Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. As a result of the rapid progression and severity of the disease, people with ALS experience loss of functionality and independence. Furthermore, it has already been described presence of autonomic dysfunction. Despite the increasing use of virtual reality (VR) in the treatment of different diseases, the use of virtual reality environment as an intervention program for ALS patients is innovative. The benefits and limitations have not yet been proven. Our objective was to evaluate the autonomic function of individuals with amyotrophic lateral sclerosis throughout the virtual reality task. The analysis of autonomic function was completed before, during, and after the virtual reality task using the upper limbs; also, all steps lasted ten minutes in a sitting position. Heart rate variability (HRV) was taken via the Polar® RS800CX cardiofrequencymeter. The following questionnaire was enforced: Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS) and Fatigue Severity Scale (FSS). Different types of HRV were revealed for the groups, indicating that the ALS group has reduced HRV, with most of the representative indices of the sympathetic nervous system. Besides, the physiological process of reducing parasympathetic activity from rest to VR activity (vagal withdrawal), with reduction in HF (ms2) and an increase in HR from rest to activity, and a further increase throughout recovery, with withdrawal of sympathetic nervous system, occurs just for the control group (CG), with no alterations between rest, activity, and recovery in individuals with ALS. We could conclude that patients with ALS have the reduction of HRV with the sympathetic predominance when equated to the healthy CG. Besides that, the ALS individuals have no capability to adapt the autonomic nervous system when likened to the CG during therapy based on VR and their recovery.
Highlights
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease categorized by progressive loss of upper and lower motor neurons [1]
heart rate variability (HRV) was logged after the initial assessments, subjects persisted at rest in the sitting position for 20 minutes, while practicing “MoveHero” for 10 minutes, and immediately after the practice for 10 minutes, we considered this the recovery period
41 subjects were included in the data analysis, 21 with ALS and 20 from the control group
Summary
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease categorized by progressive loss of upper and lower motor neurons [1]. Individuals with ALS live with continuous and multiple functional losses, presenting upper, lower, and trunk muscle atrophy, muscle weakness, fasciculation, and subsequently progressive loss of all movements [5, 6]. This population has motor symptoms, autonomic nervous system (ANS) disorders have been reported, such as decreased heart rate variability (HRV) [7,8,9,10] with chronic cardiac sympathetic hyperactivity, that is, allied in this population with sudden cardiac death and stress-induced cardiomyopathy [11, 12]. HRV has been established as a cheap technique that allows individual analysis of sympathetic and parasympathetic activity in many situations [14]
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