The Impact of an App-Based Mindfulness-Based Intervention on Resting-State Functional Connectivity in Pediatric Concussion

Abstract Objective: Mindfulness-Based Interventions (MBIs) may help normalize functional brain connectivity (FC) affected by concussion, but no pediatric trials exist. This study investigated whether an app-based MBI produced greater FC changes than a sham across the default mode (DMN), salience (SN), and central executive (CEN) networks. Methods: This randomized clinical trial (Clinicaltrials.gov ID# NCT05105802) recruited participants aged 12.00–17.99 years from the emergency department or interdisciplinary concussion clinic, then randomly assigned them to MBI or a sham app. Brain imaging sessions occurred at 72 hours and 4 weeks post-concussion. Region-of-interest and seed-to-voxel analyses examined Group × Time interactions in FC across DMN, SN, and CEN (p < .050FDR). Results: Thirty-six participants were included (MBI: n = 16, median [IQR] age = 14.23 [13.52–15.65] years, 31% female; Sham: n = 20, median [IQR] age = 14.05 [13.13–16.26] years, 45% female). Intention-to-treat analyses revealed significant Group × Time interactions across networks. DMN-CEN FC patterns differed, with MBI participants showing diminished FC. Within DMN, four clusters showed significant interactions (p < .050FDR), three exhibiting larger FC reductions at 4 weeks in MBI participants. MBI participants showed greater FC increase in one SN cluster (p = .040FDR) and larger FC decrease in one CEN cluster (p = .024FDR) at 4 weeks. Per-protocol analyses identified one significant DMN cluster (p < .001FDR) where MBI participants exhibited greater FC increases. Conclusions: MBI training led to significant changes in FC in networks implicated in concussion recovery. Larger trials are needed to support these findings.