Cardiac Autonomic Modulation in Subjects with Amyotrophic Lateral Sclerosis (ALS) during an Upper Limb Virtual Reality Task: A Prospective Control Trial

Abstract

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. As a result of the rapid progression and severity of the disease, people with ALS experience loss of functionality and independence. Furthermore, it has already been described presence of autonomic dysfunction. Despite the increasing use of virtual reality (VR) in the treatment of different diseases, the use of virtual reality environment as an intervention program for ALS patients is innovative. The benefits and limitations have not yet been proven. Our objective was to evaluate the autonomic function of individuals with amyotrophic lateral sclerosis throughout the virtual reality task. The analysis of autonomic function was completed before, during, and after the virtual reality task using the upper limbs; also, all steps lasted ten minutes in a sitting position. Heart rate variability (HRV) was taken via the Polar® RS800CX cardiofrequencymeter. The following questionnaire was enforced: Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS) and Fatigue Severity Scale (FSS). Different types of HRV were revealed for the groups, indicating that the ALS group has reduced HRV, with most of the representative indices of the sympathetic nervous system. Besides, the physiological process of reducing parasympathetic activity from rest to VR activity (vagal withdrawal), with reduction in HF (ms2) and an increase in HR from rest to activity, and a further increase throughout recovery, with withdrawal of sympathetic nervous system, occurs just for the control group (CG), with no alterations between rest, activity, and recovery in individuals with ALS. We could conclude that patients with ALS have the reduction of HRV with the sympathetic predominance when equated to the healthy CG. Besides that, the ALS individuals have no capability to adapt the autonomic nervous system when likened to the CG during therapy based on VR and their recovery.

Analysis of Heart Rate Variability in Individuals Affected by Amyotrophic Lateral Sclerosis

“…Concerning the analysis of temporal measurements, our findings confirmed significantly lower HRV index values in the ALS group compared to healthy patients. These results are aligned with those obtained by various authors, such as Pinto et al [29], who studied a population of ALS patients with a mean age of 57 years for 4 h; Silveira et al [30], who measured HRV for 20 min; and Weisy et al [17], who measured it for 10 min. These diminished HRV index values suggest poor adaptation of the ANS, representing a significant health risk factor.…”

“…Similar results were also observed by authors such as Pavlovic et al [10] and Iscan et al [15], both of whom conducted Holter monitoring for 24 h on 55 patients with a mean age of 56 and 59.8 years, respectively. These outcomes may suggest reduced vagal activity associated with cardiac electrical activity [30]. An RMSSD below 10 ms, coupled with a decrease in SDNN below 20 ms, is associated with a high risk of developing cardiac diseases.…”

Effect of Longitudinal Practice in Real and Virtual Environments on Motor Performance, Physical Activity and Enjoyment in People with Autism Spectrum Disorder: A Prospective Randomized Crossover Controlled Trial

“…The limitations of this study include the fact that we did not include heart rate variability analysis that could have provided more extensive data [ 92 , 93 , 94 ]. In addition, we did not include female participants, so we cannot generalize our data to this population.…”

Analysis of Heart Rate, Perception of Physical Effort and Performance of Individuals with Down Syndrome Submitted to a Protocol of Virtual Games for Home-Based Telerehabilitation

“…Each mobile sphere has a fixed target (fixed spheres at the end of the columns), and participants are required to move their left upper limb or right upper limb when the mobile spheres reach the fixed targets, directing the corresponding upper limbs to each column. We used this software for 20 min of practice, because it is considered a laboratory-specific motor task and has been used in several studies with motor learning protocols and showed positive outcomes in cerebral palsy [ 23 ], spinal cord injury [ 24 ], and amyotrophic lateral sclerosis (ALS) [ 25 ].…”