Biofeedback-based Video Game Device to Treat Rage Attacks in Youth with Tourette Syndrome
Matthew Tae1, Samantha Myers1, Jason Kahn2, Nicole Walsh1, Emily Stone2, Alyssa Peechatka2, Jessica Ragnio2, Jonathan Mink1, Jennifer Vermilion1
1University of Rochester Medical Center, 2Neuromotion Labs
Objective:
To evaluate the feasibility and acceptability of Mightier as a therapeutic intervention for rage attacks in youth with TS.
Background:
Approximately 20-40% of individuals with Tourette Syndrome (TS) have rage attacks, which are recurrent, explosive behavioral outbursts that can cause significant functional impairment. Despite the impact of rage attacks in TS, there has been limited research on treatment, and most studies have focused on pharmacologic interventions. Non-pharmacologic interventions have the potential to improve symptoms with fewer side effects. Mightier, a biofeedback-based video game device, may help teach emotional regulation through heart rate control and has the potential to improve rage attacks in youth with TS.
Design/Methods:
Feasibility was assessed by recruitment number and retention rate. Subjects aged 6-12 years old with a diagnosis of TS and rage attacks were enrolled between October 2021 and May 2022 into a 20-week, single-arm trial. We also evaluated efficacy by assessing rage severity (Clinical Global Impressions of Rage (CGI-Rage), Rage Outbursts and Anger Rating Scale (ROARS)) and overall aggression severity (Modified Overt Aggression Scale) pre- and post-intervention. CGI-Improvement was completed post-intervention.
Results:
Recruitment rate was 1.1 subjects per month. Of the 8 enrolled subjects, 4 have completed the study and 1 has withdrawn due to medication changes during the study period. Retention rate was 87.5% (n=7). No screening failures occurred. Post-intervention, rage attack severity on CGI-Rage and ROARS improved in 75% (n=3) of subjects and did not change in 1 subject. Aggression did not significantly change (improved by a mean 0.5 points). CGI-I was rated as much improved or very much improved across all subjects.
Conclusions:
Based on our recruitment rate and retention, Mightier may be feasible for use in youth with rage attacks and TS. Preliminary efficacy outcomes are promising.