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Published on: September 25, 2014
Performance and Physiological Response to the Buffalo Concussion Treadmill Test Can Identify Autonomic Dysfunction in
Sally Vuu1, Maayken E L van den Berg, Selena Hutchins
1Author Affiliations: College of Nursing and Health Sciences, Flinders University, Tonsley, SA, Australia (Ms Vuu, Associate Professor van den Berg, Mrs Hutchins, Dr Gough, Associate Professor Barr) and Brain Injury Rehabilitation Services, South Australian Health, Tonsley, SA, Australia (Ms Howie).
Objective:
To explore the underlying mechanisms impacting on the Buffalo Concussion Treadmill Test (BCTT) performance in a general adult population with mild traumatic brain injury (TBI).
Setting:
Outpatient TBI rehabilitation service.
Participants:
Twenty-one adults with mild TBI, 17 healthy active adults, and 14 healthy sedentary adults.
Design:
Prospective observational study comparing BCTT performance and associated physiological responses between 3 participant groups.
Main Measures:
During a single BCTT session, test duration, reason for test termination, age-predicted maximum heart rate (HR), and HR recovery (HRR) were recorded.
Results:
Fifty-two adults (60.8% male, mean ± SD age: 37.8 ± 14.6 years) were recruited. The group with mild TBI demonstrated a significantly shorter test duration (10.8 ± 5.7 min) compared to the healthy active (14.1 ± 2.9 min) and sedentary (11.6 ± 3.0 min) groups ( P < .05). Eight participants (38.1%) stopped due to symptom exacerbation. The group with mild TBI had a significantly ( P < .05) lower age-predicted maximum HR (84.3 ± 9.8%), compared to both healthy active (90.0 ± 0.2%) and sedentary adults (89.3 ± 2.8%) at test termination. Fast and slow phase HRR were significantly better in the healthy active group (fast: 69.6 ± 18.2 beats per minute [bpm], slow: 79.0 ± 13.8 bpm) compared to both the mild TBI (fast: 44.5 ± 18.7 bpm, slow: 61.1 ± 20.4 bpm) and healthy sedentary groups (fast 49.6 ± 20.1 bpm, slow 63.0 ± 11.7 bpm) ( P < .05), with no significant difference between adults with mild TBI and healthy sedentary groups. When controlling for levels of physical activity there was no longer a detectable significant difference between the healthy active and sedentary groups in HRR.
Conclusion:
This study demonstrates that the inability to exercise to a threshold HR of 90% of an individual's age-predicted maximum HR is a better indicator of autonomic dysfunction. HRR may be prolonged in those with a mild TBI, but caution should be taken if attributing this to physiological dysfunction as the predominant factor appears to be physical activity levels.
