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      Changes in Heart Rate Variability Recorded in Natural Situation with T-Shirt Integrated Sensors and Level of Observed Behavioral Excitation: A Pilot Study of Patients with Intellectual Disabilities and Psychiatric Disorders

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          The present study investigates the possibilities of using heart rate variability (HRV) parameters as physiological markers that precede increase in observed behavioral excitation of intellectually disabled individuals. The ability to recognize or predict such patterns, especially in patients showing unpredictable reactions and language deficiencies, might be a major step forward in clinical research.


          Thirteen volunteers with intellectual disabilities, who had suffered of at least one event of overt aggression in the preceding 3 months, participated to the study. The protocol consists in the acquisition of continuous electrocardiogram (ECG) throughout approximately two times of 8 h in natural situation, using a T-shirt integrated with sensors. Simultaneously, an observer evaluates the patient’s level of overt excitation from calm (level 1) to extremely tense (level 5) and send online via Bluetooth these triggers into the ECG signals. The HRV indexes were then estimated offline on the basis of the inter-beat intervals recorded by the ECG, independently for the 30 min preceding each behavioral tension marking point, averaged, and compared through non-parametric Wilcoxon matched-pairs test. Of these, the RMSSD and LF/HF calculations were used to observe the fluctuations of inhibitory activity and cardiovagal balance through different tension states.


          Seven individuals have sufficient reliable data for analysis. They have reached at least a level 3 of behavioral excitation (moderately tense) or more (very to extremely tense, level 4 and 5) and have been retained for further analysis. In sum, a total of 197 periods of tension were kept, made up of 46 periods of slight excitation (level 2), 18 of moderate excitation (level 3), 10 of high excitation (level 4), and 5 of extreme agitation (level 5). Variations in the HRV as a function of degree of excitation are observed for RMSSD index only (inhibitory parasympathetic activity). The changes from calm to increasing levels of excitation are characterized by a significant downfall in RMSSD index when patients were evaluated to be in a very high level of tension (level 4).


          The presence of precursors to agitation, reflected in the falling-off of parasympathetic activity, offers potentially interesting prospects for therapeutic development.

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          Most cited references 34

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          Heart rate variability as an index of regulated emotional responding.

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            The polyvagal theory: phylogenetic substrates of a social nervous system.

            The evolution of the autonomic nervous system provides an organizing principle to interpret the adaptive significance of physiological responses in promoting social behavior. According to the polyvagal theory, the well-documented phylogenetic shift in neural regulation of the autonomic nervous system passes through three global stages, each with an associated behavioral strategy. The first stage is characterized by a primitive unmyelinated visceral vagus that fosters digestion and responds to threat by depressing metabolic activity. Behaviorally, the first stage is associated with immobilization behaviors. The second stage is characterized by the sympathetic nervous system that is capable of increasing metabolic output and inhibiting the visceral vagus to foster mobilization behaviors necessary for 'fight or flight'. The third stage, unique to mammals, is characterized by a myelinated vagus that can rapidly regulate cardiac output to foster engagement and disengagement with the environment. The mammalian vagus is neuroanatomically linked to the cranial nerves that regulate social engagement via facial expression and vocalization. As the autonomic nervous system changed through the process of evolution, so did the interplay between the autonomic nervous system and the other physiological systems that respond to stress, including the cortex, the hypothalamic-pituitary-adrenal axis, the neuropeptides of oxytocin and vasopressin, and the immune system. From this phylogenetic orientation, the polyvagal theory proposes a biological basis for social behavior and an intervention strategy to enhance positive social behavior.
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              Software for advanced HRV analysis.

              A computer program for advanced heart rate variability (HRV) analysis is presented. The program calculates all the commonly used time- and frequency-domain measures of HRV as well as the nonlinear Poincaré plot. In frequency-domain analysis parametric and nonparametric spectrum estimates are calculated. The program generates an informative printable report sheet which can be exported to various file formats including the portable document format (PDF). Results can also be saved as an ASCII file from which they can be imported to a spreadsheet program such as the Microsoft Excel. Together with a modern heart rate monitor capable of recording RR intervals this freely distributed program forms a complete low-cost HRV measuring and analysis system.

                Author and article information

                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                01 February 2017
                : 8
                1School of Nursing Sciences, La Source, University of Applied Sciences and Arts of Western Switzerland , Lausanne, Switzerland
                2Department of Psychiatry, Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
                3Ecole Polytechnique Fédérale de Lausanne , Lausanne, Switzerland
                4Clinique Belmont , Geneva, Switzerland
                Author notes

                Edited by: Wolfram Kawohl, University of Zurich, Switzerland

                Reviewed by: Till Beiwinkel, Lüneburg University, Germany; Sebastian Olbrich, University of Zurich, Switzerland

                *Correspondence: Jérôme Favrod, j.favrod@

                Specialty section: This article was submitted to Public Mental Health, a section of the journal Frontiers in Psychiatry

                Copyright © 2017 Palix, Akselrod, Cungi, Giuliani and Favrod.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 3, Tables: 0, Equations: 0, References: 53, Pages: 7, Words: 4689
                Original Research


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