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Presenter: David Ims
INTRODUCTION/SUPPORT. Concussion incidence rates are at epidemiological levels and rising (Giza & Hovda, 2001). In 2011, the Center for Disease Control (CDC) estimated 1.6-3.8 million sport- or recreation-related concussions occur per year (Daneshvar et al., 2011), and concussion rates are increasing in adolescents (Zhang et al., 2016). Concussion is a complex pathophysiologic process affecting the brain, induced by biomechanical forces (McCrory et al., 2013). Concussion-related symptoms interrupt the daily functioning of the concussed individual and current concussion recovery guidelines emphasize rest and the avoidance of symptom provoking behaviors to minimize concussion-related symptoms throughout recovery (McCrory et al., 2013). Concussion injury results in measurable EEG abnormalities detectable by electrophysiological techniques (Rapp et al., 2015). Cortical deregulation due to concussion injury as depicted by QEEG may be addressed by neurofeedback shortly after injury.
HYPOTHESIS/JUSTIFICATION. Neurofeedback has been used as an intervention for traumatic brain injury, but requires further investigation as an evidence based practice. Neurofeedback is currently ranked as “Level 3 - Probably Efficacious” by the statement of efficacy on evidence-based practice in biofeedback and neurofeedback by the Association for Applied Psychophysiology and Biofeedback (AAPB; Yucha & Gilbert, 2004). The principle investigator hypothesizes (1) that neurofeedback interventions to inhibit slow wave activity will reduce the presence of concussion related symptoms and (2) the use of the intervention will decrease recovery time compared to recommended clinical guidelines of return-to-play concussion recovery.
METHODS. As soon as logistically possible, QEEG Data will be collected from adolescent or young adult patients presenting autonomously to a neurology clinic for the evaluation and treatment of acute concussion related to sport or recreational activity. Cognitive measurements and concussion-related symptoms will be measured and tracked using the XLNTbrain Sport Inc., Concussion Management Program as patients recover according to current evidence based guidelines outlined by McCrory et al. QEEG data, neurocognitive test results, concussion-related symptoms, and attending neurologist will guide neurofeedback protocol design. Data will be recollected after patients will undergo approximately 15 sessions of neurofeedback and are medically cleared of concussion injury.
RESULTS. Surface (scalp), sLORETA, and connectivity Z-score QEEG metrics from multiple commercially available QEEG database suites will be assessed for change from pre-neurofeedback and post-neurofeedback QEEG assessments. Changes in deviant sLORETA Z-scores and affected brain volume will be emphasized. Images of sLORETA results will be displayed visually and graphed by frequency band. Cognitive scores and concussion-related symptoms following injury and after recovery will be assessed.
CONCLUSION. Neurofeedback may provide a novel treatment option for the pervasive neuropsychopsychological concussion problem. Findings that yield z-scored brain activity largely approaching a statistically normal range (Z = 0) would suggest that neurofeedback may be beneficial to concussion recovery in comparison to recovery without the use of neurofeedback, where z-scores may remain statistically deviant upon recovery from concussion injury (Ims, 2016). Theoretically, interventional neurofeedback following concussion injury may enable the concussed individual to train his or her brain towards recovery and alter the long-term trajectory of the injured brain.