**Author details**

*Therapy Approaches in Neurological Disorders*

self-reported symptoms and driving performance).

could also be delayed.

**5. Conclusions**

toms following a concussion.

research space and helping to recruit participants.

**Acknowledgements**

**Conflict of interest**

somatic and cognitive domains [57]. It is unclear how our parameterization of the RPQ scores may have influenced the findings. Lastly, this study only looked at the immediate effects of the LoRETA neurofeedback and HRV biofeedback intervention. Although consistent with other neurofeedback studies [31, 58, 59], it is unclear whether short-term responses reflect long-term outcomes. Alternatively, there may be delays before symptoms change [1], and accordingly a reduction in symptoms

This study is the first to systematically implement and evaluate the outcomes of a LORETA neurofeedback and HRV biofeedback protocol for civilians with PPCS. It is also noteworthy that this study evaluated the outcomes of LORETA neurofeedback and HRV biofeedback in individuals that completed a rehabilitation program and had ongoing PPCS; a population with symptoms that may be difficult to treat [47]. Considering the participant population, these results are especially valuable to healthcare practitioners because they include clinically relevant outcomes (i.e.

This study implemented an intervention involving a combination of LoRETA neurofeedback and HRV biofeedback for eight weeks, based on individual EEG baseline assessments. Eleven participants with PPCS were included in the intervention group (seven that finished the protocol), 12 in the PPCS control group (nine that finished the protocol), and eight healthy control participants. Considering the PPCS intervention group as a whole, this combined intervention did not improve symptoms or driving simulation performance. However, some of the individuals did show improvements. This may indicate that this intervention is effective for a subgroup of individuals with PPCS, or perhaps that the intervention needs to be further individualized to optimize participants' responses. Specifically, the nature of the symptoms, rate of improvement, and length of symptom persistence may need to be considered to individualize the protocol. The results of this study also emphasize the importance of evaluating fitness to drive following a concussion, as well as the need for return-to-drive guidelines for individuals experiencing symp-

We would like to thank Shannon McGuire, Dalton Wolfe, and the staff of the Acquired Brain Injury Outpatient program at Parkwood Institute for donating

Dr. James Thompson is the Co-Founder of Evoke Neuroscience. Evoke Neuroscience donated the eVox EEG systems for this research, and the corresponding analyses. Dr. Thompson contributed to the research design, analysis and manuscript editing. All remaining authors have no conflict of interest to report.

**40**

Marquise M. Bonn1 , Liliana Alvarez1 , James W.G. Thompson<sup>2</sup> and James P. Dickey1 \*

1 Faculty of Health Sciences, Western University, London, Canada

2 Evoke Neuroscience Inc., New York, USA

\*Address all correspondence to: jdickey@uwo.ca

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
