Cardiovascular Function in Individuals with Incomplete Spinal Cord Injury: A Systematic Review

West, Christopher R.; Bellantoni, Austin; Krassioukov, Andrei V.

doi:10.1310/sci1904-267

Cited by 62 publications

(48 citation statements)

References 31 publications

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“…A review assessing the cardiovascular function in SCI patients concludes that there is no consensus whether cardiovascular function differs between complete and incomplete SCI. 9 Our results suggest a rise in the activity in the low frequencies throughout the observation period. The rise in SDANN could be interpreted as a rise in the sympathetic influence on the heart.…”

Section: Time Domain Analysismentioning

confidence: 50%

Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses

et al. 2014

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Objectives: Spinal cord injury (SCI) often results in severe dysfunction of the autonomic nervous system. C1-C8 SCI affects the supraspinal control to the heart, T1-T5 SCI affects the spinal sympathetic outflow to the heart, and T6-T12 SCI leaves sympathetic control to the heart intact. Heart rate variability (HRV) analysis can serve as a surrogate measure of autonomic regulation. The aim of this study was to investigate changes in HRV patterns and alterations in patients with acute traumatic SCI. Methods: As soon as possible after SCI patients who met the inclusion criteria had 24 h Holter monitoring of their cardiac rhythm, additional Holter monitoring were performed 1, 2, 3 and 4 weeks after SCI. Results: Fifty SCI patients were included. A significant increase in standard deviation of the average normal-to-normal (SDANN) sinus intervals was seen in the first month after injury (P = 0.008). The increase was only significant in C1-T5 incomplete patients and in patients who did not experience one or more episodes of cardiac arrest. Significant lower values of Low Frequency Power, Total Power and the Low Frequency over High Frequency ratio were seen in the C1-T5 SCI patients compared with T6-T12 SCI patients. Conclusions: The rise in SDANN in the incomplete C1-T5 patients could be due to spontaneous functional recovery caused by synaptic plasticity or remodelling of damaged axons. That the autonomic nervous system function differs between C1-C8, T1-T5 and T6-T12 patients suggest that the sympathovagal balance in both the C1-C8 and T1-T5 SCI patients has yet to be reached. INTRODUCTIONSpinal cord injury (SCI) patients with tetraplegia and high level paraplegia are known to suffer from dysfunction of the autonomic nervous system (ANS) including the autonomic regulation of the heart. 1 The severity and the neurological level of the SCI have major impact on ANS function. 2 Patients with SCI above T1 often have intact efferent vagal and sympathetic neural pathways innervating the heart. However, they are deprived of the supraspinal control causing reduced sympathetic activity below the level of SCI. Furthermore, the loss of supraspinal control causes morphological changes in sympathetic preganglionic neurons and peripheral alpha-adrenoceptor hyperresponsiveness. 1 Patients with T1-T5 SCI lose cardiac sympathetic preganglionic neurons as the injury occurs corresponding to the sympathetic outflow to the heart, and likewise the postganglionic sympathetic innervation to the heart undergoes plastic changes. 3 Individuals with SCI at T6 and below have intact cardiac spinal sympathetic neurons and intact innervation of the heart.In tetraplegic individuals with complete lesions, the disconnection of the spinal sympathetic neurons from cerebral control represents a unique possibility for analysis of the sympathetic influence on the heart rate (HR) variability (HRV).

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Section: Time Domain Analysismentioning

confidence: 50%

Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses

et al. 2014

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“…Depending on the level and severity of injury, cardiorespiratory function may also be impaired due to disruption of the autonomic nervous system and weakness and stiffness of the muscles involved in ventilation. [9][10][11][12] For persons with lower limb paralysis, standing and walking capacity are also limited. As a result, a cascade of secondary health complications often accompanies SCI including decreased bone mineral density, 13 increased adiposity, metabolic function, 16 and accelerated physical deconditioning.…”

mentioning

confidence: 99%

Acute Cardiorespiratory and Metabolic Responses During Exoskeleton-Assisted Walking Overground Among Persons with Chronic Spinal Cord Injury

Evans

Hartigan

Kandilakis

et al. 2015

Topics in Spinal Cord Injury Rehabilitation

114

136

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Background: Lower extremity robotic exoskeleton technology is being developed with the promise of affording people with spinal cord injury (SCI) the opportunity to stand and walk. The mobility benefits of exoskeleton-assisted walking can be realized immediately, however the cardiorespiratory and metabolic benefits of this technology have not been thoroughly investigated. Objective: The purpose of this pilot study was to evaluate the acute cardiorespiratory and metabolic responses associated with exoskeleton-assisted walking overground and to determine the degree to which these responses change at differing walking speeds. Methods: Five subjects (4 male, 1 female) with chronic SCI (AIS A) volunteered for the study. Expired gases were collected during maximal graded exercise testing and two, 6-minute bouts of exoskeleton-assisted walking overground. Outcome measures included peak oxygen consumption (V . O 2peak ), average oxygen consumption (V . O 2avg ), peak heart rate (HR peak ), walking economy, metabolic equivalent of tasks for SCI (METs sci ), walk speed, and walk distance. Results: Significant differences were observed between walk-1 and walk-2 for walk speed, total walk distance, V . O 2avg , and METs sci . Exoskeleton-assisted walking resulted in %V . O 2peak range of 51.5% to 63.2%. The metabolic cost of exoskeleton-assisted walking ranged from 3.5 to 4.3 METs sci . Conclusion: Persons with motor-complete SCI may be limited in their capacity to perform physical exercise to the extent needed to improve health and fitness. Based on preliminary data, cardiorespiratory and metabolic demands of exoskeleton-assisted walking are consistent with activities performed at a moderate intensity.

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“…Thus, the findings of this study are in line with other studies proposing the need to focus on a specific ANS examination and its incorporation into clinical practice. 33,36 Exercise modifications for people with cervical SCI should focus on blood flow facilitation principles, which have a potential to increase and maintain higher exercise intensities that are associated with health-related adaptations.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular response to peak voluntary exercise in males with cervical spinal cord injury

Machač

Radvanský

Kolář

et al. 2015

The Journal of Spinal Cord Medicine

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Context/Objective: Traumatic damage to the cervical spinal cord is usually associated with a disruption of the autonomic nervous system (ANS) and impaired cardiovascular control both during and following exercise. The magnitude of the cardiovascular dysfunction remains unclear. The aim of the current study was to compare cardiovascular responses to peak voluntary exercise in individuals with tetraplegia and able-bodied participants. Design: A case-control study. Subjects: Twenty males with cervical spinal cord injury (SCI) as the Tetra group and 27 able-bodied males as the Control group were included in the study. Outcome Measures: Blood pressure (BP) response one minute after the peak exercise, peak heart rate (HR peak ), and peak oxygen consumption (VO 2peak ) on an arm crank ergometer were measured. In the second part of the study, 17 individuals of the Control group completed the Tetra group's workload protocol with the same parameters recorded. Results: There was no increase in BP in response to the exercise in the Tetra group. Able-bodied individuals exhibited significantly increased post-exercise systolic BP after the maximal graded exercise test (123±16%) and after completion of the Tetra group's workload protocol (114±11%) as compared to pre-exercise. The Tetra group VO 2peak was 59% and the HR peak was 73% of the Control group VO 2peak and HR peak , respectively. Conclusions: BP did not increase following maximal arm crank exercise in males with a cervical SCI unlike the increases observed in the Control group. Some males in the Tetra group appeared to be at risk of severe hypotension following high intensity exercise, which can limit the ability to progressive increase and maintain high intensity exercise.

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Cardiovascular Function in Individuals with Incomplete Spinal Cord Injury: A Systematic Review

Cited by 62 publications

References 31 publications

Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses

Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses

Acute Cardiorespiratory and Metabolic Responses During Exoskeleton-Assisted Walking Overground Among Persons with Chronic Spinal Cord Injury

Cardiovascular response to peak voluntary exercise in males with cervical spinal cord injury

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