An Interventional Trial for Persisting Post-Concussive Symptoms after Mild Traumatic Brain Injury

Group 1: Neurofeedback Neurofeedback sessions will train brain specific brain regions using real-time feedback of the individual’s electrophysiological brain activity. Participants allocated to the neurofeedback group will attend the Sarich Neuroscience Research Institute – Curtin University laboratory for 18 neurofeedback sessions (3 sessions/week for 6 weeks). Each neurofeedback session is expected to take approximately 40 minutes, including time to fit the Electro-Cap, fill the electrodes and achieve good impedance, and perform rounds of neurofeedback. Neurofeedback will be conducted in 7 rounds, with 3 minutes of training and 30-second breaks in between, for a total neurofeedback time of 24.5 minutes. Participants will sit facing a computer monitor and see an electroencephalography (EEG) map on the screen. A research team member will remain with the participant, directly observing the participant as the complete the intervention. They will be given instruction on what the training will involve (i.e. meeting a target), but as an operant conditioning method will not receive specific instruction on how that is to be achieved. Instead, when the target brain behaviour is achieved, the participant is rewarded with a sound and appearance of a circle on the screen. The participant receives a score for each round which indicates their performance in achieving that target. Over time, the participant learns to regulate their own brain activity, though often they are not consciously aware of the learning mechanism. Target Z scores will be gradually reduced over each session based on improvement in performance. For example, a participant with a Z score of +3 (over-activation) will train to reduce brain activation in that area with a target Z score of 2.5. When this is achieved and maintained, the Z score will be reduced to 2, then 1.5, and so on, until the Z score is returned to a ‘normal’ score of 0. Group 2: Concentration This group will be recruited as a comparator to neurofeedback, to allow delineation of neurofeedback effects from effects of repeated focused concentration on a screen, participant-therapist interaction, environment, or other factors which may be associated with neurofeedback (but are not, in themselves, neurofeedback). This group will be informed that they are participating in a trial of concentration as a therapy for persistent post-concussive symptoms (PPCS). Participants allocated to the concentration group will attend the Sarich Neuroscience Research Institute – Curtin University laboratory for 18 concentration sessions (3 sessions/week for 6 weeks). To match the neurofeedback experience, each session is expected to take approximately 40 minutes (including fitting and filling of the Electro-Cap, etc.), with 7 rounds of 3 minute concentration and 30-second breaks in between, for a total time of 24.5 minutes. Participants will sit facing a computer monitor and see an EEG map on the screen. They will be given instruction to look at the screen and pay particular attention when a sound plays and circle appears on the screen. A research team member will remain with the participant, directly observing the participant as the complete the intervention. For this group, the sound and circle will appear at random.