scholarly journals Noninvasive Neuroprosthesis Promotes Cardiovascular Recovery After Spinal Cord Injury

2021 ◽  
Author(s):  
Rahul Sachdeva ◽  
Tom E. Nightingale ◽  
Kiran Pawar ◽  
Tamila Kalimullina ◽  
Adam Mesa ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Evidence ◽  
Autonomic Dysreflexia ◽  
Autonomic Functions ◽  
Medical Expenses ◽  
Transcutaneous Stimulation ◽  
Cord Injury ◽  
Severe Impairment ◽  
Lower Urinary

AbstractSpinal cord injury (SCI) leads to severe impairment in cardiovascular control, commonly manifested as a rapid, uncontrolled rise in blood pressure triggered by peripheral stimuli—a condition called autonomic dysreflexia. The objective was to demonstrate the translational potential of noninvasive transcutaneous stimulation (TCS) in mitigating autonomic dysreflexia following SCI, using pre-clinical evidence and a clinical case report. In rats with SCI, we show that TCS not only prevents the instigation of autonomic dysreflexia, but also mitigates its severity when delivered during an already-triggered episode. Furthermore, when TCS was delivered as a multisession therapy for 6 weeks post-SCI, the severity of autonomic dysreflexia was significantly reduced when tested in the absence of concurrent TCS. This treatment effect persisted for at least 1 week after the end of therapy. More importantly, we demonstrate the clinical applicability of TCS in treatment of autonomic dysreflexia in an individual with cervical, motor-complete, chronic SCI. We anticipate that TCS will offer significant therapeutic advantages, such as obviating the need for surgery resulting in reduced risk and medical expenses. Furthermore, this study provides a framework for testing the potential of TCS in improving recovery of other autonomic functions such lower urinary tract, bowel, and sexual dysfunction following SCI.

scholarly journals Autonomic dysreflexia in the practice of a urologist

2021 ◽  
Vol 11 (3) ◽  
pp. 257-262
Author(s):  
Roman V. Salyukov ◽  
Fedor A. Bushkov ◽  
Maria V. Frolova
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Sympathetic Neurons ◽  
Abdominal Cavity ◽  
Spinal Reflex ◽  
Autonomic Dysreflexia ◽  
Pathophysiological Mechanism ◽  
Urological Complications ◽  
Cord Injury ◽  
Lower Urinary

Autonomic dysreflexia (AD) is a potentially life-threatening condition that develops in patients with spinal cord injury (SCI) at or above the T6 segment. First of all this condition is characterized by uncontrolled arterial hypertension, which can lead to catastrophic complications and even death. The trigger for the development of AD is often urological complications, as well as diagnostic and therapeutic manipulations on the lower urinary tract. It is important for urologists to be aware of the AD syndrome, clinical features of AD, acute and chronic management, as well as prevention episodes of AD in patients with neurogenic lower urinary dysfunction. AD is defined as an increase of systolic blood pressure of 20 mmHg from baseline in response to various afferent stimuli originating below the level of spinal cord injury. AD is based on exaltation of spinal reflex activity with irradiation of impulses in the spinal cord under conditions of dennervation preganglionic sympathetic neurons located above the T6 segment and hyperactivity of peripheral -adrenergic receptors. The main pathophysiological mechanism of AD is hypernoradrenalinemia, leading to vasoconstriction the vessels of the skin, abdominal cavity, muscles below the level of neurological injury.

Spinal cord injury and pregnancy

2021 ◽  
pp. 1753495X2110119
Author(s):  
Katherine Robertson ◽  
Felicity Ashworth
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Respiratory Infections ◽  
Obstetric Care ◽  
Autonomic Dysreflexia ◽  
Existing Problems ◽  
Cord Injury ◽  
Relative Rarity ◽  
Obstetric Population ◽  
Tract Infections

Pregnancy in women with spinal cord injury is considered high risk because it may exacerbate many of their existing problems, including autonomic dysreflexia, spasms, decubitus ulcers, urinary tract infections and respiratory infections. Due to the relative rarity of spinal cord injury in the general obstetric population, clinicians often lack familiarity of these specific problems and the women themselves are usually more experienced in their own management than their obstetric team. However, studies have demonstrated that pregnancy outcomes are generally good with appropriate and experienced obstetric care. In this review, we examine the available literature and provide advice on pre-conception counselling and the antenatal, intrapartum and postnatal management of pregnant women with spinal cord injury.

scholarly journals Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury

2016 ◽  
Vol 33 (18) ◽  
pp. 1651-1657 ◽  
Author(s):  
Renée J. Fougere ◽  
Katharine D. Currie ◽  
Mark K. Nigro ◽  
Lynn Stothers ◽  
Daniel Rapoport ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Autonomic Dysreflexia ◽  
Cord Injury

scholarly journals Plasticity of TRPV1-Expressing Sensory Neurons Mediating Autonomic Dysreflexia Following Spinal Cord Injury

2012 ◽  
Vol 3 ◽  
Author(s):  
Leanne M. Ramer ◽  
A. Peter van Stolk ◽  
Jessica A. Inskip ◽  
Matt S. Ramer ◽  
Andrei V. Krassioukov
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Sensory Neurons ◽  
Autonomic Dysreflexia ◽  
Cord Injury

Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: a systematic review

2021 ◽  
pp. 1-21
Author(s):  
Charlotte Y. Adegeest ◽  
Jort A. N. van Gent ◽  
Janneke M. Stolwijk-Swüste ◽  
Marcel W. M. Post ◽  
William P. Vandertop ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Chronic Phase ◽  
Autonomic Dysreflexia ◽  
Traumatic Spinal Cord Injury ◽  
Chronic Stage ◽  
Increased Risk ◽  
Cord Injury ◽  
Meta Analyses

OBJECTIVE Secondary health conditions (SHCs) are long-term complications that frequently occur due to traumatic spinal cord injury (tSCI) and can negatively affect quality of life in this patient population. This study provides an overview of the associations between the severity and level of injury and the occurrence of SHCs in tSCI. METHODS A systematic search was conducted in PubMed and Embase that retrieved 44 studies on the influence of severity and/or level of injury on the occurrence of SHCs in the subacute and chronic phase of tSCI (from 3 months after trauma). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS In the majority of studies, patients with motor-complete tSCI (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade A or B) had a significantly increased occurrence of SHCs in comparison to patients with motor-incomplete tSCI (AIS grade C or D), such as respiratory and urogenital complications, musculoskeletal disorders, pressure ulcers, and autonomic dysreflexia. In contrast, an increased prevalence of pain was seen in patients with motor-incomplete injuries. In addition, higher rates of pulmonary infections, spasticity, and autonomic dysreflexia were observed in patients with tetraplegia. Patients with paraplegia more commonly suffered from hypertension, venous thromboembolism, and pain. CONCLUSIONS This review suggests that patients with a motor-complete tSCI have an increased risk of developing SHCs during the subacute and chronic stage of tSCI in comparison with patients with motor-incomplete tSCI. Future studies should examine whether systematic monitoring during rehabilitation and the subacute and chronic phase in patients with motor-complete tSCI could lead to early detection and potential prevention of SHCs in this population.

scholarly journals A Simple Radiological Technique for Demonstration of Incorrect Positioning of a Foley Catheter with Balloon Inflated in the Urethra of a Male Spinal Cord Injury Patient

2006 ◽  
Vol 6 ◽  
pp. 2445-2449 ◽  
Author(s):  
Subramanian Vaidyanathan ◽  
Peter L. Hughes ◽  
Bakul M. Soni
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Urinary Bladder ◽  
Contrast Medium ◽  
Foley Catheter ◽  
Autonomic Dysreflexia ◽  
X Ray ◽  
Malpractice Claims ◽  
Cord Injury ◽  
Radiological Technique

In a male patient with cervical spinal cord injury, the urinary bladder may go into spasm when a urethral catheter is removed and a new Foley catheter is inserted. Before the balloon is inflated, the spastic bladder may push the Foley catheter out or the catheter may slip out of a small-capacity bladder. An inexperienced health professional may inflate the balloon of a Foley catheter in the urethra without realizing that the balloon segment of the catheter is lying in the urethra instead of the urinary bladder. When a Foley balloon is inflated in the urethra, a tetraplegic patient is likely to develop autonomic dysreflexia. This is a medical emergency and requires urgent treatment. Before the incorrectly placed Foley catheter is removed, it is important to document whether the balloon has been inflated in the urinary bladder or not. The clinician should first use the always available tools of observation and palpation at the bedside without delays of transportation. A misplaced balloon will often be evident by a long catheter sign, indicating excessive catheter remaining outside the patient. Radiological diagnosis is not frequently required and, when needed, should employ the technique most readily available, which might be a body and pelvic CT without intravenous contrast. An alternative radiological technique to demonstrate the position of the balloon of the Foley catheter is described. Three milliliters of nonionic X-ray contrast medium, Ioversol (OPTIRAY 300), is injected through the side channel of the Foley catheter, which is used for inflating the balloon. Then, with a catheter-tip syringe, 30 ml of sterile Ioversol is injected through the main lumen of the Foley catheter. Immediately thereafter, an X-ray of the pelvis (including perineum) is taken. By this technique, both the urinary bladder and balloon of the Foley catheter are visualized by the X-ray contrast medium. When a Foley catheter has been inserted correctly, the balloon of the Foley catheter should be located within the urinary bladder, but when the Foley catheter is misplaced with the balloon inflated in the urethra, a round opaque shadow of the Foley balloon is seen separately below the urinary bladder. This radiological study takes only a few minutes to perform, can be carried out bedside with a mobile X-ray machine, and does not require special expertise or preparations, unlike transrectal ultrasonography. When a Foley balloon is inflated in the urethra, abdominal ultrasonography will show an absence of the Foley balloon within the bladder. The technique described above aids in positive demonstration of a Foley balloon lying outside the urinary bladder. Such documentation proves valuable in planning future treatment, education of health professionals, and settlement of malpractice claims.

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