Transforming TBI Recovery: Advancing Brain Assessment & neurofeedback Shows Promise for Fuller Recovery
A groundbreaking new system for evaluating traumatic brain injuries (TBI) was recently published in the journal Lancet Neurology, as detailed in a New York Times article. This new classification system, developed by 94 experts from 14 countries, aims to improve how patients with traumatic brain injuries (TBI) are evaluated and treated. For decades, TBI assessments often relied on the Glasgow Coma Scale, which categorizes injuries as mild, moderate, or severe based on basic responses. However, as neurosurgeon Dr. Geoffrey Manley highlights, this oversimplified approach can lead to misdiagnoses and insufficient care, with some "mild" injuries resulting in persistent problems and some "severe" cases achieving full recovery.
The new system incorporates additional factors such as post-traumatic amnesia, headaches, sensitivity to light or noise, blood biomarkers of brain injury, and scans like CT and MRI to look for issues such as blood clots, skull fractures, and hemorrhaging. It also uniquely considers the patient's social environment, recognizing its impact on recovery. This more comprehensive approach seeks to end reliance on oversimplified testing and help researchers develop better drug treatments and procedures.
While these advancements are crucial, they still primarily focus on structural damage and general symptoms. This is where Z-score LORETA (Low Resolution Electromagnetic Tomography) Analysis and Neurofeedback, also referred to as advanced neurofeedback, offer a revolutionary leap forward.
Beyond the Surface: Pinpointing Brain Network Dysfunction
Traditional EEG can map the surface of the cortex, providing some benefit, but it's limited in its ability to delve into the brain's deeper structures, which are central to many mental health functions and dysfunctions. Z-score LORETA analysis (ZL-Analysis), on the other hand, allows for a 3D distributed, linear imaging of electric neuronal activity, providing a much more precise view of what's happening beneath the surface.
Imagine the brain's intricate networks like an orchestra. Just as beautiful music requires precise timing and coordination between all sections, mental health, and optimal brain function depend on regions of the brain communicating and coordinating effectively. When this connectivity breaks down, it's like a discordant symphony, leading to mental health challenges. ZL-Analysis excels at identifying these breakdowns in "functional connectivity" – how different brain regions communicate and work together.
Precision Neurofeedback: Retraining the Brain for Recovery
Neurofeedback is a form of biofeedback that trains brain activity using EEG. Electrodes measure the brain's electrical activity, and a computer evaluates the brain activity from moment to moment, providing visual reward cues when the brain shifts into more integrated states (when the chosen areas to train move into more regulated states). As the EEG shows that targetted areas are communicating with each other more effectively, the bar for getting reward cues is raised. This ensures that the training is always reasonably challenging to facilitate steady improvement toward more effective communication between the selected brain regions. With Z-score LORETA Neurofeedback (ZL-Neurofeedback), this training can focus on normalizing all aspects of communication between areas.
Unlike traditional neurofeedback, which often relies on single metrics and fixed protocols, Z-score Neurofeedback utilizes multiple simultaneous measures, is database-driven, provides a whole-brain perspective, and allows for dynamic adjustment of protocols. This "precision neurofeedback" approach has shown promising results in clinical studies, often requiring fewer sessions than traditional methods. In fact, in 2024, the FDA cleared a LORETA-based neurofeedback device ("PRISM") for PTSD and ADHD, specifically training functional connectivity between the PFC and amygdala (areas of the brain).
Case in Point: A Professional’s Remarkable Recovery from Concussion
Consider the case experience of GG, a 41-year-old tech executive who presented for help with severe “brain fog” two months after a concussion sustained in a bicycling accident. She reported significant persistent cognitive deficits—specifically in memory, organization, and attention—which severely impacted both her professional efficacy and personal well-being. Despite her neurologist’s assurance of a full physical recovery and clearance to resume all activities, GG remained deeply concerned by her persistent decline in productivity at work and her ability to juggle all of her home responsibilities as well.
Our diagnostic process began by precisely mapping the high-resolution 3D information flow within her brain using advanced electrical activity measurements. Through ZL-Analysis, we rigorously compared GG's unique brain map against a normative database of over 200 age-matched individuals. This allowed us to pinpoint with accuracy the specific neural pathways where the concussion continued to exert its detrimental effects.
See the Before and After connectivity maps below. [These images are measurements of connectivity between functionally distinct areas impacted by her concussion. The data is derived from her EEGs before and after treatment.]
Over the subsequent four weeks, GG underwent eight targeted ZL-Neurofeedback sessions. These interventions were designed to facilitate the brain's innate capacity to rewire injured connections and restore optimal information processing. The results were compelling. Post-treatment, GG enthusiastically reported, 'That was amazing! I can’t believe what a difference it made in my focus and thinking.' She also noted a marked reduction in headaches and the near elimination of the 'brain fog.' Crucially, GG regained her full sense of competence and engagement in both her professional and family life. She continued with an additional eight sessions, achieving further profound advancements that solidified her recovery.
The Possibility of Recovery
This case highlights how ZL-Analysis can provide a deeper, more precise understanding of brain injury after TBI and how ZL-Neurofeedback can support a full, efficient recovery by training the brain to re-establish healthy communication pathways. While the new TBI classification system is a vital step forward, ZL-Analysis and Neurofeedback offer powerful complements to available care, enabling precise mapping of TBI injury and fuller recovery through rapid treatment.
The Possibility of Prevention of Future Disability
Most of us know that one TBI can be injurious and that multiple TBIs multiply the damage and potential long term risks. A recent study showed over 40% of high school football players brains donated after death were severely damaged by multiple head impacts (a condition called CTE, which results in changes to personality and cognitive abilities).
Perhaps addressing the damage from multiple head impacts more fully though ZL-Neurofeedback will limit the risk of such devastating outcomes whether from sports or just riding your bike.