Treatment Notes

A Day’s Session Notes of a Neurotherapy Center of Washington
EEG Neurofeedback Therapist
Mary Lee Esty, Ph.D.

The following material is a collection of annotated chart notes taken from typical events in a daily treatment schedule of EEG neurofeedback sessions at the NCW. While the material is factual, details and identification have been altered to protect identities. Most case descriptions are composite in nature to protect identities, but are illustrative of the problems treated, clinical experience, and outcomes.

The format gives some Background, the reason for entering treatment, and response (or lack of response) to treatment through that Session. Session notes include patient report since last treatment, therapist’s observations, as well as recommendations and referrals for other treatments, treatment goals/plans. An Update section follows these. All Sessions are 30 minutes.

Reasons for treatment include: Depression, Insomnia, Fatigue, Dizziness, Anxiety, Asperger’s syndrome, (Autism), Pain, Headache, Auditory hallucinations, Explosiveness, Fibromyalgia, Traumatic Brain Injury, ADHD, Shyness, Non-restorative Sleep, Cognitive Processing Problems, Chemobrain, and Stroke.

Abbreviations: Tx – treatment; Sx – symptoms; Pt. – patient; MVA – motor vehicle accident; TBI – traumatic brain injury; PTSD – post-traumatic stress disorder; FMS – fibromyalgia syndrome, sEMG –surface electromyography, r/o –rule out.

1 – M.I.- Depression/Insomnia/ Fatigue/TBI   Background: Referred by massage therapist. Male, 40s with insomnia, extreme fatigue, concentration, cognitive fog problems, dizziness, and depression. Previously high functioning & successful in technically demanding field until MVAs about 15 years ago led to inability to work outside the home due to above Sxs. Doing some contract work at home as energy allows. Session # 9: MI reports energy best in several years. Fog lifting, concentration, motivation all much better. Finished a difficult technical job in 17 minutes. Intermittent pain still present. Slept a 5-hour stretch last night. Doing errands, lots of energy. Has a social life. Update: Finished Tx in 12 Sessions over 5 months. Working 40-hour week.

2 – YFF – Dizziness/Anxiety/TBI   Background: Referred by colleague. Female 40s, referred by colleague at work for Sx of dizziness, light/sound sensitivity, headache, nausea, neck/shoulder pain, racing mind interfering with sleep. Most Sx followed blow to side of head. Interfering with job performance. Tension levels high so referred for sEMG and stress reduction biofeedback. Session # 12: Reported pretty good weekend. Using biofeedback techniques to reduce tension. Feeling more positive – control over anxiety – improved sleep. A bit less sensitive to light and sound. Sleeping 5 hours straight! Update after 15 Sessions: Suspicious of possible perilymphatic fistula causing vestibular problems. Referred to Dr. Dennis Fitzgerald, Washington Hospital Center for evaluation. Positive for fistula. Biofeedback at home helps with Sxs. Recovering faster from dizziness spells as relaxes.

3 - DC - Asperger’s syndrome   Background: Referred by family friend. Young adult male, late 20s, Asperger’s syndrome. High-functioning academically, presently working in a socially protective environment with strong family support. Social anxiety. Easily over stimulated leading to avoidance behavior (ex: unable to attend class) Session # 5. Noticeable prolonged eye contact now. Smiles and responding appropriately to small talk. Missed only 2 classes in last semester – Anxiety levels greatly reduced. Family reports improved concentration and performance. Socially much smoother interaction outside family as well. Friends commenting on changes.

4– JK – Fatigue/pain/ depression/TBI   Background: Referred by physician for Tx of fatigue, memory problems, depression, disorganization, no motivation, joint and muscle pain. Totally overwhelmed – unable to organize. Formerly very high-functioning late 30s male with history of job-related multiple TBIs with loss of consciousness. Last TBI, 3 years earlier, was quite serious – never recovered. Referred for sEMG. Receiving myofascial Tx. Session # 11. Reduced pain, multitasking now that he feels motivated to do things has wanted to do but didn’t have energy to do in past. Worked out! Update #17. Pain is gone, even the achiness. Feeling positive.

5– AL –Psychosis, TBI/ ADD/headache/explosiveness/lost ability to read.   Background: Referred by psychiatrist. 13yo male, hallucinatory episodes resulted in hospitalization. Psychiatrist recommended Tx because of 3 TBIs with loss of consciousness, plus 2 lesser head traumas, in the 2 years immediately preceding hospitalization for hallucinations. Session # 10. Hallucinations not present. No explosiveness in last few days. Fewer of the extreme behaviors. Reading now. Update - #33 – No flashbacks, in regular classroom, learning and socially appropriate. No sign of former problems. Impression – TBI induced psychiatric symptoms.

6– ST – PTSD/Fibromyalgia/TBI   Background: Referred by therapist. Female, early 40s. Multiple TBIs with loss of consciousness. Severe anxiety, confusion, depression, unable to hold regular job, or leave house at times for last 2 years. Fatigue and pain semi-disabling. Referred for sEMG treatment for pain. Session # 10. Working more hours than ever for last 2 years. Less reactive to negative events. Updating resume to start job search. Prescribing psychiatrist surprised that she is doing so much more and needing less anxiety medication. More resilient emotionally. Sleep better at times. Using skills from sEMG to reduce body pain.

7 – LN – FMS/PTSD/TBI   Background: Female, 50s. Self-referred. History of multiple traumas of various types (TBI and emotional) including chronic infection. Sxs: PTSD, severe pain, fatigue, severe cognitive fog, headaches, sleep. Formerly very high functioning. Ill for 10+ years. Multiple medications. Typical FMS. Referred for multiple therapies – sEMG, stress reduction biofeedback. Referrals for psychotherapy, myofascial/craniosacral therapy, and to specialist for chronic infection. Possibility of Lyme disease, or other infection (r/o sarcoidosis). Session #: 32 Much improved posture and awareness of body. Energy continues to improve – much better. Taking less pain medication. Reporting huge changes. No headaches. Staying up later doing projects. [One month later – Pain meds reduced even more – improving all the time. Has plan with Dr. to handle reduction. Checking out medical complications.]

8 – CI - ADHD/LD/Auditory processing problems. Referred by therapist and friend.   Background: 8y.o. male with serious learning problems: reading, writing & spelling, attention. Doing homework very difficult. Hyperactive from birth, very sensitive to fabric against skin – can’t tolerate roughness or lumps in clothes, impulsive, not aware of annoying his friends. Concussion - preschool – (possibly 2). Session# 4. Has been doing better with homework. Less distractible, more focused in school, but some belligerence. [Referred for brainwave training neurofeedback.] Update – Session #13 – Volunteering to do homework on his own. Better concentration and interaction with peers. Mood better, less daydreaming.

#9 – MT – Anxiety, depression, fatigue, shyness. TBI @ 7yo – concussion.   Background: Referred by therapist. Male, early 40s. Sxs long-standing. Medications helpful. Session # 6 – Much more active since started Tx, good energy, more social life, able to let go of problems used to obsess about. Reducing meds with psychiatrist’s direction. Much more conversational and enjoying himself. Update – Plan: Return if feels need for more treatment as reduces medications.

#10 – BD – Referred by psychiatrist.   Background: Male, 30s, high functioning but with great effort. Fatigue, and mood problems, non-restorative sleep, cognitive processing problems (too slow). Session # 11 – To date only positive response has been elimination of headache. All other Sxs, anxiety, cognitive issues seem the same. Terminated treatment pending review with physician.

#11 – CC – ADD (TBI)   Background: Referred by teacher. College student, female. Diagnosed with ADD. TBI (with loss of consciousness) in early elementary school, with 2 other milder head traumas over the next few years. History of attention, concentration, fatigue, and organization problems. Session # 10. More energy, organizing room and doing chores easily even on reduced medication. Able to read longer without losing concentration. Parents noticing changes.

#12 – FB – Chemobrain    Background: Referred by friend. Professional woman in 50s. After cancer treatments suffering from insomnia, headaches and neck pain, cognitive confusion, depression, and extreme fatigue. Referred for sEMG and stress reduction treatment. Session #10. Sleeping much better, able to fall asleep again if wakes. More energy in AM – refreshed. Headaches less intense. Mood is much lighter. Job performance – great improvement.

#13 – SE - Stroke   Background: Referred by physician. Late 50s female suffered mild stroke 3 years ago. dizziness, balance, nausea, no motivation, and fatigue main Sxs. Session #6. Walking without needing any support. Very active, making decisions easily. Mood & energy good. Plan: Discharged.