GLA Newsletter  |  Summer Issue  |  June 2017
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More Than “Just” a Hobby: Perspectives of an ABI survivor on the importance of incorporating hobbies into the recovery process.

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Happy Summer!

Mayor John Tory proclaims, "June is Brain Injury Awareness Month"!  

Congratulations to BIST/OBIA for hosting Ontario's (and likely Canada's) largest Mix n Mingle. This year's attendance was the largest to date.

Please refer to our website  to find out more information.
With the new legislation concerning application for catastrophic designation by positive findings of a head injury on a “medically recognized brain diagnostic technology”, we recently started to collect information on assessment techniques that may benefit clients who have sustained a mild traumatic brain injury (mTBI).
The Ontario Neurotrauma Foundation provides guidelines for primary health care providers to diagnose mTBI including early assessment, a thorough clinical history and guidelines for when to administer a CT scan[1].

CT scans and MRIs may not be sensitive enough to show abnormalities, while the client continues to report symptoms of post-concussion syndrome, including fatigue, headaches, dizziness and cognitive-behavioural impairments.
In this issue we chose to present the quantitative electroencephalogram (EEG), evoked potentials and heart rate variability tests, which are biofeedback techniques to assess and treat mTBI.
While some clinicians have been using biofeedback for years to assess and treat mTBI, evolving techniques are beginning to develop more traction in the rehabilitation community.
Those of us who work with clients in the months following an mTBI recognize that these symptoms can have a debilitating effect and prevent a return to a pre-accident level of functioning.
A quantitative EEG is a test that analyzes the electrical activity of the brain. It measures brain patterns that may correspond to diagnostic information including cognitive deficits. This procedure is often referred to as "brain mapping”.
Quantitative EEGs have been demonstrated as highly sensitive in their ability to identify post-concussion syndrome[2]. They have been used in patients to detect delayed physiological recovery after less sensitive testing techniques have suggested that the patient has achieved a clinical recovery[3]. This is important, as many people continue to report the effects of post-concussion syndrome long after they have been told that they “should be fine by now”.

Evoked potential (EP) tests measure the electrical activity of the brain in response to stimulation of specific sensory nerve pathways such as visual and auditory pathways. EP tests are able to detect the slowing of electrical conduction caused by damage along these pathways, even when the change is too subtle to show up on a traditional neurologic examination.
A recent Ontario study demonstrated that EP tests results were worse in high impact football players when compared to low impact football players. High impact players (those with more hits to the head over the season) showed statistically significant decreases in EP tests at midseason and postseason compared to low impact players[4]
Heart rate variability (HRV) is the physiological variation of heart rate, controlled by the autonomic nervous system. Measuring HRV can reveal important information about health and body function and can be used in patients with mTBI. Assessing HRV can show changes in the body’s stress level while other physiological tests, like blood pressure, are still in normal ranges.
Optimal HRV has been shown to improve neurocognitive performance by enhancing focus, visual acuity and by promoting emotional regulation needed for peak performance.  Treatment modalities such as biofeedback training have been shown to improve cognitive functioning in athletes with concussion[5] who are experiencing cognitive deficits.
At GLA, we are always interested in learning more about emerging modalities that may help our clients with post-concussion syndrome and we will continue to develop our practice and recommendations based on current research.
If you would like to learn more about biofeedback, please let us know. We will be more than happy to provide additional information.
In addition, in this issue of the newsletter we are sharing a client success story. With the help of his case manager, OT, SW and SLP, one of our former ABI clients has turned his passion for music and deejaying into a full time occupation and we’re delighted to share his story here.
Best wishes for a safe and happy summer ahead!
From all of us at GLA

[2] Duff, J. (2004). The usefulness of quantitative EEG (QEEG) and neurotherapy in the assessment and treatment of post-concussion syndrome. Clinical EEG and Neuroscience35(4), 198-209.
[3] McCrea, M., Prichep, L., Powell, M. R., Chabot, R., & Barr, W. B. (2010). Acute effects and recovery after sport‐related concussion: a neurocognitive and quantitative brain electrical activity study. The Journal of Head Trauma Rehabilitation25(4), 283-292.
[4] Brooks, Jeffrey S., James W. Thompson, and James P. Dickey. "P17. P3b event-related potentials show changes in varsity football players due to accumulated sub-concussive head impacts." (2017).
[5] Conder, R. L., & Conder, A. A. (2014). Heart rate variability interventions for concussion and rehabilitation. Frontiers in Psychology5, 890.

Best Regards,
Galit Liffshiz, MA OT Reg. (Ont.)
Expertise and Experience in Life Care Planning
Designated Capacity Assessor

More Than “Just” a Hobby: Perspectives of an ABI survivor on the importance of incorporating hobbies into the recovery process.

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