Changes in the cardiac autonomic control system during rehabilitation in children after severe traumatic brain injury - 27/02/22

Doi : 10.1016/j.rehab.2022.101652

Gilad Sorek ¹, Isabelle Gagnon ², Kathryn Schneider ^3,^4,⁵, Mathilde Chevignard ^6,⁷, Nurit Stern ⁸, Yahaloma Fadida ⁹, Liran Kalderon ¹, Sharon Shaklai ⁹, Michal Katz-Leurer ^1,^⁎
¹ Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
² Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
³ Sport Injury Research Prevention Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
⁴ Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
⁵ Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
⁶ Sorbonne Université, Laboratoire d'Imagerie Biomédicale, LIB, & GRC 24 HaMCRe, Paris, France
⁷ Hôpitaux de Saint Maurice, Saint Maurice, France
⁸ Alyn Children's Hospital and Rehabilitation Center, Jerusalem, Israel
⁹ Children Rehabilitation Department, Lowenstein Rehabilitation Center Ra'anana, Israel

^⁎Corresponding author: School of Health Professions, 69978, Tel: +97236405432; Fax: +972 6409223.

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Highlights

•	Cardiac autonomic function is impaired in children after severe TBI.
•	Cardiac autonomic measures at rest did not change during the sub-acute stage.
•	Cardiac autonomic measures recovered in part in response to autonomic tests.
•	Clinical trials of interventions to improve cardiac autonomic function are needed.

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Abstract

Background

One of the sequalae of severe traumatic brain injury (TBI) in children is impaired function of the cardiac autonomic control system (CACS) at rest. The CACS response to conventional autonomic tests is little known.

Objective

To examine the CACS response to conventional autonomic tests in children after severe TBI during the rehabilitation period and to compare with typically developing (TD) children.

Methods

This study combined a case-control and follow-up design. The severe TBI group (cases) consisted of 33 children aged 9-18 years, 14-142 days after severe TBI who were followed for 8 weeks during rehabilitation. The control group consisted of 19 TD children matched for age and sex. Heart rate (HR) and heart rate variability (HRV) were evaluated with the Polar RS800CX device at rest (sitting), during a handgrip test and during a paced breathing test.

Results

At the first assessment, we found lower HRV values at rest and a lower HRV response during the paced breathing and handgrip tests in the TBI group than the TD group (p<0.01). After 8 weeks, HRV values did not change at rest in the TBI group, but the response to the autonomic tests improved significantly, with increased HRV values in response to the paced breathing test (p<0.01) and the handgrip test (p=0.01).

Conclusions

After severe TBI, children exhibited an impaired CACS response to autonomic tests, with parasympathetic suppression and sympathetic arousal. After 8 weeks of rehabilitation, CACS function recovered partially and the response to the autonomic tests improved with no change in CACS function at rest.

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Keywords : Traumatic brain injury, cardiac autonomic control system, children and adolescents, handgrip test, paced breathing test