Stroke

Stroke rehabilitation is perhaps one of the most exciting areas of neurotherapy, simply because patient outcomes are so remarkable. The brain has previously been regarded as unchangeable. Hitherto, it was erroneously believed that if an area of the brain became damaged or died, that section of the brain would no longer be able to function. Thanks to the tireless work of neurologists and other scientists, we now know that the brain is fully capable of rewiring itself to adapt to changes, such as those induced by stroke. The brain masterfully compensates for damage in one area by creating similar functionality in another part - this is neuroplasticity at work. Naturally this is a complex science and there is no ‘one size fits all’ solution for for brain injuries/impairments. However, this new science does bode extremely well for stroke victims: some patients have seen dramatic improvements even two years after an incident.

Neurofeedback for Stroke

Every brain is unique and complex. Any functional impairment an individual experiences as a result of stroke is dependent upon which areas of their brain have been affected. For this reason, recovery from a stroke requires an individualised treatment approach.

 

 By rewiring the brain, it is possible to reorganise motor circuits to return movement to hands, legs, the face, etc. Along with increased mobility, brain training can also enhance speech production, improve mood regulation and behavioural control. 

Neurofeedback is able to target specific brain regions so that functional training can be individualised according to need. At the Brain Training Centre, we utilise qEEG assessment in order to devise a training protocol specifically designed to meet your recovery goals.

Evidence and experience shows that neurotherapy can assist many people in their recovery from stroke. 

Photobiomodulation for Stroke

Photobiomodulation (PBM) or low-level laser (light) therapy (LLLT) describes the use of red or near-infrared light from lasers or LEDs to heal, stimulate, and protect damaged tissues. It was first used for wound healing and pain relief but in recent years has been extensively investigated for brain disorders. One of the first applications of transcranial PBM in the brain was for acute stroke.

 

The mechanisms of action of PBM are multifactorial. PBM applied to the head can increase cerebral blood flow by releasing nitric oxide and improve tissue oxygenation in the brain. It can stimulate mitochondrial metabolism and increase ATP production. Protective mechanisms are activated that can reduce neuronal cell death and oxidative stress occurring as a result of hypoxia, while neuroinflammation is also reduced.

 

PBM can stimulate the formation of new neurons (neurogenesis) from neuroprogenitor cells in the hippocampus and subventricular zone. Finally, PBM can stimulate synaptogenesis and neuroplasticity (formation of new connections between existing neurons). 

- Michael Hamblin, PhD (phototherapy expert)

"The sooner a patient is treated [for] a stroke with photobiomodulation the better the results would be."

                                                  

                                                   - Tonie Chicchi, BS, MRT 

The Brain Training Centre is excited to offer the latest technology to assist with stroke recovery. Photobiomodulation, also called Red Light Therapy or Low Level Laser Treatment, is helping individuals the world over to regain functioning following a stroke event. Watch the video above to see what success stroke patients around the world are having with this cutting edge treatment.

Multiple studies show that PBM can significantly reduce brain damage and improve recovery outcomes after a stroke. In one study, researchers applied PBM over the entire surface of the head of stroke patients approximately 18 hours after a stroke. Five days after the stroke, they found significantly greater improvements in the PBM-treated group. The improvements continued 90 days after the stroke. At the end of the study, 70% of the patients treated with real PBM had a successful outcome compared with only 51% of the control subjects. 

Follow up studies with over 600 stroke patients found similar beneficial results. Researchers believe increase in the production of ATP within the mitochondria is responsible for the improvements.

Numerous studies also show that PBM significantly reduces neurological problems and improves behaviour in rats and rabbits after stroke. It also increases neurogenesis, the growth of new brain cells, in these animals, improving their overall recovery.

EVIDENCE-BASED RESEARCH FOR THE EFFECTIVENESS OF NEUROTHERAPY FOR BRAIN INJURY, STROKE, COMA, SPASTICITY AND CEREBRAL PALSY.

Ayers, M. E. (1981). A report on a study of the utilization of electroencephalography for the treatment of cerebral vascular lesion syndromes. Chapter in L. Taylor, M. E. Ayers, & C. Tom (Eds.), Electromyometric Biofeedback Therapy. Los Angeles: Biofeedback and Advanced Therapy Institute, pp. 244-257.

 

Ayers, M. E. (1987). Electroencephalic neurofeedback and closed head injury of 250 individuals. Head Injury Frontiers. National Head Injury Foundation, 380-392.

 

Ayers, M. E. (1991). A controlled study of EEG neurofeedback training and clinical psychotherapy for right hemispheric closed head injury. Paper presented at the National Head Injury Foundation, Los Angeles, 1991.

 

Ayers, M. E. (1995a). A controlled study of EEG neurofeedback and physical therapy with pediatric stroke, age seven months to age fifteen, occurring prior to birth. Biofeedback & Self-Regulation, 20(3), 318.

 

Ayers, M. E. (1995b). EEG neurofeedback to bring individuals out of level 2 coma. Biofeedback & Self-Regulation, 20(3), 304-305.

 

Ayers, M. E. (1999). Assessing and treating open head trauma, coma, and stroke using real-time digital EEG neurofeedback. Chapter in J. R. Evans & A. Abarbanel (Eds.), Introduction to Quantitative EEG and Neurofeedback. New York: Academic Press, pp. 203-222.

 

Ayers, M. E. (2004). Neurofeedback for cerebral palsy. Journal of Neurotherapy, 8(2), 93-94.

 

Bachers, A. (2004). Neurofeedback with cerebral palsy and mental retardation. Journal of Neurotherapy, 8(2), 95-96.

 

Bearden, T. S., Cassisi, J. E., & Pineda, M. (2003). Neurofeedback training for a patient with thalamic and cortical infarctions. Applied Psychophysiology & Biofeedback, 28(3), 241-253.

 

Bounias, M., Laibow, R. E., Bonaly, A., & Stubblebine, A. N. (2001). EEG-neurobiofeedback treatment of patients with brain injury: Part 1: Typological classification of clinical syndromes. Journal of Neurotherapy, 5(4), 23-44.

 

Bounias, M., Laibow, R. E., Stubbelbine, A. N.,Sandground, H., & Bonaly, A. (2002). EEG-neurobiofeedback treatment of patients with brain injury Part 4: Duration of treatments as a function of both the initial load of clinical symptoms and the rate of rehabilitation. Journal of Neurotherapy, 6(1), 23-38.
 

Byers, A. P. (1995). Neurofeedback therapy for a mild head injury. Journal of Neurotherapy, 1(1), 22-37.

 

Cannon, K. B., Sherlin, L., & Lyle, R. R. (2010). Neurofeedback efficacy in the treatment of a 43-year-old female stroke victim: a case study. Journal of Neurotherapy, 14(2), 107-121.

 

Doppelmayr, M., Nosko, H., Pecherstorfer, T., & Fink, A. (2007). An attempt to increase cognitive performance after stroke with neurofeedback. Biofeedback, 35(4), 126-130.

 

Duff, J. (2004). The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clinical EEG & Neuroscience, 35(4), 198-209.

 

Ham, L. P., & Packard, R. C. (1996). A retrospective, follow-up study of biofeedback-assisted relaxation therapy in patients with posttraumatic headache. Biofeedback & Self-Regulation, 21(2), 93-104.

 

Hammond, D. C. (2007). Can LENS neurofeedback treat anosmia resulting from a head injury? Journal of Neurotherapy, 11(1), 57-62.

 

Hammond, D. C. (2006). Neurofeedback to improve physical balance, incontinence, and swallowing. Journal of Neurotherapy, 9(1), 27-48.

 

Hoffman, D. A., Stockdale, S., & Van Egren, L. (1996a). Symptom changes in the treatment of mild traumatic brain injury using EEG neurofeedback [Abstract]. Clinical Electroencephalography, 27(3), 164.

 

Hoffman, D. A., Stockdale, S., & Van Egren, L. (1996b). EEG neurofeedback in the treatment of mild traumatic brain injury [Abstract]. Clinical Electroencephalography, 27(2), 6.

 

Keller, I. (2001). Neurofeedback therapy of attention deficits in patients with traumatic brain injury. Journal of Neurotherapy, 5(1,2), 19-32.

 

Laibow, R E., Stubblebine, A. N., Sandground, H.,& Bounias, M. (2001). EEG neurobiofeedback treatment of patients with brain injury: Part 2: Changes in EEG parameters versus rehabilitation. Journal of Neurotherapy, 5(4), 45-71

 

Putnam, J. A., (2001). EEG biofeedback on a female stroke patient with depression: A case study. Journal of Neurotherapy, 5(3), 27-38.

 

Rozelle, G. R., & Budzynski, T. H. (1995). Neurotherapy for stroke rehabilitation: A single case study. Biofeedback & Self-Regulation, 20(3), 211-228.

 

Schoenberger, N. E., Shiflett, S. C., Esty, M. L., Ochs, L., & Matheis, R. J. (2001). Flexyx neurotherapy system in the treatment of traumatic brain injury: An initial evaluation. Journal of Head Trauma Rehabilitation, 16(3), 260-274.

 

Sterman, M. B., Ayers, M. E., & Goodman, S. J. (1976). Case study: Effects of SMR suppression on EEG and motor patterns in a quadriplegic patient. Biofeedback & Self-Regulation, 1(3), 340-341.

 

Thatcher, R. W. (2000). EEG operant conditioning (biofeedback) and traumatic brain injury. Clinical Electroencephalography, 31(1), 38-44.

 

Thornton, K. (2000). Improvement/rehabilitation of memory functioning with neurotherapy/QEEG biofeedback. Journal of Head Trauma Rehabilitation, 15(6), 1285-1296.

 

Thornton, K. (2001). Electrophysiology of auditory memory of paragraphs towards a projection/activation theory of the mind. Journal of Neurotherapy, 4(3), 45-72.
 

Thornton, K. (2002) Rehabilitation of Memory functioning with EEG Biofeedback, Neurorehabilitation, 17(1), 69-81

 

Thornton, K. E., & Carmody, D. P. (2008). Efficacy of traumatic brain injury rehabilitation: Interventions of QEEG-guided biofeedback, computers, strategies, and medications. Applied Psychophysiology & Biofeedback, 33(2), 101-124.

 

Thornton, K. E., & Carmody, D. P. (2005). Electroencephalogram biofeedback for reading disability and traumatic brain injury. Child & Adolescent Psychiatric Clinics of North America, 14(1), 137-162.

 

Tinius, T. P., & Tinius, K. A. (2001). Changes after EEG biofeedback and cognitive retraining in adults with mild traumatic brain injury and attention deficit disorder. Journal of Neurotherapy, 4(2), 27-44.

 

Walker, J. E. (2007). A neurologist’s experience with QEEG-guided neurofeedback following brain injury. Chapter in J. R. Evans (Ed.), Handbook of Neurofeedback. Binghampton, NY: Haworth Medical Press, pp. 353-361.

 

Wing, K. (2001). Effect of neurofeedback on motor recovery of a patient with brain injury: A case study and its implications for stroke rehabilitation. Topics in Stroke Rehabilitation, 8(3), 45-53.

 

Yoo, S. S., & Jolesz, F. A. (2002). Functional MRI for neurofeedback: feasibility study on a hand motor task. Neuroreport, 13, 1377–1381.

 

Z-Score Neurofeedback Training

Collura, T. F., Guan, J., Tarrant, J., Bailey, J., & Starr, F. (2010). EEG biofeedback case studies using live Z-score training and a normative database. Journal of Neurotherapy, 14(1), 22-46.

 

Collura, T. F. (2009). Neuronal dynamics in relation to normative electroencephalography assessment and training. Biofeedback, 36, 134-139.

 

Collura, T. F. (2008b, July). Whole-head normalization using live Z-scores for connectivity training (Part 2). NeuroConnections Newsletter, 9-12.

 

Collura, T. F. (2008). Whole-head normalization using live Z-scores for connectivity training, Part 1. NeuroConnections Newsletter, April 2008, 12, 15, 18-19. San Rafael, California; ISNR

 

Smith, M. (2008). A father finds a solution: Z-score training. NeuroConnections Newsletter, April 2008, 22, 24-25. San Rafael, California; ISNR

 

Thatcher, R. W. (2008). Z-score EEG biofeedback: Conceptual foundations. NeuroConnections Newsletter, April 2008, 9, 11, 20. San Rafael, California; ISNR

 

Functional MRI (fMRI) Neurofeedback

Bray, S., Shimojo, S. & O’Doherty, J. P. (2007). Direct instrumental conditioning of neural activity using functional magnetic resonance imaging-derived reward feedback. Journal of Neuroscience, 27, 7498–7507.

 

Caria, A., Sitaram, R., Veit, R., Begliomini, C., & Birbaumer, N. (2010). Volitional control of anterior insula activity modulates the response to aversive stimuli. A real-time functional magnetic resonance imaging study. Biological Psychiatry, 68(5), 425-432.

 

Caria, A., Veit, R., Sitaram, R., Lotze, M., Weiskopf, N., Grodd, W. & Birbaumer, N. (2007). Regulation of anterior insular cortex activity using real-time fMRI. Neuroimage, 35, 1238 – 1246.

 

deCharms, R. C. (2008). Applications of real-time fMRI . Nature Neuroscience, 9, 720-729.

 

deCharms, R. (2007). Reading and controlling human brain activation using real-time functional magnetic resonance imaging. Trends in Cognitive Science, 11, 473 – 481.

 

deCharms, R.C., Maeda, F., Glover, G.H., Ludlow, D., Pauly, J.M., Soneji, D., Gabrieli, J.D. & Mackey, S.C. (2005). Control over brain activation and pain learned by using realtime functional MRI. Proceedings of the National Academy of Sciences, 102, 18626 – 18631.

 

deCharms, R., Christoff, K., Glover, G., Pauly, J., Whitfield, S. & Gabrieli, J. (2004). Learned regulation of spatially localized brain activation using real-time fMRI. Neuroimage, 21, 436 – 443.

 

Fetz, E. E. (2007). Volitional control of neural activity: implications for brain-computer interfaces. Journal of Physiology, 579, 571–579.

 

Johnston, S.J., Boehm, S.G., Healy, D., Goebel, R. & Linden, D.E.J. (2010). Neurofeedback: A promising tool for the self-regulation of emotion networks. Neuroimage, 49(1), 1066 – 1072.

 

Rota, G., Sitaram, R., Veit, R., Erb, M., Weiskopf, N., Dogil, G. & Birbaumer, N. (2009). Self-regulation of regional cortical activity using real-time fMRI: The right inferior frontal gyrus and linguistic processing. Human Brain Mapping, 30, 1605- 1614.

 

Weiskopf, N., Scharnowski, F., Veit, R., Goebel, R., Birbaumer, N. & Mathiak, K. (2004). Self-regulation of local brain activity using real-time functional magnetic resonance imaging (fMRI). Journal of Physiology (Paris) 98, 357-373.

 

Weiskopf, N., Veit, R., Erb, M., Mathiak, K., Grodd, W., Goebel, R. & Birbaumer, N. (2003). Physiological self-regulation of regional brain activity using real-time functional magnetic resonance imaging (fMRI): methodology and exemplary data. Neuroimage, 19, 577-586.

 

Yoo, S., O’Leary, H., Fairneny, T., Chen, N., Panych, L., Park, H. & Jolesz, F. (2006). Increasing cortical activity in auditory areas through neurofeedback functional magnetic resonance imaging. Neuroreport, 17, 1273-1278.
 

Yoo, S. S., & Jolesz, F. A. (2002). Functional MRI for neurofeedback: feasibility study on a hand motor task. Neuroreport, 13, 1377–1381.
 

DISCLAIMER:

All articles, documents and publications mentioned by or linked by this site or hosted at this site have been provided by The International Society for Neurofeedback and Research (ISNR) as a public service. There is absolutely no endorsement by ISNR of any statement made in any of these documents, articles, or publications. Expect to see differences of opinion between authors. That is the essence of free and open scientific study.

EVIDENCE-BASED RESEARCH FOR THE EFFECTIVENESS OF PHOTOBIOMODULATION FOR THE TREATMENT OF STROKE.

DeTaboada, L., Ilic, S., Leichliter-Martha, S., Oron, U., Oron, A., & Streeter, J. (2006). Transcranial application of low-energy laser irradiation improves neurological deficits in rats following acute stroke. Lasers in Surgery and Medicine, 38(1), 70-73. 

Hamblin, M. R. (2016). Shining light on the head: Photobiomodulation for brain disorders. BBA Clinical, 6, 113-124. 

Hamblin M.R. (2017) Photobiomodulation for Stroke. In: Lapchak P., Yang GY. (eds) Translational Research in Stroke. Translational Medicine Research. Springer, Singapore. pp.397-414.

Lampl, Y. (2007). Laser treatment for stroke. Expert Review of Neurotherapeutics,7(8), 961-965. 

Lampl, Y., Zivin, J. A., Fisher, M., Lew, R., Welin, L., Dahlof, B., … Oron, U. (2007). Infrared Laser Therapy for Ischemic Stroke: A New Treatment Strategy. Stroke, 38(6), 1843-1849. 

Lapchak, P. A. (2019). The challenge of effectively translating transcranial near-infrared laser therapy to treat acute ischemic stroke. Photobiomodulation in the Brain, 289-297. 

Lapchak, P. A., & De Taboada, L. (2010). Transcranial near infrared laser treatment (NILT) increases cortical adenosine-5′-triphosphate (ATP) content following embolic strokes in rabbits. Brain Research, 1306, 100-105. 

Lapchak, P. A., Wei, J., & Zivin, J. A. (2004). Transcranial Infrared Laser Therapy Improves Clinical Rating Scores After Embolic Strokes in Rabbits. Stroke,35(8), 1985-1988. 

Lapchak, P., Salgado, K., Chao, C., & Zivin, J. (2007). Transcranial near-infrared light therapy improves motor function following embolic strokes in rabbits: An extended therapeutic window study using continuous and pulse frequency delivery modes. Neuroscience, 148(4), 907-914. 

Liu, J., Wu, S., He, S., Dong, W., Liu, M., & Cui, X. (2016). Transcranial laser therapy for acute ischemic stroke. Cochrane Database of Systematic Reviews. 

Oron, A., Oron, U., Chen, J., Eilam, A., Zhang, C., Sadeh, M., … Chopp, M. (2006). Low-Level Laser Therapy Applied Transcranially to Rats After Induction of Stroke Significantly Reduces Long-Term Neurological Deficits. Stroke, 37(10), 2620-2624.

Schiffer, F., Johnston, A. L., Ravichandran, C., Polcari, A., Teicher, M. H., Webb, R. H., & Hamblin, M. R. (2009). Psychological benefits 2 and 4 weeks after a single treatment with near infrared light to the forehead: a pilot study of 10 patients with major depression and anxiety. Behavioral and Brain Functions, 5(1), 46. 

Schiffer, F., Johnston, A. L., Ravichandran, C., Polcari, A., Teicher, M. H., Webb, R. H., & Hamblin, M. R. (2009). Psychological benefits 2 and 4 weeks after a single treatment with near infrared light to the forehead: a pilot study of 10 patients with major depression and anxiety. Behavioral and Brain Functions, 5(1), 46. 

Stemer, A. B., Huisa, B. N., & Zivin, J. A. (2010). The Evolution of Transcranial Laser Therapy for Acute Ischemic Stroke, Including a Pooled Analysis of NEST-1 and NEST-2. Current Cardiology Reports, 12(1), 29-33. 

Xuan, W., Vatansever, F., Huang, L., Wu, Q., Xuan, Y., Dai, T., … Hamblin, M. R. (2013). Transcranial Low-Level Laser Therapy Improves Neurological Performance in Traumatic Brain Injury in Mice: Effect of Treatment Repetition Regimen. PLoS ONE, 8(1), e53454. 

Yip, S., & Zivin, J. (2008). Laser Therapy in Acute Stroke Treatment. International Journal of Stroke, 3(2), 88-91. 

Zivin, J. A., Sehra, R., Shoshoo, A., Albers, G. W., Bornstein, N. M., & Dahlof, B. (2012). NeuroThera® Efficacy and Safety Trial – 3 (NEST-3): A Double-Blind, Randomized, Sham-Controlled, Parallel Group, Multicenter, Pivotal Study to Assess the Safety and Efficacy of Transcranial Laser Therapy with the NeuroThera® Laser System for the Treatment of Acute Ischemic Stroke within 24 h of Stroke Onset. International Journal of Stroke, 9(7), 950-955. 

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