biofeedback and mindfulness - applications to acquired brain injury
TRANSCRIPT
Outline
• CHIRS & ABI clients
• Brief Summary of research on mindfulness
• Brief Summary of research on Biofeedback & Heart Rate Variability
• Measuring Heart Rate Variability using the emWave Desktop & Dual Drive Game
• ABI Specific Intervention Technique videos
Our clients
• Adults from 18-65
• Moderate to severe brain injuries
• History of substance use
• Mental health disorders and developmental delays
• Both ambulatory and physical impairments
Our Clients
Question: What is the best thing about having a brain injury?
Answer: You can hide your own Easter Eggs.
Mindfulness
Being mindful is associated with:
• Less emotional stress
• More positive states of mind
• Better quality of life
• Influencing the brain & autonomic nervous system
What is Mindfulness?
• In control of their own thoughts
• There is no need to search for answers outside ourselves
• Change starts from within
• Past and future
• The present is the only place we can make choices
• In the present is where we can affect change
Promoting optimal health in the mind, body, relationships and spirit
Key Principles
Being in the Present
Non-judgment
Acceptance, curiosity and openness
Awareness of yourself, transform your thoughts
Break old habits, new ways of responding
Biofeedback
• 1980-90s headaches & pain
• Heart rate and skin temperature
• Late 90s biofeedback and ADHD
• Price and technology
• Electroencephalography (EEG) & Electrocardiography (ECG)
• Computer game & “mind control”
Heart Rate Variability (HRV)
• Importance of cardiac rhythms
• Beat-to-beat rhythm shifts
• Inspiration and exhalation
• Aging, illness, and psychological states
• Development of electrocardiograph (ECG)
• Abnormal HRV and sudden cardiac arrest
• Role of HRV in cardiac rehab
Evolution of ECG & HRV Technology
Heart Rate Variability (HRV)
HEA
RT
RA
TE (
BP
M)
Seconds
Over Time a Heart Rhythm Pattern Emerges 100
90
80
70
60
50
40
30
20
10
0
8 10 12 14 16 18 20 22 24
Incoherence: Impairs Performance–Amplifies Energy Drains
Coherence: Promotes Optimal Performance–Builds Resilience
HE
AR
T R
AT
E
HE
AR
T R
AT
E
Inhibits
Brain Function
(Incoherence)
Facilitates
Brain Function
(Coherence)
TIME (SECONDS)
Heart Rhythms
100 –
90 –
80 –
70 –
60 –
50 –
100 –
90 –
80 –
70 –
60 –
50 –
1 50 100 150 200
Typical Treatment Session
Mindfulness & Biofeedback
Quick Reference Card
I. Baseline (5-10 mins)
5 mins - Baseline, Discussion & Updates
2 mins - Breathing Exercise
II. HMI Techniques (5-10 mins)
2 mins - Quick Coherence
2 mins - Heart Lock-in
2 mins - Attitude Breathing
III. Yoga (5-10 mins)
5 mins - Seated Yoga: guided
IV. Mindfulness (10-25 mins)
5 mins - Contemplation with Art & Poetry
10-20 mins - Meditation: guided, visualize, music, nature sounds
Total Session: 30-45 minutes
D.D. Injury
• Two traumatic separate injuries
• Dilation of the ventrical (neural atrophy)
• Right occipital infarct (vision)
• Left Cerebellar infarct (motor)
• Atrophy of the left temporal (anteriorly) & frontal lobe (memory, executive function, impulsivity)
• Possible brain stem damage – medulla
• Vascular abnormality attached to the left opthalmic artery (vision)
• Left homonymous hemianopsia (vision)
D.D. is in his early 50s
D.D. Neuropsychological Profile
• Global Intellectual Abilities: full scale IQ Average • Non-Verbal IQ – Average
• Verbal IQ – Average
• Attention & Processing Abilities Borderline Impaired • Slow and easily distractible
• Verbal & Language Abilities Average • Speech is good
• Good vocabulary
• Non-Verbal/Visual Spatial Abilities Relative Strength • Primary visual spatial skills relatively intact i.e. basic vision to perception
• Complex visual spatial skills borderline low average (integration of both hemispheres)
• Learning & Memory • Declarative Memory is impaired in both visual and auditory modality
• Procedural Memory relatively intact
• Semantic Knowledge intact
• Attention and working memory is impaired
D.D. Neuropsychological Profile
• Executive Function • Verbal abstract reasoning is average (abstract thinking)
• Non-Verbal reasoning is average
• Impulsive
• Poor planning
• Poor emotional control
• Poor initiation
• Difficulties with organization
• Sensory Motor • Left homonymous hemianopsia (visual Impairment at the nerve level)
• Fine motor dexterity impaired bilaterally
• Motor speed borderline impaired on the left and profoundly impaired on the right
• Grip Strength impaired bilaterally
• Poor balance
• Mood & Anxiety moderately severe concerns • Being unable to relax
• Numbness & tingling sensation when I hear sirens
• Difficulties breathing
He was referred to OT services managing his anxiety in relations to falls prevention
J.J. Injury
• Two injuries
• One in childhood due to severe trauma to the temporal and bifrontal lobe that resulted in surgery & a right temporal lobectomy
• One due to severe trauma that resulted in a subdural hemotoma (hemorrhage, compression of brain tissues)
• Surgery (left side frontal temporal craniotomy) to remove hemotoma (blood pooling)
Currently in his mid 20s
J.J. Neuropsychological Profile
• Global Intellectual Abilities: full scale IQ Borderline Impaired Non-Verbal IQ – Average Range
Verbal IQ – Profoundly Impaired
• Attention & Processing Abilities Impaired
• Verbal & Language Abilities Impaired Reading at grade 1 level
Slurring of speech
Simple instructions
Limited vocabulary
Verbal Abstract Reasoning impaired (ex. banana/strawberries)
• Non-Verbal/Visual Spatial Abilities Relative Strength Primary visual spatial skills relatively intact i.e. basic vision to perception
Complex visual spatial skills relatively intact (integration of both hemispheres)
J.J. Neuropsychological Profile
• Learning & Memory Declarative Memory is severely impaired in both visual and auditory modality
Procedural Memory relatively intact
Semantic Knowledge impaired
Attention and working memory is severely impaired
• Executive Function Verbal abstract reasoning is impaired (abstract thinking)
Non-Verbal reasoning is average
Impulsive
Poor planning
Poor emotional control
Poor initiation
• Sensory Motor Fine motor dexterity impaired bilaterally, qualitatively better on the right
Motor speed borderline impaired on the left and severely impaired on the right
Grip Strength impaired bilaterally
Pain Diagnosis of Post Traumatic Fybromyalgia
J.J. was referred to OT Services for managing his pain
Summary & Clinical Experience
• Client’s frustration levels are quite low during the session
• Most clients really enjoyed the session
• Compliance with attending sessions are high
• Individualized treatment plans
• Software providing feedback
• Facilitates improve awareness & insight
• It’s fun (and concrete)!!
Contact information
Amee Le
Community Head Injury Resource Services of Toronto
62 Finch Avenue West, Toronto, Ontario M2N 7G1
416-240-8000 x 284