Control of autonomic dysreflexia in patients with high level of chronic spinal cord injury during cystoscopy

Objective: To characterize heart rate (HR) changes during autonomic dysreflexia (AD) in daily life for individuals with chronic spinal cord injury (SCI). Design: Data analysis of two prospective clinical studies and one cross-sectional study. Setting: Single-center study. Participants: Forty-five individuals (including 8 females) with a chronic SCI at or above the sixth thoracic spinal segment with confirmed AD, and a median age and time since injury of 43 years (interquartile range [IQR] 36 - 50) and 17 years (IQR 6 - 23) respectively, were included for analysis. Interventions: Not applicable. Main outcome measure: Any systolic blood pressure (SBP) increase > 20mmHg from baseline from a 24-hour ambulatory surveillance period was identified and categorized as either confirmed (i.e. known AD trigger), unknown (i.e. no diary entry), and unlikely (i.e. potential physical activity driven SBP increase). SBP-associated HR changes were categorized as either unchanged, increased or decreased compared to baseline. Results: A total of 797 episodes of SBP increase above AD threshold were identified and classified as confirmed (n = 250, 31.4%), unknown (n = 472, 59.2%) or unlikely (n = 75, 9.4%). Median SBP changes and median SBP-related HR changes were 37 mmHg and -8 bpm, 28 mmHg and -6 bpm, or 30 mmHg and -4 bpm for confirmed, unknown, or unlikely episodes, respectively. HR-decrease/increase ratio was 3:1 for confirmed and unknown, and 1.5:1 for unlikely episodes. HR changes resulting in brady-/tachycardia were 34.4% / 2.8% for confirmed, 39.6% / 3.4% unknown, and 26.7% / 9.3% for unlikely episodes, respectively. Conclusions: Our findings suggest that the majority of confirmed AD episodes are associated with a HR decrease. Further improvements, such as more precise participant diaries combined with the use of 24-hour Holter electrocardiogram and wearable-sensors-derived measures of physical activity could provide a better, more detailed characterization of HR changes during AD.

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The Influence of Spinal Cord Injury on Breastfeeding Ability and Behavior

Journal of Human Lactation ◽

10.1177/0890334418774014 ◽

2018 ◽

Vol 34 (3) ◽

pp. 556-565 ◽

Cited By ~ 5

Author(s):

Theodor Holmgren ◽

Amanda H. X. Lee ◽

Shea Hocaloski ◽

Lynsey J. Hamilton ◽

Iris Hellsing ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Autonomic Dysreflexia ◽

Breastfeeding Duration ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Low Level ◽

Cord Injury ◽

High Level ◽

And Behavior

Background: Lactation dysfunction following spinal cord injury has been noted in the literature. However, researchers have often grouped together all women of physical disability or do not account for injury level. The extent of lactation dysfunction and influence of spinal cord injury on breastfeeding ability and behavior is not well understood. Research aim: This study aimed to identify major barriers to lactation and breastfeeding related to spinal cord injury, specifically comparing high- and low-level injuries. Methods: A retrospective cross-sectional survey design was used. Two online questionnaires were developed and completed by women ( N = 52) who chose to breastfeed with spinal cord injury, primarily in Canada and Sweden. Results: The first questionnaire was completed by 52 women with spinal cord injury; 38 of the original 52 participants completed the second questionnaire. Of the 52 women, 28 (53.8%) had high-level spinal cord injury (at or above T6) and 24 (46.1%) had low-level injury (below T6). On the second questionnaire, 14 (77.8%) women with high-level injury reported insufficient milk production or ejection. Only 35% of women ( n = 7) with low-level injury reported the same. Autonomic dysreflexia was experienced by 38.9% of women ( n = 7) with high-level injury. Exclusive breastfeeding duration was significantly shorter ( p < .05) in the high-level injury group (3.3 months) compared with women with low-level injury (6.5 months). Conclusion: These results further support the notion that spinal cord injury (particularly at or above T6) disrupts lactation and is associated with shorter breastfeeding duration. Autonomic dysreflexia should be addressed in prospective mothers with high-level spinal cord injury.

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