A comprehensive “Concussion Recovery Program” with emphasis on brain coaching and EEG-based neurofeedback therapy: A retrospective analysis

Purpose We have developed and implemented a “Concussion Recovery Program” (CRP) which combines promising treatment strategies from the medical literature into a comprehensive, multidisciplinary, and personalized program for patients with Post-Concussive Syndrome (PCS). The program's goal is to treat all of a patient's PCS-related symptoms under the care of a single physician. Patients receive brain coaching twice weekly in order to address their anxiety, insomnia, attention, headache, and fatigue issues. We also use EEG-based neurofeedback twice weekly to complement brain coaching sessions. Patients median time spent in the program was 16 weeks, during which they received a median number of 21 brain coaching sessions and 22 neurofeedback sessions.

Methods To evaluate the effectiveness of CRP, we performed a retrospective, exploratory analysis using de-identified patient data from the Neurogrow Brain Fitness Center (Virginia, USA; approved by the New England IRB). We used a computerized cognitive testing tool, called CNS Vital Signs, to evaluate the cognitive performance of patients at the beginning and end of the program.

Results Data from 46 patients reviewed showed significant improvements in several cognitive domains. Primary outcome measures were the 3 CNS Vital Signs domains known to be most sensitive to mild traumatic brain injury: Complex Attention, Cognitive Flexibility, and Executive Functioning. Paired t-tests were used to compare mean scores before and after treatment. For all 3 domains, patients experienced significant improvement after treatment (p < 0.00001), with medium or large effect sizes. For all 3 domains, over half of patients experienced score improvements greater than the Reliable Change Index.

Conclusions Patients with PCS who completed our CRP experienced significant improvements in their symptoms. These results are promising and now a larger prospective study is warranted.