Masters Degrees (Centre for Disability and Rehabilitation Studies)

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Browsing Masters Degrees (Centre for Disability and Rehabilitation Studies) by browse.metadata.advisor "Derman, E. W."

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    The effect of neurofeedback in post-concussion syndrome
    (Stellenbosch : Stellenbosch University, 2019-04) Lamprecht, Catherina Elizabeth; Unger, M.; Derman, E. W.; Stellenbosch University.Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
    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.