Biofeedback: Teaching the body to return to a proper homeostasis

WESTBOROUGH, MA  November 8, 2017  There are several types of biofeedback that are useful when recovering from a concussion.  The first may help with the stress response that sometimes goes into overdrive after TBI or concussion. This involves becoming familiar with the fight-flight mechanism and its useful purpose as an early warning system.  Throughout time the autonomic nervous system (ANS) allowed animals and man to be ready whenever threats to personal safety were present. When we are able to out fox the threat then our sympathetic cascade may slowly return to normal as the parasympathetic breaking mechanism exerts its balancing influence.
There is no way to avoid a stressful life it seems.  Some people are better than others at reducing the impact of stress.  Excercise, healthy eating, regular sleep, and mindfulness reduce the impact of the stress and tension we all experience in our lives.   Michael Sefton 2017
The automatic process of sympathetic arousal ramps us up as if to say “bring it on” – activating us to fight or fly the coop.  The problem all too often is an insidious elevation of normal baseline physiological values that create a sympathetic-parasympathetic mismatch. This results from over active adrenergic fibers largely activated by hormones such a cortisol looking the system.  Over time this leads to heart disease, hypertension, and a host of inflammatory diseases and may prolong those needessly.

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Shown here is the HRV biofeedback screen used for paced breathing and coherence training seen here at Whittier Rehabilitation Hospital

The primary goal of all modalities of biofeedback including psychphysiologic and neurofeedback is to restore the body to its “normal” state.  The process promotes mindfulness and paced breathing to gradually lower respiratory drive, reduce heart rate and blood pressure, and enhance other abnormal physiological readings of skin conductance, finger temperature, and electromyogrphy.  It takes practice and understanding of its value. Not everyone has elevations in each these bodily measures. The specifics of abnormal findings are discussed as part of the treatment plan with the doctor or clinician.
There is a well established link between heart rate and the pace of breathing. Autonomic regulation is the role of the brain stem that maintains the diurnal pattern of arousal for wakeful activity and sleep hygiene.  The brain stem regulates heart rate and respiratory drive as well.  These functions are vital to survival and comprise the autonomic nervous system.  The ANS functions as the brain and body’s alarm system signaling the need for fight-flight activation.  When this system is damaged due to traumatic brain injury the recovering subject can have wild swings of autonomic arousal such as elevated heart rate – patients sometimes chug along at 140-160 while autonomic storming.   Paroxysmal changes in blood pressure may pose significant risk, respiratory rate may become tachypnic, patients frequent are febrile and may become excessively sweaty  as a consequence of autonomic dysfunction.
“Autonomic dysfunction must be carefully managed in patients recovering from TBI. This is not conceptually novel although its application to health conditions continues to broaden. Biofeedback may be a useful modality for migraine headaches, anxiety, pain management, concussion, and stress. I have used a combination of physiologic and neurofeedback for patients with failure to thrive, depression, post-concussion syndrome, and severe traumatic brain injury” 2014).  In 2006 I was invited to London, UK to present the findings of a case study with a high school boy who had sustained a severe TBI and was in a minimally conscious state.  The results were remarkable and not entirely the result of the neurofeedback protocol I used with him.  Our team did a good job keeping him moving and gradually he became more functional and regained his independence. It was a fun trip I was able to take with colleague Paul Liquori, MD, medical director at Whittier Rehabilitation Hospital in Bradford.
Relaxation and mindfulness have existed for over 60 years bringing together conscious conscious effort to control bodily system that were once thought to be automatic.  Sefton, 2016

Sefton, M (2014) Blog post: https://concussionassessment.wordpress.com/consultation/topics-in-neuropsychology/tbi/autonomic-dysfunction/ Taken 11-13-17.
Sefton, M (2016) Blog post: https://concussionassessment.wordpress.com/2016/04/01/biofeedback-for-post-concussion-syndrome/ Taken 11-13-17
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