Abstract
Participants with postconcussion syndrome were taught breathing exercises and given a heart rate variability (HRV) monitor to promote reduced anxiety. Outcome measures included the Perceived Stress Scale, HRV, and anxiety tracking. Each measure improved for participants by the study's conclusion.
Primary Author and Speaker: Kelsee Hove
Contributing Authors: Callie Lodden, Emily Mock, Mariah Roe, Lindsey Schulz, and Jillian Jones
Mild traumatic brain injuries, or concussions, have become a popular topic of conversation in regard to the long term effects these injuries have on cognitive function. Individuals of all ages may experience a concussion due to a fall, motor vehicle accident, or any other event resulting in an injury to the head. Approximately 15-30% of individuals who sustain a concussion will develop post-concussion syndrome (Finn, 2015). This diagnosis is consistent with persistent concussion symptoms that impair the ability to function in daily life. Research has categorized typical concussion symptoms into the following three categories: somatic, cognitive, and affective (Broglio, Collins, Williams, Mucha, & Kontos, 2015). Occupational therapists have a unique and important role to play in assisting individuals in returning to their meaningful occupations through evidence-based intervention. Further, due to the highly individualized nature of symptom presentation, occupational therapy treatment for a concussion must also be client-centered. The individualized nature of both symptoms and treatments demonstrates the importance of strengthening the current literature regarding effective interventions for occupational therapists to utilize with this population. The objective of this study was to determine the feasibility of heart rate variability biofeedback and a breathing protocol as interventions to address heightened levels of stress and anxiety associated with post-concussion syndrome. Biofeedback is a relatively new method for changing psychosocial and physiological factors associated with post-concussion syndrome. Although there is existing literature about biofeedback and reducing anxiety, there is limited research about its value as an intervention option in the treatment of post-concussion syndrome. The current literature indicates positive results surrounding biofeedback as an intervention to improve a variety of post-concussion syndrome symptoms, including anxiety (Bhandari, Thompson, & Reid-Chung, 2013; Reid-Chung, Thompson, & Thompson, 2015; Lagos, Thompson, & Vaschillo, 2013). However, the research is limited largely to case studies and case series which make generalizability of the results challenging. For this research, a one group, non-randomized pre/posttest descriptive case study was implemented. Participants (n = 3) were between 27 and 52 years old, sustained a concussion within the last two years, and were experiencing post-concussion syndrome. Participants were recruited through On With Life's Complex Concussion program. Participants completed the 10-question version Perceived Stress Scale during weeks one, three, and six. During week one, participants learned how to use the heart rate variability monitor and anxiety tracking chart. During week two, participants were taught breathing techniques to implement and continued to track anxiety. For participants, heart rate variability and Perceived Stress Scale scores improved during intervention and follow-up. One participant retained and improved heart rate variability at follow-up. Participants' anxiety levels decreased throughout the treatment and follow-up. This study demonstrated positive outcomes for anxiety, perceived stress, and heart rate variability in those with post-concussion syndrome when tracking heart rate variability and completing breathing exercises.
Bhandari, T., Thompson, L., & Reid-Chung, A. (2013). Treating post concussion syndrome using neurofeedback: A case study. Biofeedback (Online), 41(4), 174-182.
Broglio, S. P., Collins, M. W., Williams, R. M., Mucha, A., & Kontos, A. (2015). Current and emerging rehabilitation for concussion: A review of the evidence. Clinical Sports Medicine, 34(2), 213-231. https://doi.org/10.1016/j.csm.2014.12.005
Finn, C., & Waskiewicz, M. A. (2015). The role of occupational therapy in managing post-concussion syndrome. Retrieved from https://www.aota.org/∼/media/Corporate/Files/Secure/Publications/SIS-Quarterly-Newsletters/PD/PDSIS-March-2015.pdf
Lagos, L., Thompson, J., & Vaschillo, E. (2013). A preliminary study: Heart rate variability biofeedback for treatment of postconcussion syndrome. Biofeedback, 41(3), 136-143. https://doi.org///dx.doi.org.cowles-proxy.drake.edu/10.5298/1081-5937-41.3.02