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Blood Flow Restriction Concussion

Primary Purpose

Concussion Post Syndrome

Status
Enrolling by invitation
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Blood Flow Restriction Training with Exercise
Sponsored by
Duke University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Concussion Post Syndrome

Eligibility Criteria

14 Years - 30 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Ability to read, write, and speak the English language Diagnosis of Post-Concussion Syndrome (medical diagnosis of concussion with symptoms lasting greater than four weeks.

Increased symptoms with physical activity Ages 14-30 years old

Exclusion Criteria:

Focal neurological deficits Exclusion criteria for Blood Flow Restriction (open wounds or fracture, history of clot, impaired circulation or venous compromise, sickle cell anemia, extremity infection, tumor distal to tourniquet placement, cancer, lymphectomy) Migraine history Positive image findings on MRI Benign Positional Paroxysmal Vertigo

Sites / Locations

  • Duke Sports Science Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

BFR THEN without BFR

Without BFR THEN with BFR

Arm Description

Will perform exercises with BFR at the first visit and without BFR at the second visit

Will perform exercises without BFR at the first visit and with BFR at the second visit

Outcomes

Primary Outcome Measures

Change in Post Concussion Symptom Score
The Post Concussion Symptoms Score is a self-reported measurement of symptoms associated with concussion with items ranked from 0 (no symptoms) to 6 (severe symptoms)

Secondary Outcome Measures

Change in Global Function Rating
The subject will be asked to report his/her function rating on a scale of 0-100%
Change in Heart Rate Variability
Heart Rate Variability will be compared, over time, to the baseline variability measured at the initial evaluation
Change in Presence of Orthostatic Tachycardia
Orthostatic Tachycardia will be recorded as either present or absent
Change in Presence of Orthostatic Symptoms (Headache)
Symptom of headache onset during a orthostatic position change will be recorded as present or not present
Change in Presence of Orthostatic Symptoms (dizziness/light headedness)
Symptom of dizziness/light headedness onset during a orthostatic position change will be recorded as present or absent

Full Information

First Posted
October 2, 2018
Last Updated
January 24, 2023
Sponsor
Duke University
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1. Study Identification

Unique Protocol Identification Number
NCT03695042
Brief Title
Blood Flow Restriction Concussion
Official Title
The Utilization of Blood Flow Restriction Training in Post Concussion Recovery
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Enrolling by invitation
Study Start Date
January 15, 2019 (Actual)
Primary Completion Date
December 31, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Duke University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to examine the effect that blood flow restriction training will have on patients with concussion who demonstrate an intolerance to physical activity. Progressive exercise training has been shown to effectively reduce the effects of concussion and facilitate return to academic and athletic activities. In many cases, exercises intolerance is present in these patients which hinders progression. In musculoskeletal conditions, blood flow restriction training, when combined with low load exercise, has been shown to produce similar gains as high load exercises. If a patient being treated for concussion can tolerate low load exercise without concussive symptoms, then blood flow restriction may increase exercise gains by facilitating autonomic responses similar to high load training. This study will explore this hypothesis in patients between the ages of 14 and 30 who are referred for physical therapy intervention which is the standard of care at Duke Sports Sciences Concussion Clinic. Blood flow restriction training is also used in multiple patient populations at Duke Sports Physical Therapy without adverse events.
Detailed Description
This is a prospective randomized proof of concept trial comparing the efficacy of the novel application of blood flow restriction to improve exercise tolerance in patients with post-concussion syndrome. Blood flow restriction training is commonly used in combination with low intensity/load exercise to facilitate exercise tolerance in those that would not tolerate high intensity/load exercises. While this intervention has been clinically employed in patients with concussion, research is needed to establish it's efficacy in a meaningful and prospective way. Subjects in this study will be randomly assigned to one of two groups. One group will perform exercises with BFR and then without BFR. The other group will perform the exercises without BFR first and then perform them with BFR. Each subject will undergo a single physical therapy session in each condition. Subjects meeting study criteria will be randomly allocated to each group. Because concussion symptoms can change quickly over time, it will be important to vary the timing of when the blood flow restriction is performed to better understand if improvement is due to intervention or passage of time. Randomization will be performed via sealed envelope to ensure even distribution into both groups. Patients presenting to physical therapy for treatment of concussion symptoms will undergo a physical therapy concussion evaluation that includes orthostatic measurements, cervical screen, and vestibular-oculomotor screen. Patients will report a Global Function Rating and complete a Post-concussion Symptom Score, Neck Disability Index, and Dizziness Handicap Inventory at initial visit. Heart rate variability will also be assessed at initial visit. The measurements and questionnaires collected at the initial evaluation are part of the standard of care at this clinic. Subjects will be recruited after the initial visit and will have already completed these measurements/questionnaires. It is also standard of care to continue to administer these questionnaires as symptom status changes throughout the course of treatment until discharge. At the subsequent visit, subjects will undergo cardiovascular testing on a stationary bike to identify symptom provocation and exercise tolerance with aerobic exercise. The above evaluative tools and interventions are standard of practice for concussion patients being treated by physical therapy at the Duke Sports Concussion Clinic. Intervention Procedure (BFR): A blood flow restriction (BFR) cuff is applied to dominant leg and limb occlusion pressure (LOP) and personalized tourniquet pressure (PTP) at 80% is determined with the patient in supine. Using an established BFR protocol of 4 sets of exercises with repetitions of 30-15-15-15, the patient will perform the exercises of double leg squat and forward lunge under occlusion. There will be a 30 second break between each set and 1 minute break between exercises. Then, the physical therapist will move BFR cuff to opposite leg and reassess LOP/PTP 80%. The patient will repeat squat and forward lunge exercises as above. The treatment will be discontinued if there is a greater than 3 point change in subjective symptom report. If the patient reports leg pain/discomfort, the pressure will be decreased by 10%. If still unable to complete the exercise due to leg discomfort, the intervention will be discontinued. The following will be recorded: Heart rate range during each set Maximum heart rate during the recovery period Rate of Perceived Exertion (RPE) and symptom report will be obtained during each recovery period. Total time under occlusion upon completion of the round. Intervention Procedure (No BFR): Subjects will perform the 4 sets of each exercise with repetitions of 30-15-15-15. There will be a 30 second break between each set and 1 minute break between exercises. The exercises will include double leg squat, dominant leg forward lunge, repeat double leg squat, and non-dominant leg forward lunge The following will be recorded: Heart rate range during each set Maximum heart rate during the recovery period Rate of Perceived Exertion (RPE) and symptom report will be obtained during each recovery period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Concussion Post Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
10 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
BFR THEN without BFR
Arm Type
Experimental
Arm Description
Will perform exercises with BFR at the first visit and without BFR at the second visit
Arm Title
Without BFR THEN with BFR
Arm Type
Experimental
Arm Description
Will perform exercises without BFR at the first visit and with BFR at the second visit
Intervention Type
Other
Intervention Name(s)
Blood Flow Restriction Training with Exercise
Intervention Description
The addition of BFR training to an exercise program prescribed for a patient participating in physical therapy for concussion treatment. BFR training partially occludes blood flow to extremities during exercise. This allows one to exercise at lower loads and still gain benefits similar to exercise at higher loads
Primary Outcome Measure Information:
Title
Change in Post Concussion Symptom Score
Description
The Post Concussion Symptoms Score is a self-reported measurement of symptoms associated with concussion with items ranked from 0 (no symptoms) to 6 (severe symptoms)
Time Frame
Baseline and 8 weeks
Secondary Outcome Measure Information:
Title
Change in Global Function Rating
Description
The subject will be asked to report his/her function rating on a scale of 0-100%
Time Frame
Baseline and 8 weeks
Title
Change in Heart Rate Variability
Description
Heart Rate Variability will be compared, over time, to the baseline variability measured at the initial evaluation
Time Frame
1 week, 3 weeks, 6 weeks, 8 weeks
Title
Change in Presence of Orthostatic Tachycardia
Description
Orthostatic Tachycardia will be recorded as either present or absent
Time Frame
Baseline, 1 week, 2 weeks
Title
Change in Presence of Orthostatic Symptoms (Headache)
Description
Symptom of headache onset during a orthostatic position change will be recorded as present or not present
Time Frame
Baseline, 1 week, 2 weeks
Title
Change in Presence of Orthostatic Symptoms (dizziness/light headedness)
Description
Symptom of dizziness/light headedness onset during a orthostatic position change will be recorded as present or absent
Time Frame
Baseline, 1 week, 2 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
14 Years
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ability to read, write, and speak the English language Diagnosis of Post-Concussion Syndrome (medical diagnosis of concussion with symptoms lasting greater than four weeks. Increased symptoms with physical activity Ages 14-30 years old Exclusion Criteria: Focal neurological deficits Exclusion criteria for Blood Flow Restriction (open wounds or fracture, history of clot, impaired circulation or venous compromise, sickle cell anemia, extremity infection, tumor distal to tourniquet placement, cancer, lymphectomy) Migraine history Positive image findings on MRI Benign Positional Paroxysmal Vertigo
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Laura Pietrosimone
Organizational Affiliation
Duke University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Duke Sports Science Institute
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Blood Flow Restriction Concussion

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