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Biofeedback and Mindfulness - Applications to Acquired Brain Injury

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Canadian Association of Occupational Therapists (CAOT) Conference - June 6-9, 2012 - Biofeedback and Mindfulness

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Biofeedback and Mindfulness - Applications to Acquired Brain Injury

  1. 1. Amee Le Applications to Acquired Brain Injury
  2. 2. 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
  3. 3. 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
  4. 4. Our Clients Question: What is the best thing about having a brain injury? Answer: You can hide your own Easter Eggs.
  5. 5. Mindfulness Being mindful is associated with: • Less emotional stress • More positive states of mind • Better quality of life • Influencing the brain & autonomic nervous system
  6. 6. 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
  7. 7. 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
  8. 8. 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”
  9. 9. 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
  10. 10. Evolution of ECG & HRV Technology
  11. 11. Heart Rate Variability (HRV)
  12. 12. HEARTRATE(BPM) 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
  13. 13. Incoherence: Impairs Performance–Amplifies Energy Drains Coherence: Promotes Optimal Performance–Builds Resilience HEARTRATE HEARTRATE 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. He was referred to OT services managing his anxiety in relations to falls prevention
  19. 19. 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
  20. 20. 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)
  21. 21. 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
  22. 22. J.J. was referred to OT Services for managing his pain
  23. 23. 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)!!
  24. 24. Contact information Amee Le Community Head Injury Resource Services of Toronto 62 Finch Avenue West, Toronto, Ontario M2N 7G1 416-240-8000 x 284 ameel@chirs.com

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