ASSESSMENT OF THE EFFECTIVENESS OF PHYSICAL THERAPY IN THE CORRECTION OF AUTONOMIC NERVOUS SYSTEM DYSFUNCTION AND HEART RATE VARIABILITY IN MILITARY PERSONNEL WITH SEQUELAE OF TRAUMATIC BRAIN INJURY

Abstract

Objective. To evaluate the effectiveness of a newly developed comprehensive physical therapy program in military personnel with sequelae of traumatic brain injury (TBI) based on the dynamics of autonomic regulation parameters, functional autonomic tests, and heart rate variability (HRV). Materials and Methods. The study involved 96 male military personnel. The comparison group consisted of 33 apparently healthy individuals without neurological or musculoskeletal disorders. The main group included 63 servicemen with TBI sequelae who were randomly assigned to two subgroups: Group 1 (n=32) received physical therapy according to standard rehabilitation protocols; Group 2 (n=31) underwent a newly developed comprehensive 8-week physical therapy program (4 weeks of supervised outpatient sessions followed by 4 weeks of independent training). The intervention included functional exercises, visual biofeedback training using the MotionGuidance® system, balance training on unstable surfaces, oculomotor exercises, resistance exercises with elastic bands and weights, and progressive muscle relaxation according to Jacobson. Assessments were performed at baseline and after 3 months using orthostatic and clinostatic tests, an isometric handgrip test, the O. Wayne autonomic dysfunction questionnaire, and 24-hour heart rate variability monitoring. Results. Baseline evaluation revealed statistically significant (p<0.05) signs of autonomic dysfunction in military personnel with TBI, including elevated mean heart rate, LF power, LF/HF ratio, Baevsky stress index, and Kerdo index, along with decreased RMSSD, SDNN, total power (TP), and HF power compared with the comparison group. Following the intervention, both main groups demonstrated positive changes; however, improvements were more pronounced in Group 2. These included significant increases in overall HRV parameters and vagal activity, reduction of sympathetic predominance, normalization of autonomic reactivity in functional tests, and a substantial decrease in autonomic dysfunction questionnaire scores. Conclusions. The developed comprehensive physical therapy program resulted in more effective normalization of autonomic regulation, reduction of sympathetic overactivity, and enhancement of adaptive capacity compared with standard rehabilitation. Its implementation is recommended within medical rehabilitation programs for military personnel with TBI sequelae to facilitate functional recovery and return to professional military duties