Neurofeedback for Concussion

Understanding Concussion, MTBI, and Post Concussion Syndrome

A concussion or mild traumatic brain injury (mTBI) is caused when there is excessive force applied to the head and it causes the brain to shake inside the skull. When the force is strong enough, the brain will actually hit the inside of the skull and cause a concussion or mTBI. The most common causes of a concussion are car accidents, sports related blows to the head, and falling down. As the brain shakes inside the skull some brain cells (neurons) can twist, stretch, or tear, and be damaged. This is known as diffuse axonal injury (DAI).


Concussions can affect the way your brain communicates with itself and other parts of your body and depends on where the brain has been hit. After a concussion people may have issues with balance, need to sleep more, or have foggy thinking known as brain fog. People may complain that their thinking feels a little fuzzy. Usually after a week or two these symptoms start to decrease and you may need physiotherapy to help recover your balance or strength. Sometimes a concussion can be a little more serious and symptoms do not go away.


People with who have suffered a concussion may also struggle with focus, concentration, executive functioning (tasks related to organization, planning, and working memory), emotional regulation, sleeping patterns, etc., can be affected. You may also struggle with sensitivity to light and sound, headaches, dizziness, and fatigue. Other ways to identify if someone has suffered a concussion or is struggling with post-concussive symptoms is to complete Neurocognitive Testing. This type of testing looks at the brain’s performance in multiple categories and compares the person to other people their age and gender. Someone who struggles with ADHD symptoms will usually have trouble with tests related to simple attention, complex attention, cognitive flexibility, processing speed, reaction time, and overall executive functioning. For more information on Neurocognitive Testing please visit our assessment page.


Concussions can also affect a person’s instrumental activities of daily living (IADLs) which can be simply defined as a person’s daily self care activities. Some IADLs include cooking, cleaning, communication, accessing transportation, laundry, shopping, and managing personal finances. Anxiety is usually diagnosed by a clinical psychologist or psychiatrist, but can also be diagnosed by your family physician. It is usually diagnosed after the symptoms related to concussion do not go away after 6 months. At this point you may be diagnosed with post-concussion syndrome.

Our Approach to Concussion using Neurofeedback

People who have had a concussion or mTBI can have severely deviant brain wave patterns. Sometimes there is an excess of slow brain wave patterns near the areas where their brain injury. This can cause the symptoms related to brain fog, inattention, emotional regulation, and executive functioning. Depending on the injury there can be a global reduction in some or all brain wave patterns that causes global issues in brain wave balance, communication, and speed of communication. Other areas in the brain can be stuck in fast brain wave patterns such as beta and high beta as your brain tried to compensate for an excess of slow brain wave patterns.


Once we figure out what brain wave patterns are related to your symptoms using Neurofeedback for Concussion, we can design a personalized program to target and improve them. During each session of Neurofeedback for Concussion, we monitor your brain waves in real time and when there is greater balance of brain wave patterns we reward you with video and sound. These audio and visual rewards help train and guide your brain to have improved balance and improve your symptoms.


Sometimes clients require additional support in conjunction with neurofeedback training. Some options are psychotherapy and somatic experiencing therapy.

How Do I Get Started?

Step 1

We start off with a Clinical Intake Interview. This is where we review background, medical, and developmental history, your symptoms and their severity, major life events and do our best to conceptualize the uniqueness of your case.




Step 2

The next step is a Quantitative Electroencephalogram (QEEG) baseline recording. Just as a stethoscope is placed on your chest to listen to your heart beat, electrodes are placed on your scalp to record your brainwave activity for analysis.

Step 3

Using the information from your clinical intake interview, baseline recording, and intake package we put the pieces together to create a custom Neurofeedback for Concussion program that is tailored to suit your needs.


Step 4

We debrief the results, help you understand the different statistics and brainwave patterns involved in your program, as well as help answer your questions before you can begin Neurofeedback for Concussion training.


Research Articles on Concussion

This section is meant to highlight research that has been done in the field. The following brief summaries are resources that we have gathered for the public. For an in-depth look at each research article we recommend using the citation to find and read the original article. We hope to add additional resources when possible!

  • Koberda, J. L. (2015). LORETA Z-score neurofeedback-effectiveness in rehabilitation of patients suffering from traumatic brain injury. Journal of Neurology and Neurobiology, 1(4), 1-9.

    This is a multi-case study involving 67 patients diagnosed with a traumatic brain injury that were subjected to Z-score neurofeedback therapy. Most of the patients were diagnosed with mild traumatic brain injury and treated within the first year after brain injury. A few patients were diagnosed with more severe traumatic brain injury and treated after one year or later following their head injury incident. Most of the patients complained of headaches and cognitive problems while some of them also suffered from dizziness and overlapping depression. Those who complained of cognitive problems were subjected to analysis with computerized cognitive testing before and after ten sessions of neurofeedback. In addition, QEEG maps were completed before each neurofeedback session initiation in order to see an objective improvement of QEEG abnormalities. Subsequent analysis revealed that 59 out of 67 patients noticed subjective improvement of their symptoms within 10 sessions of neurofeedback therapy, out of which most of them reported an improvement after only 1-3 neurofeedback sessions. 54 patients also had an objective improvement of QEEG maps manifesting as reduction of excessive beta activity and/or normalization of delta or theta power. 45 patients completed prior and post neurofeedback neurocognitive testing with 34 patients having significant cognitive enhancement. These results are very encouraging and indicate high potential of Z-score LORETA neurofeedback rehabilitation of patients suffering from traumatic brain injury.

  • May, G., Benson, R., Balon, R., & Boutros, N. (2013). Neurofeedback and traumatic brain injury: A literature review. Annals of Clinical Psychiatry, 25(4), 289-296.

    The purpose of this review was to assess the strengths of the available published literature on the therapeutic efficacy of neurofeedback for traumatic brain injuries and provide recommendations for future research in this area. Google Scholar was used to find 22 examples of primary research. Measures of symptom improvement, neuropsychological testing, and changes in subjects’ quantitative electroencephalogram were included in the analysis. A single reviewer classified each study according to a rubric devised by 2 societies dedicated to neurofeedback research. It was found that all studies demonstrated positive findings, in that neurofeedback led to improvement in measures of impairment, whether subjective, objective, or both. However, placebo-controlled studies were lacking, some reports omitted important details, and study designs differed to the point where effect size could not be calculated quantitatively. The authors conclude that neurofeedback is a promising treatment that warrants double-blind, placebo-controlled studies to determine its potential role in the treatment of traumatic brain injury.

  • Munivenkatappa, A., Rajeswaran, J., Devi, B. I., Bennet, N., & Upadhyay, N. (2014). EEG Neurofeedback therapy: Can it attenuate brain changes in TBI? NeuroRehabilitation, 35, 481-484.

    This study explores electroencephalogram neurofeedback therapy induced in vivo changes in traumatic brain injury patients.  2 patients with moderate head injury who had more than 7 post-concussion symptoms and poor cognitive performances were subjected to 20 sessions of electroencephalogram neurofeedback therapy. Neuropsychological test scores, post-concussion symptoms and MRI scan of the brain were recorded pre-post to electroencephalogram neurofeedback therapy. It was found that during electroencephalogram neurofeedback therapy the cognitive scores and concussion symptoms improved significantly suggesting significant potential to change and regulate impaired neural networks among patients with traumatic brain injury. Furthermore, the quality of life for moderate disability and poor cognitive performance can be significantly improved using electroencephalogram neurofeedback therapy.

  • Rostami, R., Salamati, P., Tarandi, K. K., Khoshnevisan, A., Saadat, S., Kamali, Z. S., et al. (2017). Effects of neurofeedback on the short term memory and continuous attention of patients with moderate traumatic brain injury: A preliminary randomized controlled clinical trial. Chinese Journal of Traumatology, 20, 278-282.

    The aim of this preliminary study was to evaluate the effect of neurofeedback training on the continuous attention and short term memory of  seventeen participants with moderate traumatic brain injuries using a randomized controlled clinical trial. Participants were randomly allocated in two intervention and control groups and then evaluated for continuous attention and short term memory at the start of the training period and at the end of the training period. The training period lasted for a total of four weeks. Although the results of the study yielded that  20 sessions of neurofeedback training has no effect on the continuous attention and short term memory of patients with mild traumatic brain injury, the authors call for more research to be done to explore the impact of different protocols including more sessions of treatment, longer time of follow-up and larger sample sizes of participants.

  • Popescu, M., Hughes, J. D., Popescu, E.-A., Riedy, G., & DeGraba, T. J. (2016). Reduced prefrontal MEG alpha-band power in mild traumatic brain injury with associated post traumatic stress disorder symptoms. Clinical Neurophysiology, 127, 3075-3085.

    The aim of this study was to address the long standing questions regarding resting state oscillatory brain activity in patients with a history of  mild traumatic brain injury (mTBI) and chronic post concussive symptoms who are stratified based on the severity of their PTSD symptoms. Primary analysis focused on alpha-band power, Participants on medication were not excluded from this study as the authors note that there is no significant difference in alpha frequency between medicated and non medicated patients with PTSD, although there are differences in power demonstrated at faster frequencies. Data generated from the study demonstrated a reduction in resting-state alpha activity involving much of the dorsolateral prefrontal cortex bilaterally in mTBI patients with significant PTSD symptoms compared to those without significant PTSD symptoms. It is that reductions in prefrontal resting-state alpha-band power may also be tested as a biomarker for the identification of those patients with PTSD who may benefit from a variety of treatments to increase prefrontal alpha-band power.

  • Thorton, K. E., & Carmody, D. P. (2008). Efficacy of traumatic brain injury rehabilitation: interventions of QEEG-guided biofeedback, computers, strategies, and medications. Applied Psychophysiology and Biofeedback, 33(2), 101-124.

    This paper reviews the empirical reports of changes in cognitive functioning after treatment and compares the relative effectiveness of several treatments including computer interventions, cognitive strategies, EEG biofeedback, and medications. The cognitive functions that are reviewed include auditory memory, attention and problem solving. The significance of the change in cognitive function is assessed in two ways that include effect size and longevity of effect. These analyses complement the previously published meta-reviews by adding these two criteria and include reports of EEG biofeedback, which is shown to be an effective intervention for auditory memory. The authors conclude that activation QEEG database guided biofeedback demonstrates effectiveness and the available research indicates a strong potential for positive impact for traumatic brain injuries resulting from a variety of situations including auto accidents, slip and falls or even war.

  • Conder, R., & Conder, A. A. (2014). Neuropsychological and psychological rehabilitation interventions in refractory sport-related post-concussive syndrome. Brain Injury, 29(2), 249-262.

    Due to the general lack of research on interventions for refractory sports-related concussions, this article seeks to review the known and emerging neuropsychological and psychological rehabilitation interventions for reducing morbidity among this population of patients. Despite the limited amount of empirical data available for review, the authors postulate that a mindful and ethical approach towards rehabilitation interventions are especially needed in the absence of evidence-based guidelines. Although neurofeedback rehabilitation with concussed athletes is still in its infancy, the authors suggest that it is ideal for neurofeedback treatment to be guided by a full quantitative brain map (QEEG 19 Chanel Analysis) done post-concussion to understand the neuroelectophysiologic correlates of concussion.

  • Ghaziri, J., Tucholka, A., Larue, V., Blanchette-Sylvestre, M., Reyburn, G., Gilbert, G., . . . Beauregard, M. (2013). Neurofeedback Training Induces Changes in White and Gray Matter. Clinical EEG and Neuroscience, 44(4), 265-272. doi:10.1177/1550059413476031

    In this study, Health university students were randomly assigned to the experimental group, sham group or control group. Participants in the experimental group trained to enhance beta waves at F4 and P4. Attentional performance and MRI data were recorded one week before training and one week after training. Higher scores on auditory and visual sustained attention were present in experiment group. Gray matter volume increases were detected in cerebral structures involved in this type of attention. This study constitutes the first empirical demonstration that neurofeedback training leads to microstructural changes in white and gray matter.

  • Linden M. (2015). The Effects of QEEG-Guided Neurofeedback on Postconcussion Syndrome. Biofeedback. 43(1):42-44.doi.org/10.5298/1081-5937-43.1.08

    This brief report describes the case of a 17-year-old female athlete who suffered two consecutive concussions, producing headache symptoms. The athlete was assessed following the initial concussion with quantitative electroencephalography (QEEG) and an integrated visual and auditory continuous performance test (IVA). Twenty-two sessions of QEEG-guided neurofeedback produced normalization of the QEEG and IVA profiles and a cessation of headaches. A second concussion then produced further abnormalities in the QEEG and the IVA. A final course of 40 sessions of neurofeedback was again successful in normalizing both cortical activity on the QEEG and scores on the IVA.

  • Brown J, Clark D, Pooley A. (2019). Exploring the Use of Neurofeedback Therapy in Mitigating Symptoms of Traumatic Brain Injury in Survivors of Intimate Partner Violence. Journal of Aggression, Maltreatment & Trauma. 28(6):764-783. doi.org/10.1080/10926771.2019.1603176

    Traumatic Brain Injury (TBI) is an injury to the brain caused by an acute injury to the head, neck, or face, such as a blunt force trauma. Survivors of Intimate Partner Violence (IPV) are at high risk for TBI, given how frequently they are repeatedly struck in the head. An abundance of evidence indicates that even “mild” TBI can have lifelong impacts, including personality and behavioral changes. TBI often goes undiagnosed in survivors as most do not seek medical treatment for their injuries. Given the lack of diagnoses, these symptoms may often be overlooked or misunderstood. One emerging method for treating the symptoms of TBI is neurofeedback (NF). NF is a type of biofeedback that uses operant conditioning to regulate activity in various regions of the brain. NF can lead to better cognitive performance and emotional self-regulation. Given the potentially high rate of TBI in IPV, it is worth exploring if NF can reduce the symptoms that negatively impact survivors. The current study explores the use of NF to treat IPV survivors who experienced head injury and, as such, probable TBI (N = 32). Survivors participated in a quantitative EEG (qEEG) to locate problem areas of the brain and participated in assessments, before and after treatment, to examine constructs such as depression and Post-Traumatic Stress Disorder (PTSD). Results show significant differences in both the qEEG data and written assessments following the completion of NF. These results suggest NF could mitigate symptoms of probable TBI in IPV survivors.

  • Hershaw, Hill-Pearson, C. A., Arango, J. I., Souvignier, A. R., & Pazdan, R. M. (2020). Semi-Automated Neurofeedback Therapy for Persistent Postconcussive Symptoms in a Military Clinical Setting: A Feasibility Study. Military Medicine, 185(3-4), e457–e465. https://doi.org/10.1093/milmed/usz335

    Neurofeedback therapy (NFT) has demonstrated effectiveness for reducing persistent symptoms following traumatic brain injury (TBI); however, its reliance on NFT experts for administration and high number of treatment sessions limits its use in military medicine. Here, the authors of the study assess the feasibility of live Z-score training (LZT)—a variant of NFT that requires fewer treatment sessions and can be administered by nonexperts—for use in a military clinical setting. A single group design feasibility study was conducted to assess acceptability, tolerance, treatment satisfaction, and change in symptoms after a 6-week LZT intervention in 38 Service Members (SMs) with persistent symptoms comorbid with or secondary to mild TBI. Acceptance and feasibility were assessed using treatment completion and patients’ satisfaction with treatment. To evaluate changes in symptom status, a battery of self-report questionnaires was administered at baseline, posttreatment, and 3-month follow-up to evaluate changes in psychological, neurobehavioral, sleep, pain, and headache symptoms, as well as self-efficacy in symptom management and life satisfaction. Participants tolerated the treatment well and reported a positive experience. Symptom improvement was observed, including depressive, neurobehavioral, and pain-related symptoms, with effects sustained at 3-month follow-up. LZT treatment appears to be a feasible, non-pharmacological therapy amenable to SMs. Results from this pilot study promote further investigation of LZT as an intervention for SMs with persistent symptoms following TBI.

  • Munivenkatappa, Rajeswaran, J., Indira Devi, B., Bennet, N., & Upadhyay, N. (2014). EEG Neurofeedback therapy: Can it attenuate brain changes in TBI? NeuroRehabilitation (Reading, Mass.), 35(3), 481–484. https://doi.org/10.3233/NRE-141140

    Electroencephalogram Neurofeedback therapy (EEG-NFT) has several potential beneficial effects in terms of improving cognition and electrophysiological regulation among patients with brain injury. However, in vivo structural and functional changes remain less explored. The aim of the present study was to explore EEG-NFT induced in vivo changes in traumatic brain injury (TBI) patients. Two patients with a mean age of 15 years with moderate head injury who had more than seven post concussion symptoms and poor cognitive performances (<5 percentile) were subjected to 20 sessions of EEG-NFT. The neuropsychological test scores, post concussion symptoms and MRI scan of the brain were recorded pre-post to EEG-NFT. During EEG-NFT the cognitive scores and concussion symptoms improved significantly (p < 0.05). The EEG-NFT has shown significant increase in cortical grey matter (GM) volumes (p < 0.0001) and fractional anisotropy (FA) of cortical white matter (WM) tracts (p < 0.0001, voxel max 60 and above). There was a significant decrease in global, local efficiency, cost and clustering coefficient of functional connectivity (Wilcoxon Sign Rank Test p < 0.05). Interestingly there was a significant increase in thalamo-cortical connection (increase FA value) after EEG-NFT. The EEG-NFT therapy has shown significant changes in structural and functional connectivity among young moderately injured TBI patients.

  • Surmeli, Eralp, E., Mustafazade, I., Kos, I. H., Özer, G. E., & Surmeli, O. H. (2017). Quantitative EEG Neurometric Analysis–Guided Neurofeedback Treatment in Postconcussion Syndrome (PCS): Forty Cases. How Is Neurometric Analysis Important for the Treatment of PCS and as a Biomarker? Clinical EEG and Neuroscience, 48(3), 217–230. https://doi.org/10.1177/1550059416654849

    Postconcussion syndrome (PCS)  has been used to describe a range of residual symptoms that persist 12 months or more after the injury, often despite a lack of evidence of brain abnormalities on magnetic resonance imaging and computed tomography scans. In this clinical case series, the efficacy of quantitative EEG-guided neurofeedback in 40 subjects diagnosed with with PCS was investigated. Overall improvement was seen in all the primary (Symptom Assessment-45 Questionnaire, Clinical Global Impressions Scale, Hamilton Depression Scale) and secondary measures (Minnesota Multiphasic Personality Inventory, Test of Variables for Attention). The Neuroguide Traumatic Brain Index for the group also showed a decrease. Thirty-nine subjects were followed up long term with an average follow-up length of 3.1 years (CI=2.7-3.3). All but 2 subjects were stable and were off medication. Overall neurofeedback treatment was shown to be effective in the group of subjects studied.  

  • Gupta, R. K., Afsar, M., Yadav,R. K.,Shukla, D. P.,& Rajeswaran, J. (2020). Effect of EEGneurofeedback training in patients with moderate–severe traumatic brain injury: A clinical and electrophysiological outcome study. NeuroRegulation, 7(2), 75–83. https://doi.org/10.15540/nr.7.2.75

    The need for effective rehabilitation programs for individuals with Traumatic brain injury (TBI) is on a high rise as this injury can cause a diverse range of disability that can significantly impact its survivors. This study aimed to investigate the effectiveness of EEG neurofeedback training (EEG-NFT) in moderate-severe TBI patients on their clinical and electrophysiological outcomes. 14 TBI patients in a post-injury period between 3 months and 2 years participated in the study. All participants received twenty sessions of EEG-NFT. The results of the study indicated a significant reduction in the severity of postconcussion symptoms (PCS) following EEG-NFT and a consistent pattern of reduced in slow and fast waves amplitude ratios. Overall, this study suggests EEG-Neurofeedback could be effective in improving PCS and promote normaltization of qEEG in TBI patients. 

  • Palakeel J. (2016). The Efficacy of Neurofeedback when Applied to Post-Concussion Syndrome. Illinois Mathematics and Science Academy

    Every year millions of people suffer concussions and need hospital care. Many patients are healed, but several are later diagnosed with what is known as Post-Concussion Syndrome (PCS), an adequate treatment for this condition is yet to be developed. The investigation in this article was to determine whether neurofeedback could be used to treat PCS successfully. After conducting a preliminary electroencephalogram test followed by a head injury questionnaire and a problem checklist, neurofeedback treatment was applied to one patient. The final results were compared to the pre- test results. Five regions of the brain and respective brainwaves were treated, Sensorimotor Rhythm was aimed at Fz, O1, and Cz regions of the brain, Theta Alpha Gamma was aimed at Fz,Pz, and Alpha aimed at Cz. After a period of twenty treatment sessions, the patient's condition improved, only a few symptoms remained. The data provided evidence that neurofeedback has a positive effect on those suffering from Post-Concussion Syndrome.

  • Reddy R, Rajeswaran J, Indira Devi B, Kandavel T. (2013). Neurofeedback Training as an Intervention in a Silent Epidemic: An Indian Scenario, Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience. 17:4, 213-225, DOI: 10.1080/10874208.2013.847139

    Traumatic Brain Injury (TBI) is a “silent epidemic” that creates a significant burden on health care resources across the globe. TBI is a dynamic process that involves damage to the brain, thus leading to behavioral, cognitive, and emotional consequences and poor quality of life. Neurofeedback Training (NFT) was employed as an intervention to study its efficacy in post-concussion symptoms, cognitive deficits, and quality of life. A pre-post design was adopted in which the intervention group underwent NFT and the other waitlist group served as a control. NFT was found to be efficacious in ameliorating postconcussion symptoms and cognitive dysfunctions and improving quality of life.

  • Majid F. (2018). A comprehensive “Concussion Recovery Program” with emphasis on brain coaching and EEG-based neurofeedback therapy: A retrospective analysis. Neurology. S19; DOI: 10.1212/01.wnl.0000550606.03730.0c

    A “Concussion Recovery Program” (CRP) was developed and implemented which combined promising treatment strategies from the medical literature into a comprehensive, multidisciplinary, and personalized program for patients with Post-Concussive Syndrome (PCS). The program's goal was to treat all of a patient's PCS-related symptoms under the care of a single physician. Patients received brain coaching twice weekly in order to address their anxiety, insomnia, attention, headache, and fatigue issues. The authors of the study also used EEG-based neurofeedback twice weekly to complement brain coaching sessions. Patients' median time spent in the program was 16 weeks, during which they received a median number of 21 brain coaching sessions and 22 neurofeedback sessions.  To evaluate the effectiveness of CRP, they performed a retrospective, exploratory analysis using de-identified patient data from the Neurogrow Brain Fitness Center (Virginia, USA; approved by the New England IRB). They used a computerized cognitive testing tool, called CNS Vital Signs, to evaluate the cognitive performance of patients at the beginning and end of the program. Data from 46 patients reviewed showed significant improvements in several cognitive domains. Primary outcome measures were the 3 CNS Vital Signs domains known to be most sensitive to mild traumatic brain injury: Complex Attention, Cognitive Flexibility, and Executive Functioning. Paired t-tests were used to compare mean scores before and after treatment. For all 3 domains, patients experienced significant improvement after treatment (p < 0.00001), with medium or large effect sizes. For all 3 domains, over half of patients experienced score improvements greater than the Reliable Change Index. Patients with PCS who completed our CRP experienced significant improvements in their symptoms. These results are promising and now a larger prospective study is warranted.

Share by: