Concussion Post Syndrome, Mild Traumatic Brain Injury
Conditions
Keywords
post-concussion syndrome, mild traumatic brain injury, autonomic dysfunction, concussion, capnometry-assisted respiratory training, cognitive behavioral therapy
Brief summary
The current project will examine the effect of a brief psychological intervention on post-concussion symptoms, neurocognitive function, cerebral blood flow (CBF), and psychophysiological and salivary cortisol markers of autonomic nervous system (ANS) in a sample of 20 participants between 13-25 years of age who experience long-term post-concussive (PC) symptoms 2-9 months post-injury as well as 20 age- and sex-matched controls (non-injured) participants to provide normative data on all the above measures except for concussive symptoms.
Detailed description
Participants with concussion will participate in six, home-based interventions designed to treat cognitive-behavioral factors that are maintaining their symptoms. The investigators hypothesize that the prolonged PC symptoms are in part due to disruption of autonomic nervous system function post-injury as well as exacerbation by the psychological response to the injury. This hypothesis is based on evidence showing that PC symptoms, including headache, fatigue, dizziness, and heightened anxiety overlap with upregulated sympathetic activity and elevated levels of salivary cortisol. There is evidence linking cognitive-behavioral factors (e.g., catastrophizing) to prolonged symptoms of autonomic overactivation after injury (e.g., anxiety, pain, etc.). The participants are taught shallow breathing techniques to normalize parasympathetic activity and provide cognitive-behavioral treatment to reduce psychological reactions to the injury that exacerbate the autonomic disruption and prolong recovery.
Interventions
BEHAVIORALPsychological Intervention
Psychological treatment protocol designed to treat anxiety and avoidance in an adolescent/young adult population. The focus of treatment will be to address cognitive and behavioral factors associated with prolonged symptoms. Cognitive factors that may be addressed include, but are not limited to, catastrophizing, black or white thinking, and false expectations. Behavior factors that may be addressed include, but are not limited to, avoidance, relaxation, and behavioral activation. The psychological intervention is also designed to help reduce psychophysiological arousal associated with anxiety and stress. Participants will also be taught controlled shallow breathing exercises designed to normalize the ratio of sympathetic/parasympathetic activity.
Sponsors
University of California, Los Angeles
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
An open trial will be conducted in patients with persistent post-concussion symptoms compared to non-injured controls in order to determine whether the intervention (controlled breathing and cognitive behavioral therapy for anxiety) improves parasympathetic, HPA axis activity and cerebral blood flow, and whether improvement in parasympathetic and HPA axis activity predicts reduction in PPCS symptoms. We will compare baseline evaluations to the evaluation conducted after brief CBT and controlled breathing training to demonstrate the feasibility of normalizing parasympathetic, and HPA axis activity via this intervention. If we obtain the predicted results in the current study we will design a much larger study to identify the mechanisms of change. Healthy, non-injured control participants will provide normative data on all measures except for concussion-relevant outcomes.
Eligibility
Sex/Gender
ALL
Age
13 Years to 25 Years
Healthy volunteers
Yes
Inclusion criteria
for patients: * Between the ages of 13-25 * Diagnosed with a concussion or mild traumatic brain injury by a physician * Currently experiencing post-concussive symptoms for at least two months after their injury but no longer than 9 months. * Fluent English speaker
Exclusion criteria
* History of/or comorbid neurological conditions that might affect performance (including history of stroke, seizure disorder, moderate to severe traumatic brain injury, anoxia) * Severe cardiovascular conditions. * History of psychosis and current substance abuse or dependence. * Current severe symptoms of depression and/or anxiety. Additional
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Self-Reported Symptoms After Treatment | baseline and 6 weeks | Severity of self-reported symptoms on the Post-Concussion Symptom Inventory |
| Change Self-Reported Quality of Life After Treatment | baseline and 6 weeks | Self-reported scores on quality of life on Global Quality of Life Scale |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in blood pressure after treatment | baseline and 6 weeks | Changes in blood pressure (systolic/dyastolic in mmHg) in response to stress paradigm measured through Biopac system. |
| Change in cerebral blood flow stress after treatment | baseline and 6 weeks | Changes in cerebral blood flow dynamics in bilateral middle cerebral arteries as measured by transcranial doppler. |
| Change in peak salivary cortisol after treatment | baseline and 6 weeks | Changes in peak salivary cortisol concentration will be measured in response to stress paradigm. Measurements will be taken just prior to stress paradigm and then 20 minutes after its conclusion. |
| Change in respiration rate after treatment | baseline and 6 weeks | Changes in respiration rate as measured through capnometer in response to stress paradigm |
| Change in end-tidal carbon dioxide after treatment | baseline and 6 weeks | Changes in end-tidal carbon dioxide measurement in response to stress paradigm measured through capnometer in mmHg |
| Change in heart rate after treatment | baseline and 6 weeks | Changes in heart rate (beats per minute) in response to stress paradigm measured through Biopac system. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in behavioral avoidance and distress after treatment | baseline and 6 weeks | Change in self-reported behavioral avoidance and distress due to anxiety as measured by the UCLA Behavioral Avoidance and Distress Scale |
| Change in disability perception due to injury after treatment | baseline and 6 weeks | Change in self-reported disability in social, occupational, and family/home functioning as measured by the Sheehan Disability Scale |
| Change in orthostatic blood pressure after treatment | baseline and 6 weeks | Change in orthostatic blood pressure obtained via measurements in three different positions: supine, upright sitting, and standing, each held for 5 minutes. Measurement obtained via Biopac double finger cuff. |
| Change in depressive symptoms after treatment | baseline and 6 weeks | Self-report measure of cognitive and somatic symptoms of depression, Beck Depression Inventory (BDI-II) |
| Change in anxiety symptoms after treatment | baseline and 6 weeks | Self-report measure of cognitive and somatic symptoms of anxiety, Beck Anxiety Inventory (BAI) |
| Change in sleep quality after treatment | baseline and 6 weeks | Self-report measure of sleep dysfunction, Pittsburgh Sleep Quality Index (PSQI) |
| Change in neurocognitive performance after treatment | baseline and 6 weeks | Selected subtest performance on attention, learning and memory, processing speed, and verbal fluency as measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) standardized assessment. |
| Change in perceived cognitive exertion after treatment | baseline and 6 weeks | Change in self-reported physical, emotional, and perceived cognitive symptoms from pre- to post-neurocognitive assessment. |
| Change in illness perception after treatment | baseline and 6 weeks | Change in self-reported perception of illness as measured by the Brief Illness Perception Questionnaire. |
Countries
United States
Contacts
Primary ContactAliyah R Snyder, PhD
Outcome results
None listed