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Article ; Online: The Blood Pressure Pendulum following Spinal Cord Injury

Rahul Sachdeva / Tom E. Nightingale / Andrei V. Krassioukov

International Journal of Molecular Sciences, Vol 20, Iss 10, p

Implications for Vascular Cognitive Impairment

2019 Volume 2464

Abstract: Cognitive impairment following spinal cord injury (SCI) has received considerable attention in recent years. Among the various systemic effects of SCI that contribute towards cognitive decline in this population, cardiovascular dysfunction is arguably ... ...

Abstract	Cognitive impairment following spinal cord injury (SCI) has received considerable attention in recent years. Among the various systemic effects of SCI that contribute towards cognitive decline in this population, cardiovascular dysfunction is arguably one of the most significant. The majority of individuals with a cervical or upper-thoracic SCI commonly experience conditions called orthostatic hypotension and autonomic dysreflexia, which are characterized by dangerous fluctuations in systemic blood pressure (BP). Herein, we review the potential impact of extreme BP lability on vascular cognitive impairment (VCI) in individuals with SCI. Albeit preliminary in the SCI population, there is convincing evidence that chronic hypotension and hypertension in able-bodied individuals results in devastating impairments in cerebrovascular health, leading to VCI. We discuss the pertinent literature, and while drawing mechanistic comparisons between able-bodied cohorts and individuals with SCI, we emphasize the need for additional research to elucidate the mechanisms of cognitive impairment specific to the SCI population. Lastly, we highlight the current and potential future therapies to manage and treat BP instability, thereby possibly mitigating VCI in the SCI population.
Keywords	spinal cord injury ; vascular cognitive impairment ; orthostatic hypotension ; autonomic dysreflexia ; cerebrovascular health ; Biology (General) ; QH301-705.5 ; Chemistry ; QD1-999
Subject code	306
Language	English
Publishing date	2019-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Exercise and aerobic capacity in individuals with spinal cord injury

Daniel D Hodgkiss / Gurjeet S Bhangu / Carole Lunny / Catherine R Jutzeler / Shin-Yi Chiou / Matthias Walter / Samuel J E Lucas / Andrei V Krassioukov / Tom E Nightingale

PLoS Medicine, Vol 20, Iss 11, p e

A systematic review with meta-analysis and meta-regression.

2023 Volume 1004082

Abstract: Background A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake ([Formula: see text]O2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI) and a major risk factor associated with chronic ... ...

Abstract	Background A low level of cardiorespiratory fitness [CRF; defined as peak oxygen uptake ([Formula: see text]O2peak) or peak power output (PPO)] is a widely reported consequence of spinal cord injury (SCI) and a major risk factor associated with chronic disease. However, CRF can be modified by exercise. This systematic review with meta-analysis and meta-regression aimed to assess whether certain SCI characteristics and/or specific exercise considerations are moderators of changes in CRF. Methods and findings Databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were searched from inception to March 2023. A primary meta-analysis was conducted including randomised controlled trials (RCTs; exercise interventions lasting >2 weeks relative to control groups). A secondary meta-analysis pooled independent exercise interventions >2 weeks from longitudinal pre-post and RCT studies to explore whether subgroup differences in injury characteristics and/or exercise intervention parameters explained CRF changes. Further analyses included cohort, cross-sectional, and observational study designs. Outcome measures of interest were absolute (A[Formula: see text]O2peak) or relative [Formula: see text]O2peak (R[Formula: see text]O2peak), and/or PPO. Bias/quality was assessed via The Cochrane Risk of Bias 2 and the National Institute of Health Quality Assessment Tools. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects models were used in all meta-analyses and meta-regressions. Of 21,020 identified records, 120 studies comprising 29 RCTs, 67 pre-post studies, 11 cohort, 7 cross-sectional, and 6 observational studies were included. The primary meta-analysis revealed significant improvements in A[Formula: see text]O2peak [0.16 (0.07, 0.25) L/min], R[Formula: see text]O2peak [2.9 (1.8, 3.9) mL/kg/min], and PPO [9 (5, 14) W] with exercise, relative to controls (p < 0.001). Ninety-six studies (117 independent exercise interventions ...
Keywords	Medicine ; R
Subject code	796
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Neurogenic Bowel in Acute Rehabilitation Following Spinal Cord Injury

Andrew M. Round / Min Cheol Joo / Carolyn M. Barakso / Nader Fallah / Vanessa K. Noonan / Andrei V. Krassioukov

Journal of Clinical Medicine, Vol 10, Iss 1673, p

Impact of Laxatives and Opioids

2021 Volume 1673

Abstract: Objective: To explore the association between bowel dysfunction and use of laxatives and opioids in an acute rehabilitation setting following spinal cord injury (SCI). Methods: Data was collected regarding individuals with acute traumatic/non-traumatic ... ...

Abstract	Objective: To explore the association between bowel dysfunction and use of laxatives and opioids in an acute rehabilitation setting following spinal cord injury (SCI). Methods: Data was collected regarding individuals with acute traumatic/non-traumatic SCI over a two-year period (2012–2013) during both the week of admission and discharge of their inpatient stay. Results: An increase in frequency of bowel movement (BM) ( p = 0.003) and a decrease in frequency of fecal incontinence (FI) per week ( p < 0.001) between admission and discharge was found across all participants. There was a reduction in the number of individuals using laxatives ( p = 0.004) as well as the number of unique laxatives taken ( p < 0.001) between admission and discharge in our cohort. The number of individuals using opioids and the average dose of opioids in morphine milligram equivalents (MME) from admission to discharge were significantly reduced ( p = 0.001 and p = 0.02, respectively). There was a positive correlation between the number of laxatives and frequency of FI at discharge (r = 0.194, p = 0.014), suggesting that an increase in laxative use results in an increased frequency of FI. Finally, there was a significant negative correlation between average dose of opioids (MME) and frequency of BM at discharge, confirming the constipating effect of opioids (r = −0.20, p = 0.009).
Keywords	bowel dysfunction ; acute rehabilitation ; spinal cord injury ; laxatives ; opioids ; SCI bowel management ; Medicine ; R
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Heart Rate Variability Biofeedback in Adults with a Spinal Cord Injury

Jacob Schoffl / Mohit Arora / Ilaria Pozzato / Candice McBain / Dianah Rodrigues / Elham Vafa / James Middleton / Glen M. Davis / Sylvia Maria Gustin / John Bourke / Annette Kifley / Andrei V. Krassioukov / Ian D. Cameron / Ashley Craig

Journal of Clinical Medicine, Vol 12, Iss 24, p

A Laboratory Framework and Case Series

2023 Volume 7664

Abstract: Heart rate variability biofeedback (HRV-F) is a neurocardiac self-regulation therapy that aims to regulate cardiac autonomic nervous system activity and improve cardiac balance. Despite benefits in various clinical populations, no study has reported the ... ...

Abstract	Heart rate variability biofeedback (HRV-F) is a neurocardiac self-regulation therapy that aims to regulate cardiac autonomic nervous system activity and improve cardiac balance. Despite benefits in various clinical populations, no study has reported the effects of HRV-F in adults with a spinal cord injury (SCI). This article provides an overview of a neuropsychophysiological laboratory framework and reports the impact of an HRV-F training program on two adults with chronic SCI (T1 AIS A and T3 AIS C) with different degrees of remaining cardiac autonomic function. The HRV-F intervention involved 10 weeks of face-to-face and telehealth sessions with daily HRV-F home practice. Physiological (HRV, blood pressure variability (BPV), baroreflex sensitivity (BRS)), and self-reported assessments (Fatigue Severity Scale, Generalised Anxiety Disorder Scale, Patient Health Questionnaire, Appraisal of Disability and Participation Scale, EuroQol Visual Analogue Scale) were conducted at baseline and 10 weeks. Participants also completed weekly diaries capturing mood, anxiety, pain, sleep quality, fatigue, and adverse events. Results showed some improvement in HRV, BPV, and BRS. Additionally, participants self-reported some improvements in mood, fatigue, pain, quality of life, and self-perception. A 10-week HRV-F intervention was feasible in two participants with chronic SCI, warranting further investigation into its autonomic and psychosocial effects.
Keywords	autonomic nervous system ; psychophysiology ; biofeedback ; heart rate ; spinal cord injuries ; case reports ; Medicine ; R
Subject code	796
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Reliability and validity of daily physical activity measures during inpatient spinal cord injury rehabilitation

Dominik Zbogar / Janice J Eng / William C Miller / Andrei V Krassioukov / Mary C Verrier

SAGE Open Medicine, Vol

2016 Volume 4

Abstract: Objectives: To assess the test–retest reliability and convergent validity of daily physical activity measures during inpatient spinal cord injury rehabilitation. Design: Observational study. Setting: Two inpatient spinal cord injury rehabilitation ... ...

Abstract	Objectives: To assess the test–retest reliability and convergent validity of daily physical activity measures during inpatient spinal cord injury rehabilitation. Design: Observational study. Setting: Two inpatient spinal cord injury rehabilitation centres. Subjects: Participants ( n = 106) were recruited from consecutive admissions to rehabilitation. Methods: Physical activity during inpatient spinal cord injury rehabilitation stay was recorded on two days via (1) wrist accelerometer, (2) hip accelerometer if ambulatory, and (3) self-report (Physical Activity Recall Assessment for People with Spinal Cord Injury questionnaire). Spearman’s correlations and Bland–Altman plots were utilized for test–retest reliability. Correlations between physical activity measures and clinical measures (functional independence, hand function, and ambulation) were performed. Results: Correlations for physical activity measures between Day 1 and Day 2 were moderate to high (ρ = 0.53–0.89). Bland–Altman plots showed minimal bias and more within-subject differences in more active individuals and wide limits of agreement. None of these three physical activity measures correlated with one another. A moderate correlation was found between wrist accelerometry counts and grip strength (ρ = 0.58) and between step counts and measures of ambulation (ρ = 0.62). Functional independence was related to wrist accelerometry (ρ = 0.70) and step counts (ρ = 0.56), but not with self-report. Conclusion: The test–retest reliability and convergent validity of the instrumented measures suggest that wrist and hip accelerometers are appropriate tools for use in research studies of daily physical activity in the spinal cord injury rehabilitation setting but are too variable for individual use.
Keywords	Medicine (General) ; R5-920
Subject code	796
Language	English
Publishing date	2016-08-01T00:00:00Z
Publisher	SAGE Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Neurovascular Coupling of the Posterior Cerebral Artery in Spinal Cord Injury

Darren E. R. Warburton / Mei Mu Zi Zheng / Andrei V. Krassioukov / Aaron A. Phillips

Brain Sciences, Vol 3, Iss 2, Pp 781-

A Pilot Study

2013 Volume 789

Abstract: Purpose: To compare neurovascular coupling in the posterior cerebral artery (PCA) between those with spinal cord injury (SCI) and able bodied (AB) individuals. Methods: A total of seven SCI and seven AB were matched for age and sex. Measures included PCA ...

Abstract	Purpose: To compare neurovascular coupling in the posterior cerebral artery (PCA) between those with spinal cord injury (SCI) and able bodied (AB) individuals. Methods: A total of seven SCI and seven AB were matched for age and sex. Measures included PCA velocity (PCAv), beat-by-beat blood pressure and end-tidal carbon dioxide. Posterior cerebral cortex activation was achieved by 10 cycles of (1) 30 s eyes closed (pre-stimulation), (2) 30 s reading (stimulation). Results: Blood pressure was significantly reduced in those with SCI (SBP: 100 ± 13 mmHg; DBP: 58 ± 13 mmHg) vs. AB (SBP: 121 ± 12 mmHg; DBP: 74 ± 9 mmHg) during both pre-stimulation and stimulation, but the relative increase was similar during the stimulation period. Changes in PCAv during stimulation were mitigated in the SCI group (6% ± 6%) vs. AB (29% ± 12%, P < 0.001). Heart rate and end-tidal carbon dioxide responded similarly between groups. Conclusions: Clearly, NVC is impaired in those with SCI. This study may provide a link between poor perfusion of the posterior cerebral region (containing the medullary autonomic centres) and autonomic dysfunction after SCI.
Keywords	spinal cord injury ; neurovascular coupling ; posterior cerebral artery ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Neurology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Language	English
Publishing date	2013-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Prediction of autonomic dysreflexia during urodynamics

Matthias Walter / Stephanie C. Knüpfer / Jacquelyn J. Cragg / Lorenz Leitner / Marc P. Schneider / Ulrich Mehnert / Andrei V. Krassioukov / Martin Schubert / Armin Curt / Thomas M. Kessler

BMC Medicine, Vol 16, Iss 1, Pp 1-

a prospective cohort study

2018 Volume 11

Abstract: Abstract Background Autonomic dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to ...

Abstract	Abstract Background Autonomic dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of autonomic dysreflexia. Therefore, we aimed to determine predictors of autonomic dysreflexia in individuals with spinal cord injury during urodynamic investigation. Methods This prospective cohort study included 300 patients with spinal cord injuries and complete datasets of continuous non-invasive cardiovascular monitoring, recorded during same session repeat urodynamic investigation. We used logistic regression to reveal predictors of autonomic dysreflexia during urodynamic investigation. Results We found that level of injury and presence of neurogenic detrusor overactivity were the only two independent significant predictors for autonomic dysreflexia during urodynamic investigation. A lesion at spinal segment T6 or above (odds ratio (OR) 5.5, 95% CI 3.2–9.4) compared to one at T7 or below, and presence of neurogenic detrusor overactivity (OR 2.7, 95% confidence interval (CI) 1.4–4.9) were associated with a significant increased odds of autonomic dysreflexia during urodynamic investigation. Both odds persisted after adjustment for age, sex, and completeness and stage of injury (adjusted OR (AOR) 6.6, 95% CI 3.8–11.7, and AOR 2.2, 95% CI 1.1–4.5, respectively). Further stratification by lesion level showed level-dependent significantly increased adjusted odds of autonomic dysreflexia, i.e., from C1–C4 (AOR 16.2, 95% CI 5.9–57.9) to T4–T6 (AOR 2.6, 95% CI 1.3–5.2), compared to lesions at T7 or below. Conclusions In patients with neurogenic lower urinary tract dysfunction due to spinal cord injury, autonomic dysreflexia is independently predicted by lesion level and presence of neurogenic detrusor overactivity. Considering the health risks associated with autonomic dysreflexia, such as seizures, stroke, retinal bleeding, or even death, we recommend both continuous cardiovascular monitoring during urodynamic investigation in all spinal cord-injured patients with emphasis on those with cervical lesions, and appropriate neurogenic detrusor overactivity treatment to reduce the probability of potentially life-threatening complications. Trial registration ClinicalTrials.gov, NCT01293110.
Keywords	Autonomic dysreflexia ; Neurogenic detrusor overactivity ; Neurogenic lower urinary tract dysfunction ; Prediction ; Spinal cord injury ; Urodynamic investigation ; Medicine ; R
Subject code	616 ; 610
Language	English
Publishing date	2018-04-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Integrated systems analysis reveals conserved gene networks underlying response to spinal cord injury

Jordan W Squair / Seth Tigchelaar / Kyung-Mee Moon / Jie Liu / Wolfram Tetzlaff / Brian K Kwon / Andrei V Krassioukov / Christopher R West / Leonard J Foster / Michael A Skinnider

eLife, Vol

2018 Volume 7

Abstract: Spinal cord injury (SCI) is a devastating neurological condition for which there are currently no effective treatment options to restore function. A major obstacle to the development of new therapies is our fragmentary understanding of the coordinated ... ...

Abstract	Spinal cord injury (SCI) is a devastating neurological condition for which there are currently no effective treatment options to restore function. A major obstacle to the development of new therapies is our fragmentary understanding of the coordinated pathophysiological processes triggered by damage to the human spinal cord. Here, we describe a systems biology approach to integrate decades of small-scale experiments with unbiased, genome-wide gene expression from the human spinal cord, revealing a gene regulatory network signature of the pathophysiological response to SCI. Our integrative analyses converge on an evolutionarily conserved gene subnetwork enriched for genes associated with the response to SCI by small-scale experiments, and whose expression is upregulated in a severity-dependent manner following injury and downregulated in functional recovery. We validate the severity-dependent upregulation of this subnetwork in rodents in primary transcriptomic and proteomic studies. Our analysis provides systems-level view of the coordinated molecular processes activated in response to SCI.
Keywords	systems genetics ; spinal cord injury ; transcriptome ; Medicine ; R ; Science ; Q ; Biology (General) ; QH301-705.5
Subject code	572
Language	English
Publishing date	2018-10-01T00:00:00Z
Publisher	eLife Sciences Publications Ltd
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Plasticity of TRPV1-expressing sensory neurons mediating autonomic dysreflexia following spinal cord injury

LeanneMRamer / AdrianPetervan Stolk / JessicaA.Inskip / AndreiV.Krassioukov

Frontiers in Physiology, Vol

2012 Volume 3

Abstract: Spinal cord injury (SCI) triggers profound changes in visceral and somatic targets of sensory neurons below the level of injury. Despite this, little is known about the influence of injury to the spinal cord on sensory ganglia. One of the defining ... ...

Abstract	Spinal cord injury (SCI) triggers profound changes in visceral and somatic targets of sensory neurons below the level of injury. Despite this, little is known about the influence of injury to the spinal cord on sensory ganglia. One of the defining characteristics of sensory neurons is the size of their cell body: for example, nociceptors are smaller in size than mechanoreceptors or proprioceptors. In these experiments, we first used a comprehensive immunohistochemical approach to characterize the size distribution of sensory neurons after high- and low-thoracic SCI. Male Wistar rats (300g) received a spinal cord transection (T3 or T10) or sham injury. At 30 days post-injury, dorsal root ganglia (DRGs) and spinal cords were harvested and analyzed immunohistochemically. In a wide survey of primary afferents, only those expressing the capsaicin receptor (TRPV1) exhibited somal hypertrophy after T3 SCI. Hypertrophy only occurred caudal to SCI and was pronounced in ganglia far distal to SCI (i.e., in L4-S1 DRGs). Injury-induced hypertrophy was accompanied by a small expansion of central territory in the lumbar spinal dorsal horn and by evidence of TRPV1 upregulation. Importantly, hypertrophy of TRPV1-positive neurons was modest after T10 SCI. Given the specific effects of T3 SCI on TRPV1-positive afferents, we hypothesized that these afferents contribute to autonomic dysreflexia (AD). Rats with T3 SCI received vehicle or capsaicin via intrathecal injection at 2 or 28 days post-SCI; at 30 days, AD was assessed by recording intra-arterial blood pressure during colo-rectal distension. In both groups of capsaicin-treated animals, the severity of AD was dramatically reduced. While AD is multi-factorial in origin, TRPV1-positive afferents are clearly involved in AD elicited by colo-rectal distension. These findings implicate TRPV1-positive afferents in the initiation of AD and suggest that TRPV1 may be a therapeutic target for amelioration or prevention of AD after high SCI.
Keywords	Capsaicin ; Hypertension ; Hypertrophy ; Dorsal horn ; colo-rectal distension ; dorsal root ; Dorsal root ganglion ; high blood pressure ; Physiology ; QP1-981 ; Science ; Q
Subject code	572
Language	English
Publishing date	2012-07-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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