Heart Rate Variability Responses in Children With Medical Complexity Across Sensory Domains

Purpose: Heart rate variability (HRV) is a physiologic marker of autonomic nervous system (ANS) health. Because of multisystem impairments, children with medical complexity (CMC) can be challenging to evaluate and assess. They commonly display ANS dysfunction and subsequently reduced HRV. One purpose of this study was to report respiratory sinus arrhythmia (RSA) values derived from HRV, which may provide a reference and a future method to assess CMC and related treatments. Methods: Then, 36 CMC between the ages of 5-21 years were assessed within school-based settings. All children demonstrated severe brain impairment, functional limitations, participatory restrictions in life, and high healthcare needs and utilization. A subset of 20 children with cerebral palsy (CP) was identified within the study sample. Each child was assessed by the same assessor for 5 days within a 10-day period. Using Firstbeat Bodyguard 2 monitors, cardiac data were collected prior to and during the administration of the newly developed Pediatric Assessment of Sensory Motor Awareness. CardioEdit and CardioBatch software were used to edit cardiac data and calculate RSA values. Descriptive, repeated measures, and modeling statistics were used to analyze data. Results: Descriptive RSA values for baseline and across five sensory domains are reported for the total CMC group and its subsets of children with CP and non-CP. Significant differences in RSA values were noted for the gustatory domain as compared to baseline and other sensory domains. Significant differences from statistical modeling were demonstrated between the CP and non-CP groups. Conclusions and Recommendations for Clinical Practice: This study's HRV findings provide preliminary reference RSA values in CMC. Then, 20 children considered to be CMC with primary diagnoses of CP experienced less autonomic dysfunction than other CMC diagnostic groups at baseline and across the five sensory domains. The gustatory domain significantly reduced RSA. Modeling across days indicated that CMC experience a learning effect by Day 3 or 4. The measurement of HRV may provide a method to assess health and behavioral responses in CMC and associated treatments. Replication of these study findings will be necessary.