Assessment of Post-Concussion Syndrome

In the tests described below, scores are statistically compared to large databases of people with no mental health disorders or history of head injuries. These tests have been published and validated in peer-reviewed scientific journals and are suitable for diagnostic use. They provide convergent evidence of an organic basis for post-concussion syndrome, which requires adequate nutritional supplementation and specialised Neurotherapy for tissue repair.

Methods of Assessment of Concussion

Quantitative Electroencephalography (QEEG)

QEEG of TBI patient
QEEG Mapping

QEEG involves the statistical evaluation of the brain’s electrical activity. The QEEGs of hundreds of typically functioning people, with no mental health issues or history of head injuries, make up a normative database against which the QEEG of BNC’s patients are compared. The differences are expressed as Z scores (standardised deviations from the mean). QEEG is well-suited for the evaluation of post-concussion syndrome, since it is empirical, objective, non-intrusive and is highly accurate in identifying and discriminating the various neurophysiological patterns of brain dysfunction associated with Minor TBI and post-concussion syndrome [33-35].

A 2004 review of the scientific literature by Dr. Jacques Duff, published in the journal of the EEG and Clinical Neuroscience Society suggests that QEEG is superior to structural Neuroimaging techniques that detect brain dysfunction related to Minor TBI and post-concussion syndrome [33] which can occur with or without loss of consciousness.

Traumatic Brain Injury Discriminant Analysis

TBI discriminant function
TBI Probability Index

The Traumatic Brain Injury (TBI) probability index provides the statistical likelihood that an individual has suffered a mild traumatic brain injury [35]. To calculate this probability, the QEEGs of hundreds of people with head injuries from Veteran Affairs Hospitals in the US were analysed, and a discriminant function was developed that reliably separated those people with head injuries from those without. The TBI probability index thus provides independent evidence that the symptoms of post-concussion syndrome have an organic basis [35].

There are over 40,000 QEEG papers published since 1990, all of which are free of false negatives in the domain of QEEG Discriminant Functions. The only critical paper about the clinical uses of QEEG was published in 1997, by Newer from the Academy of Neurology. The opinions expressed in this paper were refuted and discredited by the EEG and Clinical Neuroscience Society [36], since their findings were found to be largely unsupported. The 1997 paper lacked a comprehensive review of the current literature. After it was approved by the US Food and Drug Administration (FDA) based on its clinical efficacy, the QEEG system (Neuroguide) has been used extensively in the diagnosis of Post-concussion Syndrome.

Low Resolution Electromagnetic Tomography (Loreta)

LORETA TBI
LORETA at 4Hz in patient with PCS

 

 

IntegNeuro Neurocognitive Test battery

IntegNeuro touchscreen
Integ Neuro
IntegNeuro is a comprehensive Neuropsychological test battery developed by the Brain Resource Company. It is an easy to use, fully automated, and computer administered series of 14 separate neuropsychological cognitive tests (tests of mental functioning). This test battery reflects an individual’s cognitive performance profile. It draws on the Brain Resource International Database, which contains samples of 1000 healthy subjects who have undergone the same, complete, neurophysiological, and neuropsychological battery of tests [37].

IntegNeuro is used to establish the degree of cognitive impairment caused by stroke, head injury, and dementias, as well as to evaluate therapy progress. For each subtest, instructions are listened to through headphones, and the subject enters their answers into the system's touchscreen. One of IntegNeuro’s benefits is its objectivity; it is considered free of bias and human judgement since the Psychologist’s role is limited to monitoring the test.

Test of Variables of Attention (TOVA)

TOVA test
TOVA test with microswitch
TOVA comparison
TOVA scores comparison

The Test of Variables of Attention (TOVA) is a highly sensitive, objective, and independent measure that quantifies impairment to the attention system, as well as measures the progress of therapy. The TOVA consists of a computer-administered continuous performance task, which requires subjects to press a specially designed micro switch whenever a ‘target’ appears on the screen. The subjects must refrain from pressing this switch when a ‘non-target’ appears. After testing, the subject’s results are compared to an age-appropriate database to produce standardised scores, which gives useful information on four variables of attention:

  • Attention (the ability to concentrate and sustain mental effort)
  • Impulse control (the ability to inhibit impulsiveness)
  • Processing speed (reaction time)
  • Distractibility (variability in reaction time)

Treatment of Post-Concussion Syndrome

A review paper in the October 2004 issue of Clinical EEG and Neuroscience concluded that QEEG is the most sensitive Neuroimaging tool for the assessment of post-concussion syndrome and that Neurotherapy is the most promising treatment [33].

1. Medication, Counselling & Cognitive Rehabilitation

Medication can provide temporary relief from pain, and counselling helps people understand the need to control their impulses and anger. However, there is no evidence that medication or cognitive rehabilitation can effectively restore the cognitive and concentration deficits associated with post-concussion syndrome.

2. Neurotherapy

People with attention deficits and MTBI tend to have an excess of slow-wave brain electrical activity and coherence abnormalities. Neurotherapy (EEG biofeedback) uses operant conditioning to give patients audio/visual rewards for producing healthier patterns of brainwave activity. Since the 1970s, studies have shown that, through Neurotherapy, patients can be taught to normalise previously dysfunctional pattern of brain activity [33, 38-41]. More recently, QEEG (rather than EEG) has been used to identify the specific brainwave patterns that need to be addressed [42-44]. Additionally, Neurotherapy can improve mood, concentration, and enhance mental performance in people with post-concussion syndrome. For a review of the literature see this peer-reviewed medical journal article: October 2004 in Clinical Electroencephalography.

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