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Original article
Heart rate variability following youth concussion: how do autonomic regulation and concussion symptoms differ over time postinjury?
  1. Melissa Paniccia1,
  2. Lee Verweel1,
  3. Scott G Thomas2,
  4. Tim Taha2,
  5. Michelle Keightley3,4,5,
  6. Katherine E Wilson1,
  7. Nick Reed1,4,5
  1. 1 Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
  2. 2 Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
  3. 3 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, Toronto, Ontario, Canada
  4. 4 Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5 Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Melissa Paniccia; melissa.paniccia{at}utoronto.ca

Abstract

Objectives Following youth concussion, objective physiological indicators are needed to corroborate changes in subjective clinical measures. The objectives of the current study were to: (1) explore the effect of concussion on heart rate variability (HRV) across days postinjury in youth athletes aged 13–18 years old, compared with healthy age-matched and sex-matched controls and (2) examine the relationship between postconcussion symptom domains (physical, cognitive, fatigue and emotional) and HRV.

Methods Prospective, longitudinal, case-control study (N=44). This study comprised 29 concussed athletes between the ages of 13 and 18 years old (21 females, 8 males) and 15 age-matched and sex-matched controls). All participants completed baseline testing, which included demographic information (age, sex, concussion history), self-reported concussion symptoms (Post-Concussion Symptom Inventory [PCSI]) and a 24-hour heart rate recording via the Polar RS800CX system. The PCSI and HRV were collected weekly while the participant was symptomatic and then 1, 3 and 6 months following symptom resolution. HRV variables included time and frequency domain measures. Data visualisations and mixed effects modelling were used to derive parsimonious models.

Results HRV increased across days postinjury. Concussion symptom domains (physical, cognitive, fatigue and emotional) all had a significant main effect on HRV; concussed participants who reported more symptoms had higher HRV compared with those who reported fewer symptoms. Visualisations of HRV depict the recovery trajectory as non-linear across time. No significant differences on HRV measures were found between concussed and control participants.

Conclusion These preliminary findings provide the foundation to understand the varied trajectory and relationship between objective physiological measures and subjective symptom reporting.

  • concussion
  • youth
  • heart rate variability
  • recovery
  • symptoms

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjsem-2018-000355

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    Footnotes

    • Contributors MP conceptualised the study objectives, data collection and analysis and drafted manuscript. LV contributed to the conceptualisation of the study with particular expertise in methodology and data processing, contributed to literature review and manuscript draft. SGT participated in the methodology and data processing design and editing manuscript. TT participated in the conceptual design with expertise in data processing, editing manuscript. MK conceptualised study objectives and edited manuscript. KEW participated in data collection, literature review and editing manuscript. NR is the principal investigator on this manuscript with a broader role in supervising the proposal, data collection and analysis, methodology, diligent manuscript draft review and editing for submission.

    • Funding This is work was funded by the Canadian Institutes of Health Research (#127048), the Ontario Neurotrauma Foundation and the Ontario Brain Institute. The Ontario Brain Institute is an independent non-profit corporation, funded partially by the Ontario government.

    • Disclaimer This work was originally featured within the first author’s doctoral thesis, as part of a larger body of work on neurophysiological variation (Paniccia, 2018 (University of Toronto, published doctoral thesis). The opinions, results, and conclusions are those of the authors and no endorsement by the Ontario Brain Institute is intended or should be inferred.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Holland Bloorview Research Ethics Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.