STEP 2: Concussion Live Course - November 5-6, 2024, in San Diego, CA-Autonomic Dysfunction after Mild Traumatic Brain Injury

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The document titled "Variability is a Good Thing: Concussions, TBI, and the Autonomic Nervous System" by Dr. Kathleen R. Bell focuses on the relationship between traumatic brain injuries (TBI), particularly concussions, and dysfunction in the autonomic nervous system (ANS). The aim is to integrate how the ANS interacts with TBI symptoms and how a management program can be prescribed for ANS dysfunction following TBI.  <br /><br />The ANS manages bodily functions such as cardiovascular regulation through the sympathetic (stress) and parasympathetic (rest) systems, which influence heart rate variability (HRV). HRV is used as a marker for cardiovascular health and is linked to cognitive functions through its effect on the prefrontal cortex. ANS function and its interplay between sympathetic and parasympathetic systems are essential for dynamic bodily responses to internal and external stimuli, characterized by "mathematical chaos"—a concept indicating beneficial variability.<br /><br />The document explores how low HRV is associated with health issues like diabetes and suggests HRV could be indicative of cognitive health. There are gender differences in HRV, with women generally exhibiting lower HRV, though they may have protective cardiac effects influenced by estrogen and oxytocin. <br /><br />Concussions may cause the uncoupling of the ANS from cardiovascular control, leading to blunted physiological responses and possible complications such as increased peripheral arterial stiffness and autonomic dysregulation. While there's ongoing exploration into HRV as a biomarker for concussion diagnosis and recovery, no definitive markers exist yet.<br /><br />For treatment, the document suggests addressing ANS-related symptoms, co-morbid conditions, and non-orthostatic symptoms, advocating therapeutic strategies including medication, lifestyle adjustments, and an exercise regimen beginning with low-impact, leg-based activities while also ensuring proper fluid and electrolyte management. Ultimately, HRV and ANS function monitoring could help in managing recovery after concussions and potentially guide decisions regarding the return to activity.

Asset Subtitle

Kathleen R. Bell, MD

Keywords

traumatic brain injuries

concussions

autonomic nervous system

heart rate variability

sympathetic and parasympathetic systems

cognitive health

gender differences

HRV biomarker

treatment strategies

recovery management