Purpose
To characterize differences in autonomic cardiovascular regulation after spinal cord injury compared to people without spinal cord injury through objective laboratory and subjective survey data, and to determine the component contribution of group III and group IV muscle afferents to overall autonomic integrity after spinal cord injury.
Methods
Individuals with spinal cord injury (n = 36), aged 18 years or older, and similarly age and gender matched individuals without spinal cord injury (n = 44) completed the Autonomic Dysfunction After Spinal Cord Injury (ADFSCI) survey. To test physiologic responses to a well-characterized, autonomic test as well as pilot another objective test, seven individuals with spinal cord injury and 10 individuals from the uninjured control group then completed further laboratory testing, including Valsalva maneuvers and ischemic hand grip.
Results
Individuals with spinal cord injury had neurological levels of injury C3-T12 and injuries graded A-D on the American Spinal Injury Association Impairment Scale (AIS). Individuals with spinal cord injury scored significantly higher by endorsing more daily symptoms of autonomic dysfunction on the ADFSCI survey compared to their uninjured peers (W = 272, p < 0.0001). However, in the group with spinal cord injury, higher ADFSCI scores were only weakly positively correlated with higher neurological level injury (R = 0.37, n = 36, p = 0.03) and more complete (AIS A or B) injury (R = 0.46, p = 0.01). Furthermore, the subgroup with spinal cord injury (n = 7) who completed laboratory testing displayed significantly altered blood pressure response during late phase II of the Valsalva maneuver compared to controls (p = 0.02). The same group of individuals with spinal cord injury also demonstrated a significantly lower maximal diastolic blood pressure in response to ischemic hand grip when compared to the control group (p = 0.04).
Conclusion
Self-reported daily symptoms of autonomic dysfunction are markedly higher after spinal cord injury. However, the relationship between these symptoms and neurological level of injury and AIS are only weakly correlated. This nonlinear relationship between ADFSCI scores and clinical injury characteristics emphasizes the need for further characterization of autonomic integrity. Physiologic laboratory tests more completely capture these alterations after spinal cord injury and point to developing bedside exams. / 2026-10-30T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/49448 |
| Date | 31 October 2024 |
| Creators | Burns, Kathryn Renee |
| Contributors | Symes, Karen, Solinsky, Ryan |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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