Heart Rate Variability in Children and Adolescents with Cerebral Palsy—A Systematic Literature Review

Abstract

Cardiac autonomic dysfunction has been reported in patients with cerebral palsy (CP). The aim of this study was to assess the existing literature on heart rate variability (HRV) in pediatric patients with CP and a special attention was paid to the compliance of the studies with the current HRV assessment and interpretation guidelines. A systematic review was performed in PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases searched for English language publications from 1996 to 2019 using Medical Subject Headings (MeSH) terms “heart rate variability” and “cerebral palsy” in conjunction with additional inclusion criteria: studies limited to humans in the age range of 0–18 years and empirical investigations. Out of 47 studies, 12 were included in the review. Pediatric patients with CP presented a significantly higher resting heart rate and reduced HRV, different autonomic responses to movement stimuli compared to children with normal development, but also reduced HRV parameters in the children dependent on adult assistance for mobility compared to those generally independent. None of the included studies contained the necessary details concerning RR intervals acquisition and HRV measurements as recommended by the guidelines. Authors of HRV studies should follow the methodological guidelines and recommendations on HRV measurement, because such an approach may allow a direct comparison of their results.

A Pilot Study of the Reliability and Agreement of Heart Rate, Respiratory Rate and Short-Term Heart Rate Variability in Elite Modern Pentathlon Athletes

“…Spectral powers at LF and HF bands are commonly attributed to sympathetic and vagal, and vagal influences alone on HR, respectively. Thus, coaches and sport practitioners should be aware that changes in the respiratory rate may confound spectral indices [ 53 ]. It has been suggested that depth of breathing could be even more important than its rate [ 5 ].…”

“…The measurement of tidal volumes using, e.g., mouthpieces may affect HRV data [ 17 , 85 ]. Moreover, there is no optimal solution on how to record and control respiratory depth and rate in HRV studies [ 44 , 53 ]. One possible solution for future studies in athletes could be to implement the Pneumonitor 2 or 3, a portable device that would register respiratory pattern (both depth and rate) together with single-lead ECG (enough to estimate aforementioned parameters), motion, and/or pulse oximetry (saturation, pulse wave) designed for environmental physiology analyses and sports medicine [ 86 , 87 ].…”

“…There are several methodological characteristics that may cause differences in findings among studies on HRV reliability, e.g., reliability statistics adopted, number of tests performed and the time interval between them, and sample heterogeneity [ 54 ]. Lack of information about other methodological aspects also limits potential for study replication and confidence in interpretation [ 52 , 53 ], such as the lack of information on ECG acquisition and processing, including device, software, recording duration and conditions, breathing control, and position during recordings. Thus, we emphasize the importance of providing all the necessary information for reproducibility, as well as the standardization of statistics for the analysis of reliability of biomarker parameters in athletes.…”

“…Despite the large number of methodological papers published on HRV [42][43][44][45][46][47][48][49][50][51], many studies in this area failed to provide the necessary details concerning data acquisition and measurements, so the experimental design could not be replicated in laboratories, clinical settings and sports field. The lack of details concerning methodological aspects of the study significantly limits confidence in interpretation [52,53]. A recent paper on HRV reliability stated that still little is known about the reliability of baseline 5 min (short-term) measurements of HRV and studies continue to differ with respect to important methodological characteristics [54].…”

Psychophysiological Assessment of Children with Cerebral Palsy during Robotic-Assisted Gait Training through Infrared Imaging

“…As a result, the HRV reveals how well the autonomic nervous system regulates cardiac rhythm and how responsive the heart is [ 19 ]. Compared to children with normal development, pediatric patients with CP were demonstrated to show considerably greater resting heart rates, lower heart rate variability (HRV), and different autonomic responses to movement stimuli [ 20 ].…”