in one's physical functioning as a result of mental activity can be helpful in setting the tone for success in rehabilitation more generally.

The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome

Mild traumatic brain injury (TBI) is associated with damage to frontal, temporal and parietal lobes. Post-concussion syndrome has been used to describe a range of residual symptoms that persist 12 months or more after the injury, often despite a lack of evidence of brain abnormalities on MRI and CT scans. The core deficits of post-concussion syndrome are similar to those of ADHD and mood disorders, and sufferers often report memory, socialization problems and frequent headaches. While cognitive rehabilitation and psychological support are widely used, neither has been shown to be effective in redressing the core deficits of post-concussion syndrome. On the other hand, quantitative EEG has been shown to be highly sensitive (96%) in identifying post-concussion syndrome, and neurotherapy has been shown in a number of studies to be effective in significantly improving or redressing the symptoms of post-concussion syndrome, as well as improving similar symptoms in non-TBI patients.