Comparing Virtual Reality to Mental Imagery for Blood Pressure and Heart Rate Variability Improvement in People with and without Spinal Cord Injury

Abstract Spinal cord injury (SCI) often results in debilitating and sometimes life-threatening blood pressure complications in the form of abnormally high blood pressure (hypertension) and/or abnormally low blood pressure (hypotension) (Cragg et al., 2013; Garshick E. et al., 2005; Groah et al., 2011). Virtual reality (VR) has been found effective for managing hypertension (Ma, 2022; Naef et al., 2022) but, to our knowledge, no literature exists on the use of 360-degree videos or VR for modulating both hypertension and hypotension after a SCI. Thirty-one participants, including 14 individuals with non-acute SCI and 17 non-injured, participated in this study. Participants were asked to watch eight short, 360-degree VR videos, alternating between stimulating and relaxing to raise and then lower mean arterial pressure (MAP) by at least five millimeters of mercury (mmHg), respectively. Participants underwent two sessions within a week and were randomly assigned to use VR or mental imagery for the first session. Participants with SCI showed a significant decrease in MAP during relaxation cycles in both VR and mental training p = 0.0421. Heart rate variability showed significant improvement in both VR and mental sessions for all participants p = 9.29e-4. VR could be a useful tool for improving cardiovascular health in the SCI population, minimizing pharmaceutical interventions and augmenting access to neurorehabilitative therapies.