TENS attenuates response to colon distension in paraplegic and quadriplegic rats

2002 ◽  
Vol 283 (4) ◽  
pp. H1734-H1739 ◽  
Author(s):  
Heidi L. Collins ◽  
Stephen E. DiCarlo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Cervical Vertebra ◽  
Autonomic Dysreflexia ◽  
Thoracic Vertebrae ◽  
Hemodynamic Responses ◽  
Electrical Nerve Stimulation ◽  
Thoracic Level ◽  
Colon Distension ◽  
Life Threatening

Individuals with spinal cord injuries above thoracic level 6 experience episodic bouts of life-threatening hypertension as part of a condition termed autonomic dysreflexia (AD). The hypertension can be caused by stimulation of the skin, distension of the urinary bladder or colon, and/or muscle spasms. Transcutaneous electrical nerve stimulation (TENS) may reduce the severity of AD because TENS has been used to inhibit second-order neurons in the dorsal horn. Therefore, we tested the hypothesis that TENS attenuates the hemodynamic responses to colon distension. Eleven Wistar rats underwent spinal cord transection between thoracic vertebrae 4 and 5 (paraplegic, n = 6) or between cervical vertebra 7 and thoracic vertebra 1 (quadriplegic, n = 5). After recovery, all rats were instrumented with a radiotelemetry device for recording arterial pressure. Subsequently, the hemodynamic responses to graded colon distension were determined before and during TENS. During TENS the hemodynamic responses to colon distension were significantly attenuated. Thus TENS may be a preventive approach to reduce the severity of AD in paraplegic and quadriplegic individuals.

Management of autonomic dysreflexia in the community

2020 ◽  
Vol 25 (10) ◽  
pp. 496-501
Author(s):  
Sara Morgan
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Systolic Blood Pressure ◽  
Emergency Treatment ◽  
Spinal Cord Injuries ◽  
Chronic Phase ◽  
Autonomic Dysreflexia ◽  
Thoracic Vertebrae ◽  
Bowel Management

Autonomic dysreflexia (AD) is an uncontrolled increase in systolic blood pressure (by 20 mmHg or more) that occurs in those with spinal cord injuries at or above the 6th thoracic vertebrae. It usually occurs in the chronic phase of injury, at between 3 and 6 months after the injury is sustained. Most affected patients live in the community with varying levels of independence and will have contact with community nurses due to potential issues with bladder and bowel management. Therefore, community nurses may come into contact with patients in a dysreflexia crisis requiring prompt emergency treatment. Thus, the aim of this paper is to develop community nurses' understanding of AD so they are equipped with the necessary knowledge to help their clients.

Acute exercise reduces the response to colon distension in T5 spinal rats

2002 ◽  
Vol 282 (4) ◽  
pp. H1566-H1570 ◽  
Author(s):  
Heidi L. Collins ◽  
Stephen E. Dicarlo
Keyword(s):  
Spinal Cord ◽  
Adrenergic Receptor ◽  
Therapeutic Approach ◽  
Acute Exercise ◽  
Spinal Cord Injuries ◽  
Pressor Response ◽  
Dynamic Exercise ◽  
Autonomic Dysreflexia ◽  
Single Bout ◽  
Colon Distension

Individuals with spinal cord injuries above thoracic level 6 (T6) experience life-threatening bouts of hypertension, termed autonomic dysreflexia (AD). AD is mediated by peripheral α-adrenergic receptor supersensitivity as well as a reorganization of spinal pathways controlling sympathetic preganglionic neurons. A single bout of dynamic exercise may be a safe therapeutic approach to reduce the severity of AD because mild-to-moderate dynamic exercise reduces postexercise α-adrenergic receptor responsiveness, lowers postexercise sympathetic nerve activity, and reduces the postexercise response to stress. Therefore, this study was designed to test the hypothesis that mild-to-moderate dynamic exercise attenuates the postexercise response to colon distension (mechanism to elicit AD). To test this hypothesis, six male Wistar rats (406 ± 23 g), 5 wk post-T5 spinal cord transection, were instrumented with an arterial catheter. After recovery, the response to graded colon distension (10, 30, 50, and 80 mmHg, in random order) was determined before and after a single bout of mild-to-moderate dynamic exercise (9–12 m/min, 0% grade for 40 min). After exercise, the pressor response to graded colon distension was significantly attenuated (preexercise change: 2 ± 1, 9 ± 1, 14 ± 1, and 24 ± 2 vs. postexercise change: 2 ± 1, 2 ± 1, 9 ± 1, and 12 ± 3 mmHg). Thus acute exercise is a safe, therapeutic approach to reduce the severity of AD in paraplegic subjects.

scholarly journals Targeted ablation of mesenteric projecting sympathetic neurons reduces the hemodynamic response to pain in conscious, spinal cord-transected rats

2010 ◽  
Vol 298 (5) ◽  
pp. R1358-R1365 ◽  
Author(s):  
Heidi L. Lujan ◽  
Gurunanthan Palani ◽  
Jean D. Peduzzi ◽  
Stephen E. DiCarlo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Radio Telemetry ◽  
Pressor Response ◽  
Sympathetic Neurons ◽  
Autonomic Dysreflexia ◽  
Male Rats ◽  
Cholera Toxin B Subunit ◽  
Thoracic Vertebrae ◽  
Sprague Dawley

Individuals with spinal cord injuries above thoracic level 6 (T6) experience episodic bouts of life-threatening hypertension as part of a condition termed autonomic dysreflexia. The paroxysmal hypertension can be caused by a painful stimulus below the level of the injury. Targeted ablation of mesenteric projecting sympathetic neurons may reduce the severity of autonomic dysreflexia by reducing sympathetic activity. Therefore, cholera toxin B subunit (CTB) conjugated to saporin (SAP; a ribosomal inactivating protein that binds to and inactivates ribosomes) was injected into the celiac ganglion to test the hypothesis that targeted ablation of mesenteric projecting sympathetic neurons reduces the pressor response to pain in conscious, spinal cord-transected rats. Nine Sprague-Dawley male rats underwent a spinal cord transection between thoracic vertebrae 4 and 5. Following recovery (5 wk), all rats were instrumented with a radio telemetry device for recording arterial pressure and bilateral catheters in the gluteus maximus muscles for the infusion of hypertonic saline (hNa+Cl−). Subsequently, the hemodynamic responses to intramuscular injection of hNa+Cl− (100 μl and 250 μl, in random order) were determined. Following the experiments in the no celiac ganglia injected condition (NGI), rats received injections of CTB-SAP ( n = 5) or CTB ( n = 3) into the celiac ganglia. CTB-SAP rats, compared with NGI and CTB rats, had reduced pressor responses to hNa+Cl−. Furthermore, the number of stained neurons in the celiac ganglia and spinal cord (segments T6–T12), was reduced in CTB-SAP rats. Thus, CTB-SAP retrogradely transported from the celiac ganglia is effective at ablating mesenteric projecting sympathetic neurons and reducing the pressor response to pain in spinal cord-transected rats.

scholarly journals Komplikasi Autonomic Dysreflexia Pasca Cedera Medula Spinalis

2019 ◽  
Vol 8 (3) ◽  
pp. 207-16
Author(s):  
Dimas Rahmatisa ◽  
Iwan Fuadi ◽  
Sudadi Sudadi
Keyword(s):  
Spinal Cord ◽  
Functional Disability ◽  
Spinal Cord Injuries ◽  
Early Recognition ◽  
The United States ◽  
Recovery Phase ◽  
Autonomic Dysreflexia ◽  
Cord Injury ◽  
Life Threatening ◽  
Care Costs

Cedera medula spinalis merupakan kejadian yang sering dijumpai di Amerika Serikat, dengan biaya perawatan kesehatan seumur hidup yang tinggi berdasarkan tingkat kecacatan fungsional. Permasalahan yang timbul dapat berupa masalah psikologis, fisik, dan sosial, yang dapat menghabiskan biaya yang sangat besar. Tatalaksana kasus cedera medula spinalis terus menjadi tantangan pada tiap fase perawatan, mulai dari awal terjadinya cedera, hingga perawatan dan pemulihan pasca tindakan operasi, karena angka masuk ulang ke rumah sakit pasca perawatan tetap tinggi. Salah satu komplikasi cedera medula spinalis adalah adanya perubahan sistem saraf autonom dapat terjadi akibat kerusakan pada kontrol simpatis sehingga menyebabkan komplikasi yang dikenal sebagai autonomic dysreflexia (AD), yang muncul selama fase pemulihan. Manifestasinya dapat berupa hipertensi berat dengan bradikardia paradoks, kemerahan kulit, dan sakit kepala, penyakit ini dapat menyebabkan kecacatan jangka panjang dan gangguan kardiovaskular. Terapi untuk pasien dengan AD umumnya bertujuan untuk pemulihan gejala dengan cepat hal ini sangat penting karena karena dapat terjadi komplikasi parah yang mengancam jiwa bila gejala yang ada tidak ditangani dengan segera. Pencegahan yang tepat, pengenalan dini, dan manajemen akut adalah faktor penting dalam tatalaksana AD. Autonomic Dyreflexia Complication after Spinal Cord InjuryAbstractSpinal cord injury is a common occurrence in the United States, with high lifetime health care costs based on the level of functional disability. Problems that arise can be psychological, physical, and social problems, which can cost a lot of money. Management of spinal cord injuries continues to be a challenge in each phase of treatment, from the beginning of the injury, to treatment and recovery after surgery, because the rate of re-entry to the post-treatment hospital remains high. One complication of spinal cord injury is the presence of autonomic nervous system changes that can occur due to damage to sympathetic control resulting in complications known as autonomic dysreflexia (AD), which appears during the recovery phase. The manifestation can be life-threatening hypertension with paradoxical bradycardia, flushing, and headache, this disease can cause further long-term disability and cardiovascular disorders. Therapy for patients with AD generally aims to recover symptoms quickly this is very important because because there can be severe life-threatening complications if the symptoms are not treated immediately. Proper prevention, early recognition, and acute management are important factors in the maangement of AD.

scholarly journals Characterization of heart rate changes associated with autonomic dysreflexia during penile vibrostimulation and urodynamics

2021 ◽  
Author(s):  
Lauren Rietchel ◽  
Andrea L. Ramirez ◽  
Shea Hocaloski ◽  
Stacy Elliott ◽  
Matthias Walter ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Spinal Cord Injuries ◽  
Autonomic Dysreflexia ◽  
Cerebrovascular Complications ◽  
Elevated Systolic Blood Pressure ◽  
Cord Injury ◽  
Life Threatening

ABSTRACTPurposeAutonomic dysreflexia, often accompanied by heart rate changes, increases the risk of cardio-cerebrovascular complications in individuals with spinal cord injury. Thus, our aim was to characterize these changes during penile vibrostimulation and urodynamics.Materials and MethodsWe analyzed the cardiovascular (i.e. blood pressure and heart rate) data from two prospective studies, i.e. 21 individuals with chronic spinal cord injuries and history of autonomic dysreflexia, who underwent penile vibrostimulation (n=11, study 1) or urodynamics (n=10, study 2).ResultsThe cohort’s median age was 41 years (range 22 −53). Overall 47 episodes of autonomic dysreflexia were recorded (i.e. penile vibrostimulation n=37, urodynamics n=10), while at least one episode was recorded in each participant. At the threshold of autonomic dysreflexia, bradycardia was observed during penile vibrostimulation and urodynamics in 43% and 30% of all episodes, respectively. At the peak of autonomic dysreflexia during penile vibrostimulation and urodynamics, bradycardia was observed in 65% and 50%, respectively. In contrast, tachycardia was detected only once during urodynamics.ConclusionOur findings reveal that heart rate changes associated with autonomic dysreflexia during penile vibrostimulation and urodynamics appear to be related to the magnitude of systolic blood pressure increases. Thus, highly elevated systolic blood pressure associated with bradycardia suggest the presence of severe autonomic dysreflexia, which can lead to devastating cerebro-cardiovascular consequences. Therefore, we recommend cardiovascular monitoring during penile vibrostimulation and urodynamics to detect autonomic dysreflexia and stop assessments before systolic blood pressure is dangerously increasing, thereby reducing the risk of potentially life-threatening complications in this cohort.

Prevalence and Etiology of Autonomic Dysreflexia in Chiloren with Spinal Cord Injuries

2004 ◽  
Vol 27 (sup1) ◽  
pp. S54-S60 ◽  
Author(s):  
Kathryn J. Hiekey ◽  
Lawrenee C. Vogel ◽  
Kathleen M. Willis ◽  
Caroline J. Anderson
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Autonomic Dysreflexia

scholarly journals Most common arrhytmias in patients with spinal cord injury

2021 ◽  
Author(s):  
Gabriel Andreata Brandão ◽  
Vinícius Andreata Brandão ◽  
Lucas Dalvi Armond Rezende ◽  
Kelly Eduarda de Jesus Silva ◽  
Bruno Henrique Fiorin
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Sinus Node ◽  
Clinical Manifestations ◽  
Autonomic Dysreflexia ◽  
Cardiac Conduction ◽  
Conduction Disorders ◽  
Cord Injury ◽  
Touch Sensitivity

Introduction: The spinal cord injury is a public heatlh problem, and it can have three different origens: traumatic, compressive and congenital. The consequences are partial or total insufficiency of the spinal cord due to the interruption of motor and sensory nervous tracts. This injury results in clinical manifestations such as: autonomic dysreflexia, conduction disorders and loss of pain and touch sensitivity. Objectives: To describe the main cardiac conduction disorders on patients with spinal cord injury trough the guiding question: “What are the most common arrhytmic disorders in patients with spinal cord injury?” Methods: A integrative review was made in the MEDLINE and LILACS databases combining the MeSH descriptors: ‘Arrhytmias, cardiac” and “Spinal cord injuries”. Furthermore, the inclusion criteria was articles produced in the past ten years that answer the guiding question. Results: After na analysis, 6 out of 15 articles were selected to compound this review. The main disorders founded were tachycardia, sinus node dysfunction, atrial and ventricular fibrillation and bradychardia, the most founded disorder. There was also descripted the possibility for these patients to envolve into a distributive choque. Conclusion: Bradycardia was the main arrhythmic impairment found in patients with spinal cord injury, followed by ventricular and atrial fibrillation and tachycardia, with the severity of bradyarrhythmias being associated with the level and severity of the spinal cord injury

scholarly journals Successful non-surgical management of pleuroparenchymal fistula following cervical intraspinal empyema

2018 ◽  
Vol 88 (1) ◽  
Author(s):  
Christopher Ull ◽  
Mirko Aach ◽  
Josef Reichert ◽  
Thomas Armin Schildhauer ◽  
Justyna Swol
Keyword(s):  
Spinal Cord ◽  
Surgical Management ◽  
Spinal Cord Injuries ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Pulmonary Infections ◽  
Talc Pleurodesis ◽  
Lumen Tube ◽  
Cord Injury ◽  
Life Threatening

Pulmonary infections are life-threatening complications in patients with spinal cord injuries. In particular, paraplegic patients are at risk if they are ventilator-dependent. This case history refers to a spinal cord injury with a complete sensorimotor tetraplegia below C2 caused by a septic scattering of an intraspinal empyema at C2-C5 and T3-T4. A right-sided purulent pneumonia led to a complex lung infection with the formation of a pleuroparenchymal fistula. The manuscript describes successful, considerate, non-surgical management with shortterm separate lung ventilation. Treatment aimed to achieve the best possible result without additional harm. A variety of surgical and conservative strategies for the treatment of pleuroparenchymal fistula (PPF) have been described with different degrees of success. We detail the non-surgical management of a persistent PPF with temporary separate lung ventilation (SLV) via a double-lumen tube (DLT) in combination with talc pleurodesis as an approach in patients who are unable to undergo surgical treatment.

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