Thomas S. Bottiglieri, D.O.

In this post I would like to briefly describe a practice that has been utilized for my patients with post-concussion syndrome since 2010, heart rate variability biofeedback.  Among the many symptoms adolescents and young adults will report after a concussion are brain fog, depressed mood, and social detachment.  Fortunately we have learned that absolute rest and isolation after a brain injury are not the best answers to recovery.  John Leddy, MD and others have shown that exertion post injury (in a controlled and methodical way) help to recalibrate normal brain function.  Applying this stress to the body allows for more efficient blood flow to the brain.  Heart Rate Variability (HRV) Biofeedback Training has a similar effect.

The basic premise of HRV biofeedback is that there is a disruption in the brain that causes the regulatory processes to work less effectively.  There is a disruption of blood flow to the brain, as well as changes in heart rate, blood pressure control, and overall homeostasis.  It seems there is a connection that gets injured with concussion that impairs the conscious/cognitive input from the frontal part of the brain to the unconscious/automated systems located in the medulla.  This autonomic nervous system dysfunction is likely a significant contributor to the symptoms listed above.  By monitoring HRV, we can measure the health of the autonomic nervous system (ANS).  The changes of heart rate with respiration and input from the different parts of the ANS cause intervals of speeding up and slowing of heart rate.

The sympathetic nervous system is the part of the ANS that contributes to the speeding up of heart rate and increased blood pressure associated with stress requiring “fight or flight.”  The parasympathetic nervous system is the part of the ANS that contributes to slowing of HR and lower blood pressure associated with “rest and digest.”  These stress responses are impaired with brain injury, and in turn, lower the HRV.  While the details of this response are still being worked out, it is becoming clearer in the research that there is a change in HRV with brain injury.  With conscience input including paced breathing, and focused attention to the pattern of change in heart rate, those suffering with post-concussion syndrome can modulate their HRV and thus improve symptoms.

We currently recommend that our patients use HeartMath for HRV biofeedback as the cost is reasonable and the software makes the training accessible anywhere. (We have no financial interest in this company).