Changes in attentional processing following neurofeedback in patients with persistent post-concussive symptoms: a pilot study

ABSTRACT

Objective

Persistent post-concussive symptoms (PPCS) often include attention deficits, particularly orienting and executive attention. Research in other clinical populations has demonstrated that neurofeedback therapy (NFT) is effective at improving orienting and executive attention, although its effects on attentional networks in patients with PPCS are unknown.

Method

In this single-group pilot study, we examined attention-related event-related potentials (ERPs) – N1 and P3 – and cognitive outcomes following Live Z-score training (LZT), a variant of NFT.

Results

No changes in early selective attention, as indexed by N1 amplitude, were observed; however, P3 amplitude, which indexes neural resource allocation, increased following LZT and returned to baseline by 3 months. Cognitive performance improved following treatment, which was sustained at 3 months. The magnitude of change in P3 and ANT performance did not differ between orienting or executive attention, suggesting LZT improved general attentional processing efficiency.

Conclusion

Our results suggest that LZT may positively affect attention globally, but does not target specific attention networks. These pilot data warrant the initiation of a clinical trial evaluating the effectiveness of LZT for treating attention deficits in patients with PPCS.

KEYWORDS:

• Traumatic brain injury
• persistent post-concussive symptoms
• attention
• ERP
• attention network task

Disclaimer

The views expressed in this manuscript are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. This work was prepared under Contract HT0014-19-C-0004 with DHA Contracting Office (CO-NCR) HT0014 and, therefore, is defined as U.S. Government work under Title 17 U.S.C.§101. Per Title 17 U.S.C.§105, copyright protection is not available for any work of the U.S. Government. For more information, please contact [email protected].

UNCLASSIFIED

Disclosure of interest

The authors report no conflicts of interest. This research was funded by the Defense and Veterans Brain Injury Center and the AMEDD Advanced Technology Initiative (AAMTI) through the Telemedicine and Advanced Technology Research Center (TATRC). In the conduct of research where humans are the subjects, the investigators adhered to the policies regarding the protection of human subjects as prescribed by Code of Federal Regulations (CFR) Title 45, Volume 1, Part 46; Title 32, Chapter 1, Part 219; and Title 21, Chapter 1, Part 50 (Protection of Human Subjects).

Additional information

Funding

This work was supported by the Telemedicine and Advanced Technology Research Center [W91YTZ-13-P-0703].