Linear and Nonlinear Analyses of the Cardiac Autonomic Control in Children With Developmental Coordination Disorder: A Case-Control Study

Abstract

Children with Developmental Coordination Disorder (DCD) and children at risk for DCD (r-DCD) present motor impairments interfering in their school, leisure and daily activities. In addition, these children may have abnormalities in their cardiac autonomic control, which together with their motor impairments, restrict their health and functionality. Therefore, this study aimed to assess the cardiac autonomic control, by linear and nonlinear analysis, at supine and during an orthostatic stimulus in DCD, r-DCD and typically developed children. Thirteen DCD children (11 boys and 2 girls, aged 8.08 ± 0.79 years), 19 children at risk for DCD (13 boys and 6 girls, aged 8.10 ± 0.96 years) and 18 typically developed children, who constituted the control group (CG) (10 boys and 8 girls, aged 8.50 ± 0.96 years) underwent a heart rate variability (HRV) examination. R-R intervals were recorded in order to assess the cardiac autonomic control using a validated HR monitor. HRV was analyzed by linear and nonlinear methods and compared between r-DCD, DCD, and CG. The DCD group presented blunted cardiac autonomic adjustment to the orthostatic stimulus, which was not observed in r-DCD and CG. Regarding nonlinear analysis of HRV, the DCD group presented lower parasympathetic modulation in the supine position compared to the r-DCD and CG groups. In the within group analysis, only the DCD group did not increase HR from supine to standing posture. Symbolic analysis revealed a significant decrease in 2LV (p < 0.0001) and 2UV (p < 0.0001) indices from supine to orthostatic posture only in the CG. In conclusion, r-DCD and DCD children present cardiac autonomic dysfunction characterized by higher sympathetic, lower parasympathetic and lower complexity of cardiac autonomic control in the supine position, as well as a blunted autonomic adjustment to the orthostatic stimulus. Therefore, cardiovascular health improvement should be part of DCD children's management, even in cases of less severe motor impairment.

Autonomic maturation from birth to 2 years: normative values

“…Mothers' sleep and mood could interfere with the child's sleep quality [52], while this was not taken into account in this results which thus includes such variations. There could be also unmeasured confounding factors as the impact of nicotine exposure during pregnancy which may target different organs of the fetus, particularly the lung and the central nervous system [53, 54], including learning disorders, hyperactivity and attentional deficits or moderate intellectual disabilities [55, 56, 57, 58, 59, 60]. Another limitation lies in the large standard deviations of normal values.…”

Vagal Tank Theory: The Three Rs of Cardiac Vagal Control Functioning – Resting, Reactivity, and Recovery

“…The large cardiac vagal control withdrawal in this situation facilitates large increases in cardiac output by the sympathetic nervous system, which is no longer being opposed by inhibitory influences. This withdrawal serves as a quick adaptation of the body to meet the demands of the situation, for example as a response to physical activity ( Fu and Levine, 2013 ; Fisher, 2014 ) or to position change (e.g., orthostatic response, Cavalcante Neto et al, 2018 ). If the polyvagal theory is helpful to delineate the first outlines of our predictions regarding cardiac vagal control reactivity in terms of metabolic demands, it is somehow limited with its focus on social functioning, its non-specificity regarding cognitive functions, and the fact it does not envisage a cardiac vagal control increase in reaction to the event.…”