Cardiovascular Autonomic Control After Spinal Cord Injury
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| Author | : Vera-Ellen Lucci |
| Publisher | : |
| Total Pages | : 193 |
| Release | : 2020 |
| Genre | : |
| ISBN | : |
Over 86,000 Canadians live with the consequences of a spinal cord injury (SCI). Injury to spinal autonomic pathways can lead to profound cardiovascular autonomic dysfunction. Key areas of concern identified by individuals living with SCI relate to continence and cardiovascular dysfunction. Conditions that result from autonomic dysfunction, such as autonomic dysreflexia (sudden extreme hypertension) are of particular concern. This thesis examined the cardiovascular autonomic consequences of SCI and their relationship to bowel care, the most potent stimulus for dysreflexia, and a key factor that negatively impacts quality of life after SCI. To assess cardiovascular autonomic control, first a quantitative marker of autonomic dysfunction following SCI had to be identified. In Aim 1 (Chapter 3), cardiovascular dysfunction during, and beyond, the first year of injury (n=63) was assessed using a novel quantitative non-invasive marker of cardiovascular autonomic control. From here, a randomized double-blind placebo-controlled crossover clinical trial to determine the effect of topical afferent blockade (lidocaine) on dysreflexia severity during bowel care was conducted (n=13). Aim 2 (Chapter 4) provides evidence that, contrary to current clinical guidelines, topical lidocaine prolongs bowel care, worsens dysreflexia, and increases cardiovascular symptoms. Despite bowel care concerns, past research shows that individuals do not change bowel care practices, highlighting knowledge translation gaps concerning evidence-based bowel management strategies. To address this, in Aim 3 (Chapter 5), semi-structured interviews (n=13) were used to examine the barriers and facilitators to changing bowel care. The largest influences on changing bowel care and potentially relevant intervention options were identified. Finally, during dysreflexia profound sympathetic stimulation may increase risk for cardiac arrhythmia. Aim 4 (Chapter 6) evaluated susceptibility to arrhythmia in a rodent-model of SCI, the impact of the sympathomimetic drug dobutamine on arrhythmia risk, and the potential mitigating effect of exercise training. SCI increased susceptibility to cardiac arrhythmia, with dobutamine further increasing susceptibility in high-level SCI. Exercise training ameliorated markers of arrhythmia risk during dobutamine. The research conducted in this thesis uses a translational and patient-orientated approach to bridge the gap between physiological understanding and meaningful improvement in the clinical setting for individuals living with cardiovascular and continence implications of SCI.
| Author | : Lynne C. Weaver |
| Publisher | : Elsevier |
| Total Pages | : 472 |
| Release | : 2005-10-11 |
| Genre | : Medical |
| ISBN | : 0080460100 |
Autonomic dysfunction is a major and poorly understood consequence of spinal cord injury. It is a cause of very serious disability and requires much more research. It should be a focus of treatment strategies. This book will be of interest to anyone involved in research and treatment of spinal cord injury since it helps to explain the tremendously negative impact on the body caused by cord injury that is not as obvious as paralysis and loss of sensation. It contains a compilation of what is known about bladder, cardiovascular, bowel and sexual dysfunction after spinal cord injury, as it relates to the changes within the autonomic nervous system control of these functions. The book begins with a description of the time course of autonomic dysfunctions and their ramifications from the first hours after a spinal cord injury to the more stable chronic states. The next section contains three chapters that address anatomical findings that may provide some of the foundation for autonomic dysfunctions in many of the systems. The system-specific chapters then follow in four sections. Each section begins with a chapter or two defining the clinical problems experienced by people with cord injury. The following chapters present research, basic and clinical, that address the autonomic dysfunctions.
| Author | : J. Andrew Taylor |
| Publisher | : Springer |
| Total Pages | : 286 |
| Release | : 2016-12-20 |
| Genre | : Medical |
| ISBN | : 1493966642 |
Every year, around the world, between 250,000 and 500,000 people suffer a spinal cord injury (SCI). Those with an SCI are two to five times more likely to die prematurely than people without a spinal cord injury, with worse survival rates in low- and middle-income countries. Dynamic aerobic requires integrated physiologic responses across the musculoskeletal, cardiovascular, autonomic, pulmonary, thermoregulatory, and immunologic systems. Moreover, regular aerobic exercise beneficially impacts these same systems, reducing the risk for a range of diseases and maladies. This book will present comprehensive information on the unique physiologic effects of SCI and the potential role of exercise in treating and mitigating these effects. In addition, it will incorporate work from scientists across a number of disciplines and have contributors at multiple levels of investigation and across physiologic systems. Furthermore, SCI can be considered an accelerated form of aging due to the severely restricted physical inactivity imposed, usually at an early age. Therefore, the information presented may have a broader importance to the physiology of aging as it relates to inactivity. Lastly, the need for certain levels of regular aerobic exercise to engender adaptations beneficial to health is not altered by the burden of an SCI. Indeed, the amounts of exercise necessary may be even greater than the able-bodied due to ‘passive’ ambulation. This book will also address the potential health benefits for those with an SCI that can be realized if a sufficient exercise stimulus is provided.
| Author | : |
| Publisher | : |
| Total Pages | : |
| Release | : 2004 |
| Genre | : |
| ISBN | : |
Spinal cord injury (SCI) has the potential to disrupt autonomic pathways in the spinal cord leading to a range of autonomic dysfunctions. The cardiovascular (CV) and metabolic sequelae can restrict the lives of individuals with SCI and contribute to the deterioration of their cardiometabolic health. Here I investigated the whole-body CV and metabolic ramifications of experimental SCI in rats. Complete thoracic SCI was performed at two different levels in order to determine whether these outcomes demonstrated a level dependence. High-(T3) and low-(T10) thoracic SCI both result in flaccid hindlimb paralysis, but have different effects on the level of supraspinal autonomic control. CV and metabolic function were assessed at several times post-injury to investigate changes over time. Animals with acute high-thoracic SCI displayed resting hypotension that resolved with time post-injury. However, their capacity to control blood pressure (BP) in response to physiological stimuli remained deficient; animals with high-thoracic SCI displayed pronounced orthostatic hypotension (OH) and severe episodes of sensory stimulation-induced hypertension known as autonomic dysreflexia (AD). The resting BP and heart rate of animals with low-thoracic SCI, and their ability to respond to orthostatic stress, was indistinguishable from sham controls. Lipid metabolism was also disordered by SCI in a level-dependent pattern. Animals with high-thoracic SCI carried increased white adipose tissue and had higher circulating triacylglycerol levels compared to animals with low-thoracic SCI and sham controls. However, there was no difference in the distribution of cholesterol-carrying lipoproteins. Carbohydrate metabolism in animals with SCI did not support the diabetic profile suggested by the lipid results. Overall, animals with SCI were more sensitive to glucose and insulin than sham-injured animals. The pronounced ketone response to fasting in animals with high-thoracic SCI suggests that there ar.
| Author | : Henrike Joanna Cornelie Ravensbergen |
| Publisher | : |
| Total Pages | : 0 |
| Release | : 2013 |
| Genre | : Autonomic nervous system |
| ISBN | : |
Cardiovascular disease (CVD) is the leading cause for mortality and morbidity after spinal cord injury (SCI) with an earlier onset and more rapid progression compared to the general population. Lifestyle changes after injury have been suggested to be the main contributor to CVD risk, but I proposed that the issue is more complicated. Although less well-known, autonomic function is affected by SCI, in addition to motor and sensory dysfunction. Cardiovascular autonomic dysfunction is a particular concern in individuals with high lesions (above T5) due to the possible disruption of descending spinal sympathetic pathways to the heart and main vascular resistance bed. In this thesis, I propose that cardiovascular autonomic impairment plays a role in the elevated CVD risk. The thesis starts with an evaluation of the prevalence and progression of cardiovascular dysfunction after SCI. Then, the contribution of autonomic dysfunction on CVD risk is investigated. In addition, markers for obesity-related CVD risk specific to individuals with SCI and ECG markers for cardiac arrhythmias in relation to autonomic impairments are explored. Prevalence of cardiovascular dysfunction was found not to improve over time after injury and it was highest in those with lesions above T5. The second study showed that autonomic dysfunction contributes to overall CVD risk and specifically to glucose intolerance, either directly or through an interaction with physical activity levels. The data showed that waist circumference is the best marker for obesity considering ability to detect adiposity and CVD risk, and practicality of use. A specific cut-off for waist circumference was found to be lower compared to the general recommendations. The final study showed increased values for the ECG markers Tpeak-Tend variability, P-wave variability and QTVI, only in those with impairments to descending cardiac sympathetic pathways. The ECG characteristics may be indicative of susceptibility to cardiac arrhythmia related to autonomic dysfunction. Implications of these findings are that management of cardiovascular autonomic dysfunction should remain a priority into the chronic phase of injury, not merely due the direct impact on quality of life, but also due to its contribution to the elevated cardiovascular disease risk after SCI.
| Author | : C. J. Mathias |
| Publisher | : Oxford University Press, USA |
| Total Pages | : 562 |
| Release | : 1999 |
| Genre | : Medical |
| ISBN | : 9780192628510 |
This fourth edition of Autonomic Failure (now available in paperback) covers the many recent advances made in our understanding of the autonomic nervous system. There are 20 new chapters and extensive revisions of all other contributions. Autonomic failure, fourth edition makes diagnosis increasingly precise by fully evaluating the underlying anatomical and functional deficits, thereby allowing more effective treatment. This new edition continues to provide practitioners from a variety of fields, including neurology, cardiology, geriatric medicine, diabetology, and internal medicine, with a rational guide to aid in the recognition and management of autonomic disorders. The book starts with an updated classification of autonomic disorders and a history of the autonomic nervous system. The first two sections of the book deal with the fundamental aspects of autonomic structure, function, and integration. There are new chapters dealing with neurobiology, nerve growth factors, genetic mutations, neural and hormonal control of the cerebral circulation, innervation of the lung, and pathophysiological mechanisms causing nausea and vomiting. Advances in the clinical management of autonomic disorders are critically dependent on the bridge made between the basic and applied sciences.
| Author | : Kathleen C. Kobashi |
| Publisher | : Springer Nature |
| Total Pages | : 275 |
| Release | : 2021-04-13 |
| Genre | : Medical |
| ISBN | : 3030548392 |
This book is designed as a guide for management of advanced clinical scenarios encountered by the contemporary pelvic floor surgeon. It is organized by pelvic floor disorder (PFD) and covers the evaluation and treatment of urinary incontinence, fecal incontinence, and pelvic organ prolapse. Opening chapters in each section cover the fundamentals of proper and comprehensive assessment of patient PFDs, as well as the treatment options that are available for each disorder. The book then focuses on more complex and challenging situations that are becoming more frequently encountered as the number of patients being treated for PFD increases and the length of patient follow-up grows. Each chapter finally includes an expert commentary to address these new scenarios and offers a shifted approach from that required for treatment-naïve patients. Female Pelvic Medicine: Challenging Cases with Expert Commentary teaches the reader how to approach the most difficult of clinical situations in a multidisciplinary fashion.
| Author | : Krishnan Padmakumari Sivaraman Nair |
| Publisher | : Cambridge University Press |
| Total Pages | : 255 |
| Release | : 2018-10-11 |
| Genre | : Medical |
| ISBN | : 110718469X |
This practical handbook for clinicians covers pharmacological and non-pharmacological treatment options in neurological rehabilitation.
| Author | : Susan J. Harkema |
| Publisher | : |
| Total Pages | : 200 |
| Release | : 2011 |
| Genre | : Medical |
| ISBN | : 0195342089 |
Physical rehabilitation for walking recovery after spinal cord injury is undergoing a paradigm shift. Therapy historically has focused on compensation for sensorimotor deficits after SCI using wheelchairs and bracing to achieve mobility. With locomotor training, the aim is to promote recovery via activation of the neuromuscular system below the level of the lesion. What basic scientists have shown us as the potential of the nervous system for plasticity, to learn, even after injury is being translated into a rehabilitation strategy by taking advantage of the intrinsic biology of the central nervous system. While spinal cord injury from basic and clinical perspectives was the gateway for developing locomotor training, its application has been extended to other populations with neurologic dysfunction resulting in loss of walking or walking disability.
| Author | : Denise I. Campagnolo |
| Publisher | : Lippincott Williams & Wilkins |
| Total Pages | : 1899 |
| Release | : 2011-12-07 |
| Genre | : Medical |
| ISBN | : 1451154275 |
This comprehensive and practical reference is the perfect resource for the medical specialist treating persons with spinal cord injuries. The book provides detail about all aspects of spinal cord injury and disease. The initial seven chapters present the history, anatomy, imaging, epidemiology, and general acute management of spinal cord injury. The next eleven chapters deal with medical aspects of spinal cord damage, such as pulmonary management and the neurogenic bladder. Chapters on rehabilitation are followed by nine chapters dealing with diseases that cause non-traumatic spinal cord injury. A comprehensive imaging chapter is included with 30 figures which provide the reader with an excellent resource to understand the complex issues of imaging the spine and spinal cord.
