Concussion awareness and prevention strategies for sports related concussion is on the rise. This includes multiple concussion assessment tools, on field screening, post concussion assessment, and an increased awareness among coaches, trainers, and on field health professionals. This is partially due to increased media exposure and awareness of concussion and Chronic Traumatic Encephalopathy (CTE) in the NFL but also Mild Traumatic Brain Injury (mTBI) and PTSD in the military.
Whereas PTSD and mTBI in military veterans is gaining attention and becoming a popular area of study, CTE in former NFL players and boxers is now an increasingly hot topic. MTBI and CTE both place a significant impact on individuals suffering from TBI/CTE and their families as well as society itself. Addiction, chronic pain, and mood disorders are widely prevalent in populations suffering from these illnesses. Although we are now seeing increasing awareness in sports and the military toward these injuries, we have a long way to go towards helping these individuals.
Even with this increased awareness, treatment advice for those with Post-Concussive symptoms (TBI, and CTE) remains limited. Commonly prescribed modalities include physical therapy, vestibular therapy, cognitive therapy, medications for sleep and mood disorder, and manipulation techniques for neck injury and headache. And while these treatments may help relieve symptoms, they often fail to treat the actual injury to the brain.
Education and Prevention is Key
Although prevention strategies are slowly improving, we are still lacking when it comes to educating athletes and parents of the risks of concussion on cognitive ability and the dangers of Second Concussion Syndrome. This also includes a lack of education about the risks of developing Chronic Traumatic Encephalopathy/CTE with repeated concussions.
As a society, we still display loud applause when a athelete is injured and concussed but gets up, shakes it off and returns to play. Coaches, parents, and healthcare personnel on the field should not be allowing them to return until they have been properly assessed and are symptom free. In order to better protect our young athletes, coaches, parents, the athletes themselves and and even the fans in the stands need to understand the risks and dangers of concussion, especially in high risk sports like football, soccer (especially girls soccer), boxing, and lacrosse.
Neurofeedback and Photomodulation
For more than ten years, Neurofeedback and Photomodulation/Near Infrared Light Therapy have shown the potential to help those suffering from CTE/TBI. These treatments can improve symptoms, metrics on Brain SPECT scans, improve markers and scores on QEEG analysis, improve concussion assessment scores, reduce headaches, improve memory and sleep, improve mood disorder, and even help those with CTE.
Current studies on Photomodulation in the last two years increasingly show results with wavelengths between 810-1060 nm with increasing focus being applied to more wattage and wavelengths between 810-960 nm. Multiple studies and MetaAnalysis are now available showing efficacy and safety in these settings. We still need more studies on number of treatments, when to institute therapy, employing Neurofeedback with Hyperbaric Oxygen Therapy and Photomodulation, as well as collaboration among clinics treating concussion, TBI, and CTE. ISNR and Neurofield are groups who are thankfully working on certification, research, and collaboration amongst providers.
Neurofeedback is a large field employing many treatment devices and different types of practitioners using these technologies. Observational trials, pilot studies, and small blind studies are scattered throughout these fields partly due to the wide range of practitioners offering treatments and the number of FDA approved machines available for use. Comparison trials among different devices have not been conducted on a large scale and are only known by the clinics practicing in the field for many years. This is partly due to the lack of funding for larger studies.
Increasingly, more QEEG amplifiers, differing types of Loretta neurofeedback, neurostimulation, and neurofeedback ampliers have entered the field, making things even more complex. These devices have been successfully used to reduce symptoms of anxiety, depression, headache, ADD/ADHD, OCD, and schizophrenia. However, the most successful devices often take the most training severely limiting their impact on society.
In recent years, Neurofeedback has been shown to reduce post concussion symptoms including CTE, often immediately, especially when combined with therapy like PEMF, tACS, and photomodulation. Clinics like ours (Mid-Atlantic Health Institue) and several around the country are now seeing good results in CTE, including improvement in anxiety, depression, irritability, insomnia, and memory in former atheletes and others suffering from these injuries. However, despite the growing availability of these treatments, we need to place a greater focus on prevention of concussion in order to prevent these injuries in the first place.