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Kennedy CM, Burma JS, Smirl JD. Sensor-Assisted Analysis of Autonomic and Cerebrovascular Dysregulation following Concussion in an Individual with a History of Ten Concussions: A Case Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:4404. [PMID: 39001186 PMCID: PMC11244393 DOI: 10.3390/s24134404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Concussion is known to cause transient autonomic and cerebrovascular dysregulation that generally recovers; however, few studies have focused on individuals with an extensive concussion history. METHOD The case was a 26-year-old male with a history of 10 concussions, diagnosed for bipolar type II disorder, mild attention-deficit hyperactivity disorder, and a history of migraines/headaches. The case was medicated with Valproic Acid and Escitalopram. Sensor-based baseline data were collected within six months of his injury and on days 1-5, 10, and 14 post-injury. Symptom reporting, heart rate variability (HRV), neurovascular coupling (NVC), and dynamic cerebral autoregulation (dCA) assessments were completed using numerous biomedical devices (i.e., transcranial Doppler ultrasound, 3-lead electrocardiography, finger photoplethysmography). RESULTS Total symptom and symptom severity scores were higher for the first-week post-injury, with physical and emotional symptoms being the most impacted. The NVC response showed lowered activation in the first three days post-injury, while autonomic (HRV) and autoregulation (dCA) were impaired across all testing visits occurring in the first 14 days following his concussion. CONCLUSIONS Despite symptom resolution, the case demonstrated ongoing autonomic and autoregulatory dysfunction. Larger samples examining individuals with an extensive history of concussion are warranted to understand the chronic physiological changes that occur following cumulative concussions through biosensing devices.
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Affiliation(s)
- Courtney M Kennedy
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB T2N 1N4, Canada
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Kostoglou K, Bello-Robles F, Brassard P, Chacon M, Claassen JA, Czosnyka M, Elting JW, Hu K, Labrecque L, Liu J, Marmarelis VZ, Payne SJ, Shin DC, Simpson D, Smirl J, Panerai RB, Mitsis GD. Time-domain methods for quantifying dynamic cerebral blood flow autoregulation: Review and recommendations. A white paper from the Cerebrovascular Research Network (CARNet). J Cereb Blood Flow Metab 2024:271678X241249276. [PMID: 38688529 DOI: 10.1177/0271678x241249276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Cerebral Autoregulation (CA) is an important physiological mechanism stabilizing cerebral blood flow (CBF) in response to changes in cerebral perfusion pressure (CPP). By maintaining an adequate, relatively constant supply of blood flow, CA plays a critical role in brain function. Quantifying CA under different physiological and pathological states is crucial for understanding its implications. This knowledge may serve as a foundation for informed clinical decision-making, particularly in cases where CA may become impaired. The quantification of CA functionality typically involves constructing models that capture the relationship between CPP (or arterial blood pressure) and experimental measures of CBF. Besides describing normal CA function, these models provide a means to detect possible deviations from the latter. In this context, a recent white paper from the Cerebrovascular Research Network focused on Transfer Function Analysis (TFA), which obtains frequency domain estimates of dynamic CA. In the present paper, we consider the use of time-domain techniques as an alternative approach. Due to their increased flexibility, time-domain methods enable the mitigation of measurement/physiological noise and the incorporation of nonlinearities and time variations in CA dynamics. Here, we provide practical recommendations and guidelines to support researchers and clinicians in effectively utilizing these techniques to study CA.
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Affiliation(s)
- Kyriaki Kostoglou
- Department of Electrical and Computer Engineering, McGill University, Montreal, QC, Canada
- Institute of Neural Engineering, Graz University of Technology, Graz, Austria
| | - Felipe Bello-Robles
- Departamento de Ingeniería Informática, Universidad de Santiago de Chile, Santiago, Chile
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, QC, Canada
| | - Max Chacon
- Departamento de Ingeniería Informática, Universidad de Santiago de Chile, Santiago, Chile
| | - Jurgen Ahr Claassen
- Department of Geriatrics, Radboud University Medical Center, Research Institute for Medical Innovation and Donders Institute, Nijmegen, The Netherlands
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM), Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Marek Czosnyka
- Department of Clinical Neurosciences, Neurosurgery Department, University of Cambridge, Cambridge, UK
| | - Jan-Willem Elting
- Department of Neurology and Clinical Neurophysiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Kun Hu
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- Research Center of the Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, QC, Canada
| | - Jia Liu
- Laboratory for Engineering and Scientific Computing, Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Vasilis Z Marmarelis
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Stephen J Payne
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | - Dae Cheol Shin
- Department Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - David Simpson
- Institute of Sound and Vibration Research, University of Southampton, Southampton, UK
| | - Jonathan Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM), Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation, Glenfield Hospital, Leicester, UK
| | - Georgios D Mitsis
- Department of Bioengineering, McGill University, Montreal, QC, Canada
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Burma JS, Roy MA, Kennedy CM, Labrecque L, Brassard P, Smirl JD. A systematic review, meta-analysis, and meta-regression amalgamating the driven approaches used to quantify dynamic cerebral autoregulation. J Cereb Blood Flow Metab 2024:271678X241235878. [PMID: 38635887 DOI: 10.1177/0271678x241235878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Numerous driven techniques have been utilized to assess dynamic cerebral autoregulation (dCA) in healthy and clinical populations. The current review aimed to amalgamate this literature and provide recommendations to create greater standardization for future research. The PubMed database was searched with inclusion criteria consisting of original research articles using driven dCA assessments in humans. Risk of bias were completed using Scottish Intercollegiate Guidelines Network and Methodological Index for Non-Randomized Studies. Meta-analyses were conducted for coherence, phase, and gain metrics at 0.05 and 0.10 Hz using deep-breathing, oscillatory lower body negative pressure (OLBNP), sit-to-stand maneuvers, and squat-stand maneuvers. A total of 113 studies were included, with 40 of these incorporating clinical populations. A total of 4126 participants were identified, with younger adults (18-40 years) being the most studied population. The most common techniques were squat-stands (n = 43), deep-breathing (n = 25), OLBNP (n = 20), and sit-to-stands (n = 16). Pooled coherence point estimates were: OLBNP 0.70 (95%CI:0.59-0.82), sit-to-stands 0.87 (95%CI:0.79-0.95), and squat-stands 0.98 (95%CI:0.98-0.99) at 0.05 Hz; and deep-breathing 0.90 (95%CI:0.81-0.99); OLBNP 0.67 (95%CI:0.44-0.90); and squat-stands 0.99 (95%CI:0.99-0.99) at 0.10 Hz. This review summarizes clinical findings, discusses the pros/cons of the 11 unique driven techniques included, and provides recommendations for future investigations into the unique physiological intricacies of dCA.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Marc-Antoine Roy
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Courtney M Kennedy
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Lawrence Labrecque
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
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4
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Burma JS, Griffiths JK, Smirl JD. Validity and reliability of deriving the autoregulatory plateau through projection pursuit regression from driven methods. Physiol Rep 2024; 12:e15919. [PMID: 38262711 PMCID: PMC10805621 DOI: 10.14814/phy2.15919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
To compare the construct validity and between-day reliability of projection pursuit regression (PPR) from oscillatory lower body negative pressure (OLBNP) and squat-stand maneuvers (SSMs). Nineteen participants completed 5 min of OLBNP and SSMs at driven frequencies of 0.05 and 0.10 Hz across two visits. Autoregulatory plateaus were derived at both point-estimates and across the cardiac cycle. Between-day reliability was assessed with intraclass correlation coefficients (ICCs), Bland-Altman plots with 95% limits of agreement (LOA), coefficient of variation (CoV), and smallest real differences. Construct validity between OLBNP-SSMs were quantified with Bland-Altman plots and Cohen's d. The expected autoregulatory curve with positive rising and negative falling slopes were present in only ~23% of the data. The between-day reliability for the ICCs were poor-to-good with the CoV estimates ranging from ~50% to 70%. The 95% LOA were very wide with an average spread of ~450% for OLBNP and ~350% for SSMs. Plateaus were larger from SSMs compared to OLBNPs (moderate-to-large effect sizes). The cerebral pressure-flow relationship is a complex regulatory process, and the "black-box" nature of this system can make it challenging to quantify. The current data reveals PPR analysis does not always elicit a clear-cut central plateau with distinctive rising/falling slopes.
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Affiliation(s)
- Joel S. Burma
- Cerebrovascular Concussion Lab, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Sport Injury Prevention Research Centre, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance Laboratory, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
| | - James K. Griffiths
- Cerebrovascular Concussion Lab, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Faculty of Biomedical EngineeringUniversity of CalgaryCalgaryAlbertaCanada
| | - Jonathan D. Smirl
- Cerebrovascular Concussion Lab, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Sport Injury Prevention Research Centre, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Human Performance Laboratory, Faculty of KinesiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Integrated Concussion Research ProgramUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
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5
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Dalton C, Ahn J, Jeyarajan G, Krigolson OE, Heath M. Distinct cortical haemodynamics during squat-stand and continuous aerobic exercise do not influence the magnitude of a postexercise executive function benefit. J Sports Sci 2023; 41:1459-1470. [PMID: 37884880 DOI: 10.1080/02640414.2023.2275086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
A single bout of aerobic exercise benefits executive function (EF). A potential mechanism for this benefit is an exercise-mediated increase in cerebral blood flow (CBF) that elicits vascular endothelial shear-stress improving EF efficiency. Moderate intensity continuous aerobic exercise (MCE) asymptotically increases CBF, whereas continuous body weight squat-stand exercise (SSE) provides a large amplitude oscillatory response. Some work has proposed that an increase in CBF oscillation amplitude provides the optimal shear-stress for improving EF and brain health. We examined whether a large amplitude oscillatory CBF response associated with a single bout of SSE imparts a larger postexercise EF benefit than an MCE cycle ergometer protocol. Exercise changes in middle cerebral artery velocity (MCAv) were measured via transcranial Doppler ultrasound to estimate CBF, and pre- and postexercise EF was assessed via the antisaccade task. MCE produced a steady state increase in MCAv, whereas SSE produced a large amplitude MCAv oscillation. Both conditions produced a postexercise EF benefit that null hypothesis and equivalence tests showed to be comparable in magnitude. Accordingly, we provide a first demonstration that a single bout of SSE benefits EF; however, the condition's oscillatory CBF response does not impart a larger benefit than a time- and intensity-matched MCE protocol.
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Affiliation(s)
- Connor Dalton
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Joshua Ahn
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Gianna Jeyarajan
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Olave E Krigolson
- Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
- Canadian Centre for Activity and Aging, University of Western Ontario, London, ON, Canada
- Graduate Program in Neuroscience, University of Western Ontario, London, ON, Canada
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6
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Whitaker AA, Vidoni ED, Montgomery RN, Carter K, Struckle K, Billinger SA. Force sensor reduced measurement error compared with verbal command during sit-to-stand assessment of cerebral autoregulation. Physiol Rep 2023; 11:e15750. [PMID: 37308311 PMCID: PMC10260377 DOI: 10.14814/phy2.15750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/12/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023] Open
Abstract
Current methods estimate the time delay (TD) before the onset of dynamic cerebral autoregulation (dCA) from verbal command to stand. A force sensor used during a sit-to-stand dCA measure provides an objective moment an individual stands (arise-and-off, AO). We hypothesized that the detection of AO would improve the accuracy of TD compared with estimation. We measured middle cerebral artery blood velocity (MCAv) and mean arterial pressure (MAP) for 60 s sitting followed by 2-min standing, three times separated by 20 min. TD was calculated as the time from: (1) verbal command and (2) AO, until an increase in cerebrovascular conductance index (CVCi = MCAv/MAP). Sixty-five participants were enrolled: young adults (n = 25), older adults (n = 20), and individuals post-stroke (n = 20). The TD calculated from AO (x ¯ $$ \overline{x} $$ = 2.98 ± 1.64 s) was shorter than TD estimated from verbal command (x ¯ $$ \overline{x} $$ = 3.35 ± 1.72 s, η2 = 0.49, p < 0.001), improving measurement error by ~17%. TD measurement error was not related to age or stroke. Therefore, the force sensor provided an objective method to improve the calculation of TD compared with current methods. Our data support using a force sensor during sit-to-stand dCA measures in adults across the lifespan and post-stroke.
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Affiliation(s)
- Alicen A. Whitaker
- Department of Physical Therapy, Rehabilitation Science, and Athletic TrainingUniversity of Kansas Medical CenterKansas CityKansasUSA
- Department of Physical Medicine and RehabilitationMedical College of WisconsinMilwaukeeWisconsinUSA
- Cardiovascular CenterMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Eric D. Vidoni
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Robert N. Montgomery
- Department of Biostatistics & Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Kailee Carter
- Department of Physical Therapy, Rehabilitation Science, and Athletic TrainingUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Katelyn Struckle
- Department of Physical Therapy, Rehabilitation Science, and Athletic TrainingUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Sandra A. Billinger
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
- Department of Physical Medicine and RehabilitationUniversity of Kansas Medical CenterKansas CityKansasUSA
- Department of Cell Biology and PhysiologyUniversity of Kansas Medical CenterKansas CityKansasUSA
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Kostoglou K, Simpson DM, Payne SJ. Point/counterpoint: We should not take the direction of blood pressure change into consideration for dynamic cerebral autoregulation quantification. J Cereb Blood Flow Metab 2022; 42:2354-2356. [PMID: 36113047 PMCID: PMC9670004 DOI: 10.1177/0271678x221123442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over the past years, a wide range of studies have provided evidence of asymmetry in the response of static and dynamic cerebral autoregulation (CA) during increasing and decreasing pressure challenges. The main message is that CA is stronger during transient increases of arterial blood pressure rather than decreases. Here we do not argue against the presence of CA asymmetry but we seek to raise questions regarding the measurement of the effect and whether this effect needs to be taken into account, especially in clinical settings.
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Affiliation(s)
- Kyriaki Kostoglou
- Institute of Neural Engineering, Graz University of Technology, Graz, Austria
| | - David M Simpson
- ISVR, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | - Stephen J Payne
- Institute of Applied Mechanics, National Taiwan University, Taipei
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8
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Whitaker AA, Vidoni ED, Aaron SE, Rouse AG, Billinger SA. Novel application of a force sensor during sit-to-stands to measure dynamic cerebral autoregulation onset. Physiol Rep 2022; 10:e15244. [PMID: 35384357 PMCID: PMC8980899 DOI: 10.14814/phy2.15244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023] Open
Abstract
Current sit-to-stand methods measuring dynamic cerebral autoregulation (dCA) do not capture the precise onset of the time delay (TD) response. Reduced sit-to-stand reactions in older adults and individuals post-stroke could inadvertently introduce variability, error, and imprecise timing. We applied a force sensor during a sit-to-stand task to more accurately determine how TD before the onset of dCA may be altered. Middle cerebral artery blood velocity (MCAv) and mean arterial pressure (MAP) were measured during two sit-to-stands separated by 15 min. Recordings started with participants sitting on a force-sensitive resistor for 60 s, then asked to stand for 2 min. Upon standing, the force sensor voltage immediately dropped and marked the exact moment of arise-and-off (AO). Time from AO until an increase in cerebrovascular conductance (CVC = MCAv/MAP) was calculated as TD. We tested the sensor in four healthy young adults, two older adults, and two individuals post-stroke. Healthy young adults stood quickly and the force sensor detected a small change in TD compared to classically estimated AO, from verbal command to stand. When compared to the estimated AO, older adults had a delayed measured AO and TD decreased up to ~53% while individuals post-stroke had an early AO and TD increased up to ~14%. The stance time during the sit-to-stand has the potential to influence the TD before the onset of dCA metric. As observed in the older adults and participants with stroke, this response may drastically vary and influence TD.
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Affiliation(s)
- Alicen A. Whitaker
- Department of Physical Therapy, Rehabilitation Science, and Athletic TrainingUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Eric D. Vidoni
- University of Kansas Alzheimer’s Disease Research CenterFairwayKansasUSA
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Stacey E. Aaron
- Department of Physical Therapy, Rehabilitation Science, and Athletic TrainingUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Adam G. Rouse
- Department of Molecular and Integrative PhysiologyUniversity of Kansas Medical CenterKansas CityKansasUSA
- Department of NeurosurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
- Department of Electrical Engineering and Computer ScienceUniversity of KansasLawrenceKansasUSA
| | - Sandra A. Billinger
- Department of Physical Therapy, Rehabilitation Science, and Athletic TrainingUniversity of Kansas Medical CenterKansas CityKansasUSA
- University of Kansas Alzheimer’s Disease Research CenterFairwayKansasUSA
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
- Department of Molecular and Integrative PhysiologyUniversity of Kansas Medical CenterKansas CityKansasUSA
- Department of Physical Medicine and RehabilitationUniversity of Kansas Medical CenterKansas CityKansasUSA
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9
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Mori S, Tarumi T, Kosaki K, Matsui M, Yoshioka M, Sugawara J, Kuro-O M, Saito C, Yamagata K, Maeda S. Effects of the number of sit-stand maneuver repetitions on baroreflex sensitivity and cardiovascular risk assessments. Am J Physiol Regul Integr Comp Physiol 2022; 322:R400-R410. [PMID: 35293262 DOI: 10.1152/ajpregu.00141.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sit-stand maneuvers (SSM) have increasingly been used for baroreflex sensitivity (BRS) measurement in physiological research, but it remains unknown as to how many SSM need to be performed to measure BRS and assess its relation with cardiovascular disease (CVD) risk. Therefore, this study aimed to determine 1) the effect of the number of SSM repetitions on BRS and 2) the association between BRS and CVD risk factors. Data were collected from 174 individuals during 5 minutes of spontaneous rest and 5 minutes of repeated SSM at 0.05 Hz (i.e., 15 cycles of 10-second sit and 10-second stand). During SSM, BRS was calculated from the incremental cycles of 3, 6, 9, 12, and 15 SSM using transfer function analysis of heart rate (HR) and systolic blood pressure (SBP). General CVD risk factors, carotid arterial stiffness, and cardiorespiratory fitness were measured. In result, HR and SBP increased during SSM (p<0.05). The BRS remained at a similar level during the resting and SSM conditions, while the coherence function reached its peak after 3 cycles of SSM. BRS with ≥6 cycles of SSM was strongly correlated with age (r=-0.721 to -0.740), carotid distensibility (r=0.625 to 0.629), and cardiorespiratory fitness (r=0.333 to 0.351) (all p<0.001). Multiple regression analysis demonstrated that BRS with ≥6 cycles of SSM explained >60% of the variance in CVD risk factors. Therefore, our findings suggest that repeated SSM significantly strengthens the association between BRS and CVD risk factors. Particularly, BRS with ≥6 cycles of SSM is strongly associated with CVD risk.
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Affiliation(s)
- Shoya Mori
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takashi Tarumi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
| | - Keisei Kosaki
- Faculty of Health and Sports Sciences, University of Tsukuba, Ibaraki, Japan
| | - Masahiro Matsui
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Masaki Yoshioka
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Jun Sugawara
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Japan
| | - Makoto Kuro-O
- Division of Anti-aging Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Chie Saito
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,R&D Center for Smart Wellness City Policies, University of Tsukuba, Ibaraki, Japan
| | - Seiji Maeda
- Faculty of Health and Sports Sciences, University of Tsukuba, Ibaraki, Japan.,Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Burma JS, Kennedy CM, Penner LC, Miutz LN, Galea OA, Ainslie PN, Smirl JD. Long-term heart transplant recipients: heart rate-related effects on augmented transfer function coherence during repeated squat-stand maneuvers in males. Am J Physiol Regul Integr Comp Physiol 2021; 321:R925-R937. [PMID: 34730005 DOI: 10.1152/ajpregu.00177.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous research has highlighted that squat-stand maneuvers (SSMs) augment coherence values within the cerebral pressure-flow relationship to ∼0.99. However, it is not fully elucidated if mean arterial pressure (MAP) leads to this physiological entrainment independently, or if heart rate (HR) and/or the partial pressure of carbon dioxide (Pco2) also have contributing influences. A 2:1 control-to-case model was used in the present investigation [participant number (n) = 40; n = 16 age-matched (AM); n = 16 donor control (DM); n = 8 heart transplant recipients (HTRs)]. The latter group was used to mechanistically isolate the extent to which HR influences the cerebral pressure-flow relationship. Participants completed 5 min of squat-stand maneuvers at 0.05 Hz (10 s) and 0.10 Hz (5 s). Linear transfer function analysis (TFA) examined the relationship between different physiological inputs (i.e., MAP, HR, and Pco2) and output [cerebral blood velocity (CBV)] during SSM; and cardiac baroreceptor sensitivity (BRS). Compared with DM, cardiac BRS was reduced in AM (P < 0.001), which was further reduced in HTR (P < 0.045). In addition, during the SSM, HR was elevated in HTR compared with both control groups (P < 0.001), but all groups had near-maximal coherence metrics ≥0.98 at 0.05 Hz and ≥0.99 at 0.10 Hz (P ≥ 0.399). In contrast, the mean HR-CBV/Pco2-CBV relationships ranged from 0.38 (HTR) to 0.81 (DM). Despite near abolishment of BRS and blunted HR following heart transplantation, long-term HTR exhibited near-maximal coherence within the MAP-CBV relationship, comparable with AM and DM. Therefore, these results show that the augmented coherence with SSM is driven by blood pressure, whereas elevations in TFA coherence as a result of HR contribution are likely correlational in nature.
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Affiliation(s)
- Joel S Burma
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Courtney M Kennedy
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Linden C Penner
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Lauren N Miutz
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Olivia A Galea
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jonathan D Smirl
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.,Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
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