The Cardiac Autonomic Response Recovery to the Modified Tilt Test in Children Post Moderate–Severe Traumatic Brain Injury

ABSTRACT

Objective

To assess the recovery of the cardiac autonomic control system (CACS) response to the modified tilt-test during rehabilitation, in children post moderate-severe TBI at the subacute phase post-injury.

Method

Thirty-seven children aged 6-18 years, 14-162 days post moderate-severe TBI, participated in the study. The assessment included CACS values evaluation (heart rate (HR), heart rate variability (HRV) and blood pressure) during the modified tilt-test: five minutes lying supine and five minutes passive standing. Re-assessment was performed after eight weeks of rehabilitation.

Results

In both assessments, only four children reported symptoms associated with orthostatic intolerance during the modified tilt-test. No change was found over time in the HR and HRV values at rest. In response to the modified tilt-test, the systolic blood pressure showed change over time, with a significant interaction effect (p=0.04); while in the first assessment the SBP values showed a hypertension trend in the second assessment the SBP values showed a hypotension trend.

Conclusions

Children post moderate-severe TBI at the sub-acute phase post-injury, have a better systolic blood pressure response during the modified tilt-test after eight weeks of individually tailored rehabilitation program, despite no change in the CACS values at rest.

Clinical trial gov. number

NCT03215082

KEYWORDS:

• Traumatic brain injury
• tilt test
• rehabilitation
• cardiac autonomic control system
• children

Acknowledgments

This study was performed in partial fulfillment of the requirements for a Ph.D. degree of Gilad Sorek, Sackler Faculty of Medicine, Tel Aviv University, Israel.

We would like to thank the whole SiMPLy-Rehab team for the partnership, support and knowledge sharing.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Israeli Ministry of Health through the European Research Area - the Network of European Funding for Neuroscience Research (ERA-NET NEURON) under grant number 13897 as part of the SiMPLy-Rehab project.