Background: Acute concussions impair driving performance. Similar impairments may be present in individuals experiencing persistent post-concussive symptoms (PPCS). Therefore, there is a need for interventions that can improve driving outcomes in this population. Low resolution electromagnetic tomography (LoRETA) neurofeedback and heart rate variability (HRV) biofeedback can improve attention, impulse control, peripheral vision, and reduce stress; all of which may impact driving ability. Hypotheses/Objectives: To evaluate the preliminary impact of LoRETA neurofeedback and HRV biofeedback on driving performance in individuals experiencing PPCS. Methods: Over an eight-week span, individuals with PPCS (n = 7) received LoRETA neurofeedback and HRV biofeedback interventions three times per week. Additionally, they performed HRV biofeedback twice a day at home. We evaluated the simulated driving performance (i.e. reaction time and lane deviation) and self-reported symptoms in this experimental group, as well as two control groups (nine individuals with PPCS and eight healthy controls) at baseline and post- intervention. Results/Discussion: Headache, nausea, and dizziness severity decreased in the experimental group (p = 0.003) and the PPCS controls (p = 0.001) compared to healthy controls. Additionally, there was some evidence of decreased lane deviation in the intervention group, although not statistically significant in this small sample (p =0.067). This result may have clinical significance. Future Applications/Directions: Future studies with a larger sample size, longer follow-up times, and additional driving simulation metrics may help to evaluate the efficacy and effectiveness of this intervention for individuals with PPCS.

Biofeedback can improve driving performance in individuals with persistent post-concussive symptoms: Preliminary findings from an eight-week intervention