The Broad Applicability and Simplicity of Autonomic Rehabilitation

Autonomic Rehabilitation (AR) is an evidence-based approach that modulates and restores a dysregulated autonomic system. We have pioneered a novel interdisciplinary approach in the Comprehensive Autonomic center (CAC) at Virginia Commonwealth University (VCU) School of Medicine, which combines a sophisticated diagnostic strategy with a biobehavioral management approach. This approach has a top-down component focused on ameliorating dysfunctional cognitive sets and a bottom-up component focused on improving autonomic physiology, the core concept of AR. This CAC clinical arm has a research counterpart, the VCU AWARE (Autonomic Wellness And Research and Education) Center, focused on innovative, pragmatic autonomic research on the impact of both the top-down and bottom-up strategies, education, and training. The CAC clinicians and research personnel employ and investigate the power of heart rate variability (HRV) biofeedback (HRVB) in daily practice. HRV data can provide diagnostic information, outcome measurement, and be utilized for therapeutics, and is increasingly used for predictive analytics in transdiagnostic clinical populations. The VCU center is successfully applying AR in disorders where autonomic dysregulation is prominent, such as long COVID, Postural Tachycardia Syndrome (POTS), concussion, traumatic brain injury, functional neurological disorders, disorders of gut-brain interface (DGBI), migraine headache, syncope, and chronic overlapping pain conditions. Thus AR is applicable to a wide rangeof clinical transdiagnostic populations, and new diagnostic conditions are continually emerging. In parallel, AWARE is investigating the optimal methodology, dissemination, and applications of AR, its impact on brain networks, and its impact on systemic inflammation. The ultimate goal is an understanding of the extent and complexity that autonomic dysregulation creates in the development of brain-based, systemic, and inflammatory pathology. This panel will address some of the application areas and known mechanisms encompassed by AR.