By Maggie Christ

The Department of Defense has awarded $6 million to Virginia Commonwealth University for the study of a treatment targeting long-term symptoms that can follow a concussion.

The four-year study related to mTBI – mild traumatic brain injury – focuses on whether a treatment called heart rate variability biofeedback can help veterans and service members suffering from ongoing post-concussion symptoms. The research will test HRV biofeedback for addressing issues such as poor sleep, fatigue, dizziness and trouble with memory or concentration – common problems that make life difficult for people who have had a concussion.

The HERO study – shorthand for HRV Biofeedback for Enhancing Autonomic Resilience and mTBI Outcomes – is co-led by James Burch, Ph.D., a professor in VCU’s School of Public Health, and William Walker, M.D., a professor in the School of Medicine.

HRV biofeedback helps patients control their breathing and heart rate. In training sessions, patients can see how breathing in a certain pattern – five seconds in, five seconds out – impacts their heart rate by monitoring it on a computer screen. Over time, this exercise helps people lower stress and improve heart function. 

HRV biofeedback has been shown in other studies to help with symptoms including pain, post-traumatic stress disorder and depression. It has not yet been tested on veterans and service members who have had a concussion.

The HERO study will also compare HRV biofeedback against current treatments, which focus on educating patients about how to manage concussion symptoms. Researchers think HRV biofeedback will be more effective because it actively helps the body’s nervous system return to a healthier state. The nervous system controls automatic body functions, such as heart rate and digestion, which often get disrupted after a concussion. By learning to control their heart rate, patients can improve their overall health and the resiliency of their cardiovascular system.

“What’s really neat is we’re not in this to keep people bound to the medical system,” Burch said. “When we show people this technique, they can use it whenever they need. Whenever they’re stressed out – at a stoplight, standing in line or just dealing with trauma – they can use this breathing technique.”

A major goal of the study is to identify which patients benefit most from HRV biofeedback. Researchers will look at whether people with multiple concussions, or those who also have PTSD, get better results. They also will explore if women respond differently to the treatment.

If the study reveals success, HRV biofeedback could become a common treatment for people with long-term concussion symptoms. It could give veterans, service members and civilians a new, low-cost way to improve health without medicine or surgery. This could also help lower the risk of dementia, which is more common in people with repeated brain injuries.

“We are studying core health principles in this study that should open the door to healthy behavioral changes and evidence-based treatment options,” said Raouf Gharbo, D.O., director of autonomic rehabilitation in VCU’s School of Medicine and a member of the HERO study team. He plans future research into how HRV biofeedback could improve the quality and efficiency of sleep, which impacts a person’s ability to recover from conditions such as concussion, cancer, long COVID and even emotional health disorders like PTSD.

Joining primary investigators Burch and Walker on the HERO study team are Gharbo; Jennifer Weggen, Ph.D. candidate in VCU’s Department of Kinesiology and Health Sciences; David Cifu, M.D., professor in VCU’s School of Medicine; JP Ginsberg, Ph.D., adjunct faculty at Saybrook University; Robert Perera, Ph.D., associate professor in VCU’s School of Public Health; and Clara Dismuke-Greer, Ph.D., of the Health Economics Resource Center, U.S. Department of Veterans Affairs.