Autonomic Modulation in Duchenne Muscular Dystrophy during a Computer Task: A Prospective Control Trial

Abstract

IntroductionDuchenne Muscular Dystrophy (DMD) is characterized by progressive muscle weakness that can lead to disability. Owing to functional difficulties faced by individuals with DMD, the use of assistive technology is essential to provide or facilitate functional abilities. In DMD, cardiac autonomic dysfunction has been reported in addition to musculoskeletal impairment. Consequently, the objective was to investigate acute cardiac autonomic responses, by Heart Rate Variability (HRV), during computer tasks in subjects with DMD.MethodHRV was assessed by linear and nonlinear methods, using the heart rate monitor Polar RS800CX chest strap Electrocardiographic measuring device. Then, 45 subjects were included in the group with DMD and 45 in the healthy Typical Development (TD) control group. They were assessed for twenty minutes at rest sitting, and five minutes after undergoing a task on the computer.ResultsIndividuals with DMD had a statistically significant lower parasympathetic cardiac modulation at rest when compared to the control group, which further declined when undergoing the tasks on the computer.ConclusionDMD patients presented decreased HRV and exhibited greater intensity of cardiac autonomic responses during computer tasks characterized by vagal withdrawal when compared to the healthy TD control subjects.

Simvastatin provides long‐term improvement of left ventricular function and prevents cardiac fibrosis in muscular dystrophy

“…; Alvarez et al. ). There is, however, evidence that impaired parasympathetic activity mediates decreased HRV in DMD.…”

Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial

“…In addition, there is another gap in knowledge concerning the adaptation of the autonomic nervous system (assessed through heart rate variability–HRV) to a combined therapy of VR and tDCS, by measuring HRV before, during, and after this intervention. Heart Rate Variability is a well-known risk marker for chronic disorders and reflects the control of autonomic nervous system in the sinus node in different health conditions, physical activity levels and exercise ( 70 , 72 , 86 ). HRV is impaired in individuals with CP, with a sympathetic predominance, which leads to less adaptation to physical demands ( 78 ).…”

“…The HRV will be assessed by 20 min of rest seated in a comfortable chair or their own wheelchair, as used by Alvarez et al ( 72 ).…”

“…HRV represents the autonomic function, and short-term HRV measurement has been used to evaluate sympathetic and parasympathetic heart rate modulation. Therefore, because of the ease of evaluation (non-invasively, through a chest strip) and because of its high clinical relevance, it is important to evaluate HRV before and during the intervention with tDCS and VR, since some studies indicate improvement of the autonomic balance after VR tasks in individuals with Duchenne muscular dystrophy ( 72 ) and post-stroke ( 79 ). In the case of CP, some studies had identified low HRV in foetuses that would later be given a CP diagnosis ( 80 ), at rest and during postural change ( 81 ), and submaximal tests ( 78 ).…”

The Use of Virtual Reality Technologies in the Treatment of Duchenne Muscular Dystrophy: Systematic Review

“…We must provide studies with specific respiratory and cardiac variables that provide data concerning the metabolic effort during and after exercise and the protection of cardiac activity during exercise. Therapy times and intensities should be defined in individuals with high fatigue and difficulty breathing [ 26 ]. Virtual reality can be a great tool for physiotherapy in individuals with Duchenne muscular dystrophy.…”