Vancouver Concussion & Neurofeedback Centre

Services

 

Neuropsychological Assessment

Neuropsychological assessment involves investigation of various aspects of function including intellectual, emotional, perceptual, sensory, strength, and coordination with consideration in relation to integrity of brain function. Detailed interview, review of medical and educational records, and the use of published standardized psychological tests are the most commonly used methods used in this type of assessment; quantitative EEG (QEEG) and event related potentials (ERP) can also be incorporated into this type of assessment. Neuropsychological assessment is used for diagnostic purposes (learning disabilities, concussions and more severe brain injury, developmental disabilities, loss of mental efficiency with aging, dementing processes, posttraumatic stress disorder, and emotional problems), to characterize change following compromise of brain function, determinations relating to return to play in sports, and determinations of mental efficiency in relation to careers.

Quantitative EEG (QEEG)

This method is used to record and analyze the brain’s own natural electrical activity as recorded from the surface of the scalp by digital electroencephalographic equipment. Raw waveforms and computer analyzed data are carefully interpreted. This is an exquisitely sensitive and relatively low price technique for exploring efficiency of brain function. It is also used to guide neurofeedback therapy (a particular variation is used for LENS therapy).

 

Neurofeedback Therapy

Neurofeedback may bring about the reduction of symptoms associated with many challenges, amongst them: depression, brain injury, anxiety, ADD/ADHD, epilepsy, posttraumatic stress disorder, stroke, headache, balance problems, autistic spectrum disorder, anxiety disorder and fibromyalgia.

There are two major techniques of neurofeedback: (1) the earlier developed and more widely used technique that is most typically associated with the term “neurofeedback” and which may be described as “traditional” neurofeedback; and (2) the more recently developed technique known as the “Low Energy Neurofeedback System” usually referred to by the acronym LENS.

In traditional neurofeedback the client attempts to change patterns of functioning in brain circuits by receiving near instantaneous feedback (auditory or visual) about features of their brain waves. It is biofeedback as it is commonly defined specifically directed towards brainwaves. This approach begins with some determination by the clinician as to what would be a healthier pattern of neurophysiological functioning as represented by brain waves for the client. The client then over many sessions attempts--with the aid of computer generated signals— to shift their brain waves in the direction of the formulated target thereby possibly inducing long term modifications in the functioning of brain circuits. Overall, the process can help establish healthier brain function via repeated retraining of neurophysiology represented by features of brain waves.

The second major method, LENS, utilizes a feedback loop component between the client’s brain waves and an energetically extremely tiny, subtle signal applied to the scalp via a sensor for one or a number of seconds. The signal has the intensity of output that is so small it approaches being immeasurable (less than a trillionth of a cell phone output). The effectiveness of LENS seems to be in part derived from the combination of: the very low intensity of the signal compatible with the magnitude of actual biological energy; the application of the single being closely guided by analysis of features of the client’s brain wave patterns; and the unique dynamics of the actual feedback loop where there is a rapid interactive updating between the signal and the brain’s fluctuating dominant frequency. LENS can be highly effective for gently helping brain circuits to move towards more optimal variability and become more flexible and self-regulating. It tends to achieve effects considerably more quickly than traditional neurofeedback.

I use both techniques in my work and both can bring about remarkable results in reducing symptoms.

Heart Rate Variability Biofeedback

Heart rate variability (HRV) is a measure of naturally occurring fluctuations in the time interval between heart beats, typically monitored when an individual is in a resting state. In a healthy state, even when a person is sitting still and resting, the pace of heart beats may speed up and slow down from beat to beat, so that the interval of time between neighboring heart beats frequently changes—it is variable rather than constant. For example, the time between two back-to-back heart beats may be one second; and the interval between the next two back-to- back heart beats may be thee-quarters of a second. The space of time between heart beats may be abnormally constant with minimal variation; this is commonly described as a state of low HRV. There are many studies now that report an association between low HRV and a wide range of physical and psychological problems and low HRV seems to well predict future health problems. It is also thought that too high HRV is also associated with health problems—this relates to an excessive instability in pacing between heart beats. Researchers have identified a pattern of fluctuation in the interval between adjacent heart beats over time that they believe represents, “optimal” HRV, as this pattern is most strongly associated with emotional and physical health as well as efficiency in aspects of intellectual functioning. This optimal pattern involves a repeated cycle of rhythmic speeding up and slowing down of heart beat rate at a specific pace.

HRV biofeedback is a method that can be used to assist individuals to learn to shift their own HRV so that during the biofeedback session they move closer or into the optimal pattern, and with increasing practice are able to learn to longer sustain the time at the determined level of optimal HRV. The individual receiving this therapy is provided with visual or auditory indicators—this being the “feedback”—that instantaneously inform of movement towards or into the optimal HRV pattern or away from it. Over time this feedback helps the client to learn how to bring about a favourable shift in HRV.

Sports Concussion Issues

Dr. Lewkis offers opinion on the issues of return to play and career continuation for parents who are concerned about their child's well being and semi-professional and professional athletes. Assessments are conducted with interviewing, psychometric challenges and quantitative EEG.