Concussionology® - Master The Complex
Research 28
Brain Waves Do Not Lie, Now or A Year From Now
Comment by Dr. Mladenoff
This unique study did a EEG brain wave exam under four conditions and 5 different times after head trauma:
1. sitting
2. Standing on a force plate
3. Standing on foam with eyes open
4. Standing on foam with eyes closed
These results reiterate that sport-related brain injuries may disproportionately influence attention and memory-related processes ( Aubry et al., 2002;Ellemberg et al., 2009;Baillargeon et al., 2012;Moore et al., 2015). More importantly, these results also reinforce the importance of employing neurophysiological measures to gain a more comprehensive understanding of outcomes following sport-related brain injuries ( Ellemberg et al., 2009;Broglio et al., 2011;Slobounov et al., 2012;Bigler, 2013). Not only do neurophysiological measures demonstrate superior sensitivity relative to neuropsychological assessments ( Münte et al., 2000;Luck, 2005;Polich, 2007;Broglio et al., 2011;Slobounov et al., 2012), but measures such as ERPs provide a direct functional interpretation of altered neurophysiological function ( Münte et al., 2000;Luck, 2005;Polich, 2007). ...
The conclusion is very revealing two profound areas. Firstly residual brain dysfunction can persist for a year following mTBI and secondly the initial evaluation of an EEG and balance evaluation can predict length of recovery via the percent of EEG alpha power suppression changes from sitting to standing.
EEG evaluation of a concussed patient even a year after trauma would be appropriate independent of any clinical symptomatology.
Residual brain dysfunction observed one year post-mild traumatic brain injury: combined EEG and balance study. Semyon Slobounov, Wayne Sebastianelli, Mark Hallett. Clinical Neurophysiology: Official Journal of the International Federation of Clinical. Neurophysiology 2012, 123 (9): 1755-61
OBJECTIVES: There is still considerable debate and controversy about whether EEG can be used as a robust clinical tool for assessment of mild traumatic brain injury (MTBI). Nonhomogeneous subject populations, inaccurate assessment of severity of brain injury, time since injury when EEG testing was performed, the lack of EEG research conducted serially and in conjunction with other behavioral measures as injury evolves over time may contribute to the existing controversies. In this study, we implemented a concussion assessment protocol combining a series of EEG and balance measures throughout one year post-injury to document the efficacy of EEG and balance measures as relate to differential recovery of patients suffering from MTBI.
METHODS: Three hundred and eighty subjects at risk for MTBI were initially recruited for baseline testing. Forty nine from this initial subjects pool subsequently suffered a single episode of concussive blow and were tested on day 7, 15, 30 days, 6 months and 12 months post-injury. EEGs were recorded while sitting, standing on the force plate and then on a foam base of support with eyes open/closed conditions. EEG alpha power (8-12 Hz) and its percent suppression from sitting to standing postures were computed. The center of pressure (COP) measures were obtained from the force platform and analyzed for eyes open and eyes closed conditions.
RESULTS: Percent alpha power suppression from sitting to standing postural conditions significantly increased in MTBI subjects shortly after the injury (p<0.01). Percent alpha power suppression significantly correlated with increased area of COP during standing posture with eye closed (r(2)=0.53, p<0.01). The magnitude of alpha power suppression predicted the rate of recovery of this measure in sub-acute and chronic phases of injury (r(2)=0.609, p<0.01). Finally, 85% of MTBI subjects who showed more than 20% of alpha power suppression in the acute phase of injury did not return to pre-injury status up to 12 months post-injury.
CONCLUSIONS: The efficacy of serially implemented EEG measures in conjunction with balance assessment over the course of MTBI evolution to document residual cerebral dysfunction was demonstrated. Specifically, alteration of EEG alpha power dynamics in conjunction with balance data in the acute phase of injury with respect to baseline measures may predict the rate of recovery from a single concussive blow.
SIGNIFICANCE: Neurophysiological measures are excellent tools to assess the status and prognosis of patients with MTBI.
OBJECTIVES: There is still considerable debate and controversy about whether EEG can be used as a robust clinical tool for assessment of mild traumatic brain injury (MTBI). Nonhomogeneous subject populations, inaccurate assessment of severity of brain injury, time since injury when EEG testing was performed, the lack of EEG research conducted serially and in conjunction with other behavioral measures as injury evolves over time may contribute to the existing controversies. In this study, we implemented a concussion assessment protocol combining a series of EEG and balance measures throughout one year post-injury to document the efficacy of EEG and balance measures as relate to differential recovery of patients suffering from MTBI.
METHODS: Three hundred and eighty subjects at risk for MTBI were initially recruited for baseline testing. Forty nine from this initial subjects pool subsequently suffered a single episode of concussive blow and were tested on day 7, 15, 30 days, 6 months and 12 months post-injury. EEGs were recorded while sitting, standing on the force plate and then on a foam base of support with eyes open/closed conditions. EEG alpha power (8-12 Hz) and its percent suppression from sitting to standing postures were computed. The center of pressure (COP) measures were obtained from the force platform and analyzed for eyes open and eyes closed conditions.
RESULTS: Percent alpha power suppression from sitting to standing postural conditions significantly increased in MTBI subjects shortly after the injury (p<0.01). Percent alpha power suppression significantly correlated with increased area of COP during standing posture with eye closed (r(2)=0.53, p<0.01). The magnitude of alpha power suppression predicted the rate of recovery of this measure in sub-acute and chronic phases of injury (r(2)=0.609, p<0.01). Finally, 85% of MTBI subjects who showed more than 20% of alpha power suppression in the acute phase of injury did not return to pre-injury status up to 12 months post-injury.
CONCLUSIONS: The efficacy of serially implemented EEG measures in conjunction with balance assessment over the course of MTBI evolution to document residual cerebral dysfunction was demonstrated. Specifically, alteration of EEG alpha power dynamics in conjunction with balance data in the acute phase of injury with respect to baseline measures may predict the rate of recovery from a single concussive blow.
SIGNIFICANCE: Neurophysiological measures are excellent tools to assess the status and prognosis of patients with MTBI.