Neurofeedback Intervention for Persistent Post-Concussion Symptoms: A Case Series on Functional Connectivity in the Salience Network — The Association Specialists
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Neurofeedback Intervention for Persistent Post-Concussion Symptoms: A Case Series on Functional Connectivity in the Salience Network (22063)

André Avila 1 2 , Caerwen S Beaton 1 2 , Melissa Papini 1 2 , Francesca Buhagiar 3 , Melinda Fitzgerald 1 2 , Sarah C Hellewell 1 2
  1. Curtin Health Innovation Research Institute, Curtin University, Perth
  2. Perron Institute for Neurological and Translational Science , Perth
  3. School of Pyschological Science, The University of Western Australia, Crawley

Objectives: Persistent post-concussion symptoms (PPCS) may occur in up to 50% of concussion cases. There is no effective treatment for PPCS. The salience network (SN), involved in shifting between internally and externally directed cognitive states, can be altered in PPCS. This pilot study explores the utility of Z-score neurofeedback to attenuate PPCS and restore changes in functional connectivity within the SN.

Methods: Two participants with PPCS aged 36 (16m post-injury) and 26 (13m post-injury), were randomised to two intervention conditions: (1) 18 sessions of personalised qEEG-informed neurofeedback targeting frontoparietal hyperactivity over 6-weeks, (2) placebo-neurofeedback of the same quantity and duration to delineate effects of environment. The post-concussive symptom scale (PCSS) was used to assess pre- and post-intervention symptom severity. NeuroNavigator was used to measure SN functional connectivity, expressed as Z-score coherence and averaged to examine percentage change pre- and post-treatment.

Findings: Neurofeedback was associated with improvements in the SN across all frequency bands: delta (49.99%), theta (69.71%), alpha (62.57%), beta (63.35%), and high-beta (28.16%). In contrast, the placebo participant had minimal changes, with delta worsening by 1.29%, and modest improvements in theta (9.40%), alpha (18.43%), beta (9.68%), and high-beta (9.74%). The neurofeedback participant demonstrated a full (100%) resolution of PCSS severity, while the placebo participant endorsed only a 22% reduction in symptom severity.

Conclusions:  These pilot findings suggest that, compared to placebo, neurofeedback may improve SN functional connectivity and abrogate PPCS. This data supports a larger ongoing study to validate these findings and further investigate the mechanisms underlying neurofeedback.