One of the underlying difficulties which acts to help maintain symptoms following mild traumatic brain injury (mTBI) is fatigue. Dealing with fatigue is therefore one of the lynchpins to create improvements in the individuals’ dysfunctional behaviour loops.

By helping the individual feel less fatigued, the other symptoms they experience will usually reduce in severity or even disappear altogether. This results in the individual feeling more in control and often acts as the catalyst to turn their dysfunctional loop within which they are stuck into a progressively positive self fulfilling loop.

A typical dysfunctional loop could be characterised as follows: ‘I cannot concentrate very easily, so I try harder, which makes me more fatigued, then I get frustrated because it still doesn’t work, and I start to worry about it, and this causes me to sleep less well, which again leads to ongoing fatigue, which means I have less capacity and resources to concentrate well, so my problems are getting worse’.

A typical positive self fulfilling loop could be characterised as follows: ‘I feel less fatigued, so I find I have more energy to concentrate, and when I do begin to get tired I know how to overcome the tiredness, and then I can concentrate more easily, so I can see myself being in charge and maybe even improving my symptoms, I am beginning to see a future in which I can cope’.

In the UK military rehabilitation programme designed specifically for treatment of mild traumatic brain injury, the treatment of fatigue is therefore considered of prime importance. An extensive relaxation programme was developed ‘Active Relaxation Training’ to help deal with the fatigue, along with traditional fatigue management and sleep management approaches. This programme includes brain entrainment using the iAwake programmes as a core component. Brain entrainment is one of the first relaxation techniques taught to the patients and they are encouraged to listen every day for 30 – 60 minutes with the aim of moving their brain wave electrical activity into more restful phases. The purpose of this is so that the patient knows what a relaxed state feels like, so that they can then learn to use some very rapid relaxation techniques to nudge themselves into or towards that same state in everyday life interactions (hence the title ‘Active Relaxation Training’).

The patients are not told anything about the brain entrainment approach other than some basic information about how brain wave electrical activity correlates with wake to sleep cycles and meditation states. It is merely suggested to them that this may be useful and to try it out. Over the last 5 years the team has consistently reported a 75% success rate with the brain entrainment approach; success being measured in terms of patients reporting either that they slept better, or feel more relaxed as a direct result of the listening. It is important to reiterate again that they have not been conditioned towards reporting this as they receive very limited information about it prior to listening (we only provide a fuller explanation after they have given their initial reports). The vast majority of these patients get a ‘wow’ reaction when they first use the brain entrainment i.e. ‘That was the first night I have slept well for several years’, ‘I thought nothing was going to happen and then after about 15 minutes I just felt really good like I was floating and I am still holding onto that good feeling’, ‘It just switched me off and next thing I know I was waking up in the morning’.

The 25% of patients who do not give a positive response often continue to try to use it and sometimes are then able to get a positive response, but it appears that it does not work with all our patients. We are not sure why this is, but it may have something to do with noise sensitivity (this is an issue for some patients who develop hyperacusis) in some, and in resistance in others. Or maybe it just doesn’t suit everyone.

We have not experienced any negative reactions or problems as a result of use of brain entrainment in this group of patients – many of whom suffer from PTSD, and epilepsy.

As a result of these positive results the brain entrainment usage has become a staple of the active relaxation programme and it has been extended with more recent iAwake products which do not require the use of headphones (Activate and Audio Oxygen, and Heartwave) into playing in the background, either on volume, or on no volume, via the Sonos speakers in the waiting area, classroom and treatment rooms. It has been observed on a number of occasions that patients who are not part of the mTBI programme come into the waiting room during their breaks from other forms of rehabilitation because they enjoy the sounds that are being played.

In conclusion, the brain entrainment products available from iAwake have been very useful in the rehabilitation programme within the UK military and form an essential component of the Active Relaxation Training programme, which in itself is one of the major components of the treatment offered.

Kit Malia, BED, MPhil, CPCRT
Project Officer for the Mild Traumatic Brain Injury Programme at Headley Court
BrainTree Training

About Kit Malia
Kit Malia, BED, MPhil, CPCRT, is the only Certificated Cognitive Rehabilitation Therapist in the UK (via the Society for Cognitive Rehabilitation, USA), with a research degree in Neuropsychology.

He initially trained as a teacher for people with learning disabilities and, following 6 years of teaching, spent over two decades working as a cognitive rehabilitation therapist with adults who have acquired neurological injuries, at one of the largest brain injury rehabilitation units in the UK: The Defence Medical Rehabilitation Centre, Headley Court.

His current role is Project Officer for the mild Traumatic Brain Injury Programme at Headley Court where he is responsible for managing the delivery, by the multi-disciplinary team, of the specialised programme he designed and produced. He has published scientific papers on cognitive and psychosocial rehabilitation, and clinical standards in brain injury rehabilitation. He is the primary author of Brainwave-R (an extensive collection of cognitive strategies and techniques for brain injury rehabilitation).

He has also co-authored The Brain Injury Workbook with Dr Trevor Powell. Mr Malia has lectured at various conferences in Canada, USA, Sweden, Norway, Denmark, Finland, The Netherlands, Belgium, Slovenia, Spain, New Zealand and the UK. He is the invited International Fellow in Cognitive Rehabilitation for the Institute for Complex Neurodisability. He is also on the Board of Directors for the Society for Cognitive Rehabilitation, USA, and is the chairperson of the International Division for the SCR.