Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Autonomic impairment is not explained by neurological level of injury or motor-sensory completeness

Spinal Cord (2024)Cite this article

Subjects

Abstract

Study design

Cross-sectional study.

Objectives

Determine how well common clinical assessments of level and completeness of injury are correlated with symptoms of autonomic blood pressure instability and secondary medical complications after spinal cord injury (SCI).

Setting

Academic medical center, United States.

Methods

Eighty-two individuals with (n = 48) and without (n = 34) SCI had symptoms of autonomic blood pressure instability quantified with the Autonomic Dysfunction Following SCI (ADFSCI) survey. Health histories quantified the secondary medical complications through number of urinary tract infections and hospitalizations in the past year, time to complete bowel program, and lifetime pressure injuries. Regression models were completed to identify strengths of associated correlations.

Results

ADFSCI scores were significantly higher in individuals with SCI than controls. Neurological level of injury and ASIA impairment scale were both minimally correlated to symptoms of autonomic blood pressure instability, accounting for only 11.5% of variability in regression models. Secondary medical complications had similar, minimal correlations to level and motor/sensory completeness of SCI (R2 = 0.07 and R2 = 0.03 respectively). Contrasting this, symptoms of blood pressure instability on ADFSCI far outperformed the common clinical motor/sensory bedside exam, with moderately strong correlations to the ranked number of secondary medical complications after SCI (R2 = 0.31).

Conclusion

Neurological level of injury and motor/sensory completeness provided limited insights into which individuals with SCI would have blood pressure instability or secondary medical complications. Interestingly, symptoms of blood pressure instability outperform the clinical motor/sensory bedside exam, with higher correlations to secondary medical complications after SCI.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Regression analyses of ranked total complications.

Similar content being viewed by others

Data availability

The authors agree to make data available upon reasonable request to corresponding author.

References

  1. Wecht JM, Bauman WA. Implication of altered autonomic control for orthostatic tolerance in SCI. Auton Neurosci. 2018;209:51–8.

    Article  PubMed  Google Scholar 

  2. Kruger EA, Pires M, Ngann Y, Sterling M, Rubayi S. Comprehensive management of pressure ulcers in spinal cord injury: current concepts and future trends. J Spinal Cord Med. 2013;36:572–85.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Taweel WA, Seyam R. Neurogenic bladder in spinal cord injury patients. Res Rep. Urol. 2015;7:85–99.

    PubMed  PubMed Central  Google Scholar 

  4. Krause JS, Carter RE, Pickelsimer EE, Wilson D. A prospective study of health and risk of mortality after spinal cord injury. Arch Phys Med Rehabil. 2008;89:1482–91.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Garstang SV, Miller-Smith SA. Autonomic nervous system dysfunction after spinal cord injury. Phys Med Rehabilitation Clin North Am. 2007;18:275–96.

    Article  Google Scholar 

  6. Linsenmeyer TA, Gibbs K, Solinsky R. Autonomic dysreflexia after spinal cord injury: beyond the basics. Curr Phys Med Rehabil Rep. 2020;8:443–51.

    Article  Google Scholar 

  7. Teasell RW, Arnold JM, Krassioukov AV, Delaney GA. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Arch Phys Med Rehabil. 2000;81:506–16.

    Article  CAS  PubMed  Google Scholar 

  8. West CR, AlYahya A, Laher I, Krassioukov A. Peripheral vascular function in spinal cord injury: a systematic review. Spinal Cord. 2013;51:10–9.

    Article  CAS  PubMed  Google Scholar 

  9. Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma. 2004;21:1371–83.

    Article  PubMed  Google Scholar 

  10. Krassioukov AV, Eng JJ, Claxton G, Sakakibara BM, Shum S. Neurogenic bowel management after spinal cord injury: a systematic review of the evidence. Spinal Cord. 2010;48:718–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Prüss H, Tedeschi A, Thiriot A, Lynch L, Loughhead SM, Stutte S, et al. Spinal cord injury-induced immunodeficiency is mediated by a sympathetic-neuroendocrine adrenal reflex. Nat Neurosci. 2017;20:1549–59.

    Article  PubMed  Google Scholar 

  12. Rodgers KA, Kigerl KA, Schwab JM, Popovich PG. Immune dysfunction after spinal cord injury - A review of autonomic and neuroendocrine mechanisms. Curr Opin Pharm. 2022;64:102230.

    Article  CAS  Google Scholar 

  13. Wecht JM, Krassioukov AV, Alexander M, Handrakis JP, McKenna SL, Kennelly M, et al. International Standards to document Autonomic Function following SCI (ISAFSCI): Second Edition. Top Spinal Cord Inj Rehabilitation. 2021;27:23–49.

    Article  Google Scholar 

  14. Koyuncu E, Ersoz M. Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury. J Spinal Cord Med. 2017;40:170–4.

    Article  PubMed  Google Scholar 

  15. Huang YH, Bih LI, Chen GD, Lin CC, Chen SL, Chen WW. Autonomic dysreflexia during urodynamic examinations in patients with suprasacral spinal cord injury. Arch Phys Med Rehabil. 2011;92:1450–4.

    Article  PubMed  Google Scholar 

  16. Solinsky R, Linsenmeyer TA. Anxiety masquerading as autonomic dysreflexia. J Spinal Cord Med. 2019;42:639–42.

    Article  PubMed  Google Scholar 

  17. Solinsky R. Autonomic Dysreflexia: Current Pharmacologic Management. PM&R; https://doi.org/10.1002/pmrj.13051 (2023).

  18. Round AM, Park SE, Walden K, Noonan VK, Townson AF, Krassioukov AV. An evaluation of the International Standards to document remaining autonomic function after spinal cord injury: input from the international community. Spinal Cord. 2017;55:198–203.

    Article  CAS  PubMed  Google Scholar 

  19. Hubli M, Gee CM, Krassioukov AV. Refined assessment of blood pressure instability after spinal cord injury. Am J Hypertension. 2015;28:173–81.

    Article  Google Scholar 

  20. Nightingale TE, Zheng MMZ, Sachdeva R, Phillips AA, Krassioukov AV. Diverse cognitive impairment after spinal cord injury is associated with orthostatic hypotension symptom burden. Physiol Behav. 2020;213:112742.

    Article  CAS  PubMed  Google Scholar 

  21. Draghici AE, Taylor JA. Baroreflex autonomic control in human spinal cord injury: physiology, measurement, and potential alterations. Auton Neurosci. 2018;209:37–42.

    Article  PubMed  Google Scholar 

  22. Solinsky R, Vivodtzev I, Hamner JW, Taylor JA. The effect of heart rate variability on blood pressure is augmented in spinal cord injury and is unaltered by exercise training. Clin Auton Res. 2021;31:293–301.

    Article  PubMed  Google Scholar 

  23. West CR, Bellantoni A, Krassioukov AV. Cardiovascular function in individuals with incomplete spinal cord injury: a systematic review. Top Spinal Cord Inj Rehabil. 2013;19:267–78.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Curt A, Weinhardt C, Dietz V. Significance of sympathetic skin response in the assessment of autonomic failure in patients with spinal cord injury. J Auton Nerv Syst. 1996;61:175–80.

    Article  CAS  PubMed  Google Scholar 

  25. Kalpakjian CZ, Scelza WM, Forchheimer MB, Toussaint LL. Prelimary reliability and validity of a Spinal Cord Injury Secondary Conditions Scale. J Spinal Cord Med. 2007;30:131–9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Linsenmeyer TA, Campagnolo DI, Chou IH. Silent autonomic dysreflexia during voiding in men with spinal cord injuries. J Urol. 1996;155:519–22.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

Funding

Data used for this study was derived from previous studies including K23HD102663 through NIH/NICHD and the Foundation for Physical Medicine & Rehabilitation. Further data was supported by pilot funding from the National Institutes of Health National Center of Neuromodulation for Rehabilitation, the National Center for Complementary and Integrative Health, the National Institute on Deafness and Other Communication Disorders, and the National Institute of Neurological Disorders and Stroke. NIH/NICHD Grant Number P2CHD086844 which was awarded to the Medical University of South Carolina. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NICHD.

Author information

Authors and Affiliations

  1. Spaulding Rehabilitation Hospital, Boston, USA

    Kathryn Burns & Ryan Solinsky

  2. Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, USA

    Ryan Solinsky

  3. Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, USA

    Ryan Solinsky

Authors
  1. Kathryn Burns
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan Solinsky
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KB and RS both contributed substantially to the study design, data capture and aggregation, statistical analysis, and manuscript preparation.

Corresponding author

Correspondence to Ryan Solinsky.

Ethics declarations

Competing interests

The authors have no competing financial interests in relation to the work described.

Ethical approval

Institutional Review Board approval was in place and active for all studies contributing data to this analysis.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Burns, K., Solinsky, R. Autonomic impairment is not explained by neurological level of injury or motor-sensory completeness. Spinal Cord (2024). https://doi.org/10.1038/s41393-024-00994-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41393-024-00994-7

Search

Advanced search

Quick links