Solinsky Ryan, Burns Kathryn, Hamner Jason W, Veith Daniel D, Singer Wolfgang, Taylor J Andrew
Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota.
Spaulding Rehabilitation Hospital, Cambridge, Massachusetts.
Top Spinal Cord Inj Rehabil. 2025 Spring;31(2):50-61. doi: 10.46292/sci24-00071. Epub 2025 Jun 19.
Autonomic dysfunction is common after spinal cord injury (SCI). There are currently limited tools to comprehensively characterize its deficits. 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.
To assess a strategic battery of autonomic tests to characterize and act as a biomarker of autonomic regulation for individuals with SCI and to develop a novel graphical representation of these data to facilitate understanding of autonomic dysfunction after SCI.
We outline a battery of six laboratory autonomic tests that were curated to collectively describe the ability of individuals with SCI to inhibit and recruit sympathetic activity through the injured spinal cord. Heart rate/blood pressure variability, bolus phenylephrine, hand and foot cold pressor, Valsalva maneuver, and bladder pressor are herein described. Incorporating normative control data for 30 uninjured individuals completing this testing battery, we further demonstrate the utility of a composite biomarker, comparing these control results to 11 individuals with SCI.
Results demonstrate strong normality of data with testing psychometrics, suggesting stable reproducibility with repeat testing. Even in this preliminary sample of individuals with SCI, clear differences begin to emerge compared to uninjured norms. This illustrates the ability of this collective testing battery to characterize autonomic regulation after SCI. 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 SCI.
Utilizing these autonomic phenotypes, three example cases of individuals with SCI highlight evidence of varied degrees of autonomically complete SCI. Together, this represents a key advancement in our understanding of autonomic function after SCI.
脊髓损伤（SCI）后自主神经功能障碍很常见。目前，全面描述其功能缺陷的工具有限。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。
评估一系列自主神经测试，以表征SCI患者的自主神经调节功能并作为其生物标志物，并开发一种新颖的图形表示法来促进对SCI后自主神经功能障碍的理解。
我们概述了一组六项实验室自主神经测试，这些测试旨在共同描述SCI患者通过受损脊髓抑制和激发交感神经活动的能力。本文描述了心率/血压变异性、大剂量去氧肾上腺素、手足冷加压试验、瓦尔萨尔瓦动作和膀胱加压试验。纳入30名未受伤个体完成该测试组的标准对照数据，我们进一步证明了复合生物标志物的效用，将这些对照结果与11名SCI患者进行比较。
结果表明测试心理测量学的数据具有很强的正态性，表明重复测试具有稳定的可重复性。即使在这个SCI患者的初步样本中，与未受伤的标准相比，明显的差异也开始显现。这说明了这个综合测试组表征SCI后自主神经调节的能力。为了帮助临床转化，我们进一步展示了一种图形表示法，即 ，它可以快速了解SCI后交感神经抑制和激活激发是正常还是异常。
利用这些自主神经表型，三个SCI患者的示例病例突出了不同程度的自主神经完全性SCI的证据。总之，这代表了我们对SCI后自主神经功能理解的关键进展。
