Database : MEDLINE
Search on : Autonomic and Dysreflexia [Words]
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[PMID]: 28457670
[Au] Autor:Cruz S; Blauwet CA
[Ad] Address:University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
[Ti] Title:Implications of altered autonomic control on sports performance in athletes with spinal cord injury.
[So] Source:Auton Neurosci;209:100-104, 2018 01.
[Is] ISSN:1872-7484
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:It is well known that athletes with spinal cord injury (SCI) may experience altered autonomic physiology that impacts their exercise capacity and sports performance. This is particularly relevant given the ever-increasing number of individuals with SCI who are actively engaged in sports at all levels, from community-based adaptive sports to elite Paralympic competitions. As such, the purpose of this article is to review the present literature regarding the implications of altered autonomic control on the safety and performance of athletes with SCI. A particular emphasis will be placed on the autonomic aspects of cardiovascular and thermoregulatory control in the athlete population, as well as the implications of autonomic dysreflexia in enhancing sports performance. Further research is needed to understand the autonomic factors that influence athletes with SCI in order to ensure optimal and safe sports competition. Additionally, this information is crucially relevant to the coaches, sports administrators, and team medical staff who work closely with athletes with SCI.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1705
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process

  2 / 872 MEDLINE  
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[PMID]: 29515212
[Au] Autor:Brown JP; Bauman KA; Kurili A; Rodriguez GM; Chiodo AE; Sitrin RG; Schotland HM
[Ad] Address:Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA. jeanette.brown@hsc.utah.edu.
[Ti] Title:Positive airway pressure therapy for sleep-disordered breathing confers short-term benefits to patients with spinal cord injury despite widely ranging patterns of use.
[So] Source:Spinal Cord;, 2018 Mar 07.
[Is] ISSN:1476-5624
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:STUDY DESIGN: Prospective, cohort study. OBJECTIVES: To evaluate the effectiveness of bi-level positive airway pressure (PAP) therapy and the patterns of use for sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI). SETTING: Academic tertiary care center, USA. METHODS: Overall, 91 adults with C1-T6 SCI for ≥3 months were recruited and 74 remained in the study to be evaluated for SDB and follow-up. Individuals with SDB but no nocturnal hypercapnia (NH) were prescribed auto-titrating PAP. Those with NH were prescribed PAP with volume-assured pressure support. Device downloads and overnight transcutaneous capnography were performed at 3, 6, and 12 months to quantify PAP use and effectiveness. Participants kept daily event logs, and quality of life (QOL) questionnaires were performed after 3, 6, and 12 months. RESULTS: Overall, 45% of 91 participants completed the study. There was great diversity among SCI patients in PAP utilization; after 3 months, 37.8% of participants used PAP for ≥70% nights and ≥240 min per night, whereas 42.2% seldom used PAP and 20% used PAP sporadically or for short periods. PAP therapy was effective in improving OSA in 89% and nocturnal hypercapnia in 77%. Higher PAP pressures predicted higher levels of device use. There were marked reductions in symptoms of autonomic dysreflexia (AD) and orthostatic hypotension as well as some improved indices of QOL. CONCLUSIONS: Despite widely diverse patterns of use, PAP therapy may have short-term benefits with regard to QOL and reducing episodes of dizziness and autonomic dysreflexia.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1038/s41393-018-0077-z

  3 / 872 MEDLINE  
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[PMID]: 29485358
[Au] Autor:Strcic N; Markic D
[Ad] Address:a Faculty of Health Studies , University of Rijeka , Rijeka , Croatia.
[Ti] Title:The knowledge about autonomic dysreflexia among nursing and physiotherapy students.
[So] Source:J Spinal Cord Med;:1-10, 2018 Feb 27.
[Is] ISSN:2045-7723
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:CONTEXT/OBJECTIVE: Autonomic dysreflexia is a clinical syndrome affecting persons with spinal cord lesions. The aim of the study was to detect the level of knowledge among students about autonomic dysreflexia in persons with spinal cord lesions. DESIGN: Single centre questionnaire study. SETTING: Faculty of Health Studies, Rijeka, Croatia. PARTICIPANTS: Nursing (n = 43) and physiotherapy (n = 48) students. OUTCOME MEASURES: AD knowledge test. RESULTS: More of the half of the students (57%) had contact with persons with spinal cord lesions during work, especially nursing students. The self-estimated knowledge of autonomic dysreflexia was judged as poor or none in 73.6% of students. On the autonomic dysreflexia knowledge test, nursing students collected mean of 5.6 points and physiotherapy students 4.9 points (P = 0.173). There was no difference in the autonomic dysreflexia test results regardless of work experience or group affiliation. CONCLUSION: The level of knowledge about autonomic dysreflexia among students was low. Our results suggest the need for more education of students and health care professionals to apply adequate treatment to persons with episodes of autonomic dysreflexia.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180227
[Lr] Last revision date:180227
[St] Status:Publisher
[do] DOI:10.1080/10790268.2018.1439432

  4 / 872 MEDLINE  
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[PMID]: 29239268
[Au] Autor:Inskip JA; Lucci VM; McGrath MS; Willms R; Claydon VE
[Ad] Address:1 Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia, Canada .
[Ti] Title:A Community Perspective on Bowel Management and Quality of Life after Spinal Cord Injury: The Influence of Autonomic Dysreflexia.
[So] Source:J Neurotrauma;, 2018 Feb 09.
[Is] ISSN:1557-9042
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Autonomic dysfunction is common in individuals with spinal cord injury (SCI) and leads to numerous abnormalities, including profound cardiovascular and bowel dysfunction. In those with high-level lesions, bowel management is a common trigger for autonomic dysreflexia (AD; hypertension provoked by sensory stimuli below the injury level). Improving bowel care is integral for enhancing quality of life (QoL). We aimed to describe the relationships between bowel care, AD, and QoL in individuals with SCI. We performed an online community survey of individuals with SCI. Those with injury at or above T7 were considered at risk for AD. Responses were received from 287 individuals with SCI (injury levels C1-sacral and average duration of injury 17.1 ± 12.9 [standard deviation] years). Survey completion rate was 73% (n = 210). Bowel management was a problem for 78%: it interfered with personal relationships (60%) and prevented staying (62%) and working (41%) away from home. The normal bowel care duration was >60 min in 24% and most used digital rectal stimulation (59%); 33% reported bowel incontinence at least monthly. Of those at risk for AD (n = 163), 74% had AD symptoms during bowel care; 32% described palpitations. AD interfered with activities of daily living in 51%. Longer durations of bowel care (p < 0.001) and more severe AD (p = 0.04) were associated with lower QoL. Bowel management is a key concern for individuals with SCI and is commonly associated with symptoms of AD. Further studies should explore ways to manage bowel dysfunction, increase self-efficacy, and ameliorate the impact of AD to improve QoL.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180209
[Lr] Last revision date:180209
[St] Status:Publisher
[do] DOI:10.1089/neu.2017.5343

  5 / 872 MEDLINE  
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[PMID]: 29424661
[Au] Autor:Lofters A; Chaudhry M; Slater M; Schuler A; Milligan J; Lee J; Guilcher SJT
[Ad] Address:a Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital , Ontario , Canada.
[Ti] Title:Preventive care among primary care patients living with spinal cord injury.
[So] Source:J Spinal Cord Med;:1-7, 2018 Feb 09.
[Is] ISSN:2045-7723
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVE: Context/Objective: Family physicians may lack the knowledge or resources to adequately support patients with spinal cord injury (SCI). Our objectives were to determine patterns of preventive care for patients with SCI in a primary care setting (i.e. cancer screening, influenza vaccinations, general physicals, bone mineral density tests), and determine physicians' level of comfort with providing primary care to patients with SCI. DESIGN: i) Retrospective chart review, ii) Survey of physicians in the family practice. SETTING: Six primary care practice sites in Ontario, Canada. PARTICIPANTS: All adult rostered patients of the family practice with SCI; All family physicians in the six sites. OUTCOME MEASURES: Proportion of patients up-to-date on cancer screening, proportion of patients with influenza vaccinations, general physicals, bone mineral density tests; physicians' level of comfort with providing care to patients with SCI. RESULTS: Sixty patients were included in analyses. Rates of cancer screening were generally poor. The highest uptake was seen for cervical cancer screening, where 50% of eligible women were up-to-date on Pap tests. Only 36.7% of patients were up-to-date on colorectal cancer screening. Only 14 (23.3%) patients had a documented general physical exam in their electronic record. There was a recorded flu vaccination for 55% of patients, and of those, there was a median of 19 months since last vaccination. Fifteen physicians (21.4%) responded to the survey. Ten physicians reported at least one patient with SCI, with the maximum being 20 patients. Comfort level in managing SCI-relevant conditions varied and was lowest for spasticity, respiratory issues and autonomic dysreflexia, where only 27.3% of respondents had some level of comfort. CONCLUSION: There are many opportunities to improve the preventive care of patients living with SCI.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180209
[Lr] Last revision date:180209
[St] Status:Publisher
[do] DOI:10.1080/10790268.2018.1432308

  6 / 872 MEDLINE  
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[PMID]: 29339896
[Au] Autor:Noller CM; Groah SL; Nash MS
[Ad] Address:The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
[Ti] Title:Inflammatory Stress Effects on Health and Function After Spinal Cord Injury.
[So] Source:Top Spinal Cord Inj Rehabil;23(3):207-217, 2017.
[Is] ISSN:1945-5763
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Injury to the spinal cord produces immediate, adaptive inflammatory responses that can exacerbate the initial injury and lead to secondary damage. Thus far, researchers and clinicians have focused on modulating acute inflammation to preserve sensorimotor function. However, this singular approach risks overlooking how chronic inflammation negatively impacts the broader health of persons with a spinal cord injury (SCI). The aim of this monograph was to discuss interrelated processes causing persistent inflammatory stress after SCI, along with associated health risks. We review archetypal factors that contribute to a chronic inflammatory state, including response to injury, acute infection, and autonomic dysreflexia. Secondary complications producing and exacerbating inflammation are also discussed, including pain, depression, obesity, and injury to the integumentary and skeletal systems. Finally, we discuss the role of bacteria and the gut microbiome in this process and then conclude with a discussion on how a pro-inflammatory phenotype promotes an elevated risk for cardiovascular disease after injury. Effectively managing chronic inflammation should be a high priority for clinicians and researchers who seek to improve the health and life quality of persons with SCI. Chronic inflammation worsens secondary medical complications and amplifies the risk for cardiometabolic disorders after injury, directly impacting both the quality of life and mortality risk after SCI. Inflammation can worsen pain and depression and even hinder neurological recovery. It is, therefore, imperative that countermeasures to chronic inflammation are routinely considered from the point of initial injury and proceeding throughout the lifespan of the individual with SCI.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180119
[Lr] Last revision date:180119
[St] Status:In-Process
[do] DOI:10.1310/sci2303-207

  7 / 872 MEDLINE  
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[PMID]: 29339878
[Au] Autor:Alexander M; Courtois F; Elliott S; Tepper M
[Ad] Address:Department of Rehabilitative Medicine, Birmingham VA Medical Center, Birmingham, Alabama.
[Ti] Title:Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom.
[So] Source:Top Spinal Cord Inj Rehabil;23(1):57-70, 2017.
[Is] ISSN:1945-5763
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Sexuality is an important part of life, and it is necessary for clinicians to have a specific format in which to address sexual issues with their patients. A systematic approach to working with patients with spinal cord injury (SCI) to improve their sexual functioning and response is presented. Nonjudgmental communication about sexual concerns is followed by a detailed pre- and postinjury medical, psychosocial, and sexual history. If preexisting sexual issues are present, it is recommended that the patient be referred for assessment and treatment of these separate from the patient's SCI-related concerns. Physical examination, with special attention to issues that could impact the patient's sexuality, is followed by a detailed neurologic assessment with specific attention to the T11-L2 and S3-5 spinal segments. Education of the patient with regard to his or her sexual potential and the need to be flexible in his or her sexual repertoire is followed by self-exploration and practice. Routine follow-up is suggested after patient's initial sexual exploration. Treatment of confounding and iatrogenic factors related to SCI is followed by more sexual experience. Afterwards the clinician is encouraged to use simple techniques to treat sexual issues and follow-up with the patient to assess the outcome. A structured program utilizing vibratory stimulation with or without midodrine is described as a way to achieve ejaculation and potentially orgasm, and techniques for treating severe autonomic dysreflexia are discussed. If these interventions do not alleviate the patient's sexual concerns, the clinician should refer the patient for more specialized consultation.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180119
[Lr] Last revision date:180119
[St] Status:In-Process
[do] DOI:10.1310/sci2301-57

  8 / 872 MEDLINE  
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[PMID]: 29339874
[Au] Autor:Courtois F; Alexander M; McLain ABJ
[Ad] Address:Departement of Sexology, Université du Québec à Montréal, Montreal, Canada.
[Ti] Title:Women's Sexual Health and Reproductive Function After SCI.
[So] Source:Top Spinal Cord Inj Rehabil;23(1):20-30, 2017.
[Is] ISSN:1945-5763
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Sexual function and to a lesser extent reproduction are often disrupted in women with spinal cord injuries (SCI), who must be educated to better understand their sexual and reproductive health. Women with SCI are sexually active; they can use psychogenic or reflexogenic stimulation to obtain sexual pleasure and orgasm. Treatment should consider a holistic approach using autonomic standards to describe remaining sexual function and to assess both genital function and psychosocial factors. Assessment of genital function should include thoracolumbar dermatomes, vulvar sensitivity (touch, pressure, vibration), and sacral reflexes. Self-exploration should include not only clitoral stimulation, but also stimulation of the vagina (G spot), cervix, and nipples conveyed by different innervation sources. Treatments may consider PDE5 inhibitors and flibanserin on an individual basis, and secondary consequences of SCI should address concerns with spasticity, pain, incontinence, and side effects of medications. Psychosocial issues must be addressed as possible contributors to sexual dysfunctions (eg, lower self-esteem, past sexual history, depression, dating habits). Pregnancy is possible for women with SCI; younger age at the time of injury and at the time of pregnancy being significant predictors of successful pregnancy, along with marital status, motor score, mobility, and occupational scores. Pregnancy may decrease the level of functioning (eg, self-care, ambulation, upper-extremity tasks), may involve complications (eg, decubitus ulcers, weight gain, urological complications), and must be monitored for postural hypotension and autonomic dysreflexia. Taking into consideration the physical and psychosocial determinants of sexuality and childbearing allows women with SCI to achieve positive sexual and reproductive health.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180119
[Lr] Last revision date:180119
[St] Status:In-Process
[do] DOI:10.1310/sci2301-20

  9 / 872 MEDLINE  
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[PMID]: 29339873
[Au] Autor:Davidson R; Phillips A
[Ad] Address:International Collaboration On Repair Discoveries, Vancouver, BC, Canada.
[Ti] Title:Cardiovascular Physiology and Responses to Sexual Activity in Individuals Living with Spinal Cord Injury.
[So] Source:Top Spinal Cord Inj Rehabil;23(1):11-19, 2017.
[Is] ISSN:1945-5763
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Spinal cord injury (SCI) may profoundly impact autonomic function producing a variable degree of dysfunction in cardiovascular, bronchopulmonary, sweating, bladder, bowel, and sexual function. The cardiovascular system is crucially important for sexual function, as it is responsible for blood flow shifts to cavernous and musculoskeletal tissue during sexual activity. This system is prone to 3 main abnormalities after SCI including low resting blood pressure (LRBP), orthostatic hypotension (OH), and autonomic dysreflexia (AD), all of which have important effects on sexual function. We review the current etiological mechanisms and manifestations of cardiovascular dysfunction after SCI and discuss how this is documented to impact sexual function in individuals living with SCI. All individuals with SCI at or above the T6 neurologic level have an increased risk of AD during sexual stimulation, with increasing risk associated with higher levels of injury and greater completeness of injury. AD can be silent, and individuals living with SCI should be aware of blood pressure values at baseline and during sexual activity. Clinicians performing vibrostimulation fertility procedures need to be aware of the risk of AD and consider pretreatment if needed. Researchers studying the cardiovascular response to sexual stimulation should consider continuous monitoring of blood pressure, as intermittent monitoring may underestimate true blood pressure values.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180119
[Lr] Last revision date:180119
[St] Status:In-Process
[do] DOI:10.1310/sci2301-11

  10 / 872 MEDLINE  
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[PMID]: 29252405
[Au] Autor:Yoon JA; Shin YB; Shin MJ; Kang MS; Ko HY
[Ad] Address:From the Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea (JAY, YBS, MJS); and Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea (MSK, H-YK).
[Ti] Title:Cardiovascular Monitoring During Video Urodynamic Studies in Persons With Spinal Cord Injury.
[So] Source:Am J Phys Med Rehabil;97(1):1-6, 2018 Jan.
[Is] ISSN:1537-7385
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: The aims of the study were to observe cardiovascular responses during video urodynamic studies and to identify correlations between autonomic dysreflexia events and video urodynamic study findings in spinal cord injuries. DESIGN: Thirty-four persons with spinal cord injury were enrolled and investigated using continuous cardiovascular monitoring during video urodynamic studies. Associations between cardiovascular responses and video study variables were analyzed. RESULTS: Bladder type-specific cardiovascular responses occurred during the study. The incidence of overactive detrusor during urodynamic study and bladder trabeculation on voiding cystourethrogram was significantly higher in autonomic dysreflexia persons with spinal cord injury (P < 0.05). Systolic blood pressure changes showed moderate negative correlation (r = -0.402, P = 0.020) with bladder compliance and high positive correlation (r = 0.810, P = 0.000) with maximum detrusor pressure. However, no significant differences in neurological level of injury, injury completeness, autonomic dysreflexia symptoms, and voiding type were found. Spinal cord injury increase at each section was significantly higher in overactive detrusor group (P < 0.05). Significant bradycardia or tachycardia correlating with autonomic dysreflexia during urodynamic studies was not observed. CONCLUSIONS: Unpredictable cardiovascular reactions during urodynamic study should be considered carefully in persons with a spinal cord injury above T6. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe limitations of previous cardiovascular monitoring during urodynamic study to observe changes in cardiovascular responses; (2) Identify factors contributing to autonomic dysreflexia during urodynamic testing; and (3) Discuss the effect of morphologic features in voiding cystourethrogram including trabeculation and vesicourethral reflux on autonomic dysreflexia. LEVEL: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
[Mh] MeSH terms primary: Autonomic Dysreflexia/physiopathology
Urinary Bladder Diseases/etiology
Urodynamics
Video Recording
[Mh] MeSH terms secundary: Cardiovascular System
Humans
Spinal Cord Injuries/physiopathology
Urinary Bladder Diseases/physiopathology
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 171227
[Lr] Last revision date:171227
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:171219
[St] Status:MEDLINE
[do] DOI:10.1097/PHM.0000000000000839


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