The approach to treating mild traumatic brain injury (mTBI) has long been the same regardless of what is going on with that specific patient. Patients are told to rest, then gradually return to activity. But concussion affects different people in different ways – one patient’s primary struggle may be dizziness and balance, another’s is headaches and sleep disruption. Should treatment reflect that?
A March 2026 randomized clinical trial (RCT) published in JAMA Network Open, “Targeted Multidomain Treatment for Mild Traumatic Brain Injury,” by Dr. Anthony Kontos, Dr. Michael Collins, Dr. David Okonkwo, and colleagues at the University of Pittsburgh and Inova Sports Medicine Concussion Program, set out to answer that question.
What the Study Did
The trial enrolled 162 adults (ages 18–49) who had sustained an mTBI within the prior 8 days to 6 months. Participants were randomized into two groups. The first received a Targeted Treatment intervention – meaning each patient’s treatment was individually tailored to the specific clinical domains affected by their injury, such as vestibular (balance and dizziness), ocular (eye movement), cognitive, migraine, anxiety and mood, sleep, and autonomic function. The second group, the control group, received a standardized behavioral management program: uniform guidance on physical activity, hydration, nutrition, sleep, and stress regulation.
Both groups completed their assigned programs over four weeks, with follow-up assessments at two weeks, four weeks, and three months.
Key Findings
The headline result was a tie – but that’s not the whole story.
On the two primary outcomes – overall symptom severity and patients’ own perception of improvement – both groups improved similarly over four weeks. There was no statistically significant difference between targeted and standardized care on these global measures.
However, in sensitivity analyses that accounted for differences in race, baseline symptom severity, and number of affected clinical domains, the Targeted Treatment group showed meaningfully greater improvement in several specific areas:
- Ocular symptoms – problems with eye movement and visual processing that commonly follow concussion
- Vestibular symptoms – dizziness, balance disruption, and sensitivity to motion
- Specific eye-movement tests, including convergence (the eyes’ ability to track a near object), the vestibulo-ocular reflex (which coordinates eye and head movement), and visual motion sensitivity
- Cognitive processing speed – how quickly the brain processes information
By three months, 94% of Targeted Treatment participants reported moderate or greater improvement, compared with 82% in the control group. The trial was stopped early due to funding and time constraints and but this preliminary analysis is encouraging.
What This Means in Practice
Two conclusions are worth considering. First, structured behavioral management – even the standardized kind – works. Both groups got better. That finding somewhat validates the importance of active, guided care over passive rest. Second, patients with ocular and vestibular involvement appear to benefit specifically from targeted treatment in those domains. For clinicians managing concussion patients with prominent visual or balance symptoms, this study suggests that matching the intervention to the impairment produces better outcomes in those specific areas.
The authors noted that the majority of participants – 54% – presented with five or more affected clinical domains simultaneously, reinforcing how rarely concussion is a single-symptom injury.
Where EyeBOX Fits In
The ocular and vestibular findings in this study are particularly relevant to objective concussion assessment. Both domains – eye movement and vestibular-ocular coordination – are neurological functions that standard symptom checklists struggle to capture reliably. Patients may underreport, or subtle impairments may not be obvious on clinical examination.
EyeBOX is the only FDA-cleared objective concussion test that measures oculomotor function – how the eyes move and coordinate – without requiring a pre-injury baseline. For clinicians working to identify which clinical domains are involved following an mTBI, that kind of objective data can inform not just diagnosis, but the treatment decisions this trial examined.