“Your boss wants to see you now!” “Your appointment is downtown in 15 minutes and 395 is backed up.” “Seventy percent of your grade is based on the test tomorrow.” “We’d like you to give a talk to the group.” “And oh, by the way, it’s due tomorrow.” “We’ll hear your testimony now.” “Your test results are back.” “What’s for dinner?”
There’s no shortage of stressors in the Washington, D.C. area. Stress is tough to avoid, what you need is a way to change your brain’s response to stress and increase your ability to downshift into a less stressed mode when you have down time. Down time, what’s that? It may only be the few precious hours (minutes!) we get after commuting, homework, dinner, that extra work we brought home. Since down time is in such short supply we need to learn how to optimize our brain and body’s ability to relax and take advantage of it. And of course help it do the ultimate downshift into sleep at the end of the day.
Brainwave Basics
Our overall brain activity is a mix of brainwaves at a lot of different frequencies at the same time (you can think of them as the different wavelengths of light or colors in a rainbow), some in greater quantities and strength than others. Balance is the key. We don't want to regularly produce too much or too little of any brainwave frequency. When the brainwaves get out of balance we usually experience symptoms of some sort.
Beta Brain
This month we’ll look at the most common type of stressed brain--”beta brain”. NASA played a role in our conception of this type in its work monitoring the brain waves of pilots. They found that pilots who shifted into beta mode for in-flight maneuvers were quite effective. However, they also found that those who stayed in high levels of beta, burned out quickly, unable to sustain such effective performance. The pilots who were able to down-shift into a predominantly alpha state, or calm alert idle state after a maneuver were able to sustain peak performance over long periods. They operated efficiently, shifting into beta only when necessary, conserving brain power for when it was needed.
If you have a beta brain you are over producing beta typically in your right hemisphere, but it could be your whole brain. Beta waves are made when we’re actively thinking or problem-solving, a good thing. When there are too many of them it can be correlated with symptoms of anxiety, fatigue, muscle tension, headache, irritability, insomnia, and eventually exhaustion. You might feel like you can’t shut-off your busy brain to sleep at night. People might refer to you as being really wired. If you’re a kid with a beta brain you might be a night owl, fidget a lot, be sensitive to light or noise.
Neurofitness can help with beta brain. Using neurofeedback, a form of brain exercise, we can teach your brain to calm itself, to regain its ability to shift in and out of beta mode as needed during the day and sleep soundly at night.
Author
Cynde Margritz
“I was on the top of the pyramid one minute and the next, I was on the gym floor with people standing around me asking if I was ok. My Mom took me to the Emergency Room.
While I was there another girl on the squad arrived with an injury as well. I used to do well in school, but now I can’t keep up with the work and all the bright lights give me a headache. It’s hard to focus. I feel more clumsy than I used to, in fact I fell in my driveway and hit my head again, which I’m sure didn’t help!”
This was the story of one teen who came to our office seeking help for attention, focus, and anxiety following a head injury. Unfortunately she is not alone in her experience. Read on to learn what are the riskiest sports, signs and symptoms of TBI, and how to protect your child.
Riskiest sports
Nearly a half million sports related head injuries annually according to estimates by the American Association of Neurological Surgeons (AANS). You may be surprised at the sports with the highest incidences of head injuries for children 14 years old and younger. Cycling is #1, followed closely by football, baseball, basketball, skateboards/ scooters, water sports (diving, swimming, water skiing) and soccer. Powered recreational vehicles, winter sports, ice hockey, and trampolines are responsible for injuries as well. I’d like to add cheerleading to the list.
What is TBI?
A traumatic brain injury (TBI) can result when the head suddenly and violently hits an object, when an object pierces the skull and enters brain tissue, or when the brain is subjected to concussive or shearing forces such as an explosion or whiplash. It is important to note that brain injury can occur without unconsciousness or injury to the skull. Symptoms of a TBI can be mild, moderate or severe, depending on the extent of damage to the brain. Mild cases may result in a brief change in one’s mental state or consciousness, while severe cases may result in extended periods of unconsciousness, coma or even death. Mild TBI is the terminology replacing “concussion.” New research into the cumulative effect of head injuries has been spawned by the spotlight on football players who sustain repetitive mild TBI.
Signs and symptoms of TBI
How do you recognize if your child may have had a mild TBI? The Brain Injury Association of America (BIA) notes that you may notice one or more of the following changes:
Physical changes or symptoms
These may be common immediately after a head injury, such as speech, vision, hearing changes/problems; headaches; nausea; difficulty with motor coordination; trouble with balance; sensitivity to loud noises, bright lights; and fatigue/change of sleep/wake state may be common. Immediately report any of these symptoms to your pediatrician for further evaluation or contact with your physician or pediatrician is delayed in any way take your child to the Emergency Room or Urgent Care. If your child cannot be awakened with a nudge or loud call of their name, call 911 immediately.
Cognitive impairments
Changes in the way your child thinks or communicates can be associated with TBI. This may include short term memory problems (forgetting their address, phone #, or familiar names), impaired concentration (difficulty keeping their attention on one thing at a time); slowness of thinking (trouble putting their words into thoughts); and a limited attention span. As well, changes in how their five senses are working (hearing, touching, seeing, smelling, tasting) can alert you to problem. Communication problems (difficulty getting their ideas in words) may start to show and difficulty planning things that were always easy for them, e.g. their free time, remembering their usual routines. Difficulty in your child’s writing (in school or during homework) or judgment (e.g. they forget to look both ways when they cross a street, when it has never been a problem before) are other problem signs to watch for.
Emotional changes
Mood swings or trouble controlling emotions can occur after a TBI as well. These include: denial of their expression of strong emotions; crying at the smallest of troubles; laughing at strange things; more restlessness with increased anxiety (nervousness) and over focus on worries and fears may become prominent. Overly sad or depressed states about their troubles, lack of motivation to do normal “kid things” may also be present. Again, please contact your physician if you identify any or many of these behaviors after a head/brain injury. It is imperative to their long term functioning. Even if your child has not had a head injury that you’re aware of, if they show any of the previous behavioral changes, please contact your physician as soon as possible.
Children are especially at risk
For children, cognitive (thinking and communication) changes after a head injury may not be immediately obvious, but may only become apparent years later as the child gets older and faces increased cognitive and social demands. The BIA reports that a brain injury actually has a more devastating impact on a child, than an injury of the same severity on a mature adult. The old thinking was that a child, due to the young brain’s greater neuroplasticity, would “grow out of it.” The new thinking is that the child “grows into” or adapts to the brain injury they sustained. Depending on the where and what of the brain injury, it may become harder and harder for the child to keep up with their peers in terms of the demands of development. Your child may have done well in the lower grades, but as the teaching material becomes more abstract it is harder for the child’s injured brain to keep up with learning needs. You may also see more of the emotional problems (stated above) in your child, due to their inability to adapt to the demands of growing up and the resulting sense of being different than others or damaged. These emotional changes will also present the injured brain with continued difficulty in doing its job.
What can a parent do?
Helmets are a must. Buy your child the right size helmet and insist on its use for high risk activities. Yep, with increased awareness and concern, helmets are even being considered for soccer, although there is still much debate around their use. In general, helmets are becoming more comfortable, accepted and hipper, with Olympic and professional athletes lending their endorsement and upping the cool factor. If the prices of helmets are too costly, and/or you have a number of young children, ask your School Nurse if she can help you out. Often, they have access to free or low-priced safety equipment.
Schools are encouraged to alert parents when their child has any level of head injury while in their care. Please take these notifications seriously, even if you think the injury was minimal. Call the school nurse for further information and direction. Also let your pediatrician’s office know and get direction. If you still have a nagging feeling about your child’s reactions take your child to an urgent care center. Also, always keep track in your child’s health diary, when head injuries occur and the behavior that follows.
Helmets are only part of the answer, estimates from the Quebec Trauma Center note that wearing a helmet only reduces the risk of head injury by 35% for certain sports. Make sure your child learns how to do a high risk activity safely and is well supervised by coaches, who are well informed on head injury prevention. Help educate yourself, your child’s coaches, and other parents with the Center for Disease Control’s Heads Up: Concussion in High School Sports. Learn how to respond if a concussion occurs and get lots of free videos, on-line training and brochures. Their biggest advice is not to assess an injury yourself, but to pull the student from play and seek the advice of a health care professional. A player who has sustained a concussion is 3-6 times more likely to sustain another if not removed from play for an appropriate amount of time.
Sports are a great way for kids to stay, healthy while learning important team-building skills. Let’s help them do it safely.
Note: This article is intended as educational material only and is not medical advice. Consult a medical professional if you have any medical concerns.
Author
Cynde MargritzLast month we talked about how to recognize the signs and symptoms of concussion, now called mild Traumatic Brain Injury (mild TBI) by medical professionals. There’s actually not much mild about it. It’s only mild compared to more serious head injuries. Children and teens are especially at risk. When any trauma happens to a developing brain, regardless of the classification, there may be serious short-term and/or long term effects. Awareness of prevention strategies is key to safe-guarding your brain, because it’s the only brain you get.
Limit or closely monitor participation in the riskiest sports.
You may be surprised at the sports with the highest incidences of head injuries. The American Association of Neurological Surgeons (AANS) reports for children 14 years old and younger: Cycling is #1, followed closely by football, baseball, basketball, skateboards/ scooters, water sports (diving, swimming, water skiing) and soccer. Driving or racing off-road recreational vehicles, winter sports, ice hockey, cheerleading and trampolines are responsible for many head injuries as well.
Use a helmet, but we aware of its limitations.
Buy the right size helmet and insist on its use for high risk activities. But don’t count on a helmet to prevent concussion. After all, think of all those football players with concussion who were all wearing helmets. However, they would likely be a lot worse off without the helmets. Biomechanical studies show that helmets reduce the severity of impact and prevent skull fractures and other head injuries like lacerations. Helmets protect your head, but they can’t fully protect your brain. Kids and teens should be reminded they’re not invincible just because they have a helmet on. Especially of concern are repeated assaults over time even while wearing a helmet.
Educate yourself and your kids.
Talk with them about concussions. Let them know the signs that something could be wrong. Explain how damage occurs. For younger children, you can use one of your fists to represent the brain and the other hand to cover the fist representing the skull. You can show them that during concussion the brain knocks against the very hard brain. Any damage can effect their ability to learn, speak, write, or play x-box!
All adults need to monitor and respond.
While prevention is key, it is also important for adults and kids who experience head trauma to report it and seek help right away. Unfortunately, in sports and the military where strength and a fighting spirit are celebrated many people won’t report their symptoms. Most players know that if they develop symptoms that are suspicious for concussions, they’re going to get pulled from the game.
Therefore, it’s important for people to monitor each other. Coaches and teachers should be alert for concussion symptoms (including confusion, delayed reaction times, agitation, knowledge of surroundings, date and time, headache, dizziness, balance, inappropriate responses, etc) among their players/ students and parents should ask their children if they’ve been hit in the head during practice (and be alert for symptoms). Even mild head trauma should be reported and treated promptly to avoid worsening of symptoms and the risk of new blows to the head. An environment where people feel safe to report their symptoms and where coaches, trainers, and parents work to prevent trauma could go a long way in reducing the risk for long term problems from head trauma.
The Centers of Disease Control “Heads Up” campaign provides free educational materials on concussion for parents, coaches, students. CDC - Heads up to High School Sports.
Consider baseline testing.
New on the sports scene and being explored by the Consensus Statement on Concussion in Sport (2012) is the idea of pre-season baseline neuropsych and electrophysiological testing (Quantitative Electroencephalogram, QEEG). While QEEG is not a diagnostic tool, it does provide insight into how areas of the brain are performing from an electrical perspective. Please contact our office if you are interested in learning more about how we do QEEGs, also called brain maps. We also offer scientifically validated training that can help mitigate the cognitive and emotional symptoms that may be associated with concussion/ mild TBI.
Note: This information is for educational purposes only and should not be interpreted as medical advice. Please see your medical professional if you have any health concerns.
Author
Cynde MargritzMy Dad was a Purple Heart decorated army combat veteran of WWII. He never spoke of the war or his friend he kept in touch with who was the only other survivor of his company. The only evidence of his Post Traumatic Stress Disorder (PTSD) was whenever any of us in the household of three women raised their voice in conflict, he retreated to the back porch where he might stay for hours, long after the issue was over. I didn’t know about PTSD back then, but we speculated that his behavior was related to his experiences in the war.
Definition
PTSD has likely been around as long as people have been experiencing stress and trauma. One doesn’t necessarily have to be in a war in order to suffer from it. PTSD is primarily caused by human reactions to a negative event outside the realm of ordinary life experiences. Domestic and criminal violence, physical or emotional abuse, natural disasters, transportation accidents, significant illnesses, even a life-threatening scare or witnessing a traumatic event can all be triggers for PTSD. PTSD may also result from long-term exposure to trauma, such as that experienced by rescue workers, doctors, and nurses.
What happens to the brain in PTSD?
Basically the brain gets stuck to a certain degree re-living the event. As part of the brain’s neuroplastic behavior (learning and adapting to situations) it has learned that life is traumatic and it is staying hyper-vigilent to be alert for it happening again. Recent research at the Marine Corps Base Camp Lejeune suggest that PTSD causes actual physiological changes in the brain. The brain has rewired itself in an attempt to cope with the traumatic event.
Symptoms
PTSD is not just the classic flash-backs. PTSD symptoms can range in severity from mild to severe, depending on a person's personality and genetic make-up and the severity of the event. Symptoms may include: insomnia, easy startling, difficulty concentrating, irritability, nightmares, avoidance of exposure to anything that might trigger memories of the trauma, feelings of disconnection from other people (including loved ones), lack of sense of meaning in life, feeling numb, and attempts to self-medicate to feel better can lead to an increased risk of substance abuse.
What can be done?
I love this quote from Jacqueline N. Martin, M.S. “A diagnosis of PTSD does not indicate personal weakness or mental illness. It is a perfectly natural and normal reaction to one or more abnormal events. Just like a perfectly healthy bone will break if placed under enough stress, a perfectly healthy person placed under sufficient stress can develop PTSD.”
Returning to resiliency by training the brain to “un-do” the traumatic stress wiring is possible with neurofeedback, a type of biofeedback. A Quantitative Electroencephalogram (QEEG), or brain map, can show characteristic patterns of brain electrical activity typically associated with PTSD symptoms. We can then target those areas for training. Research supports the use of neurofeedback to balance and calm down the over activation in the central nervous system.
The results can be astounding. One example: a veteran who had been a medic in Vietnam was still experiencing flashbacks, insomnia, alcoholism, depression, anxiety, and irritability. After neurofeedback training he became more functional, could hold down a job, began sleeping better, had far fewer flashbacks, and could maintain sobriety. The turning point came when he had a dream of himself as a whole, healthy person walking through a field in Vietnam. The changes in his brain activity were documented using SPECT imaging and are available on our website.
We work with veterans as well as other individuals who feel PTSD has impacted their lives. For a list of providers who have agreed to provide training to one veteran per year at no cost, check Homecoming 4 veterans. Neurofeedback is compatible with other treatments such as psychotherapy and medication.
Author
Cynde MargritzThere has been a lot of discussion in the media this past month regarding the world of football since PBS aired its investigative documentary “A League of Denial: The NFL’s Concussion Crisis.” http://to.pbs.org/1c8cP3W. A similar investigative report was on Frontline in 2011 called “Football High” that dealt with football injuries in teens.
You can keep tabs on the running total of concussions this NFL season at http://www.pbs.org/wgbh/pages/frontline/concussion-watch/, where they report a total of 53 players being sidelined so far this year with concussion. The 2011 season saw a total of 171 concussions. Wide receivers and cornerbacks seem to get them the most often. Linebackers, defensive ends, running backs. guards, and safeties are the second most frequent position, but no position is immune.
It’s tough for a neurofeedback practitioner to watch the stories of those who suffered concussion (and those who left behind young families) and not want to speak out about the efficacy and availability of our modality that can help with many of the symptoms of concussion. While neurofeedback isn’t a panacea that can patch up brains and let them take a continued beating, it can help with the often significant cognitive and emotional symptoms that can arise with concussion. It is best implemented as part of a comprehensive rest and recovery program along with your physician’s treatment.
Symptoms addressed
This fall in our office, we’ve seeing local young athletes with concussions from football, cheerleading, and field hockey. The most common symptoms we work with are attention, short term memory, anxiety, negative mood, irritability, headaches, reading difficulties, and sleep. Solid science and research support results in these areas.
From our unique perspective looking at the brain as a complex and delicate array of electrophysiology, we help the brain re-establish it’s connections, calm over-activation, slowly reactivate impacted areas, and regain or exceed its former performance. The process works like an electronic coach that provides feedback when the brain is working better.
Ultimately, we share information with our clients and their parents about the risks involved with continued play so that they along with their physician can make the decision about a judicious return to play when recovery is complete.
Monitor and respond
Parents, coaches and teachers should be alert for concussion symptoms (including confusion, delayed reaction times, agitation, headache, dizziness, inappropriate or unusual responses, altered sleep patterns) among their players and students. Parents should ask their children if they’ve been hit in the head during practice as well as games. Even mild head trauma should be reported and treated promptly to avoid worsening of symptoms and the risk of new blows to the head.
Consider baseline testing
Some schools have begun using pre-season neurocognitive testing so they have a baseline to monitor for concussion. We also recommend electrophysiological testing (Quantitative Electroencephalogram, QEEG) also called brain mapping, a type of functional imaging. QEEG is not diagnostic; it does provide insight into how areas of the brain are currently performing. Please contact our office if you are interested in learning more about getting a pre or mid-season baseline.
Note: This information is for educational purposes only and should not be interpreted as medical advice. Please see your medical professional if you have any health concerns.
Author
Cynde MargritzA single mother brought her bright, music-loving eight-year-old son, Brian, to my office because the behaviors stemming from his ADHD had become intolerable. He was confrontational and aggressive. He had been threatened with suspension from school for his anger and for hitting other students, but he continued.
His mother hoped that neurofeedback would help provide a positive change in his behavior. At Brian’s first visit, he was so hyperactive, he could barely sit still long enough to put the sensors on but, after a only few minutes of training, he began to calm down.