Jay Gunkelman’s presentation on “Consciousness” given at a one day workshop at the Biofeedback Society of Michigan’s annual meeting. Download the full Power Point Presentation on Consciousness
Consciousness – A seven part video series. Part 1.
Continue reading to view parts 2 – 7.
On Saturday evening I spoke with my father, who just returned to Arizona from the Thanksgiving holiday back in North Dakota. I quickly noticed that he had trouble putting the ending to a thought, and specific words were difficult for him to “find”. I knew he had fallen about four weeks ago on the ice, and hit his head on the concrete. At the time they were worried about possible rib fractures, though they did suture his left eyebrow at the time.
I put two and two together, and figured he had a big likelihood of a subdural hematoma putting pressure on his language and speech motor areas on the left frontal dorso-lateral area. Subdurals are common in elderly individuals who fall and hit their head, and need to be ruled out if there is a recurrent or persistent complaint following TBI. He complained of headaches which were unrelenting, but they had not scanned him even with his returns to their medical plan 2-3 times in the weeks following the fall.
I figured it would be impossible for him to tell the ER what he needed (as CT or MRI to look for the subdural), so I wrote him an e-mail summary of the findings and pertinent history for my mother to print out and take with them. I sent my elderly father and mother off to the ER, and my dad didn’t want to go because he figured he would miss football games. By Sunday noon, he was in the neurosurgeon’s hands, and they removed a LARGE subdural of 150 Ccs. He is now fine, with all his language skills returned. He even caught the late game on the tube.
After the surgical prep my mother called, and I was asked to “call the doctor”, and I rang in on the neurosurgeon’s headset when he had my dad’s head open. It was a pretty routine evacuation of a subdural, but they were very happy to be handed the case on a platter with the e-mail. He said he was surprised at the “diagnosis” done via telephone and gut instinct, but even more by the accuracy of the localization of the subdural to the left dorso-lateral frontal as well as left temporal areas. The subdural was very large, and encompassed the entire area described.
I’ve had enough drama for the holidays. You would think maybe he will stop bugging me to be a doctor now.
This brief summary will discuss the various EEG findings seen in head injury when it results in a brain injury, though any given head injury may or may not result in traumatic brain injury. When an injury is incurred by the brain there are a few varieties of findings seen in the EEG, ranging from spectral changes associated with either white or gray matter damage, to the changes in “connectivity”, seen as changes in coherence or correlation measured across the cortex, or between more distant functionally related areas.
Identifying subtypes of specific disorders is an attractive exercise, as it expands our understanding of the individual’s response to therapy, but it remains attached to the approach based on the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is rooted in behavior and frequently does not predict therapeutic response by any individual within the DSM grouping. Phenotypes are an intermediate step between genetics and behavior. These proposed electroencephalography (EEG) phenotypes are semistable states of neurophysiological function. The author proposes a framework allowing one to describe much of the observed EEG variance with a small number of phenotypical categories. These groupings cut across the DSM categories, and unlike the DSM, the phenotypes predict the individual’s response to therapy, for neurofeedback as well as for medication.