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      Toward an Embodied Medicine: A Portable Device with Programmable Interoceptive Stimulation for Heart Rate Variability Enhancement

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          Abstract

          In this paper, we describe and test a new portable device that is able to deliver tactile interoceptive stimulation. The device works by delivering precise interoceptive parasympathetic stimuli to C-tactile afferents connected to the lamina I spinothalamocortical system. In humans, interoceptive stimulation can be used to enhance heart rate variability (HRV). To test the effectiveness of the device in enhancing HRV, 13 subjects were randomly assigned in a single-blind between-subjects design either to the experimental condition or to the control condition. In the experimental condition, subjects received stimulation with the developed device; in the control condition subjects received stimulation with static non-interoceptive pressure. Subjects’ electrocardiograms (ECG) were recorded, with sampling at 1000 Hz for 5 min as a baseline, and then during the stimulations (11 min). Time domain analyses were performed to estimate the short-term vagally mediated component (rMSSD) of HRV. Results indicated that the experimental group showed enhanced rMSSD, compared to the control group. Moreover, frequency domain analyses indicated that high frequency band power, which reflects parasympathetic activity in humans, also appeared to be enhanced in the experimental group compared to control subjects. Conclusions and future challenges for an embodied perspective of rehabilitative medicine are discussed.

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          Interoception: the sense of the physiological condition of the body.

          AD (Bud) Craig (2003)
          Converging evidence indicates that primates have a distinct cortical image of homeostatic afferent activity that reflects all aspects of the physiological condition of all tissues of the body. This interoceptive system, associated with autonomic motor control, is distinct from the exteroceptive system (cutaneous mechanoreception and proprioception) that guides somatic motor activity. The primary interoceptive representation in the dorsal posterior insula engenders distinct highly resolved feelings from the body that include pain, temperature, itch, sensual touch, muscular and visceral sensations, vasomotor activity, hunger, thirst, and 'air hunger'. In humans, a meta-representation of the primary interoceptive activity is engendered in the right anterior insula, which seems to provide the basis for the subjective image of the material self as a feeling (sentient) entity, that is, emotional awareness.
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            The hidden island of addiction: the insula.

            Nasir Naqvi, Antoine Bechara (2009)
            Most prior research on the neurobiology of addiction has focused on the role of subcortical systems, such as the amygdala, the ventral striatum and mesolimbic dopamine system, in promoting the motivation to seek drugs. Recent evidence indicates that a largely overlooked structure, the insula, plays a crucial part in conscious urges to take drugs. The insula has been highlighted as a region that integrates interoceptive (i.e. bodily) states into conscious feelings and into decision-making processes that involve uncertain risk and reward. Here, we propose a model in which the processing of the interoceptive effects of drug use by the insula contributes to conscious drug urges and to decision-making processes that precipitate relapse.
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              A quantitative systematic review of normal values for short-term heart rate variability in healthy adults.

              DAVID NUNAN, GAVIN SANDERCOCK, DAVID BRODIE (2010)
              Heart rate variability (HRV) is a known risk factor for mortality in both healthy and patient populations. There are currently no normative data for short-term measures of HRV. A thorough review of short-term HRV data published since 1996 was therefore performed. Data from studies published after the 1996 Task Force report (i.e., between January 1997 and September 2008) and reporting short-term measures of HRV obtained in normally healthy individuals were collated and factors underlying discrepant values were identified. Forty-four studies met the pre-set inclusion criteria involving 21,438 participants. Values for short-term HRV measures from the literature were lower than Task Force norms. A degree of homogeneity for common measures of HRV in healthy adults was shown across studies. A number of studies demonstrate large interindividual variations (up to 260,000%), particularly for spectral measures. A number of methodological discrepancies underlined disparate values. These include a systematic failure within the literature (a) to recognize the importance of RR data recognition/editing procedures and (b) to question disparate HRV values observed in normally healthy individuals. A need for large-scale population studies and a review of the Task Force recommendations for short-term HRV that covers the full-age spectrum were identified. Data presented should be used to quantify reference ranges for short-term measures of HRV in healthy adult populations but should be undertaken with reference to methodological factors underlying disparate values. Recommendations for the measurement of HRV require updating to include current technologies. ©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Sensors (Basel)
                Journal ID (iso-abbrev): Sensors (Basel)
                Journal ID (publisher-id): sensors
                Title: Sensors (Basel, Switzerland)
                Publisher: MDPI
                ISSN (Electronic): 1424-8220
                Publication date (Electronic): 30 July 2018
                Publication date Collection: August 2018
                Volume: 18
                Issue: 8
                Electronic Location Identifier: 2469
                Affiliations
                [1 ]Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20100 Milan, Italy; p.cipresso@ 123456auxologico.it (P.C.); giuseppe.riva@ 123456unicatt.it (G.R.)
                [2 ]Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco, 2, 20149 Milan, Italy; e.pedroli@ 123456auxologico.it
                Author notes
                [* ]Correspondence: daniele.dilernia@ 123456unicatt.it ; Tel.: +39-02-72343863
                Author information
                https://orcid.org/0000-0002-0662-7678
                https://orcid.org/0000-0003-3657-106X
                Article
                Publisher ID: sensors-18-02469
                DOI: 10.3390/s18082469
                PMC ID: 6111417
                PubMed ID: 30061531
                SO-VID: a0dfae00-2ee2-4cfc-b0cf-337768ae0e4e
                Copyright © © 2018 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 29 May 2018
                Date accepted : 25 July 2018
                Categories
                Subject: Article

                ScienceOpen disciplines: Biomedical engineering
                Keywords: interoception,interoceptive stimulation,heart rate variability,c-tactile,affective touch,ct afferents,rehabilitative medicine
                Data availability:
                ScienceOpen disciplines: Biomedical engineering
                Keywords: interoception, interoceptive stimulation, heart rate variability, c-tactile, affective touch, ct afferents, rehabilitative medicine

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