Use of Neurofeedback to Enhance Attention After Brain Injury
Condition: Brain Injuries
MeSH terms: Brain Injuries; Wounds and Injuries
Study type: Interventional

Summary: 
      Difficulty to sustain attention over a prolonged period of time is one of the core
      difficulties experienced by people who have undergone traumatic brain injury. Rehabilitation
      of attention is often based on compensatory strategies, because of the limited impact of
      cognitive training on improving attentional capacity after brain injury. New therapeutic
      approaches to explore the plastic recovery of the brain after injury, and consequent
      performance improvement, are warranted.

      Neurofeedback (NFB) allows the self-regulation of brain activity using visual feedback. Very
      recently, it has been demonstrated that NFB training targeted at reducing alpha power (alpha
      desynchronization NFB), can induce initial plastic changes in brain networks associated with
      attention. It has been proposed that NFB can improve cognitive performance by tuning
      oscillatory activity of the brain towards a more healthy balance between neural network
      flexibility and stability. It is speculated that the use of alpha desynchronization NFB
      training, with people who present with brain injury, can enhance sustained attention in as
      much as the training promotes neural variability during resting state (i.e. more flexible
      network configuration) and neural stability during a sustained attention task (i.e. more
      stable network configuration).

      However, before assessing the effectiveness of the intervention, it is necessary to evaluate
      the feasibility and acceptability thereof. This study will recruit 14 participants and
      randomly assign them to two groups: a NFB group and a video games control group. Long-term
      changes will be evaluated at two time points for both groups: baseline and post-intervention.
      The NFB group will have a follow-up session one week after the intervention, to evaluate
      whether there are long lasting changes after NFB training. In addition, short-term changes of
      NFB will be evaluated for the experimental group, contrasting EEG activity immediately before
      and after the last NFB session.
    

Detailed description: 
      Participants taking part in the neurofeedback group will undertake sixteen 30-minute sessions
      of neurofeedback training, from Tuesday to Friday, distributed over the course of four weeks.
      Sessions will be performed at the same time each day. Each 30-min NFB session will consist of
      7 x 3-minute blocks of training flanked by a 3-minute resting state block with eyes-open.
      During the training blocks participants will seat in front of a laptop screen displaying an
      image that will change according the brain activity produced by the participant. One
      electrode will be located at the centro parietal region of the scalp (Pz) and another one in
      the earlobe as a reference. Participants taking part in the control group will play video
      games for 30 minutes during the same number of sessions, also distributed across four weeks.
      The same experimental set-up will be used, but EEG activity will not be recorded.
      Participants will follow the same structure as the NFB group, playing video games during 7 x
      3-minute blocks flanked by a 3-minute seated relaxation.

      Each participant will be involved in the study for a maximum of 5 weeks. The NFB training and
      control sessions for all participants are expected to be completed over the course of five
      months.
    

Intervention name(s): Neurofeedback training; Video game
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Sixteen 30-minute sessions of neurofeedback training over four weeks: 7 x 3-minute blocks of training flanked by a 3-minute resting state block with eyes-open.; Sixteen 30-minute sessions of video game playing over four weeks: 7 x 3-minute blocks flanked by a 3-minute seated relaxation.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A pilot two-armed, parallel-design, individually randomised controlled trial, using stratified randomization with blocking
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Neurofeedback; Attention