This may be an especially important consideration for brain-injured patients who may not be able to tolerate the claustrophobic conditions of an fMRI or its noise, or who have trouble with motor coordination and holding still for multiple scans. With fNIRS, the infrared lights are attached to a swimming cap that is placed on the patient’s head. The patient is unconstrained and can sit comfortably in an environment that’s familiar. The device is portable, tolerates movement, and can be easily incorporated into the rehabilitation setting. It’s also a more cost-effective option for rehabilitation clinics. While an fMRI is a multimillion-dollar investment, fNIRS costs a fraction of that and has no run-time costs.
Impact On Treatment
To date, therapists have had little evidence-based information available about the physiological changes produced at the brain level by specific interventions. They typically assess brain injury by measuring its impact on a person’s distraction and structure tolerance, and ability to perform certain skills, such as buttoning a shirt or identifying words. Based on these observations, they recommend a treatment plan that incorporates the patient’s interests and goals, and then regularly monitor progress.
Therapists at Pate Rehabilitation are among the first in the nation to use fNIRS to better understand the brain’s neuroplasticity. By looking at activation patterns and how the brain responds to tasks, they hope to gain insight on how the brain reorganizes itself after injury and which type of treatment may be most effective for improving brain recovery.
Preliminary results have led to a surprising re-evaluation of what was known about impulse control. Patients with TBI are often unable to inhibit automatic responses because of damage to the frontal area. In order to gauge attention-capability, therapists frequently administer a Stroop test to brain-injured patients, in which they are asked to identify the color of ink of the printed word, not the word itself. The patient has to focus and override the impulse to do what comes naturally and, instead, perform a less habitual response.
Pate Rehabilitation researchers using fNIRS fully expected to see less activation in the part of the brain controlling behavior. Instead, they found just the opposite: There was as much activity during the simple word-reading phase as there was during the more complex color-naming phase, suggesting that the patients had significant difficulty focusing on relevant aspects of the task.
The findings beg us to reconsider traditional approaches to improving concentration. So rather than trying to boost activation levels in brain-injured patients, therapists might consider treatments to lower stimulation levels.
Having hard data at our disposal will help us be more objective and effective in our evaluation of brain injury and lead the way to better treatments. And it may one day give hope to survivors of brain injury and their families.
Patrick Plenger, Ph.D., is a board-certified clinical neuropsychologist with more than 30 years’ experience in assessments, treatments and directing brain-injury rehabilitation programs. He is currently the director of clinical research at Pate Rehabilitation.
Matthew Cloud is a doctoral student in biomedical engineering at the University of Texas at Arlington and a research assistant with Pate Rehabilitation. Having gone through rehabilitation due to a transient ischemic attack and spinal cord injuries, he has a thorough understanding of the effects of TBI and stroke.
This article was first published in Brain World Magazine’s Winter 2013 issue.
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