No abstract

Objective Mild traumatic brain injuries (mTBIs) are common and may result in persisting symptoms. Mobile health (mHealth) applications enhance treatment access and rehabilitation. However, there is limited evidence to support mHealth applications for individuals with an mTBI. The primary purpose of this study was to evaluate user experiences and perceptions of the Parkwood Pacing and Planning™ application, an mHealth application developed to help individuals manage their symptoms following an mTBI. The secondary purpose of this study was to identify strategies to improve the application. This study was conducted as part of the development process for this application. Methods A mixed methods co-design encompassing an interactive focus group and a follow-up survey was conducted with patient and clinician-participants (n = 8, four per group). Each group participated in a focus group consisting of an interactive scenario-based review of the application. Additionally, participants completed the Internet Evaluation and Utility Questionnaire (UQ). Qualitative analysis on the interactive focus group recordings and notes was performed using phenomenological reflection through thematic analyses. Quantitative analysis included descriptive statistics of demographic information and UQ responses. Results On average, clinician and patient-participants positively rated the application on the UQ (4.0 ± .3, 3.8 ± .2, respectively). User experiences and recommendations for improving the application were categorized into four themes: simplicity, adaptability, conciseness, and familiarity. Conclusion Preliminary analyses indicates patients and clinicians have a positive experience when using the Parkwood Pacing and Planning™ application. However, modifications that improve simplicity, adaptability, conciseness, and familiarity may further improve the user's experience.

BackgroundANS function can be measured noninvasively and relatively inexpensively through heart rate variability (HRV). Reduced HRV is representative of an uncoupling between the ANS and cardiovascular system, which may be proportional to the severity of a neurological injury. Reduced HRV has been observed in patients diagnosed with a sport‐related concussion, and therefore may be a useful outcome measure in identifying the chronic effects of heading during a youth soccer season.ObjectivesThe purpose of this study was to evaluate the effects of one season of competitive soccer, with the inherent subconcussive header impacts, on autonomic function in female youth soccer players.ParticipantsTwenty‐three female youth soccer players (13.4 ± 0.84 years old) were recruited from three competitive soccer teams.MethodsThe number of headers performed during the season were quantified using game video analysis. Players that performed fewer than the average number of headers (20) at the end of the season were classified into the “low header” group (N=13), while players with 20 or more headers at the end of the season were classified into the “high header” group (N=10). A five‐minute resting electrocardiogram data was collected from all players at baseline and post‐season. These data were analyzed using a two‐way mixed ANOVA in order to calculate heart rate variability time‐domain and frequency‐domain measures, which included mean heart rate, standard deviation of the N‐N interval, total power, low frequency, high frequency, and low to high frequency ratio (LF/HF).ResultsThere was a statistically significant interaction between time and group for LF/HF from preseason (6.24 ± 5.77; 2.96 ± 1.81) to postseason (6.79 ± 6.75; 1.90 ± 1.02) in the low and high header groups, respectively (p=.024, partial h2=0.313). There were no other statistically significant changes in HRV for any other time or frequency domain outcome measure.ConclusionOur preliminary findings indicate that the LF/HF in the high header group differed from the low header group over the course of a soccer season. This may indicate that an increased number of chronic head impacts might result in an imbalance between sympathetic and parasympathetic activity, which would signify an alteration in autonomic function. These preliminary results demonstrate that additional research is needed in order to further understand the effects of heading on ANS function.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Background Case reports indicate that low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback may improve physiological functioning in individuals with persistent post-concussive symptoms. However, it is unclear whether larger-scale studies are feasible. Purpose To evaluate the feasibility of a combined low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback intervention for individuals with persistent post-concussive symptoms. Methods Individuals with persistent post-concussive symptoms were randomized into intervention and control groups, and their baseline and post-test assessments were compared to a healthy control group. Outcomes included self-report questionnaires, resting electroencephalograph and electrocardiograph recordings, and a driving simulation task. Participants in the intervention group completed three 20 min low-resolution electromagnetic tomography neurofeedback sessions per week and at-home heart rate variability biofeedback training every morning and night for 8 weeks. Feasibility was evaluated according to recruitment capability and sample characteristics, data collection procedures, suitability of the intervention and study procedures, management and implementation of the study intervention, and preliminary participant responses to the intervention. Results Thirty-three individuals were recruited and 24 completed this study (seven intervention participants, nine persistent post-concussive symptoms control participants, and eight healthy control participants). One-quarter of participants (four intervention participants and three persistent post-concussive symptoms control participants) experienced simulator sickness during the driving simulator task and had to withdraw from the study. Intervention participants had an 88% and 86% compliance rate for the low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback sessions, respectively. Low-resolution electromagnetic tomography neurofeedback sessions took approximately 1 h to complete per participant. Preliminary analysis indicated that the intervention reduced electroencephalograph z-score deviation with a very large effect size ( d = 1.36) compared to the other study groups. Conclusions Pilot studies evaluating the efficacy of low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback should be performed to confirm these preliminary findings. However, the protocol should be modified to reduce participant fatigue and withdrawal. This trial was registered with Clinicialtrials.gov (NCT03338036; https://clinicaltrials.gov/ct2/show/NCT03338036?term=03338036&draw=2&rank=1 ).