Heart rate variability biofeedback, executive functioning and chronic brain injury

Brain Inj. 2013;27(2):209-22. doi: 10.3109/02699052.2012.729292.


Primary objective: To determine if individuals with brain injury can modify heart rate variability (HRV) through biofeedback and, if so, enhance its pattern to improve emotional regulation and problem-solving ability.

Design: A quasi-experimental design with repeated measures was employed. Thirteen individuals aged 23-63 years with severe brain injury (13-40 years post-onset) participating in a community-based programme were enrolled.

Main outcomes: Response-to-treatment was measured with HRV indices, Behavior Rating Inventory of Executive Function (BRIEF-A-Informant) and attention/problem-solving tests.

Results: At post-treatment, HRV indices (Low Frequency/High Frequency [LF/HF] and coherence ratio) increased significantly. Increased LF/HF values during the second-half of a 10-minute session were associated with higher attention scores. Participants who scored better (by scoring lower) in informant ratings at pre-treatment had highest HRV scores at post-treatment. Accordingly, at post-treatment, families' ratings of participants' emotional control correlated with HRV indices; staffs' ratings of participants' working memory correlated with participants' HRV indices. Self-ratings of the BRIEF-A Task Monitoring scale at post-treatment correlated with family ratings at pre-treatment and post-treatment.

Conclusions: Results demonstrate an association between regulation of emotions/cognition and HRV training. Individuals with severe, chronic brain injury can modify HRV through biofeedback. Future research should evaluate the efficacy of this approach for modifying behavioural problems.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Autonomic Nervous System / physiopathology*
  • Biofeedback, Psychology*
  • Brain Injury, Chronic / complications
  • Brain Injury, Chronic / epidemiology
  • Brain Injury, Chronic / physiopathology*
  • Brain Injury, Chronic / psychology*
  • Cognition
  • Electrocardiography
  • Executive Function*
  • Female
  • Heart Rate*
  • Humans
  • Male
  • New York City / epidemiology
  • Prospective Studies
  • Quality of Life
  • Self Report