Cognitive Decline

Traumatic Brain Injury (TBI) rehabilitation has had a limited number of strategies used in the treatment of cognitive disorders. These methods included procedures that utilize stimulation and practice (to help improve memory and recall); strategy cognitive rehabilitation (e.g., visualization and creating associations), compensatory cognitive rehabilitation strategies; and medications that help to aid with attention and/or memory recall.

Many problem areas seen in TBI patients that neurofeedback has been used to improve are attention, impulse/emotional control, memory, anxiety, insomnia, depression, and physical balance.

Hammond, C. (2012) discussed that “Some recent studies with normal individuals also have implications for TBI treatment. Vernon et al. (2003) documented in a control group study that only 8 sessions of neurofeedback could improve memory recall, and a recent placebo-controlled study (Hoedlmoser et al., 2008) of neurofeedback validated that only 10 sessions improved sleep onset latency and subsequent declarative learning in normal subjects. Other reviews have been published on the use of neurofeedback in the treatment of depression and anxiety (Hammond, 2005a), for improving physical balance (Hammond, 2005b), and in the treatment of obsessive-compulsive disorder (Hammond, 2003). 

Although better and more well-controlled research is needed preliminary neurofeedback treatment outcome studies of closed and open brain injuries too numerous to cite have been published. For example, Schoenberger et al (2001) compared treatment (25 sessions) with the Low Energy Neurofeedback System (LENS) of 9 mild and 3 moderate TBI patients with a wait-list control group. They found significant improvement in measures of attention and recall. Thornton and Carmody (2005) found 186% improvement in memory scores in TBI patients treated with neurofeedback compared to a control group with no TBI history. When Thornton and Carmody (2008) compared neurocognitive rehabilitation strategies, medication treatment, and neurofeedback treatment in an effect size analysis, neurofeedback appeared more efficacious than other treatment strategies. Ayers (1999) has even brought many patients out of coma using neurofeedback.” Uncontrolled epileptic seizures have been effectively treated using neurofeedback. Research in this area began in the early 1970’s, including blind, placebo-controlled and cross-over studies (reviewed in Sterman, 2000). Neurofeedback has been found to be helpful in many forms of epilepsy, including grand mal, complex partial, and petit mal (absence) seizures. Although the larger proportion of seizure patients are adequately controlled by medication, most of the individuals who have been treated with neurofeedback in research studies are among the most severe epilepsy patients, where anticonvulsant drug therapy was unable to control their seizures. However, even in this most severe group of patients, research found that neurofeedback training on average produced a 70% reduction in seizures. In these severe cases of medically intractable epilepsy, neurofeedback was able to facilitate greater control of seizures in 82% of patients, often reducing the level of medication required, which can be very positive given the long-term negative effects of some medications. Many patients, however, will need to remain on some level of medication following neurofeedback. Training often requires 50 sessions or more. Treatment outcome studies of closed and open head brain injuries are also now beginning to be seen, as well as with stroke, but better research still needs to be done in these latter areas.

Putting back the pieces after a brain injury is a complex journey, we aim to tailor our treatment approach to you or your loved one’s specific needs.

This next section is taken from the Brain Injury Association of American. They do a great job explaining the different parts of the brain and how it processes information.

The human brain is magnificent and complex. The brain is made up of many parts, each with a specific and important function. It controls our ability to balance, walk, talk, and eat. It coordinates and regulates our breathing, blood circulation, and heart rate. It is responsible for our ability to speak, to process and remember information, make decisions, and feel emotions. Every brain is unique, ever-changing, and extremely sensitive to its environment.

The brain is divided into functional sections called lobes: 

  • Frontal Lobe (shown in orange)
  • Temporal Lobe (pink)
  • Parietal Lobe (blue)
  • Occipital Lobe (green)
  • Cerebellum (red)
  • Brain Stem (yellow)

Each lobe has an important and specific function detailed below:

Frontal Lobes Functions (Orange)

Expressive Language (Speaking)
Motor Planning & Initiation
Awareness of Abilities
Awareness of Limitations

Mental Flexibility
Inhibition of Behavior
Problem Solving

An injury to the frontal lobes may affect an individual’s ability to control emotions, impulses, and behavior or may cause difficulty recalling events or speaking.

Temporal Lobes Functions (Pink)

Parietal Lobes Functions (Blue)

Understanding Language (Receptive Language)

An injury to the temporal lobes may lead individuals to demonstrate difficulty with communication or memory.

Sense of Touch
Spatial Perception (Depth Perception)
Identification of Sizes, Shapes, Colors
Visual Perception

Individuals who have injured their parietal lobes may have trouble with their five primary senses.

Cerebellum Functions (Red)

  • Balance & Coordination
  • Skilled Motor Activity
  • Visual Perception

An injury to the cerebellum may affect balance, movement, and coordination.


Occipital Lobes Functions (Green)

  • Vision

An injury to one’s occipital lobes may lead to trouble seeing or perceiving the size and shape of objects.

The functional sections (lobes) of the brain are also categorized by side – the right side and the left side. If you split the brain down the middle into two equally-sized parts, they are not the same and do not carry the same functions. The right side of the brain controls the left side of the body, while the left side of the brain controls the right side of the body. Each side is responsible for different functions, and general patterns of dysfunction may occur depending on the side of the brain sustaining an injury.

The traits of each side are detailed below:


  • Analytical
  • Logical
  • Precise
  • Organized
  • Detached
  • Literal

Injuries of the left side of the brain can cause:


  • Difficulties understanding language (receptive language)
  • Difficulties in speaking or verbal output (expressive language)
  • Catastrophic reactions (depression, anxiety)
  • Difficulty speaking
  • Impaired logic
  • Sequencing difficulties
  • Decreased control over right-sided body movements


  • Creative
  • Imaginative
  • Intuitive
  • Conceptual
  • Empathetic
  • Figurative

Injuries of the right side of the brain can cause:

  • Visual-spatial impairment
  • Visual memory deficits
  • Left neglect (inattention to the left side of the body)
  • Decreased awareness of deficits
  • Altered creativity and music perception
  • Loss of “the big picture” type of thinking
  • Decreased control over left-sided body movements
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