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Srirubkhwa S, Brockmann L, Vichiansiri R, Hunt KJ, Saengsuwan J. Reliability of five-minute vs. one-hour heart rate variability metrics in individuals with spinal cord injury. PeerJ 2023; 11:e16564. [PMID: 38130919 PMCID: PMC10734434 DOI: 10.7717/peerj.16564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/12/2023] [Indexed: 12/23/2023] Open
Abstract
Background A previous study showed low reliability of 1-h HRV outcomes in participants with spinal cord injury (SCI), but it was not certain whether the low reliability was due to the unrestricted activity of participants. We aimed to investigate test-retest reliability of HRV metrics in individuals with SCI using a 1-h measurement in a supine position. Methods Individuals with SCI underwent two sessions of 1-h recording of the time between consecutive R waves (RR-intervals) in a supine position. HRV outcomes were obtained from a single 5-min data segment and for the full 1-h recording. HRV parameters of interest were: standard deviation of all normal-to-normal R-R intervals (SDNN) and square root of the mean of the squared differences between successive R-R intervals (RMSSD) (time domain); and high frequency power (HF), low frequency power (LF), very low frequency power (VLF), ultra-low frequency power (ULF) and total power (TP) (frequency domain). Relative reliability was assessed by intraclass correlation coefficient (ICC). Absolute reliability was assessed by coefficient of variation (CV) and Bland-Altman limits of agreement (LoA). Results Data from 37 individuals (14 with tetraplegia and 23 with paraplegia) were included. Relative reliability was higher for the 1-h (ICCs ranged from 0.13-0.71) than for the 5-min duration (ICCs ranged from 0.06-0.50) in the overall SCI group for all HRV metrics. Participants with tetraplegia had lower relative reliability compared to participants with paraplegia in all HRV metrics for the 5-min duration (ICCs ranged from -0.01-0.34 vs. 0.21-0.57). For the 1-h duration, participants with paraplegia showed higher relative reliability than participants with tetraplegia in all HRV metrics (ICCs ranged from 0.18-0.79 vs. 0.07-0.54) except TP (ICC 0.69 vs. 0.82). In terms of absolute reliability, the CVs and LoAs for the 1-h duration were better than for the 5-min duration. In general, time domain metrics showed better reliability than frequency domain metrics for both durations in participants with tetraplegia and paraplegia. The lowest CV and narrowest 95% LoA were found for SDNN in 5-min and 1-h durations overall and in both lesion levels. Conclusions The supine position did not provide better reliability compared to unrestricted activity in participants with SCI. HRV analysis using a 5-min duration is of limited value in SCI due to poor reliability. For the 1-h analysis duration, interpretation of the reliability of HRV varies according to lesion level: it is recommended to take lesion level into account when interpreting reliability measures.
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Affiliation(s)
- Siriwipa Srirubkhwa
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Lars Brockmann
- The Laboratory for Rehabilitation Engineering, Institute for Human Centred Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Ratana Vichiansiri
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kenneth J. Hunt
- The Laboratory for Rehabilitation Engineering, Institute for Human Centred Engineering, Bern University of Applied Sciences, Biel, Switzerland
| | - Jittima Saengsuwan
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- The Laboratory for Rehabilitation Engineering, Institute for Human Centred Engineering, Bern University of Applied Sciences, Biel, Switzerland
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Moro V, Beccherle M, Scandola M, Aglioti SM. Massive body-brain disconnection consequent to spinal cord injuries drives profound changes in higher-order cognitive and emotional functions: A PRISMA scoping review. Neurosci Biobehav Rev 2023; 154:105395. [PMID: 37734697 DOI: 10.1016/j.neubiorev.2023.105395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023]
Abstract
Spinal cord injury (SCI) leads to a massive disconnection between the brain and the body parts below the lesion level representing a unique opportunity to explore how the body influences a person's mental life. We performed a systematic scoping review of 59 studies on higher-order cognitive and emotional changes after SCI. The results suggest that fluid abilities (e.g. attention, executive functions) and emotional regulation (e.g. emotional reactivity and discrimination) are impaired in people with SCI, with progressive deterioration over time. Although not systematically explored, the factors that are directly (e.g. the severity and level of the lesion) and indirectly associated (e.g. blood pressure, sleeping disorders, medication) with the damage may play a role in these deficits. The inconsistency which was found in the results may derive from the various methods used and the heterogeneity of samples (i.e. the lesion completeness, the time interval since lesion onset). Future studies which are specifically controlled for methods, clinical and socio-cultural dimensions are needed to better understand the role of the body in cognition.
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Affiliation(s)
- Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy.
| | - Maddalena Beccherle
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy; Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy
| | - Salvatore Maria Aglioti
- Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy; Fondazione Santa Lucia IRCCS, Roma, Italy
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Salas-Monedero M, Lozano-Berrio V, Cazorla-Martínez MJ, Ceruelo-Abajo S, Gil-Agudo Á, Hernández-Sánchez S, Jiménez-Díaz JF, DelosReyes-Guzmán A. Is it Feasible to Use a Low-Cost Wearable Sensor for Heart Rate Monitoring within an Upper Limb Training in Spinal Cord Injured Patients?: A Pilot Study. Bioengineering (Basel) 2022; 9:bioengineering9120763. [PMID: 36550969 PMCID: PMC9774606 DOI: 10.3390/bioengineering9120763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Cervical spinal cord injury (SCI) patients have impairment in the autonomic nervous system, reflected in the cardiovascular adaption level during the performance of upper limb (UL) activities carried out in the rehabilitation process. This adaption level could be measured from the heart rate (HR) by means of wearable technologies. Therefore, the objective was to analyze the feasibility of using Xiaomi Mi Band 5 wristband (XMB5) for HR monitoring in these patients during the performance of UL activities; (2) Methods: The HR measurements obtained from XMB5 were compared to those obtained by the professional medical equipment Nonin LifeSense II capnograph and pulse oximeter (NLII) in static and dynamic conditions. Then, four healthy people and four cervical SCI patients performed a UL training based on six experimental sessions; (3) Results: the correlation between the HR measurements from XMB5 and NLII devices was strong and positive in healthy people (r = 0.921 and r = 0.941 (p < 0.01) in the static and dynamic conditions, respectively). Then, XMB5 was used within the experimental sessions, and the HR oscillation range measured was significantly higher in healthy individuals than in patients; (4) Conclusions: The XMB5 seems to be feasible for measuring the HR in this biomedical application in SCI patients.
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Affiliation(s)
- Miriam Salas-Monedero
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
- International Doctoral School, Castilla La-Mancha University, 14507 Toledo, Spain
| | - Vicente Lozano-Berrio
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
| | | | - Silvia Ceruelo-Abajo
- Rehabilitation Department, Hospital Nacional de Parapléjicos (SESCAM), 14507 Toledo, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
- Rehabilitation Department, Hospital Nacional de Parapléjicos (SESCAM), 14507 Toledo, Spain
| | - Sonsoles Hernández-Sánchez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sports Sciences, Castilla- La Mancha University, 14507 Toledo, Spain
| | - José-Fernando Jiménez-Díaz
- Performance and Sport Rehabilitation Laboratory, Faculty of Sports Sciences, Castilla- La Mancha University, 14507 Toledo, Spain
| | - Ana DelosReyes-Guzmán
- Biomechanics and Technical Aids Unit, Hospital Nacional de Parapléjicos (SESCAM), Finca La Peraleda s/n CP 45071, 14507 Toledo, Spain
- Correspondence:
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Increased Prevalence of Blood Pressure Instability Over Twenty-Four Hours in Chronic Spinal Cord Injury. Neurotrauma Rep 2022; 3:522-533. [DOI: 10.1089/neur.2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chen XY, Wang MH, Xiao X, Dong YH, Tan B, Dong HR, Zhou LN, Zhao JL, Xie R. Blood Pressure Variability Associates with Six-Month Outcomes in Acute Cervical Spinal Cord Injury: An Analysis of 105 Patients. World Neurosurg 2022; 168:e480-e489. [DOI: 10.1016/j.wneu.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
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Wahl U, Hirsch T. A systematic review of cardiovascular risk factors in patients with traumatic spinal cord injury. VASA 2021; 51:46-55. [PMID: 34852665 DOI: 10.1024/0301-1526/a000981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: The main risk factors for cardiac events, and particularly for the development of atherosclerosis, are diabetes mellitus, arterial hypertension, dyslipidemia and smoking. Patients with a traumatic spinal cord injury (SCI) may present with autonomic nervous system dysfunction depending on their level of spinal cord injury. Studies have found a rise in cardiovascular mortality. A systematic review was conducted that focused on this patient group's predisposition to vascular risk. Methods: We performed a PubMed and Cochrane database search. After applying specific search criteria, 42 articles were included in our analysis out of a total of 10,784 matches. The articles were selected with the aim of establishing cardiovascular risk factors in patients with traumatic spinal cord injury. Results: Patients with SCI are at an increased risk for peripheral artery disease even in the absence of cardiovascular risk factors. Major vascular changes to the arteries of patients with SCI include: a reduction in lumen size, increased vessel wall tension, higher vascular stiffness, an impaired reactive hyperemic response, and a lack of reduced vascular resistance. The findings for carotid atherosclerosis were inconclusive. This group of patients also has a higher disposition for diabetes mellitus, lipid metabolism disorders and coronary artery disease. Paraplegics are more likely to suffer from dyslipidemia, obesity and PAD, while tetraplegics are more likely to have diabetes mellitus. Conclusions: Patients with SCI are more likely to have cardiovascular risk factors and have cardiovascular disease compared to the normal population. Peripheral circulatory disorders are particularly common. Patients with SCI are now considered to be a new risk group for cardiovascular disease; however, large epidemiological studies are needed to verify in more detail the cardiovascular risk profile of this patient group.
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Affiliation(s)
- Uwe Wahl
- Department of Internal Medicine, BG Hospital Bergmannstrost Halle, Halle/Saale, Germany
| | - Tobias Hirsch
- Practice for Internal Medicine and Vascular Diseases, Vein Competence Centre, Halle/Saale, Germany
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The effect of heart rate variability on blood pressure is augmented in spinal cord injury and is unaltered by exercise training. Clin Auton Res 2020; 31:293-301. [DOI: 10.1007/s10286-020-00677-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
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Li P, Wei Z, Zhang H, Zhang K, Li J. Effects of decompressive operation on cardiac autonomic regulation in patients with cervical spondylotic myelopathy: analysis of blood pressure, heart rate, and heart rate variability. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1864-1871. [DOI: 10.1007/s00586-019-05972-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
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Biering-Sørensen F, Biering-Sørensen T, Liu N, Malmqvist L, Wecht JM, Krassioukov A. Alterations in cardiac autonomic control in spinal cord injury. Auton Neurosci 2018; 209:4-18. [DOI: 10.1016/j.autneu.2017.02.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 01/30/2017] [Accepted: 02/14/2017] [Indexed: 01/22/2023]
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Dost A, Bechtold-Dalla Pozza S, Bollow E, Kovacic R, Vogel P, Feldhahn L, Schwab KO, Holl RW. Blood pressure regulation determined by ambulatory blood pressure profiles in children and adolescents with type 1 diabetes mellitus: Impact on diabetic complications. Pediatr Diabetes 2017; 18:874-882. [PMID: 28117539 DOI: 10.1111/pedi.12502] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 11/09/2016] [Accepted: 12/21/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The combination of high blood pressure and hyperglycemia contributes to the development of diabetic complications. Ambulatory monitoring of blood pressure (ABPM) is seen as standard to assess blood pressure (BP) regulation. OBJECTIVE We evaluated 24-hour BP regulation in 3529 children with type 1 diabetes, representing 5.6% of the patients <20 years of age documented in the DPV registry, and studied the influence of BP parameters including pulse pressure (PP) and blood pressure variability (BPV) on microalbuminuria (MA) and diabetic retinopathy (DR). RESULTS BP was increased in this selected cohort of children with diabetes compared to healthy German controls (standard deviation score (SDS) day: systolic BP (SBP) +0.06, mean arterial pressure (MAP) +0.08, PP +0.3; night: SBP +0.6, diastolic BP +0.6, MAP +0.8), while daytime diastolic BP (SDS -0.2) and dipping of SBP and MAP were reduced (SBP -1.1 SDS, MAP 12.4% vs 19.4%), PP showed reverse dipping (-0.7 SDS). Children with microvascular complications had by +0.1 to +0.75 SDS higher BP parameters, except of nocturnal PP in MA and diurnal and nocturnal PP in DR. Reverse dipping of PP was more pronounced in the children with MA (-5.1% vs -0.8%) and DR (-2.6% vs -1.0%). BP alteration was stronger in girls and increased with age. CONCLUSION There is an early and close link between 24-hour blood pressure regulation and the development of diabetic complications not only for systolic, diastolic, and mean arterial BP but also for the derived BP parameter PP and BPV in our selected patients.
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Affiliation(s)
- A Dost
- Department of Pediatric Endocrinology and Diabetes, University Hospital Jena, Jena, Germany
| | - S Bechtold-Dalla Pozza
- Department of Pediatric Endocrinology and Diabetology, University Hospital Munich, Munich, Germany
| | - E Bollow
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neu-Herberg, Germany
| | - R Kovacic
- Pediatric Diabetes Center, Debant, Austria
| | - P Vogel
- Department of Pediatrics, Departments of Pediatrics, Garmisch-Partenkirchen, Germany
| | | | - K O Schwab
- Department of Pediatrics, University Hospital, Freiburg, Germany
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neu-Herberg, Germany
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