Clinical And Neural Effects Of Multidomain Augmented Reality Rehabilitation In Persistent Post-Concussion Syndrome

Abstract

Persistent post-concussion symptoms (PPCS) cause debilitating impairments lasting months to years and resist conventional rehabilitation. Cognitive-motor integration (CMI) networks are particularly vulnerable following concussion yet remain an unexplored therapeutic target. We investigated whether augmented reality-based multidomain rehabilitation targeting CMI could induce clinical and neural recovery in adults with chronic PPCS. Seven participants (mean age 50.7 years, 71% female, mean 38.1 months post-injury) completed a twice-weekly, 8-week intervention combining visuospatial working memory, visuomotor transformation, and progressive vestibular challenge. Participants demonstrated large effect size improvements (r = 0.83–0.90) in energy, emotional wellbeing, perceived stress, and dizziness, though statistical power was limited by sample size, with seven measures meeting or exceeding estimated minimal clinically important difference (MCID) thresholds. A neuroimaging subset (n=3) revealed white matter recovery and limbic-striatal-thalamic functional connectivity reorganization. The concordance between behavioral engagement, white matter plasticity, and functional improvement suggests use-dependent neuroplasticity and positions CMI training as a promising approach warranting controlled trials.