Changes in the cardiac autonomic control system during rehabilitation in children after severe traumatic brain injury
Gilad Sorek1, Isabelle Gagnon2, Kathryn Schneider3
1Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Children with severe traumatic brain injury (TBI) show impaired cardiac autonomic control system (CACS) function. Rehabilitation improved CACS response to autonomic tests, but resting function remained impaired.
Area of Science:
- Pediatric neurology
- Autonomic neuroscience
- Cardiovascular physiology
Background:
- Severe traumatic brain injury (TBI) in children can impair cardiac autonomic control system (CACS) function at rest.
- The CACS response to conventional autonomic tests following pediatric TBI is not well understood.
Purpose of the Study:
- To investigate the CACS response to autonomic tests in children with severe TBI during rehabilitation.
- To compare CACS function in children with TBI to typically developing (TD) children.
Main Methods:
- A case-control and follow-up study involving 33 children (9-18 years) with severe TBI and 19 TD children.
- Heart rate (HR) and heart rate variability (HRV) were measured at rest and during handgrip and paced breathing tests over 8 weeks of rehabilitation.
- Data were collected using the Polar RS800CX device.
Main Results:
- Children with TBI had lower resting HRV and reduced HRV response to autonomic tests compared to TD children.
- After 8 weeks of rehabilitation, HRV response to paced breathing and handgrip tests significantly improved in the TBI group.
- Resting HRV values in the TBI group did not change significantly over the 8-week period.
Conclusions:
- Children with severe TBI exhibit impaired CACS response, characterized by parasympathetic suppression and sympathetic arousal.
- Partial recovery of CACS function and improved autonomic test responses were observed after 8 weeks of rehabilitation.
- Resting CACS function in children with severe TBI remained impaired despite improvements in autonomic test responses.
Background:
One of the sequalae of severe traumatic brain injury (TBI) in children is impaired function of the cardiac autonomic control system (CACS) at rest. The CACS response to conventional autonomic tests is little known.
Objective:
To examine the CACS response to conventional autonomic tests in children after severe TBI during the rehabilitation period and to compare with typically developing (TD) children.
Methods:
This study combined a case-control and follow-up design. The severe TBI group (cases) consisted of 33 children aged 9-18 years, 14-142 days after severe TBI who were followed for 8 weeks during rehabilitation. The control group consisted of 19 TD children matched for age and sex. Heart rate (HR) and heart rate variability (HRV) were evaluated with the Polar RS800CX device at rest (sitting), during a handgrip test and during a paced breathing test.
Results:
At the first assessment, we found lower HRV values at rest and a lower HRV response during the paced breathing and handgrip tests in the TBI group than the TD group (p<0.01). After 8 weeks, HRV values did not change at rest in the TBI group, but the response to the autonomic tests improved significantly, with increased HRV values in response to the paced breathing test (p<0.01) and the handgrip test (p = 0.01).
Conclusions:
After severe TBI, children exhibited an impaired CACS response to autonomic tests, with parasympathetic suppression and sympathetic arousal. After 8 weeks of rehabilitation, CACS function recovered partially and the response to the autonomic tests improved with no change in CACS function at rest.
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