A study into the feasibility of using HRV variables to guide treatment in patients with paroxystic sympathetic hyperactivity in a neurointensive step-down unit
Restricted accessResearch articleFirst published online February 20, 2019
A study into the feasibility of using HRV variables to guide treatment in patients with paroxystic sympathetic hyperactivity in a neurointensive step-down unit
Patients suffering brain injury may experience paroxystic sympathetic hyperactivity,
presenting diagnostic and therapeutic challenges in neurointensive rehabilitation. The
syndrome has been modelled as peripheral and central excitatory:inhibitory ratios of
autonomous nervous activity. Another model represents the symptoms as oscillations of
the two components of the autonomous nervous system. In therapeutic framework, the
syndrome is perceived as the patient misconstruing sensory input relating to body
positioning.
OBJECTIVE:
To investigate whether changes in frequency domain of heart rate variability reflect
pharmacological and/or therapeutic measures in rehabilitation.
METHODS:
ECG was recorded before and after pharmacological and therapeutic interventions in
eight patients with high probability of the syndrome in a neurointensive step-down unit.
Recordings were analysed off-line in frequency parameters. Appropriate statistical
methods were applied.
RESULTS:
Low, high frequency and the LF/HF ratio changed significantly following therapeutic as
well as pharmacological interventions.
DISCUSSION:
The cohort was small, the setting the immediate postictal period of intensive care with
multidisciplinary rehabilitation. Still, changes in frequency domain were detected
following therapeutic efforts. This opens up the venue of on-line monitoring of the
intended therapeutic effect.
Affolter,
F., (2004). From
action to interaction as primary root for development. In StockmanI. J.
(Ed.), Movement and action in learning and
development: clinical implications for pervasive developmental disorders (pp.
xiv, 381 p.). Amsterdam;
Boston: Elsevier Academic
Press.
2.
Andelic,
N., Bautz-Holter, E.,
Ronning,
P., Olafsen, K., Sigurdardottir,
S., Schanke, A.K., …
Roe,
C. (2012). Does an
early onset and continuous chain of rehabilitation improve the long-term functional
outcome of patients with severe traumatic brain injury?J Neurotrauma, 29(1),
66–74. doi:10.1089/neu.2011.1811.
3.
Ansari,
N.N., Naghdi, S.
(2007). The effect of Bobath approach on the excitability of
the spinal alpha motor neurones in stroke patients with muscle
spasticity. Electromyogr Clin Neurophysiol,
47(1),
29–36.
4.
Baguley,
I.J. (2008). The
excitatory:inhibitory ratio model (EIR model): An integrative explanation of acute
auto-nomic overactivity syndromes. Med Hypotheses,
70(1), 26–35.
doi:10.1016/j.mehy.2007.04.037.
5.
Baguley,
I.J., Heriseanu, R.E.,
Felmingham,
K.L., Cameron, I.D.
(2006). Dysautonomia and heart rate variability following
severe traumatic brain injury. Brain Inj,
20(4), 437–444.
doi:10.1080/02699050600664715.
6.
Baguley,
I.J., Perkes, I.E.,
Fernandez-Ortega,
J.F., Rabinstein, A.A.,
Dolce,
G., Hendricks, H.T.,
Consensus Working,
G. (2014).
Paroxysmal sympathetic hyperactivity after acquired brain injury:
consensus on conceptual definition, nomenclature, and diagnostic
criteria. J Neurotrauma,
31(17), 1515–1520.
doi:10.1089/neu.2013.3301.
7.
Blackman,
J.A., Patrick, P.D.,
Buck,
M.L., Rust, R.S.,
Jr. (2004). Paroxysmal
autonomic instability with dystonia after brain injury. Arch
Neurol, 61(3),
321–328. doi:10.1001/archneur.61.3.321.
8.
Brennan,
M., Palaniswami, M.,
Kamen,
P. (2002).
Poincare plot interpretation using a physiological model of HRV based on
a network of oscillators. Am J Physiol Heart Circ
Physiol, 283(5),
H1873–1886. doi:10.1152/ajpheart.00405.2000.
9.
Buhl,
I., Pallesen, H.
(2015). Early rehabilitation of patients with severe
acquired brain injury: strategies to promote participation.
Scand J Occup Ther, 22(3),
181–195. doi:10.3109/11038128.2015.1008567.
10.
Fernandez-Ortega,
J.F., Baguley, I.J.,
Gates,
T.A., GarciaCaballero, M.,
Quesada-Garcia,
G., Prieto-Palomino, M.A.
(2016). Catecholamines and Paroxysmal Sympathetic
Hyper-activity following traumatic brain injury. J
Neurotrauma. doi:10.1089/neu.2015.4364.
11.
Gentile,
A.M. (1998).
Movement Science: Implicit and Explicit Processes during Acquisition of
Functional Skills. Scandinavian Journal of Occupational
Therapy, 5(1),
7–16. doi:10.3109/11038129809035723.
12.
Gjelsvik,
B.E.B., Syre, L.
(2016). The Bobath concept in adult neurology
(2nd edition. ed.). Stuttgart; New
York: Thieme.
13.
Health,
N.B., o
(2011). Brain Injury - A Health Technology Assessment.Copenhagen: :National Board of Health, Danish Centre of Health Technology Assessment
(DACEHTA).
14.
Heart rate, variability (1996). Standards of
measurement, physiological interpretation, and clinical use. Task Force of the European
Society of Cardiology and the North American Society of Pacing and
Electrophysiology. Eur Heart J,
17(3),
354–381.
15.
Henden,
P.L., Sondergaard, S.,
Rydenhag,
B., Reinsfelt, B.,
Ricksten,
S.E., Aneman, A.
(2014). Can baroreflex sensitivity and heart rate
variability predict late neurological outcome in patients with traumatic brain
injury?JNeurosurg Anesthesiol, 26(1),
50–59. doi:10.1097/ANA.0b013e3182a47b62.
16.
Hinson,
H.E., Sheth, K.N.
(2012). Manifestations of the hyper-adrenergic state after
acute brain injury. Curr Opin Crit Care,
18(2), 139–145.
doi:10.1097/MCC.0b013e3283513290.
17.
Hinson,
H.E., Puybasset, L.,
Weiss,
N., Perlbarg, V.,
Benali,
H., Galanaud, D.,
Neuro Imaging for Coma Emergence,
R. C. (2015).
Neuroanatomical basis of paroxysmal sympathetic hyperactivity: a
diffusion tensor imaging analysis. Brain Inj,
29(4), 455–461.
doi:10.3109/02699052.2014.995229.
18.
Hørder,
M., Bech, M., Andersen,
S.E. (2011). Brain
Injury - A Health Technology Assessment. Retrieved from
Copenhagen: National Board of Health, Danish Centre of Health Technology Assessment
(DACEHTA):
19.
Huikuri,
H.V., Perkiomaki, J.S.,
Maestri,
R., Pinna, G.D.
(2009). Clinical impact of evaluation of cardiovascular
control by novel methods of heart rate dynamics. Philos Transact
A Math Phys Eng Sci, 367(1892),
1223–1238. doi:367/1892/1223 [pii]
10.1098/rsta.2008.0294
20.
Khandoker,
A.H., Karmakar, C.,
Brennan,
M., Voss, A., Palaniswami,
M. (2013). Poincar plot
methods for heart rate variability analysis.New York:
Springer.
21.
Kielhofner,
G. (2010). MOHO-modellen
: modellen for menneske-lig aktivitet : ergoterapi til uddannelse og praksis
(2. udgave. ed.). Kbh.:
Munksgaard Danmark.
22.
Kjeldsen,
S.S., Søndergaard, S.,
Mikkelsen,
L.R., Nielsen, J.F.
(2018). A retrospective study of 251 patients with severe
acquired brain injury admitted to a multidisciplinary, highly specialised rehabilitation
unit with ICU capabilities. Disabil Rehabil,
1–8.
23.
Kollen,
B.J., Lennon, S., Lyons,
B., Wheatley-Smith, L.,
Scheper,
M., Buurke, J.H., …
Kwakkel,
G. (2009). The
effectiveness of the Bobath concept in stroke rehabilitation: what is the
evidence?Stroke, 40(4),
e89–97. doi:10.1161/STR0KEAHA.108.533828
24.
Lombardi,
F., Taricco, M., De Tanti,
A., Telaro, E., '
Liberati,
A. (2002).
Sensory stimulation of brain-injured individuals in coma or vegetative
state: results of a Cochrane systematic review. Clin
Rehabil, 16(5),
464–472. doi:10.1191/0269215502cr519oa.
Motulsky,
H.J., Brown, R.E.
(2006). Detecting outliers when fitting data with nonlinear
regression - a new method based on robust nonlinear regression and the false discovery
rate. BMC Bioinformatics,
7(1), 123. doi:10.1186/1471-2105-7-123.
27.
Pallesen,
H., Lund, L.B., Jensen,
M., Roenn-Smidt, H.
(2018). The body participating: a qualitative study of early
rehabilitation participation for patients with severe brain injury and low level of
consciousness. European Journal of Physiotherapy,
20(1), 2–11. doi:10.1080/21679169.2017.1347706.
28.
Pedersen,
A.R., Stubbs, P.W.,
Nielsen,
J.F. (2018).
Reducing redundant testing using the Functional Independence Measure and
Early Functional Abilities scale during rehabilitation in patients with brain
injury. Brain Inj,
32(9), 1090–1095.
doi:10.1080/02699052.2018.1482425.
29.
Perkes,
I.E., Menon, D.K., Nott,
M.T., Baguley, I.J.
(2011). Paroxysmal sympathetic hyperactivity after acquired
brain injury: a review of diagnostic criteria. Brain
Inj, 25(10),
925–932. doi:10.3109/02699052.2011.589797.
30.
Shumway-Cook,
A., Woollacott, M.H.
(2017). Motor control : translating research into clinical
practice (Fifth edition. ed.).
Philadelphia: Wolters
Kluwer.
Tang,
Q., Wu, X., Weng,
W., Li, H., Feng,
J., Mao, Q.,… Jiang,
J. (2017). The
preventive effect of dexmedetomidine on paroxysmal sympathetic hyperactivity in severe
traumatic brain injury patients who have undergone surgery: a retrospective
study. Peer J, 5,
e2986. doi:10.7717/peerj.2986
34.
Townsend,
E.A. (2008). Menneskelig
aktivitet II, en ergoter-apeutisk vision om sundhed, trivsel og retfxrdighed muliggjort
gennem betydningsfulde aktiviteter(1 udgave. 1. oplag ed.). Kbh:
Munksgaard.
35.
Turner-Stokes,
L., Pick, A., Nair,
A., Disler, P.B.,
Wade,
D.T. (2015).
Multi-disciplinary rehabilitation for acquired brain injury in adults of
working age. Cochrane Database Syst Rev
(12), CD004170. doi:10.1002/14651858.CD004170.pub3
36.
Vistisen,
S.T., Hansen, T.K.,
Jensen,
J., Nielsen, J.F.,
Fleischer,
J. (2014). Heart
rate variability in neurorehabilitation patients with severe acquired brain
injury. Brain Inj,
28(2), 196–202.
doi:10.3109/02699052.2013.860477.
37.
Vistisen,
S.T., Jensen, J., Fleischer,
J., Nielsen, J.F.
(2015). Association between the sensory-motor nervous system
and the autonomic nervous system in neurorehabilitation patients with severe acquired
brain injury. Brain Inj,
29(3), 374–379.
doi:10.3109/02699052.2014.969312.
