HEART RATE VARIABILITY AND EXERTIONAL TASK ANALYSIS IN THE RECOVERY OF MILD TRAUMATIC BRAIN INJURY IN SERVICEMEMBERS (HEARTS)

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  • Prim, Julianna Holly
    • Affiliation: School of Medicine, Department of Allied Health Sciences, Curriculum in Human Movement Science
Abstract
  • ABSTRACT Julianna H. Prim: Heart Rate Variability and Exertional Task Analysis in the Recovery of Mild Traumatic Brain Injury in Servicemembers (HEARTS) (under the direction of Karen McCulloch) Context: The Defense and Veterans Brain Injury Center (DVBIC) guideline for Healthcare Providers treating mild traumatic brain injury (mTBI) recommends an exertional test before return to duty (RTD), yet no standardized test currently exists. Autonomic nervous system (ANS) impairments after concussion may be measured by heart rate variability (HRV). Objective: To develop clinically feasible exertional tasks to assess ANS balance with HRV measurements that can identify deficits and aid clinicians in RTD decisions for service members (SMs) with acute mTBI. Methods: 44 participants (40 Heathy Controls-HC, 4 mTBI) completed our exertional testing protocol while wearing heart rate (HR) monitors. After baseline rest, participants completed two short exertional tasks: a stepping and push-up task with a recovery period after each. The stepping task was 6 minutes with speed increases every 2 minutes utilizing a metronome for pacing and a 12’ step. The push-up task was a maximum of two minutes, self-paced, with total number recorded. Main Outcomes: (1) HR and HRV measures for two sensors, observational measures of time, space, equipment, physiological response in HC; (2) mTBI and HC HRV measures during resting, exertion, and recovery. Case series of task performance for mTBI participants, (3) successful task completion, exertion level, symptoms, HR. Results: (1) High reliability between the PolarH10 monitor and Faros180 ECG in HR and HRV component analyses during resting and exertional conditions was found. Both tasks met standards of clinical feasibility and physiological response. (2) mTBI SMs had lower baseline and recovery values of cardiac vagal control compared to HC. mTBI SMs also had lower rate of cardiac vagal recovery and heart period recovery compared to HC. Both tasks provoked symptoms in a majority of mTBI SMs, even with reported readiness to RTD. (3) Both tasks had similar completion, symptom and exertion levels. Conclusions: Completion of exertional tasks provided insight on recovery. An objective physiological measure could be used alongside symptom report and clinical opinion in prescribing activity and managing recovery after acute mTBI. Future research should prioritize clinical implementation of exertional tasks and how the physiological measure of HRV can be used clinically.
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Advisor
  • McCulloch, Karen
  • Cecchini, Amy
  • Davila-Hernandez, Maria
  • Fröhlich, Flavio
  • Register Mihalik, Johna
  • Ranapurwala, Shabbar
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2020
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