Commentary: Spinal Cord Stimulation to Improve Autonomic Regulation After Spinal Cord Injury: Can Reflex Control Be Restored?

Top Spinal Cord Inj Rehabil, 2023 · DOI: 10.46292/sci22-00048 · Published: July 1, 2023

Simple Explanation

Spinal cord electrical stimulation has recently become popular as a research tool to improve function in individuals with spinal cord injuries (SCI). Studies using spinal cord stimulation to address autonomic dysfunction have largely been aimed at ameliorating orthostatic hypotension by supporting blood pressure. Spinal cord stimulation in those with SCI during orthostasis may increase blood pressure through sympathetic activation, but it may not involve improved autonomic regulation by boosting weak regulatory pathways through the injured cord.

Study Duration

Not specified

Participants

Individuals with spinal cord injuries

Evidence Level

Commentary

Key Findings

1
Spinal cord stimulation may improve blood pressure in SCI patients with orthostatic hypotension by stimulating vascular sympathetic outflow.
2
The mechanism of blood pressure improvement with spinal cord stimulation may not be due to improved autonomic regulation, but rather other factors like unperceived pain or venoconstriction.
3
Comprehensive testing of both sympatho-excitatory and sympatho-inhibitory pathways is needed to determine if spinal cord stimulation truly enhances reflex autonomic regulation.

Research Summary

Spinal cord electrical stimulation is being explored to improve autonomic function in individuals with spinal cord injuries (SCI), particularly to address orthostatic hypotension. The commentary questions whether spinal cord stimulation improves autonomic regulation or if blood pressure improvements are due to other mechanisms such as autonomic dysreflexia or venoconstriction. The authors emphasize the need for comprehensive testing of sympatho-excitatory and sympatho-inhibitory pathways to determine if stimulation enhances reflex autonomic regulation.

Practical Implications

Research

Future research should focus on comprehensive assessment of autonomic function (both excitatory and inhibitory pathways) during spinal cord stimulation.

Clinical Practice

Clinicians should be aware that blood pressure improvements with spinal cord stimulation may not indicate improved autonomic regulation and could be due to other mechanisms.

Long-term Health

Inducing repeated dysreflexia with spinal cord stimulation may have negative consequences for long-term health.

Study Limitations

1
Commentary is a perspective, not an original research study.
2
The exact mechanisms of spinal cord stimulation on autonomic function require further investigation.
3
The long-term effects of spinal cord stimulation on autonomic regulation are unknown.

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