Neurofeedback with a Stroke PatientKelley Villegas, OTR

Meet Annette• She is a 48 yo female who is 3 years post thalamic

CVA (ruptured aneurysm);

• She was referred to me by a hand therapist colleague, Heidi White, OTR/CHT, whom was seeing her for tendon releases of the wrist and elbow due to severe muscle contractures (see prior pictures).

• She wanted to know if I could help her “get her arm back.” I informed her of some of the case studies out there that I found, but no concrete evidence that NF would help.

• I also explained other benefits of NF that would improve her quality of life.

• When she started with me (Jan. 5, 2019), she had just had her wrist released, and after 2 sessions, she got her elbow released.

• After the 5th session, Heidi informed me that she was getting active elbow extension and shoulder flexion, which is documented in her OT notes on March 1, 2019.

• Her pain also resolved in her hand, which had been a major issue previously.

• Functionally, she had also achieved improved independence in dressing skills to independent with her upper body dressing, minimal assistance with bathing, and ambulating with a cane.

• Her next reassessment, on April 17, 2019, showed all goals met for ADL’s, ROM, and function.

• This included goals for the following: Annette assessing her LUE for hygiene independently, increasing her LUE AROM, decreasing LUE hypertonicity, and decreasing pain in her LUE.

• It was also noted in her reassessment that the therapist was able to elicit active triceps and wrist extension, with use of vibration (not previously achieved).

• Additionally, her therapist noted in the last re-evaluation that Annette has become more actively engaged in her therapy sessions, and is problem-solving ways she can improve her independence.

The following were her protocols:

• She was seen twice/week for 30-minute sessions from session 1-25.

• Session 1-3: Started T3-T4 at .001

• Session 4-6: added T4-P4 at .001

• Session 7-9: added T4-Fp2 at .001

• Session 10-25: added T4-C4 at .001

At session 25, we decided to do one-hour sessions, once/week to challenge her brain, and we added T3-Fp1 on Session 26/27, due to c/o depression.

On her 30th visit, she informed me that in PT, she started walking without her cane, and then sent this picture of her and her mother on Mother’s Day...

I am quite honored to treat Annette, because she is my age, and it’s a great feeling that I am helping her gain independence and self-worth after such a traumatic last few years. She is still very focused on improving her LUE function, but has seen the following progress in her symptom tracker: (in percent of improvements)

Right Parietal: • Physical tension: 30%• Lack of body awareness: 75%• Feeling disconnected from body: 100%• Muscle aches/pains: 40%• Lack of time awareness: 100%• Inability to fall asleep within 20 minutes: 50%• Poor balance: 75%• Poor fine motor coordination: 50%• Muscle spasticity: 75%• Reflux: 50%• Chronic nerve pain: 50%

Right Pre-Frontal: • Paranoia: 50%

Left Pre-Frontal:• Poor working memory: 75%• Chronic aching pain: 50%• Attention deficit: 50%

Left Parietal:• Difficulty with L-R awareness: 100%• Easily distracted: 75%

Interhemispheric:• Night sweats: 100%• Vertigo: 75%• Poor auditory Processing: 75%• Hot flashes: 50%