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Autogenic biofeedback training improves autonomic responses in a participant with cervical motor complete spinal cord injury- case report

Spinal Cord Series and Cases volume 9, Article number: 31 (2023) Cite this article

Subjects

A Correction to this article was published on 24 August 2023

This article has been updated

Abstract

Study design

Single-subject case design

Objective

To evaluate the Autogenic Feedback Training Exercise (AFTE) on autonomic nervous system responses.

Introduction

AFTE combines specific autogenic exercises with biofeedback of multiple physiological responses. Originally developed by the National Aeronautics and Space Administration (NASA), AFTE is used to improve post-flight orthostatic intolerance and motion sickness in astronauts. Individuals with cervical or upper thoracic spinal cord injury (SCI) often present symptoms of autonomic dysfunction similar to astronauts. We hypothesize that AFTE challenges nervous system baroreflex, gastric and vascular responses often impaired after SCI.

Methods

Using a modified AFTE protocol, we trained a hypotensive female participant with cervical motor complete (C5/6-AIS A) SCI, and a male non-injured control participant (NI) and measured blood pressure (BP), heart rate (HR), gastric electrical activity, and microvascular blood volume before, during and after AFTE. The participants were instructed to complete breathing and imagery exercises to help facilitate relaxation. Subsequently, they were instructed to use stressful imagery and breathing exercises during arousal trials.

Results

Both participants completed 8 sessions of approximately 45 min each. Microvascular blood volume decreased 23% (SCI) and 54% (NI) from the beginning to the end of the stimulation cycles. The participant with SCI became progressively more normotensive and improved levels of gastric electrical activity, while the NI participant’s changes in HR, gastric electrical activity, and BP were negligible.

Conclusions

AFTE may offer a novel non-pharmacologic intervention to minimize symptoms of dysautonomia in people with SCI.

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Fig. 1: Microvascular Blood Volume across 8 sessions of AFTE.
Fig. 2: Microvascular Blood Volume Changes before and after AFTE.
Fig. 3: Gastric electrical activity.
Fig. 4: Heart rate changes.
Fig. 5: Changes in blood pressure.

Data availability

The data generated and analyzed during this study is available from the corresponding author on reasonable request.

Change history

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Acknowledgements

The authors would like to express their gratitude to the research participants and Tryphena Sithu for her contribution during data acquisition. The material is based upon work supported by NASA Kentucky under NASA award number 80NSSC20M0047. Also, the study was partially funded by the University of Louisville College of Education and Human Development research and professional development mini-grant and by the Owsley Brown Frazier Endowment in Physical Medicine Rehabilitation (PMR) at the University of Louisville School of Medicine.

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Authors and Affiliations

  1. Interdisciplinary Program in Translational Neuroscience, University of Louisville, Louisville, KY, USA

    Rachel D. Torres

  2. Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA

    Hani Rashed

  3. Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY, USA

    Prateek Mathur & Thomas Abell

  4. Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, KY, USA

    Camilo Castillo

  5. School of Medicine, Department of Physiology, University of Louisville, Louisville, KY, USA

    Daniela G. L. Terson de Paleville

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Contributions

H.R., T.A., R.T., and D.T. were responsible for designing the adapted AFTE protocol, writing and the protocol. R.T. and D.T. were responsible for writing the report, extracting, and analyzing the data, interpreting the results. R.T. was responsible for creating the figures, recruiting and consenting participants. C.C. contributed to the refinement of the protocol, recruiting the SCI participant, performing ASIA evaluation, and contributed to writing the report. H.R., T.A. and P.M. extracted and analyzed the EGG data for gastric electrical activity and contribute to the writing of the report

Corresponding author

Correspondence to Daniela G. L. Terson de Paleville.

Ethics declarations

Competing interests

Dr. Abell is an Investigator for: Censa, Cindome, Vanda, Allergan, Neurogastrx; a Consultant for Censa, Nuvaira, Takeda, Medtronic; a speaker for Takeda, Medtronic; a reviewer for UpToDate; the GES editor for Neuromodulation, Wikistim; and the founder of ADEPT-GI which has IP for autonomic/enteric and bioelectric diagnosis and therapies. The rest of the authors have no conflicts to declare.

Ethical approval

The study was approved by the University of Louisville Institutional Review Board (IRB# 20.0186).

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Torres, R.D., Rashed, H., Mathur, P. et al. Autogenic biofeedback training improves autonomic responses in a participant with cervical motor complete spinal cord injury- case report. Spinal Cord Ser Cases 9, 31 (2023). https://doi.org/10.1038/s41394-023-00593-3

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  • DOI: https://doi.org/10.1038/s41394-023-00593-3

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