A Study on the Effect of Mindfulness-based Yoga on Youth With Persistent Concussion Symptoms
Condition: Brain Concussion; Mild Traumatic Brain Injury
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Brain Concussion
Study type: Interventional

Summary: 
      Mild traumatic brain injury (mTBI), also known as concussion, is of great concern in the
      youth population, with incidences of injury steadily increasing within the past few years.
      Current Canadian estimates have indicated that the total rate of concussions per 100,000
      increased from 467 to 754 for boys and from 209 to 441 for girls from 2003-2010. As defined
      by the recent Zurich Consensus statement, concussion is a pathophysiological injury induced
      by biomechanical forces, which can be caused by impact to the head, neck or body. In 10-20%
      of youth, concussion symptoms persist in the weeks, months or even years following the
      injury. Consequently, youth with persistent concussion symptoms are unable to fully
      participate in the meaningful activities (e.g. attending school, engaging with friends and
      community) they did prior to the injury and experience a reduced quality of life.

      Persistent concussion symptoms in youth requires an approach that directly addresses the
      rumination and attention to distressful thoughts about their functional performance, while
      still promoting appropriate levels of physical and cognitive demands. Targeting these
      constructs may shift the focus away from symptoms, while building self-efficacy and enhancing
      participation in daily activities. Mindfulness-based yoga (MBY) is a mind-body intervention
      that uses physical yoga poses, purposeful breathing techniques and a focus on being in the
      present moment. MBY encourages participants to develop moment-to-moment awareness of physical
      sensations, emotions, and thoughts, and promotes the cultivation of non-judgemental and
      accepting relationships to personal experiences. In chronic pain, fibromyalgia, mental health
      and now TBI populations, MBY has demonstrated benefits in physical (i.e. increased muscle
      strength, endurance), psychological (i.e. decreased stress, increased self-efficacy),
      cognitive (i.e. increased concentration) and social (i.e. emotional regulation, improved
      mood) domains. Although mindfulness based yoga has been validated as a form of rehabilitation
      in the adult population, its applicability for youth with persistent concussion symptoms has
      yet to be explored. Understanding the impact of a MBY intervention on this population may
      enhance management of persistent symptoms and ultimately, participation in meaningful
      activities.

      In addition to the functional sequelae that ensue following this injury, concussion in both
      the acute and persistent phases is being recognized as a neurophysiological injury.
      Traditional methods of assessment following concussion place emphasis on subjective
      self-report and administration of neuropsychological batteries. These assessments are used in
      an effort to return the youth to activity (i.e school, sport). However, these methods can be
      unreliable as youth have a high incentive to return to play and neurocognitive resolution
      does not necessarily equate to pre-injury function. To augment these measures, an objective
      indicator of neurophysiological stress is needed. Heart rate variability (HRV) is an
      objective, neurophysiological indicator of autonomic nervous system functioning. HRV is
      quantified by measuring the time intervals between heartbeats. Increased variability in heart
      rate (i.e. increased HRV) is seen as healthy neurophysiological function, demonstrating an
      individual's ability to adapt and be flexible to the demands of the environment. Conversely,
      decreased HRV is demonstrative of an individual's reduced ability to respond flexibly to
      their environment. Investigating the impact of persistent concussion symptoms on HRV has the
      potential to enhance our understanding of autonomic nervous system functioning in the chronic
      phases of this injury for an understudied population.

      The specific objectives are to: (1) adapt the MBY intervention protocol to suit the unique
      needs of youth with mTBI (i.e. safety, fatigue), (2) collect data on the impact of MBY on
      HRV, self-efficacy and participation, (3) describe changes in HRV, self-efficacy and
      participation associated with MBY across pre-intervention, post-intervention and 3 months
      following intervention, (4) identify if post concussion symptoms change (i.e. increase or
      decrease) following MBY and (5) identify if changes in post concussion symptoms occur with
      changes in HRV, self-efficacy and participation.
    


Intervention name(s): Mindfulness-based Yoga Arm
Intervention type(s): Behavioral
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Heart rate variability; Self-efficacy; Pediatrics; Mindfulness-based yoga; Symptoms