PICOT Question: “In Traumatic brain injuries on returning soldiers how effective is EEG Biofeedback medication of Traumatic Brain Injuries compared to computer medication in improving memory during the pretreatment to post-treatment time?”‘
P=Patient / Population and Problem
Traumatic Brain Injury (TBI) is an injury in cognitive functioning. TBI is a disruption of the brain functions as a result of sudden trauma to the head. Traumatic Brain Injury is caused by blast waves resulting from explosions in wars as well as direct impacts that result in severe head injuries. It is observed that TBI causes secondary injuries such as increased pressure within the skull as well as changes in cerebral blood flow that worsen the initial brain injuries that are caused by blast waves.
TBI is known to cause a lot of physical, behavioral as well as emotional problems that are not easily detectable. Research indicates that TBI is associated with causing accelerated hormone deficiency that triggers physiological, psychological and physical manifestations that are expressed in form of memory loss, anxiety, depression, anger, high blood pressure, loss of libido among others (Levine, Cabeza, McIntosh, Black, Grady& Stuss, 2002).
It is noted that those patients who suffer from TBI are mainly dependent on that part of the brain that is damaged. Soldiers have a high prevalence of being affected by TBI. Many soldiers are diagnosed with TBI after returning home from war as a result of being exposed to blast waves that originate from explosives that are used during the war. Many US military officers who were deployed in Iraq and Afghanistan showed signs of traumatic brain injury in a number of months or days after returning home from the war. This has shown that there might be long-term effects to this condition that may affect the returning soldiers over a long period of time.
The research established that most US military personnel who returned home from the Golf War in Iraq showed some symptoms of traumatic brain injury. Some of the symptoms noted included: concussion which is a condition that entails a brief loss of consciousness. Irritability which is the tendency of being easily annoyed by things that a normal person who is not exposed to brain damage cannot mind about. Many soldiers were noted to have difficulty remembering things.
Some soldiers were noted to have a problem recalling simple instructions or tasks. Others complained about prolonged headaches, migraines and having difficulty in concentration. There are some soldiers who lamented of having a problem in sleeping and companied of staying up all night. There are others who complained of feeling tired and at the same time having blurred vision that affected their sight. Lastly there are those soldiers who complained about difficulty in driving as a result of muscle weaknesses.
I=Intervention under Consideration (Change in Treatment Adopted)
EEG Biofeedback interventions are the most recent strategies for TBI rehabilitation. The approach entails operant conditioning of brainwave patterns through reinforcement. The feedback aims at returning fundamental electrophysiological function of the brain to its original normative form. The method entails four strategies that include: Flexyx Neurotherapy approach which is an improved EEG biofeedback technique that combines small radio frequency with conventional QEEG biofeedback. It does so in order to change QEEG patterns that are linked with cognitive dysfunction.
The standard quantitative QEEG strategy focuses on enhancing the strength of beta microvolt activity as well as reducing the strength of theta microvolt activity (Thatcher, 2000). The eye closed QEEG involve comparing the behavior of a patient’s who is resting with the eyes closed QEEG to a reference database. This is aimed at producing more protocols for patients. The last strategy which is the most recent advancement is the activation database QEEG-guided biofeedback. This approach assesses the brain functions of resting patients with their eyes closed (Lubar & Davidson, 2004).
C=Comparison: The Current Treatment Being Compared With Intervention
Many patients who are diagnosed with TBI are mainly treated through Cognitive Rehabilitation (CR). CR is considered as a systematic, functionally based approach of therapy that is founded on an evaluation and understanding of one’s brain behavior deficit. CR entails redirecting brain services in order to achieve changes in brain functioning by strengthening, reinforcing or reestablishing previously acquired behaviors.
Most physicians use computer interventions and strategy instruction in the treatment of TBI (Cappa, Benke, Clarke, Rossi, Stemmer & van, 2003). This method of treatment is designed in a manner to enhance attention of the patient. The patient is required to tab the bar of the computer every time a large red circle is displayed on the monitor. There are three strategies used in this method that entail; restorative cognitive rehabilitation that entail use of computer simulation that is designed to cause repetition in order to restore function (Guyatt & Rennie, 2008).The strategy aims at reinforcing, strengthening as well as reestablishing previously acquired patterns of behaviors.
However, very little success is achieved through this process. The second method is strategy cognitive rehabilitation that concentrates on developing conscious cognitive strategies by anticipating that improvements will generalize to daily activities through establishing new patterns of cognitive activity. However, research has shown high failure rate of this approach as patients fail to continue using the strategy during post treatment period.
The third method that is also widely employed in the treatment of TBI is compensatory cognitive rehabilitation that offers outside, prosthetic help for dysfunctions. This method is appraised by many scholars for its cost benefit effects. However, it does not result to any meaningful enhancement in a patient’s core cognitive skills (Cherek & Taylor, 2005; Ashley, Krych, & Lehr,1990).
O=Outcome: What is the effect of the “I” on “P?” What is desired outcome?
The use of computer interventions in the treatment of TBI is not associated with significant improvement in the memory, attention as well as problem solving skills for patients suffering from TBI. However, EEG biofeedback interventions are associated with great outcomes in acquisition of long term memory, attention and problem solving skills for those suffering from TBI.
T=Time
Traditionally, improvements as well as recovery of those suffering from TBI were considered to occur after a short time span following medication, although there is no evidence to support this claim. Nowadays, neurological function improvements for those suffering from TBI are noted a few weeks after medications for mild TBI (Belanger, Vanderploeg, Curtiss & Warden, 2007). However, for serious complications, improvements are observed after two or more years after patients start computer interventions. However, with the adoption of EEG biofeedback interventions, the recovery of those suffering from TBI is expected to reduce considerably (Cherek & Taylor, 2005).
Reference List
Ashley, M. J., Krych, D. K., & Lehr, R. P. (1990). Cost/Benefit analysis For post-Acut Rehabilitation of the Traumatically Brain-Injured Patient. Journal of Insurance Information. 22, 2, 156-161.
Belanger, H. G., Vanderploeg, R. D., Curtiss, G., & Warden, D. L. (2007). Recent Neuroimaging Techniques in Mild Traumatic Brain Injury. Journal of Neuropsychiatry, 5, 7, 78-89 and Clinical Neurosciences, 19(1), 5-20.
Cappa, S. F., Benke, T., Clarke, S., Rossi, B., Stemmer, B., & van, C. M. (2003). EFNS Guidelines on Cognitive Rehabilitation: Report of an EFNS Task Force. European Journal of Neurology. 10,1, 11-23.
Cherek, L., & Taylor, M. (2005). Rehabilitation, Case Management, and Functional Outcome: An Insurance Industry Perspective. Neurorehabilitation, 5,1, 87-95.
Guyatt, G. H., & Rennie, D. (Eds.). (2008). Users’ guide to the medical literature: Essentials of evidence-based clinical practice (2nd ed.). Chicago: AMA Press.
Levine, B., Cabeza, R., McIntosh, A. R., Black, S. E., Grady, C. L., & Stuss, D. T. (2002). Functional reorganization of memory after traumatic brain injury: a study With H2150 Positron Emission Tomography. Journal of Neurology, Journal of Neurosurgery & Psychiatry, 73, 2, 173-181.
Lubar, J.O., & Davidson, J.F. (2004). Electroencephalographic Biofeedback of SMR and Beta for Treatment of Attention Deficit Disorders in a Clinical Setting. Journal of Biofeedback and Self-Regulation, 9, 1, 1-23.
Thatcher, R. W. (2000). EEG Operant Conditioning and Traumatic Brain Injury. Journal of Clinical Electroencephalography, 31, 1, 38-44.