Autonomic dysreflexia （AD） is a serious cardiovascular disorder in patients with spinal cord injury （SCI）. The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons ...Autonomic dysreflexia （AD） is a serious cardiovascular disorder in patients with spinal cord injury （SCI）. The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons （SPNs） caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. In parallel, upregulated peripheral vascular sensitivity following SCI exacerbates the hypertensive response by augmenting gastric and pelvic vasoconstriction. Currently, the majority of clinically employed treatments for AD involve anti-hypertensive medications and Botox injections to the bladder. Although these approaches mitigate the severity of AD, they only yield transient effects and target the effector organs, rather than addressing the primary issue of central sympathetic dysregulation. As such, strategies that aim to restore supraspinal reinnervation of SPNs to improve cardiovascular sympathetic regulation are likely more effective for AD. Recent pre-clinical investigations show that cell transplantation therapy is efficacious in reestablishing spinal sympathetic connections and improving hemodynamic per- formance, which holds promise as a potential therapeutic approach.展开更多
Background: Functional electrically stimulated (FES)-arm ergometry has been shown to increase peak power output and aerobic capacity in individuals with cervical SCI. However, the functional benefits remain unknown. O...Background: Functional electrically stimulated (FES)-arm ergometry has been shown to increase peak power output and aerobic capacity in individuals with cervical SCI. However, the functional benefits remain unknown. Objective: To determine the effects of FES-arm ergometry on exercise performance, upper limb function and resting cardiovascular function in individuals with tetraplegia. Methods: Five individuals (43.8 ± 15.4 years old) with SCI (C3-C5, AIS C-D, 14.0 ± 11.1 years post-injury) completed 12 weeks FES-arm ergometry. Exercise performance (time and distance to fatigue), perceived upper limb function [Capabilities of Upper Extremity Questionnaire (CUE), short form-Quadriplegia Index of Function Questionnaire (sf-QIF) and Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET)] and resting mean arterial pressure (MAP) and heart rate (HR) were measured pre and post. Results: Following training, MAP significantly decreased (91.1 ± 14.0 to 87.7 ± 14.7 mmHg;p = 0.04), and there was a trend for an increased time to fatigue (804.6 ± 359.4 to 1483.8 ± 1110.2 sec;p = 0.08), distance to fatigue (3508.4 ± 3524.5 to 7412.6 ± 7773.1 m, p = 0.08) and the CUE scores pertaining to hand function (31.6 ± 12.8 to 38.0 ± 17.7;p = 0.07). Conclusion: Twelve-week FES-arm ergometry was associated with decreased resting MAP in individuals with tetraplegia, and may show promise as a means to increase exercise performance and hand function. Further research is required to verify these preliminary findings.展开更多
基金supported by NIH NINDS R01NS099076,Morton Cure Paralysis Funds(MCPF)
文摘Autonomic dysreflexia （AD） is a serious cardiovascular disorder in patients with spinal cord injury （SCI）. The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons （SPNs） caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. In parallel, upregulated peripheral vascular sensitivity following SCI exacerbates the hypertensive response by augmenting gastric and pelvic vasoconstriction. Currently, the majority of clinically employed treatments for AD involve anti-hypertensive medications and Botox injections to the bladder. Although these approaches mitigate the severity of AD, they only yield transient effects and target the effector organs, rather than addressing the primary issue of central sympathetic dysregulation. As such, strategies that aim to restore supraspinal reinnervation of SPNs to improve cardiovascular sympathetic regulation are likely more effective for AD. Recent pre-clinical investigations show that cell transplantation therapy is efficacious in reestablishing spinal sympathetic connections and improving hemodynamic per- formance, which holds promise as a potential therapeutic approach.
文摘Background: Functional electrically stimulated (FES)-arm ergometry has been shown to increase peak power output and aerobic capacity in individuals with cervical SCI. However, the functional benefits remain unknown. Objective: To determine the effects of FES-arm ergometry on exercise performance, upper limb function and resting cardiovascular function in individuals with tetraplegia. Methods: Five individuals (43.8 ± 15.4 years old) with SCI (C3-C5, AIS C-D, 14.0 ± 11.1 years post-injury) completed 12 weeks FES-arm ergometry. Exercise performance (time and distance to fatigue), perceived upper limb function [Capabilities of Upper Extremity Questionnaire (CUE), short form-Quadriplegia Index of Function Questionnaire (sf-QIF) and Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET)] and resting mean arterial pressure (MAP) and heart rate (HR) were measured pre and post. Results: Following training, MAP significantly decreased (91.1 ± 14.0 to 87.7 ± 14.7 mmHg;p = 0.04), and there was a trend for an increased time to fatigue (804.6 ± 359.4 to 1483.8 ± 1110.2 sec;p = 0.08), distance to fatigue (3508.4 ± 3524.5 to 7412.6 ± 7773.1 m, p = 0.08) and the CUE scores pertaining to hand function (31.6 ± 12.8 to 38.0 ± 17.7;p = 0.07). Conclusion: Twelve-week FES-arm ergometry was associated with decreased resting MAP in individuals with tetraplegia, and may show promise as a means to increase exercise performance and hand function. Further research is required to verify these preliminary findings.
