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Developing the Standard of Care for Post-Concussion Treatment: Neuroimaging-Guided Rehabilitation of Neurovascular Coupling

Benjamin H. Wing1,2; Braden J. Tucker1,4; Alina K. Fong, PhD1,3; Mark D. Allen, PhD1,2

1Cognitive FX, Provo, UT
2Notus Neuropsychological Imaging, Orem, UT
3Utah Valley Regional Medical Center, Provo, UT
4Case Western Reserve University School of Medicine, Cleveland, OH

 

Abstract. OBJECTIVE: Emerging research proposes the imbalance between microvascular supply and metabolic demand as a contributing factor in the pathophysiology of mild traumatic brain injury (mTBI). Prolonged effects on the dysregulation of neurovascular coupling (NVC) may explain persistent symptomatic models such as Post-Concussion Syndrome (PCS). Increased knowledge of what we refer to as Neurovascular Uncoupling (NVU) provides a template for establishing a new concussion treatment standard in the assessment and therapeutic guidance of concussion. PARTICIPANTS & METHODS: The degree and localization of NVU was statistically contextualized against a normative-based atlas in 270 concussed patients using Functional NeuroCognitive ImagingTM (fNCI) to establish pre-treatment benchmarks and methodically guide neurotherapy. Conventional and fNCI-directed measures were used to evaluate post-rehabilitative outcomes. RESULTS: fNCI was successful in identifying regions of NVU unique to each patient’s brain and concussion profile. Longitudinal objective outcome measures demonstrated timely and lasting improvement of NVC functioning in a significant majority of patients. CONCLUSIONS: We present practice-based evidence supporting the clinical administration of fNCI with particular efficacy in the neurorehabilitation of mTBI. We advocate the reliability of fNCI in assessing severity and localization of NVU, and promote its use in the therapeutic guidance and neurorehabilitation of mTBI. We further support the continual exploration of other potential pathophysiological involvement in this complex brain injury.

 

 Keywords. Mild traumatic brain injury (mTBI), concussion, post-concussion syndrome (PCS), regional cerebral blood flow (rCBF), neurovascular coupling (NVC), neurovascular uncoupling (NVU), enhanced performance in cognitionTM (EPIC), functional magnetic resonance imaging (fMRI), clinical fMRI, blood oxygen level dependent (BOLD) signals, functional neurocognitive imagingTM (fNCI), severity index score (SIS), post-concussion symptom scale (PCSS), neurorehabilitation, treatment standards, accelerated improvement, longitudinal outcomes

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