Clinical recommendations for use of lidocaine lubricant during bowel care after spinal cord injury prolong care routines and worsen autonomic dysreflexia: results from a randomised clinical trial

Cardiovascular and cerebrovascular responses to urodynamics testing after spinal cord injury: The influence of autonomic injury

“…We have confirmed previous reports that UDS, like other visceral stimuli, is a potent trigger for AD in susceptible individuals with SCI (Giannantoni et al, 1998;Huang et al, 2013;Liu et al, 2013;Lucci et al, 2020). With beat-to-beat monitoring we showed that blood pressure increases with UDS in those with autonomically-complete SCI are profound, with SAP values in excess of 200 mmHg.…”

“…The true magnitude of AD may be underestimated with intermittent cardiovascular monitoring because it may fail to capture sporadic increases in blood pressure. While we examined responses to UDS in the present study, it is likely that other medical and self-care procedures, particularly those associated with visceral stimuli, will also provoke similarly severe responses in susceptible individuals (Claydon et al, 2006;Lucci et al, 2020) and caregiver, healthcare practitioners, and individuals living with SCI should monitor for and treat episodes of AD in these situations.…”

“…SCI is a heterogeneous condition and, despite the risk of AD in high-level SCI, the presence and magnitude of response cannot be anticipated based on the standard clinical quantification of SCI using the American Spinal Injury Association (ASIA) Impairment Scale (AIS), which focuses on motor and sensory deficits and does not include a quantitative assessment of autonomic function (Alexander et al, 2009). Previous work to quantify the progression of autonomic dysfunction following SCI and its effects on cardiovascular control has provided strong rationale for the evaluation of injury to descending spinal autonomic pathways using simple quantitative measures of autonomic function because they are more strongly related to measures of cardiovascular and cerebrovascular function (Claydon and Krassioukov, 2007;Ravensbergen et al, 2012;Sahota et al, 2012;Lucci et al, 2020;Lucci et al, 2021a). More recently, an addition to the AIS, the International Standards to document Autonomic Function following SCI (ISAFSCI) has been developed, but it is not yet known whether this addition correlates well with the severity of cardiovascular or cerebrovascular dysfunction after SCI (Wecht et al, 2021).…”

Barriers and facilitators to changing bowel care practices after spinal cord injury: a Theoretical Domains Framework approach

“…Furthermore, adherence to clinical care guidelines is most beneficial when they reflect current best practices; unfortunately, this is not always the case, as there can be a significant lag between research discovery and adoption into clinical standards. For example, current bowel care guidelines incorporate advice concerning the use of local anaesthetics for the management of cardiovascular complications of bowel care [ 45 ], advice that directly contradicts recent data [ 46 ]. This finding highlights the need for evidence-based bowel management strategies and regular updates to clinical care guidelines.…”

“…Given that bowel care is a key concern for individuals with SCI [ 5 , 7 , 48 ], it is imperative that changes and advances to care are also implemented and assessed in a community setting, shedding light on potential improvements to real-world bowel care after SCI. In addition, guidelines for at-home community neurogenic bowel management are dated and provide conflicting evidence [ 46 , 49 , 50 ]. Together these implementation gaps provide a unique opportunity to address prominent bowel care concerns.…”