Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review

J. Pers. Med., 2022 · DOI: https://doi.org/10.3390/jpm12071110 · Published: July 7, 2022

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

The autonomic nervous system (ANS) maintains homeostasis by influencing smooth muscle, cardiac muscle, blood vessels, glands, and organs. After a spinal cord injury (SCI), the brain's influence on the ANS is disrupted, leading to sympathetic blunting and parasympathetic dominance. This disruption can cause cardiac issues, low blood pressure, breathing problems, and bowel, bladder, and sexual dysfunction.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Level 5, Narrative Review

Key Findings

1
SCI disrupts supraspinal influence on the ANS, leading to sympathetic blunting and parasympathetic dominance, resulting in various dysfunctions.
2
Noxious stimuli below the SCI level elicit unabated reflex sympathetic outflow, contributing to autonomic dysreflexia.
3
Individuals with SCI are often described as poikilothermic, taking on the ambient temperature due to impaired thermoregulation.

Research Summary

Autonomic dysfunction is a profound change following SCI, often overlooked but crucial for quality of life. SCI leads to sympathetic blunting and parasympathetic dominance, causing various cardiovascular, thermoregulatory, respiratory, and genitourinary dysfunctions. Uninhibited reflex sympathetic outflow in response to stimuli below the injury level can cause hyperhidrosis and life-threatening hypertensive crisis.

Practical Implications

Clinical Management Strategies

Highlights the importance of managing autonomic disturbances like blood pressure, thermoregulation, and bladder/bowel function in SCI patients.

Importance of Autonomic Function

Emphasizes that patients with tetraplegia and paraplegia consider the elimination of autonomic dysfunction and recovery of bowel, bladder, and sexual function as more desirable than regaining the ability to walk.

Future Research

Highlights the need for developing strategies to manage various autonomic dysfunctions in the setting of SCI.

Study Limitations

1
The review is narrative and may be subject to selection bias.
2
Specific management strategies may not be universally applicable and require individualization.
3
Further research is needed to validate the effectiveness of various interventions for autonomic dysfunction after SCI.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury