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Pinto SM, Wright B, Annaswamy S, Nwana O, Nguyen M, Wilmoth K, Moralez G. Heart rate variability (HRV) after traumatic brain injury (TBI): a scoping review. Brain Inj 2024; 38:585-606. [PMID: 38590161 DOI: 10.1080/02699052.2024.2328310] [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: 08/15/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Heart rate variability (HRV), defined as the variability between successive heart beats, is a noninvasive measure of autonomic nervous system (ANS) function, which may be altered following traumatic brain injury (TBI). This scoping review summarizes the existing literature regarding changes in HRV after TBI as well as the association between measures of HRV and outcomes following TBI. METHODS A literature search for articles assessing 'heart rate variability' and 'brain injury' or 'concussion' was completed. Articles were included if HRV was measured in human subjects with TBI or concussion. Review articles, protocol papers, and studies including non-traumatic injuries were excluded. RESULTS Sixty-three articles were included in this review. Varied methods were used to measure HRV in the different studies. Forty articles included information about differences in HRV measures after TBI and/or longitudinal changes after TBI. Fifteen studies assessed HRV and symptoms following TBI, and 15 studies assessed HRV and either functional or cognitive outcomes after TBI. CONCLUSIONS HRV has been studied in the context of mortality, clinical symptoms, and medical, functional, or cognitive outcomes following TBI. Methods used to measure HRV have varied amongst the different studies, which may impact findings, standardized protocols are needed for future research.
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Affiliation(s)
- Shanti M Pinto
- Department of Physical Medicine and Rehabilitation, O'Donnell Brain Institute Clinical Neuroscience Scholar, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brittany Wright
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shreyas Annaswamy
- National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Maryland, USA
| | - Ola Nwana
- Department of Neurology, Houston Methodist Neuroscience Center Team at Willowbrook, Houston, Texas, USA
| | - Michael Nguyen
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Brain Injury and Stroke Medicine, TIRR Memorial Hermann, Houston, Texas, USA
| | - Kristin Wilmoth
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gilbert Moralez
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Tan CO, Grashow R, Thorpe R, Miller KK, Nathan DM, Izzy S, Radmanesh F, Kim JH, Weisskopf MG, Taylor HA, Zafonte RD, Baggish AL. Concussion burden and later-life cardiovascular risk factors in former professional American-style football players. Ann Clin Transl Neurol 2024; 11:1604-1614. [PMID: 38808967 PMCID: PMC11187967 DOI: 10.1002/acn3.52045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/18/2024] [Accepted: 03/04/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Mid-life cardiovascular risk factors are associated with later cognitive decline. Whether repetitive head injury among professional athletes impacts cardiovascular risk is unknown. We investigated associations between concussion burden and postcareer hypertension, high cholesterol, and diabetes among former professional American-style football (ASF) players. METHODS In a cross-sectional study of 4080 professional ASF players conducted between January 2015 and March 2022, we used an mulitsymptom concussion symptom score (CSS) and the number of loss-of-consciousness (LOC) episodes as a single severe symptom to quantify football-related concussion exposure. Primary outcomes were hypertension, dyslipidemia, and diabetes, defined by current or recommended prescription medication use. RESULTS The prevalence of hypertension, high cholesterol, and diabetes among former players (52 ± 14 years of age) was 37%, 34%, and 9%. Concussion burden was significantly associated with hypertension (lowest vs. highest CSS quartile, odds ratio (OR) = 1.99; 95%CI: 1.33-2.98; p < 0.01) and high cholesterol (lowest vs. moderate CSS, OR = 1.46, 95%CI, 1.11-1.91; p < 0.01), but not diabetes. In fully adjusted models, the prevalence of multiple CVD was associated with CSS. These results were driven by younger former players (≤ 40 year of age) in which the odds of hypertension were over three times higher in those in the highest CSS quartile (OR = 3.29, 95%CI: 1.39-7.61; p = 0.01). Results were similar for LOC analyses. INTERPRETATION Prior concussion burden is associated with postcareer atherogenic cardiovascular risk profiles among former professional American football players.
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Affiliation(s)
- Can Ozan Tan
- RAM Group, Department of Electrical Engineering, Mathematics, and Computer ScienceUniversity of Twentethe Netherlands
| | - Rachel Grashow
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Roland Thorpe
- Program of Research on Men's Health, Hopkins Center for Health Disparities SolutionsJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Health Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging ResearchBaltimoreMarylandUSA
| | - Karen K. Miller
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Neuroendocrine UnitMassachusetts General Hospital and Harvard Medical SchoolBoston02114MassachusettsUSA
| | - David M. Nathan
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Diabetes Research CenterMassachusetts General Hospital and Harvard Medical SchoolBoston02114MassachusettsUSA
| | - Saef Izzy
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Farid Radmanesh
- Department of Neurology, Divisions of Stroke, Cerebrovascular, and Critical Care NeurologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Division of Neurocritical Care, Department of NeurologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Jonathan H. Kim
- Emory Clinical Cardiovascular Research InstituteEmory University School of MedicineAtlantaGeorgiaUSA
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Herman A. Taylor
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Cardiovascular Research InstituteMorehouse School of MedicineAtlantaGeorgiaUSA
| | - Ross D. Zafonte
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Department of Physical Medicine and RehabilitationSpaulding Rehabilitation HospitalCharlestownMassachusettsUSA
- Cardiovascular Performance ProgramMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Aaron L. Baggish
- Football Players Health Study at Harvard UniversityHarvard Medical SchoolBostonMassachusettsUSA
- Cardiovascular Performance ProgramMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Department of CardiologyUniversity of LausanneLausanneSwitzerland
- Department of Sports ScienceUniversity of LausanneLausanneSwitzerland
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Wesolowski E, Ahmed Z, Di Pietro V. History of concussion and lowered heart rate variability at rest beyond symptom recovery: a systematic review and meta-analysis. Front Neurol 2024; 14:1285937. [PMID: 38318235 PMCID: PMC10838961 DOI: 10.3389/fneur.2023.1285937] [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: 08/30/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Concussion is a growing concern in worldwide sporting culture. Heart rate variability (HRV) is closely tied with autonomic nervous system (ANS) deficits that arise from a concussion. The objective of this review was to determine if a history of concussion (HOC) can impact HRV values in the time-domain in individuals at rest. This review works to add to the literature surrounding HRV testing and if it can be used to check for brain vulnerabilities beyond the recovery of concussion symptoms. Materials and methods The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method. A computer based systematic review scanned articles dating from 1996 to June 2023 through PubMed, Cochrane Library, Google Scholar, and EMBASE databases. A risk of bias assessment was conducted using the ROBINS-E tool. The average difference in time between heartbeats (MeanNN), the standard deviation of the differences (SDNN), and the root mean squared of the successive intervals (RMSSD) were measured. Results Six total studies were found that fit the inclusion criteria including a total of 242 participants (133 without HOC, 109 with HOC). The average age of the control group was 23.3 ± 8.2, while the average age of the history of TBI group was 25.4 ± 9.7, with no significant difference between the groups (p = 0.202). Four of the studies reported no significant difference in any of the three measures, while two of the studies reported significant difference for all three measures. The meta-analysis was conducted and found that MeanNN (p = 0.03) and RMSSD (p = 0.04) reached statistical significance, while SDNN did not (p = 0.11). Conclusion The results of this meta-analysis showed significant difference in two of the three HRV time-domain parameters evaluated. It demonstrates that there can be lowered HRV values that expand beyond the recovery of symptoms, reflecting an extensive period of ANS susceptibility after a concussion. This may be an important variable in determining an athlete's return to play (RTP). Lack of homogenous study populations and testing methods introduces potential for bias and confounding factors, such as gender or age. Future studies should focus on baseline tests to compare individuals to themselves rather than matched controls.
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Affiliation(s)
- Eric Wesolowski
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Zubair Ahmed
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, United Kingdom
| | - Valentina Di Pietro
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Centre for Trauma Sciences Research, University of Birmingham, Birmingham, United Kingdom
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Parks A, Hogg-Johnson S. Autonomic nervous system dysfunction in pediatric sport-related concussion: a systematic review. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2023; 67:246-268. [PMID: 38283159 PMCID: PMC10814701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Objective To identify, appraise and synthesize the evidence of autonomic nervous system (ANS) dysfunction following sport-related concussion in pediatric populations. Methods A literature search was conducted using MEDLINE (Ovid), SportDiscus (EBSCO), CINAHL (EBSCO), EMBASE (Ovid) and PsycINFO (Ovid). Studies were selected and appraised using the Joanna Briggs Institute (JBI) critical appraisal tools. Data was extracted from the included studies and qualitatively synthesized. Results Eleven studies were included in the synthesis. There was variability in the methods used to measure ANS function between studies, and sample populations and time to assessment following concussion varied considerably. There was also variability in the direction of change of ANS function between some studies. Conclusion This systematic review identifies that concussion is associated with dysregulation of ANS function in pediatric athletes. We identified some weaknesses in the extant literature which may be due to existing logistical and financial barriers to implementing valid ANS measurements in clinical and sports settings.
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Affiliation(s)
- Andrew Parks
- Division of Graduate Studies, Sports Sciences, Canadian Memorial Chiropractic College
- Private Practice
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College
- Dalla Lana School of Public Health, University of Toronto
- Institute for Disability and Rehabilitation Research, Ontario Tech University
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Izzy S, Grashow R, Radmanesh F, Chen P, Taylor H, Formisano R, Wilson F, Wasfy M, Baggish A, Zafonte R. Long-term risk of cardiovascular disease after traumatic brain injury: screening and prevention. Lancet Neurol 2023; 22:959-970. [PMID: 37739576 PMCID: PMC10863697 DOI: 10.1016/s1474-4422(23)00241-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 09/24/2023]
Abstract
Traumatic brain injury (TBI) is highly prevalent among individuals participating in contact sports, military personnel, and in the general population. Although it is well known that brain injury can cause neurological and psychiatric complications, evidence from studies on individuals exposed to a single or repetitive brain injuries suggests an understudied association between TBI and the risk of developing chronic cardiovascular diseases and risk factors for cardiovascular disease. Several studies have shown that people without pre-existing comorbidities who sustain a TBI have a significantly higher risk of developing chronic cardiovascular disease, than people without TBI. Similar observations made in military and professional American-style football cohorts suggest causal pathways through which modifiable cardiovascular risk factors might mediate the relationship between brain injury and chronic neurological diseases. A better understanding of cardiovascular disease risk after TBI combined with a proactive, targeted screening programme might mitigate long-term morbidity and mortality in individuals with TBI, and improve their quality of life.
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Affiliation(s)
- Saef Izzy
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Football Players Health Study at Harvard University, Boston, MA, USA
| | - Rachel Grashow
- Department of Environmental Health, T H Chan School of Public Health, Harvard University, Boston, MA, USA; Football Players Health Study at Harvard University, Boston, MA, USA
| | - Farid Radmanesh
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Division of Neurocritical Care, University of New Mexico, Albuquerque, NM, USA
| | - Patrick Chen
- Department of Neurology, University of California Irvine, Orange, CA, USA
| | - Herman Taylor
- Football Players Health Study at Harvard University, Boston, MA, USA; Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Fiona Wilson
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Meagan Wasfy
- Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Boston, MA, USA; Institute for Sport Science and Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Ross Zafonte
- Harvard Medical School, Boston, MA, USA; Football Players Health Study at Harvard University, Boston, MA, USA; Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, Boston, MA, USA.
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Reddy P, Izzetoglu K, Shewokis PA, Sangobowale M, Diaz-Arrastia R. Differences in time-frequency characteristics between healthy controls and TBI patients during hypercapnia assessed via fNIRS. Neuroimage Clin 2023; 40:103504. [PMID: 37734166 PMCID: PMC10518610 DOI: 10.1016/j.nicl.2023.103504] [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: 03/10/2023] [Revised: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023]
Abstract
Damage to the cerebrovascular network is a universal feature of traumatic brain injury (TBI). This damage is present during different phases of the injury and can be non-invasively assessed using functional near infrared spectroscopy (fNIRS). fNIRS signals are influenced by partial arterial carbon dioxide (PaCO2), neurogenic, Mayer waves, respiratory and cardiac oscillations, whose characteristics vary in time and frequency and may differ in the presence of TBI. Therefore, this study aims to investigate differences in time-frequency characteristics of these fNIRS signal components between healthy controls and TBI patients and characterize the changes in their characteristics across phases of the injury. Data from 11 healthy controls and 21 TBI patients were collected during the hypercapnic protocol. Results demonstrated significant differences in low-frequency oscillations between healthy controls and TBI patients, with the largest differences observed in Mayer wave band (0.06 to 0.15 Hz), followed by the PaCO2 band (0.012 to 0.02 Hz). The effects within these bands were opposite, with (i) Mayer wave activity being lower in TBI patients during acute phase of the injury (d = 0.37 [0.16, 0.57]) and decreasing further during subacute (d = 0.66 [0.44, 0.87]) and postacute (d = 0.75 [0.50, 0.99]) phases; (ii) PaCO2 activity being lower in TBI patients only during acute phase of the injury (d = 0.36 [0.15, 0.56]) and stabilizing to healthy levels by the subacute phase. These findings demonstrate that TBI patients have impairments in low frequency oscillations related to different mechanisms and that these impairments evolve differently over the course of injury.
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Affiliation(s)
- Pratusha Reddy
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA.
| | - Kurtulus Izzetoglu
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA.
| | - Patricia A Shewokis
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA; Nutrition Sciences Department, Health Sciences Division of College of Nursing and Health Professions, Drexel University, Philadelphia, PA 19104, USA
| | - Michael Sangobowale
- Clinical TBI Research Center and Department of Neurology at University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Ramon Diaz-Arrastia
- Clinical TBI Research Center and Department of Neurology at University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
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Pelo R, Suttman E, Fino PC, McFarland MM, Dibble LE, Cortez MM. Autonomic dysfunction and exercise intolerance in concussion: a scoping review. Clin Auton Res 2023; 33:149-163. [PMID: 37038012 PMCID: PMC10812884 DOI: 10.1007/s10286-023-00937-x] [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: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Concussion commonly results in exercise intolerance, often limiting return to activities. Improved understanding of the underlying mechanisms of post-concussive exercise intolerance could help guide mechanism-directed rehabilitation approaches. Signs of altered cardiovascular autonomic regulation-a potential contributor to exercise intolerance-have been reported following concussion, although it is not clear how these findings inform underlying mechanisms of post-concussive symptoms. Systematic summarization and synthesis of prior work is needed to best understand current evidence, allowing identification of common themes and gaps requiring further study. The purpose of this review was to (1) summarize published data linking exercise intolerance to autonomic dysfunction, and (2) summarize key findings, highlighting opportunities for future investigation. METHODS The protocol was developed a priori, and conducted in five stages; results were collated, summarized, and reported according to PRISMA guidelines. Studies including injuries classified as mild traumatic brain injury (mTBI)/concussion, regardless of mechanism of injury, were included. Studies were required to include both autonomic and exercise intolerance testing. Exclusion criteria included confounding central or peripheral nervous system dysfunction beyond those stemming from the concussion, animal model studies, and case reports. RESULTS A total of 3116 publications were screened; 17 were included in the final review. CONCLUSION There was wide variability in approach to autonomic/exercise tolerance testing, as well as inclusion criteria/testing timelines, which limited comparisons across studies. The reviewed studies support current clinical suspicion of autonomic dysfunction as an important component of exercise intolerance. However, the specific mechanisms of impairment and relationship to symptoms and recovery require additional investigation.
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Affiliation(s)
- Ryan Pelo
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Erin Suttman
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Mary M McFarland
- Eccles Health Sciences Library, University of Utah, Salt Lake City, UT, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Melissa M Cortez
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
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Harrison A, Lane-Cordova A, La Fountaine MF, Moore RD. Concussion History and Heart Rate Variability During Bouts of Acute Stress. J Athl Train 2022; 57:741-747. [PMID: 36356617 PMCID: PMC9661928 DOI: 10.4085/1062-6050-0314.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT After a sport-related concussion, many athletes experience persisting neurophysiological alterations. These alterations may be absent at rest but emerge during moments of physiological stress. Unnoticed and untreated neurophysiological dysfunction may negatively affect long-term neurologic health in adolescent athletes, as they are at a critical point in development. OBJECTIVE To assess cardio-autonomic functioning in athletes with and those without a history of concussion by quantifying measures of heart rate variability (HRV) during times of physical and mental exertion. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-four male Hockey Quebec Midget-AAA hockey players were separated into those with (n = 16; age = 16.06 ± 0.73 years, body mass index = 23.29 ± 1.79) and those without (n = 18; age = 15.98 ± 0.62 years, body mass index = 23.60 ± 2.49) a history of concussion. INTERVENTION(S) All athletes underwent a series of HRV recording sessions (1) at rest, (2) while completing a cognitive task at rest, and (3) while completing a cognitive task after a bout of submaximal aerobic exercise. MAIN OUTCOME MEASURE(S) Time-domain measures of HRV, including mean NN intervals, SD of NN intervals, and root mean square of successive NN interval differences, were quantified for each assessment. RESULTS No differences in characteristics were evident between groups. No between-groups differences in HRV at rest were observed. However, during the cognitive task at rest and after aerobic exercise, athletes with a history of concussion demonstrated a higher SD of NN intervals (78.1 ± 4.3 versus 63.2 ± 4.1 milliseconds and 71.2 ± 4.3 versus 65.2 ± 3.8 milliseconds, respectively; F1,31 = 4.31, P = .046) and root mean square of successive NN interval differences (75.8 ± 6.0 versus 59.0 ± 5.6 milliseconds and 74.0 ± 5.5 versus 59.0 ± 5.2 milliseconds, respectively; F1,31 = 4.88, P = .04) than athletes without a history of concussion. CONCLUSIONS Concussive injuries may result in long-term cardio-autonomic dysfunction. These deficits may not be present at rest but may be triggered by physiological stress.
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Affiliation(s)
- Adam Harrison
- Department of Exercise Science, University of South Carolina, Columbia
| | - Abbi Lane-Cordova
- Department of Exercise Science, University of South Carolina, Columbia
| | - Michael F. La Fountaine
- Department of Physical Therapy, The Institute for Advanced Study of Rehabilitation and Sports Science, Seton Hall University, Nutley, NJ
- Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ
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Heart Rate Variability as a Reliable Biomarker Following Concussion: A Critically Appraised Topic. J Sport Rehabil 2022; 31:954-961. [PMID: 35894898 DOI: 10.1123/jsr.2021-0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022]
Abstract
CLINICAL SCENARIO Recent systematic reviews show conflicting information regarding the effect of concussion on cardiac autonomic function. Controlled aerobic exercise is the most popular intervention for those recovering from a concussion. There is a gap in the literature supporting the utility of objective metrics during exertional return to play protocols and rehabilitation. CLINICAL QUESTION Can heart rate variability (HRV) during physical exertion be a reliable biomarker over time for those who suffered a sport-related concussion? SUMMARY OF KEY FINDINGS A literature search produced 3 studies relevant to the clinical question. One, a prospective-matched control group cohort study, reported disturbances in HRV during physical exertion in those with a history of concussion, and identified persistent HRV dysfunction after resolution of subjective complaints, return to play, and with multiple concussive events. Second, a cross-sectional cohort study found an HRV difference in those with and without a history of concussion and in HRV related to age and sex. Finally, the prospective longitudinal case-control cohort study did not find sex or age differences in HRV and concluded that, although postconcussion HRV improved as time passed, resting HRV was not as clinically meaningful as HRV during exertional activities. CLINICAL BOTTOM LINE There is emerging evidence to support the use of HRV as an observable biomarker, over time, of autonomic function during physical exertion following a sport-related concussion. However, the meaningfulness of HRV data is not fully understood and the utility seems individualized to the level of athlete, age, and sex and, therefore, cannot be generalizable. In order to be more clinically meaningful and to assist with current clinical decision making regarding RTP, a preinjury baseline assessment would be beneficial as an individualized reference for baseline comparison. STRENGTH OF RECOMMENDATION Although HRV is not fully understood, currently, there is grade B evidence to support the use of individualized baseline exertional HRV data as comparative objective metric to assess the autonomic nervous system function, over time, following a concussive event.
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Jacob D, Unnsteinsdóttir Kristensen IS, Aubonnet R, Recenti M, Donisi L, Ricciardi C, Svansson HÁR, Agnarsdóttir S, Colacino A, Jónsdóttir MK, Kristjánsdóttir H, Sigurjónsdóttir HÁ, Cesarelli M, Eggertsdóttir Claessen LÓ, Hassan M, Petersen H, Gargiulo P. Towards defining biomarkers to evaluate concussions using virtual reality and a moving platform (BioVRSea). Sci Rep 2022; 12:8996. [PMID: 35637235 PMCID: PMC9151646 DOI: 10.1038/s41598-022-12822-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Current diagnosis of concussion relies on self-reported symptoms and medical records rather than objective biomarkers. This work uses a novel measurement setup called BioVRSea to quantify concussion status. The paradigm is based on brain and muscle signals (EEG, EMG), heart rate and center of pressure (CoP) measurements during a postural control task triggered by a moving platform and a virtual reality environment. Measurements were performed on 54 professional athletes who self-reported their history of concussion or non-concussion. Both groups completed a concussion symptom scale (SCAT5) before the measurement. We analyzed biosignals and CoP parameters before and after the platform movements, to compare the net response of individual postural control. The results showed that BioVRSea discriminated between the concussion and non-concussion groups. Particularly, EEG power spectral density in delta and theta bands showed significant changes in the concussion group and right soleus median frequency from the EMG signal differentiated concussed individuals with balance problems from the other groups. Anterior-posterior CoP frequency-based parameters discriminated concussed individuals with balance problems. Finally, we used machine learning to classify concussion and non-concussion, demonstrating that combining SCAT5 and BioVRSea parameters gives an accuracy up to 95.5%. This study is a step towards quantitative assessment of concussion.
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Affiliation(s)
- Deborah Jacob
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | | | - Romain Aubonnet
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Marco Recenti
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Leandro Donisi
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
- Department of Chemical, Materials and Production Engineering, University of Naples Federico II, Naples, Italy
| | - Carlo Ricciardi
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Halldór Á R Svansson
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Sólveig Agnarsdóttir
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
| | - Andrea Colacino
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
- Department of Computer Engineering, Electrical and Applied Mathematics, University of Salerno, Salerno, Italy
| | - María K Jónsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
- Landspitali National University Hospital of Iceland, Reykjavik, Iceland
| | - Hafrún Kristjánsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
- Physical Activity, Physical Education, Sport and Health (PAPESH) Research Centre, Sports Science Department, School of Social Sciences, Reykjavik University, Reykjavik, Iceland
| | - Helga Á Sigurjónsdóttir
- Landspitali National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Mario Cesarelli
- Department of Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
- Department of Information Technology and Electrical Engineering, University of Naples, Naples, Italy
| | - Lára Ósk Eggertsdóttir Claessen
- Landspitali National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Mahmoud Hassan
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland
- MINDig, 35000, Rennes, France
| | - Hannes Petersen
- Department of Anatomy, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Akureyri Hospital, Akureyri, Iceland
| | - Paolo Gargiulo
- Institute of Biomedical and Neural Engineering, Reykjavik University, Reykjavik, Iceland.
- Department of Science, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland.
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11
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Leddy JJ, Haider MN, Noble JM, Rieger B, Flanagan S, McPherson JI, Shubin-Stein K, Saleem GT, Corsaro L, Willer B. Clinical Assessment of Concussion and Persistent Post-Concussive Symptoms for Neurologists. Curr Neurol Neurosci Rep 2021; 21:70. [PMID: 34817724 DOI: 10.1007/s11910-021-01159-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Concussion produces a variety of signs and symptoms. Most patients recover within 2-4 weeks, but a significant minority experiences persistent post-concussive symptoms (PPCS), some of which may be from associated cervical or persistent neurologic sub-system (e.g., vestibular) dysfunction. This review provides evidence-based information for a pertinent history and physical examination of patients with concussion. RECENT FINDINGS The differential diagnosis of PPCS is based on the mechanism of injury, a thorough medical history and concussion-pertinent neurological and cervical physical examinations. The concussion physical examination focuses on elements of autonomic function, oculomotor and vestibular function, and the cervical spine. Abnormalities identified on physical examination can inform specific forms of rehabilitation to help speed recovery. Emerging data show that there are specific symptom generators after concussion that can be identified by a thorough history, a pertinent physical examination, and adjunct tests when indicated.
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Affiliation(s)
- John J Leddy
- UBMD, Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA.
| | - Mohammad Nadir Haider
- UBMD, Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA.,Department of Neuroscience, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | - James M Noble
- Department of Neurology, Taub Institute for Research On Alzheimer's Disease and the Aging Brain, and G.H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Brian Rieger
- Department of Physical Medicine and Rehabilitation, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Steven Flanagan
- Department of Rehabilitation Medicine, Rusk Institute of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Jacob I McPherson
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | | | - Ghazala T Saleem
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
| | - Louis Corsaro
- Northern Westchester and Southern Putnam County School Districts, New York, NY, USA
| | - Barry Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 160 Farber Hall, Buffalo, NY, 14214, USA
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12
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La Fountaine MF, Hohn AN, Leahy CL, Testa AJ, Weir JP. Use of Mayer wave activity to demonstrate aberrant cardiovascular autonomic control following sports concussion injury. Ann N Y Acad Sci 2021; 1507:121-132. [PMID: 34480369 PMCID: PMC9291215 DOI: 10.1111/nyas.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 12/02/2022]
Abstract
Dysregulation of cardiovascular autonomic control is gaining recognition as a prevailing consequence of concussion injury. Characterizing the presence of autonomic dysfunction in concussed persons is inconsistent and conventional metrics of autonomic function cannot differentiate the presence/absence of injury. Mayer wave (MW) activity originates through baroreflex adjustments to blood pressure (BP) oscillations that appear in the low‐frequency (LF: 0.04–0.15 Hz) band of the BP and heart rate (HR) power spectrum after a fast Fourier transform. We prospectively explored MW activity (∼0.1 Hz) in 19 concussed and 19 noninjured athletes for 5 min while seated at rest within 48 h and 1 week of injury. MW activity was derived from the LF band of continuous digital electrocardiogram and beat‐to‐beat BP signals (LFHR, LF‐SBP, MWHR, and MW‐SBP, respectively); a proportion between MWBP and MWHR was computed (cMW). At 48 h, the concussion group had a significantly lower MWBP and cMW than controls; these differences were gone by 1 week. MWHR, LFHR, and LF‐SBP were not different between groups at either visit. Attenuated sympathetic vasomotor tone was present and the central autonomic mechanisms regulating MW activity to the heart and peripheral vasculature became transiently discordant early after concussion with apparent resolution by 1 week.
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Affiliation(s)
- Michael F La Fountaine
- Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, Nutley, New Jersey.,Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, New Jersey.,Department of Neurology, Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Asante N Hohn
- Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, Nutley, New Jersey.,Spectrum Physical Therapy and Athletic Training, Morristown, New Jersey
| | - Caroline L Leahy
- Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, Nutley, New Jersey.,SportsCare Physical Therapy, Cedar Knolls, New Jersey
| | - Anthony J Testa
- Center for Sports Medicine, Seton Hall University, South Orange, New Jersey
| | - Joseph P Weir
- Department of Health, Sport and Exercise Sciences, University of Kansas, Lawrence, Kansas.,Osness Human Performance Laboratories, University of Kansas, Lawrence, Kansas
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