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Pediatric Rehabilitation

The Role of Heart Rate Variability in Adolescent and Young Adult Concussion: A Scoping Review

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 7

    Primary Author(s)

  • Zarif Ladak, Other

    Medical Student
    Rowan University School of Osteopathic Medicine
    Princeton, New Jersey

    • Co-Author(s)

  • SS

    Stacy Suskauer, MD

    Professor
    Kennedy Krieger Institute and Johns Hopkins PM&R
    Baltimore, Maryland

  • BS

    Beth Slomine, PhD

    Neuropsychologist
    Kennedy Krieger Institute
    Baltimore, Maryland

  • AS

    Adrian Svingos, PhD

    Neuropsychologist/ Assistant Professor
    Kennedy Krieger Institute/ Johns Hopkins University School of Medicine
    Baltimore, Maryland

  • DR

    Danielle Ransom, PhD

    Neuropsychologist
    Johns Hopkins All Children's Hospital
    Baltimore, Maryland

Disclosure(s):
Zarif Ladak, Other: No financial relationships to disclose
Background and/or Objectives: Concussion causes physical and cognitive changes linked to autonomic dysregulation. Heart rate variability (HRV) has emerged as a promising biomarker for assessing autonomic function. Adolescents face greater concussion risk, yet research on HRV after concussion in this population remains limited. This scoping review aims to characterize the current state of the science on HRV in adolescents with sport-related and non-sport-related concussions, exploring temporal changes, differences by injury mechanism, and potential sex-based variations to evaluate HRV's clinical utility in recovery assessment.

Design: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, systematically analyzing 12 studies from 851 records initially identified from PubMed, Scopus, Embase, Web of Science, and Google Scholar.

Setting : Included studies were conducted in clinical and athletic settings, encompassing diverse populations from sports teams, hospitals, and academic institutions.

Participants : Adolescents and young adults aged 13–21 with sport-related or non-sport-related concussions, including athletes, patients from clinical settings, and mixed cohorts.

Interventions: The included studies primarily assessed HRV through 5-minute ECG recordings, 24-hour Holter monitors, and wearable devices.

Main Outcome Measures: Assessing key HRV metrics such as Root Mean Square Sum of Differences(RMSSD) and Standard Deviation of NN Intervals (SDNN) across acute, subacute, and chronic phases of concussion recovery.

Results: Some studies have reported decreased HRV in the acute and subacute phases, while others have shown no significant differences. Autonomic dysregulation persisted in some cases even after symptomatic recovery, particularly during physiological stress tasks. Sex differences in HRV patterns were noted in a subset of studies.

Conclusions: Current evidence remains inconsistent due to methodological variability and gaps in research. Limitations include the underrepresentation of non-sport-related injuries, lack of acute-phase data for these cases, and inconclusive findings on sex differences. Standardized protocols, larger sex-stratified samples, and targeted investigations into non-sport mechanisms to clarify HRV's clinical utility in guiding concussion management and rehabilitation are needed.