Evaluation of Cardiovascular Autonomic Function during Inpatient Rehabilitation following Traumatic Spinal Cord Injury

Journal of Neurotrauma, 2022 · DOI: 10.1089/neu.2021.0379 · Published: December 1, 2022

Spinal Cord Injury Cardiovascular Science Neurology

Simple Explanation

The study evaluates how well current methods, ISNCSCI and ISAFSCI, assess cardiovascular autonomic function in patients undergoing rehabilitation after a traumatic spinal cord injury (SCI). The researchers monitored heart rate (HR) and blood pressure (BP) to estimate cardiovascular function and looked at cardio-vagal modulation and sympathetic vasomotor regulation. The study found that neither ISNCSCI nor ISAFSCI were sensitive enough to detect changes in cardiovascular autonomic function after a traumatic SCI.

Study Duration

July 2017 to March 2020

Participants

41 participants with traumatic SCI

Evidence Level

Not specified

Key Findings

1
The ISNCSCI and ISAFSCI examinations have limited sensitivity in discerning the degree of cardiovascular ANS impairment during inpatient rehabilitation following traumatic SCI.
2
There was a significant and linear association between NLI and HFHRV—that is, the higher the NLI the higher the degree of cardio-vagal tone.
3
Patients with complete AIS A lesions had significantly lower amplitudes of SBP oscillations between 0.07 and 0.14 Hz as compared with patients with AIS B/C/D.

Research Summary

This study examined the utility of the ISNCSCI and ISAFSCI in documenting cardiovascular ANS impairment at a baseline assessment in patients with SCI during inpatient rehabilitation following injury. The findings suggest that the ISAFSCI examination has limited sensitivity in discerning the degree of cardiovascular ANS impairment during inpatient rehabilitation following traumatic SCI. Improvements in the clinical assessment of global ANS function, should be prioritized in clinical practice given the importance of regaining ANS control of multiple organ systems to promote health, vitality, and longevity in individuals living with SCI.

Practical Implications

Clinical Assessment

Routine clinical assessment should include measurement of global ANS function.

Risk Identification

Gaining a better understanding regarding the ability of the ISAFSCI to identify patients at risk of ANS impairment will alert clinicians to individual patient needs.

Intervention Strategies

Appropriate interventions, such as compression garments, blood pressure medications, or care-giver education, can be initiated to improve long-term outcomes following traumatic SCI.

Study Limitations

1
Data were collected at the bedside in patients with SCI, and while we attempted to control the environment during testing, background noise, room lighting, and temperature were not rigorously controlled.
2
We did not control for medication use, and acknowledge that the number, timing, and dose of prescription medications use may have influenced the study results in an unpredictable manner.
3
There is no ‘‘gold-standard’’ to document cardiovascular ANS control and the utility of the ISAFSCI examination is not currently known.

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