Solinsky Ryan, Burns Kathryn, Hamner Jason W, Singer Wolfgang, Taylor J Andrew
medRxiv. 2024 Jun 1:2024.05.31.24308290. doi: 10.1101/2024.05.31.24308290.
Autonomic dysfunction is common after spinal cord injury, though differing from motor and sensory function, there are currently no established batteries of tests to comprehensively characterize these deficits. Further, while individual established autonomic tests have a long history and sound scientific background, translating these autonomic testing results to inform clinical understanding is a major barrier. Herein, we outline a battery of six laboratory autonomic tests which were carefully curated to collectively describe the ability of individuals with spinal cord injury to inhibit and recruit sympathetic activity through the injured spinal cord. Presenting normative control data in 23 uninjured individuals completing this testing battery, we further demonstrate the utility of extracting three key testing metrics for each test, comparing these control results to 11 individuals with spinal cord injury. Results demonstrate strong normality of data with testing psychometrics suggesting reliable reproducibility on repeat testing. Further, even in this preliminary sample of individuals with spinal cord injuries, clear differences begin to emerge. This illustrates the ability of this collective testing battery to characterize autonomic regulation after spinal cord injury. To aid in clinical translation, we further present a graphical representation, an , which serves as a snapshot of how normal or abnormal sympathetic inhibition and recruitment of activation may be after spinal cord injury. Utilizing these , three example cases of individuals with spinal cord injury highlight evidence of varied degrees of autonomically complete spinal cord injury. Together, this represents a key advancement in our understanding of autonomic function after spinal cord injury.
自主神经功能障碍在脊髓损伤后很常见,尽管与运动和感觉功能不同,但目前尚无成熟的测试组合来全面描述这些缺陷。此外,虽然个别既定的自主神经测试历史悠久且有坚实的科学背景,但将这些自主神经测试结果转化为临床理解是一个主要障碍。在此,我们概述了一组六项实验室自主神经测试,这些测试经过精心挑选,以共同描述脊髓损伤个体通过受损脊髓抑制和激发交感神经活动的能力。在23名完成该测试组合的未受伤个体中呈现了标准对照数据,我们进一步展示了为每项测试提取三个关键测试指标的效用,并将这些对照结果与11名脊髓损伤个体进行比较。结果表明数据具有很强的正态性,测试心理测量学表明重复测试具有可靠的可重复性。此外,即使在这个脊髓损伤个体的初步样本中,明显的差异也开始显现。这说明了这个综合测试组合能够表征脊髓损伤后的自主神经调节。为了帮助临床转化,我们进一步展示了一种图形表示,即 ,它可以作为脊髓损伤后交感神经抑制和激活激发正常或异常程度的快照。利用这些 ,三个脊髓损伤个体的示例病例突出了不同程度的自主神经完全性脊髓损伤的证据。总之,这代表了我们对脊髓损伤后自主神经功能理解的一项关键进展。