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Editorial Commentary
Traumatic Brain Injury: Is Neurofeedback the Best Available Therapy?

  J Lucas Koberda1,2*

1Director of Tallahassee NeuroBalance Center, Tallahassee, FL 32309, USA
2CEO-Brain Enhancement Inc., USA

*Corresponding author: J. Lucas Koberda, Director of Tallahassee NeuroBalance Center, Tallahassee, FL 32309, USA, E-mail:


Neurofeedback; TBI; Z-score; LORETA; EEG; QEEG


Traumatic brain injury (TBI) can be easily diagnosed in the case of major head trauma with positive structural imaging findings (MRI-, CTof the brain). Unfortunately, if the injuries are subtle-no major alteration of the consciousness—making the diagnosis of mild TBI (mTBI) can be more challenging. More recently, electrical imaging called quantitative electroencephalography (QEEG) has been useful in confirming mTBI diagnosis [1-3].

Despite the relatively high occurrence of TBI’s, the available therapies for this condition are limited-relying primarily on symptomatic treatment and with unsatisfactory results. Chronic sequela of TBI include neurological impairments (cognitive deficits such as ADD-like symptoms, seizures, headaches, weakness, numbness and/or balance problems) and are frequently associated with psychiatric dysfunction (depression, anxiety, PTSD, etc.). Pharmacotherapy, cognitive behavioral therapy, physical therapy, and occupational therapy are frequently employed in the rehabilitation of these patients.

Neuromodulation represented by neurofeedback (NFB; also called EEG-biofeedback), has been known as a potential therapeutic modality for fifty years. This type of biofeedback uses real-time displays of EEG to illustrate brain activity. One or two sensor based NFB therapy required in many instances 50 or more sessions in order to achieve the therapeutic goals. Z-score Low Resolution Electro-magnetic Tomography Analysis (LORETA) 19-electrode (cap system) NFB was relatively recently introduced to the market (Applied Neurosciences, Inc.). This system has the potential for faster results based on the larger number of electrodes (scalp sensors) applied during treatment [4]. In Z-Score NFB, a real-time comparison to an age-matched population of healthy subjects is used for data acquisition—simplifying protocol generation and allowing clinicians to target modules/hubs that indicate abnormalities in networks related to the patient’s symptoms [5]. Z-score NFB increases specificity in operant conditioning, this provides a guide that links extreme Z-score outliers to symptoms and then reinforces Z-score shifts toward states of greater homeostasis and stability. The goal is increased efficiency of information processing in brain networks related to the patient’s symptoms [6].

This technology has been recently shown to be effective in therapy of many neuropsychiatric disorders including: chronic pain, depression, stroke rehabilitation as well as cognitive dysfunction [6-9]. The potential advantage of neuromodulation over pharmacotherapy is its ability of bypassing the digestive tract to interact almost directly with dysregulated neurons. This creates the opportunity to potentially lower side effects while increasing therapeutic gains.

Our clinical research has previously demonstrated the efficiency of LORETA Z-score NFB in patients suffering from epilepsy, chronic pain, Alzheimer’s disease, autistic spectrum disorders, attention deficit hyperactivity disorder and other neuropsychiatric conditions [9-14]. Recently published papers [15,16] reported the marked improvements of cognitive function, MRI abnormalities, and quality of life of TBI patients subjected to NFB. Post-NFB findings have shown significant increase in cortical grey matter (GM) volumes and fractional anisotropy (FA) of cortical white matter (WM) tracts [15]. Similar MRI findings were previously reported by University of Montreal group [17] in a randomized study performed on normal volunteers. Also other groups reported beneficial effects of NFB in therapy of TBI patients [16,18].

Preliminary data coming from my clinic indicates a very promising response of TBI patients to LORETA Z-score NFB therapy. The majority of patients reported an improvement of their TBI-related symptoms within ten NFB sessions. Many of them were also found to have an objective cognitive improvement documented by a computerized cognitive testing. In addition to that, this type of NFB rehabilitation therapy was able to normalize many QEEG abnormalities identified in TBI patients during the initial pre-NFB evaluations. This editorial serves as the introduction to the upcoming original article reporting the effectiveness of Z-score LORETA NFB in therapy of patients suffering from TBI. Preliminary results of this study were presented during the International Society for Neurofeedback and Research (ISNR) 2014 meeting and subsequently published in the abstract form [19]. In the future a larger placebo controlled study may be beneficial to further document efficiency of this type of NFB in therapy of TBI patients.

  1. Thatcher RW, North DM, Curtin RT, Walker RA, Biver CJ, et al. (2001) An EEG severity index of traumatic brain injury. J Neuropsychiatry Clin Neurosci 13: 77-87. [Ref.]
  2. Koberda JL, Moses A, Koberda P, Koberda L (2013) Clinical advantages of quantitative electroencephalogram (QEEG)-electrical neuroimaging application in general neurology practice. Clin EEG Neurosci 44: 273-85. [Ref.]
  3. Schmitt S, Dichter MA (2015) Electrophysiologic recordings in traumatic brain injury. Handb Clin Neurol. 127: 319-39. [Ref.]
  4. Koberda JL, Moses A, Koberda L, Koberda P (2012) Cognitive Enhancement Using 19-electrode Z-score Neurofeedback. J Neurother 224-230. [Ref.]
  5. Thatcher RW (2013) Latest Developments in Live Z-Score Training: Symptom Check List, Phase Reset, and Loreta Z-Score Biofeedback. J Neurotherapy 17: 69-87. [Ref.]
  6. Koberda JL, Moses A, Koberda P, Koberda L (2012) Comparison of the Effectiveness of Z-Score Surface/LORETA 19-Electrodes Neurofeedback to Standard 1-Electrode Neurofeedback. J Neurotherapy 4: 302. [Ref.]
  7. Koberda, JL (2014) Z-score LORETA Neurofeedback as a Potential Rehabilitation Modality in Patients with CVA. J Neurol Stroke 1: 00029. [Ref.]
  8. Koberda JL (2014) Z-score LORETA Neurofeedback as a Potential Therapy in Cognitive Dysfunction and Dementia. J Psychology and Clinical Psychiatry 1: 00037 . [Ref.]
  9. Frey LC, Koberda JL (2015) LORETA Z-score neurofeedback in patients with medically-refractory epilepsy. J Neurol Neurobiol 1: 102. [Ref.]
  10. Koberda JL (2012) Autistic Spectrum Disorder (ASD) as a Potential Target of Z-score LORETA Neurofeedback. Neuroconnection (ISNR) 24. [Ref.]
  11. Koberda JL, Koberda P, Bienkiewicz A, Moses A, Koberda L (2013) Pain Management Using 19-Electrode Z-Score LORETA Neurofeedback. J Neurother 3: 179-190. [Ref.]
  12. Koberda JL, Koberda P, Moses A, Winslow J, Bienkiewicz A, et al. (2014) Z-score LORETA Neurofeedback as a potential therapy of ADHD. Special Edition-Biofeedback Magazine-summer 2014 [Ref.]
  13. Koberda JL (2015) Z-score LORETA Neurofeedback as a Potential Therapy in Depression/Anxiety and Cognitive Dysfunction in “Z Score Neurofeedback: Clinical Applications”. Editors-Thatcher, RE and Lubar, JF-Academic Press, San Diego, CA
  14. Koberda, JL, Frey LC (2015) Application of Z-score LORETA Neurofeedback in Therapy of Epilepsy. J Neurol Neurobiol 1: e101. [Ref.]
  15. Munivenkatappa A, Rajeswaran J, Indira Devi B, Bennet N, Upadhyay N (2014) EEG Neurofeedback therapy: Can it attenuate brain changes in TBI? NeuroRehabilitation 35: 481-484. [Ref.]
  16. Reddy RP, Rajeswaran J, Bhagavatula ID, Kandavel T (2014) Silent Epidemic: The Effects of Neurofeedback on Quality-of-Life. Indian J Psychol Med 36: 40-44. [Ref.]
  17. Ghaziri J, Tucholka A, Larue V, Blanchette-Sylvestre M, Reyburn G, et al. (2013) Neurofeedback Training Induces Changes in White and Gray Matter. Clin EEG Neurosci 44: 265-272. [Ref.]
  18. Duff J (2004) The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clin EEG Neurosci 35:198-209. [Ref.]
  19. Koberda JL, Bienkiewicz A, Koberda L, Koberda P, Moses A, et al. (2014) Accelerated Recovery from Traumatic Brain Injury (TBI) with Z-score Neurofeedback Therapy-presented during the ISNR meetingSan Diego, CA NeuroRegulation 1: 273-316.

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Article Information

Aritcle Type: Editorial Commentary

Citation: Koberda JL (2015) Traumatic Brain Injury: Is Neurofeedback the Best Available Therapy? J neurol Neurobiol 1(3): doi

Copyright:© 2015 Koberda JL. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication history: 

  • Received date: 23 July 2015

  • Accepted date: 25 July 2015

  • Published date: 28 July 2015