The effect of neurofeedback in post-concussion syndrome

Lamprecht, Catherina Elizabeth (2019-04)

Thesis (MScPhysio)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Introduction: Concussion in sport as well as the risk of repeated concussion if athletes return too soon, is well documented. Current intervention guidelines recommend rest followed by graded return to physical activity. There are however increasing interventions aimed at speeding up the recovery process. Similarly, there is a drive to include assessment of postural control, especially dynamic balance (with and without cognitive loading) after a person has sustained a concussion and to monitor recovery to ensure persons who have sustained a concussion injury do not return to play too soon. Aim: This study aimed to investigate the effects of a novel intervention, namely neurofeedback, on postural control recovery in sport related concussion. This study also aimed to explore the use of selected postural control measures, namely the Functional Gait Assessment (FGA) and Tandem Gait time (TG), without and with cognitive loading in assessment and determine whether there is any correlation between these and the Sport Concussion Assessment Tool (SCAT 5). Methodology: A randomised controlled, double blind study design was used to determine the effect of neurofeedback on postural control as measured by the SCAT 5, FGA and TG, with and without loading in young collegiate adults who reported to Stellenbosch University Campus Health with a concussion sustained during participation in sport. Participants were randomly assigned to either an intervention group (neurofeedback) or a control group (sham feedback). Neither participants nor the researcher knew to which group participants were assigned. Baseline measurements (SCAT 5, FGA and TG, with and without loading) were recorded at baseline. Participants in both groups were given 4 treatment session. The FGA and TG measures were also repeated before each treatment session. The SCAT 5 was repeated at the time to return to play or after the 4th treatment session (due to time constraints). Data was processed and analysed using Stata version 14 with the help of a statistician. Results: Sixteen participants were finally recruited into the study, 7 in the intervention group and 9 in the control group. Data was not normally distributed and as such results are reported as medians (ranges) and were analysed using non-parametric analyses. A significant change in the treatment group compared to the placebo group was found on the TG without loading measurement. The FGA and TG with loading showed a positive trend. All participants scored below the norms for the postural control assessments (FGA and TG, with and without loading), suggesting dynamic balance is affected in persons with concussion. Significant correlations between the TG without loading and the SCAT 5 number of symptoms (ICC=0.512 )(p<0.05) and severity of symptoms (ICC=0.419 )(p<0.05) was found. Similarly significant correlations were also found for TG with loading and the SCAT 5 number of symptoms (ICC=-0.271 )(p<0.05) and severity of symptoms (ICC=-0.153 )(p<0.05). Gender differences were found in that males participants significantly under-reported both the number of symptoms and severity of symptoms when comparing these with their dynamic balance scores on the FGA and TG (p=0.01). Conclusion: Neurofeedback may be an effective intervention to impact recovery after concussion injury. The current study showed that neurofeedback had a significant effect on gait speed as measured by the TG with both loading and had a positive effect on postural control compared to a placebo group. Sport related concussion does affect postural control as measured by FGA, TG time, with and without loading. The FGA showed a moderate negative correlation to the SCAT 5 number of symptom and severity of symptoms reported indicating that as the number of and severity symptoms increases, the FGA scores decreased. Similar findings were found for TG time without loading. There were a difference in gender in their TG time with and without loading as well as their reporting of symptoms on the SCAT. It is clear that male students under report their symptoms as well as their severity in order to return to sport sooner. Our recommendation is that further studies be done on the effect of neurofeedback as a treatment in the recovery of postural control after sport related concussion. Furthermore that FGA, TG time with and without loading be taken into consideration when the return-to-play decision is made especially if a pre-seasons time can be established.

AFRIKAANSE OPSOMMING : Inleiding: Konkussie in sport asook die risiko vir herhaalde konkussie indien atlete te vroeg terugkeer tot sport, is reeds literatuur beskryf. Huidige riglyne stel rus voor tot simptoomvry en dan ’n gegradeerde program van fisiese aktiwiteit. Daar is egter al hoe meer navorsing wat kyk na intervensies wat die herstel proses kan bespoedig. Daar word in literatuur groter poging aangewend om , veral dinamiese balans, as evalueerings metode in die standaard konkussie evalueering in te sluit. Posturale beheer word aangedui as n sensitiewe meet instrument om sodoende te bepaal of ‘n atleet herstel het na sport geinduseerde konkussie en nie te vinnig terugkeer tot sport nie. Doelwitte: Hierdie studie bestudeer die effek van ’n nuwe behandelings metode, naamlik “neurofeedback”, op die herstel van posturale beheer na ’n sport verwante konkussie. In hierdie studie word die gebruik van Functional Gait Assessment (FGA), Tandem Gait tyd (TG) met en sonder kognitiewe lading as n evalueirng van die effek van konkussie ondersoek, asook die korrelasie tussen hierdie instrumente en die “Sport Concussion Assessment Tool “(SCAT 5). Metodologie: ’n Dubbelblinde, ewekansige studieontwerp is gebruik om die effek van “neurofeedback” op posturale beheer, soos gemeet deur die FGA en TG (met en sonder kognitiewe lading) onder Stellenbosch universitiets studente wat ‘n konkussie tydens sport opgedoen het, te ondersoek. Deelnemers was ewekansig toegewys in ‘n “neurofeedback”/ intervensie groep of n “neurofeedback sham”/ plasebo groep. Nie die studie leier of die deelnemers het geweet wie aan watter groep toegewys is nie. Basislyn evalueeing van die SCAT 5, FGA asook TG (met of sonder kognitiewe lading) is gedoen net na konkussie. Al die deelnemers het 4 behandelings sessies ondergaan waar tydens die FGA, TG met en sonder lading weer herhaal is. Die SCAT 5 is herhaal voor terugkeer tot sport of na die 4de sessie ( a.g.v. tyds beperking). Data is verwerk met behulp van Strata program en n statistikus. Resultate: Daar was 16 deelnemers gewerf vir die studie waarvan 7 aan die intervensie groep toegewys is en 9 aan die plasebo groep. Daar was nie ’n normale verspreiding van data nie en daarom is nie- parametriese toetse gebruik om data te analiseer en word resultate aangedui in mediaan en verspreiding. Daar was 'n beduidende verskil tussen die intervensie en plasebo groep op die TG sonder kognitiewe terwyl die FGA en TG met lading ook n positiewe trant getoon het. Al die deelnemers het tellings onder die norm vir posturale beheer, behaal wat aandui dat dinamiese balans wel aangetas is na sport verwante konkussie. Daar was ‘n beduidende korrelasie tussen die TG sonder lading en die aantal symptome (ICC=0.512) (p,.05) asook die ernstigheid graad van simptome (ICC=0.419) (p<0.05) soos gemeet deur die SCAT 5. Verder was daar verskille tussen die geslagte in die aanmelding van aantal en ernstigheids graad van simptome. Die manlike studente het hulle simptome asook die ernstigheid daarvan onderskat of nie aangemeld nie in vergelyking met die FGA en TG. Gevolgtrekking: “Neurofeedback” blyk n effektiewe behandelingsmetode te wees om herstel na sport verwante konkussie te bespoedig. Hierdie studie wys dat “neurofeedback” n beduidende effek het op stap spoed soos gemeet deur TG met en sonder lading asook op posturale beheer soos gemeet deur die FGA, in vergelyking met die plasebo groep. Sportverwante konkussie het ‘n duidelike effek op postruale beheer soos gemeet deur die FGA, TG met en sonder kognitiewe lading. Die FGA het n matige negatiewe korrelasie getoon teenoor die SCAT 5 (aantal asook ernstigheid graad van simptome) wat beteken dat indien simptome en die ernstigheids graad toeneem, so neem die telling op die FGA af. Die TG met en sonder lading het ‘n matige positiewe korrelasie getoon, wat beteken hoe erger die simptome op die SCAT hoe langer het deelnemers geneem op die toets. Daar was duidelike verskille tussen mans en vrouens in hulle stap spoed asook hulle raportering van simptome. Hieruit blyk dat die mansstudente simptome onder rapporteer om te kan terugkeer na sport. Dit is ons aanbeveling dat verdere studie gedoen word om die effek van “neurofeedback” as behandelings metode in die herstel van posturale beheer na sportverwante konkussie te ondersoek. Verder, dat die gebruik van die FGA en TG met en sonder lading oorweeg word tydens die besluitnemings proses om te bepaal of atlete kan begin terugkeer na sport veral as daar n basislyn vasgestel kan word voor die seisoen begin. Sleutel woorde: Sportverwante konkussie, “neurofeedback”, Functional Gait Assessment, Tandem Gait, Posturale beheer.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/106114
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