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Stretching is a ubiquitous rehabilitation intervention for individuals with spinal cord injury (SCI), intended to reduce spasticity, maintain or improve joint range of motion, and prevent joint contractures. Although people with SCI report that stretching is their preferred approach to reduce spasticity, limited evidence supports the use of stretching for people with SCI, including short-term (< one hour) effects on spasticity. Further, the long-term effects and the effects of stretching on motor function have yet to be examined in humans with SCI. Evidence from pre-clinical studies in rats with SCI demonstrates that stretching impairs motor output, reduces spinal cord excitability, and abolishes walking function. This perspective paper discusses evidence of static stretching in humans and rats with SCI regarding the effects on range of motion, joint contractures, and effects on voluntary and involuntary (i.e., spasticity) motor output. Additionally, we aim to challenge assumptions regarding the use of stretching and encourage research to advance the understanding of this common rehabilitation approach. Research is needed to investigate underlying mechanisms of stretch-induced effects and to advance stretching protocols to optimize the potential beneficial effects of stretching for people with SCI. [ABSTRACT FROM AUTHOR]

Autonomic dysreflexia is a potentially life-threatening condition that can affect people with established spinal cord injuries above the level of T6. If left untreated, it can lead to uncontrolled hypertension causing stroke, seizures, pulmonary oedema and death. In Ireland and the UK, there are approximately 60 000 people living with spinal cord injuries who are at risk of developing autonomic dysreflexia. Despite this, there are no prehospital guidelines on treating the condition to date. This educational article aims to address this gap in knowledge and offer potential treatment options for paramedics and ambulance clinicians, which can be effectively applied to this cohort of patients in the future. [ABSTRACT FROM AUTHOR]

Hyperreflexia associated with spasticity is a prevalent neurological condition characterized by excessive and exaggerated reflex responses to stimuli. Hyperreflexia can be caused by several diseases including multiple sclerosis, stroke and spinal cord injury (SCI). Although we have previously identified the contribution of the RAC1‐PAK1 pathway underlying spinal hyperreflexia with SCI‐induced spasticity, a feasible druggable target has not been validated. To assess the utility of targeting PAK1 to attenuate H‐reflex hyperexcitability, we administered Romidepsin, a clinically available PAK1 inhibitor, in Thy1‐YFP reporter mice. We performed longitudinal EMG studies with a study design that allowed us to assess pathological H‐reflex changes and drug intervention effects over time, before and after contusive SCI. As expected, our results show a significant loss of rate‐dependent depression – an indication of hyperreflexia and spasticity – 1 month following SCI as compared with baseline, uninjured controls (or before injury). Romidepsin treatment reduced signs of hyperreflexia in comparison with control cohorts and in pre‐ and post‐drug intervention in SCI animals. Neuroanatomical study further confirmed drug response, as romidepsin treatment also reduced the presence of SCI‐induced dendritic spine dysgenesis on α‐motor neurons. Taken together, our findings extend previous work demonstrating the utility of targeting PAK1 activity in SCI‐induced spasticity and support the novel use of romidepsin as an effective tool for managing spasticity. Key points: PAK1 plays a role in contributing to the development of spinal cord injury (SCI)‐induced spasticity by contributing to dendritic spine dysgenesis.In this study, we explored the preclinical utility of inhibiting PAK1 to reduce spasticity and dendritic spine dysgenesis in an SCI mouse model.Romidepsin is a PAK1 inhibitor approved in the US in 2009 for the treatment of cutaneous T‐cell lymphoma.Here we show that romidepsin treatment after SCI reduced SCI‐induced H‐reflex hyperexcitability and abnormal α‐motor neuron spine morphology.This study provides compelling evidence that romidepsin may be a promising therapeutic approach for attenuating SCI‐induced spasticity. [ABSTRACT FROM AUTHOR]

Individuals with spinal cord injury (SCI) at and above T6 experience impaired descending cortical control of the autonomic nervous system, which predisposes them to blood pressure (BP) disorders including persistent hypotension. The primary aim of this investigation was to determine the effects of midodrine, 10 mg, administered daily over a 30-day period in the home environment, compared to placebo, on laboratory assessments of BP, cerebral blood flow velocity (CBFv), and cognitive performance in hypotensive individuals with chronic SCI. This prospective, randomized, placebo-controlled, double-blind, crossover trial was conducted in 15 individuals with tetraplegia. In the first 30-day period, five participants were randomized to midodrine and 10 were randomized to placebo; participants were then crossed over to the second 30-day period following a 14-day washout. Laboratory assessments of BP, CBFv, and cognitive performance were measured before and after each of the two study arms. Systolic BP (SBP) was significantly increased following midodrine administration compared to placebo (116 ± 23 mm Hg vs 94 ± 16 mm Hg; p =.002). In addition, diastolic CBFv was increased after midodrine administration compared to placebo (31.0 ± 11.2 vs 25.6 ± 9.1 cm/s; p =.04). However, there were no significant drug by time interaction effects for systolic or mean CBFv (p >.172) and cognitive performance (p =.689). The results suggest significant increases in SBP and diastolic CBFv without appreciable effects on cognition after 30 days of midodrine administration. Further investigation is needed to identify effective antihypotensive treatment options that not only normalize BP but also improve CBFv and cognition. [ABSTRACT FROM AUTHOR]

Abstract Background Heart rate variability (HRV) may provide objective information about cardiogenic autonomic balance in individuals with spinal cord injury (SCI). The aim of this study was to characterize the diurnal variation of HRV in individuals with SCI at lesion level T6 and above and lesion level below T6. Methods This was a retrospective analysis of a prior cross-sectional study. Individuals with chronic SCI underwent 24 h recording of the time between consecutive R waves (RR interval) to derive parameters of HRV as follows: standard deviation of all normal-to-normal R–R intervals (SDNN) and square root of the mean of the squared differences between successive R–R intervals (RMSSD) (time domain); and high frequency power (HF), low-frequency power (LF), very low frequency power (VLF), ultra-low frequency power (ULF) and total power (TP) (frequency domain). Changes in the magnitude of HRV outcomes over the 24 h period were investigated using a novel multi-component cosinor model constrained to the form of a three-harmonic Fourier series. Results Participants were grouped as lesion level T6 and above (n = 22) or below T6 (n = 36). Most of them were male (n = 40, 69%) and the median age (interquartile range) was 50.5 (28) years. Both groups exhibited similar diurnal patterns in most HRV metrics. The lowest values occurred in the late afternoon (4–6 pm) and gradually increased, peaking around midnight to early morning (1–6 am). Exceptions included RMSSD, which peaked before midnight, and ULF, which showed a double peak pattern that peaked from 11 am to 1 pm and 4–6 am in participants with lesion level at T6 and above. The HRV values in participants with lesion level T6 and above were generally lower than participants with lesion level below T6, except for peak values of RMSSD, HF and LF. Conclusion This study demonstrated substantial diurnal variation of HRV in participants with SCI in both groups of participants. In clinical and research settings, diurnal variations in HRV must be taken into consideration.

Background: Heart rate variability (HRV) may provide objective information about cardiogenic autonomic balance in individuals with spinal cord injury (SCI). The aim of this study was to characterize the diurnal variation of HRV in individuals with SCI at lesion level T6 and above and lesion level below T6. Methods: This was a retrospective analysis of a prior cross-sectional study. Individuals with chronic SCI underwent 24 h recording of the time between consecutive R waves (RR interval) to derive parameters of HRV as follows: standard deviation of all normal-to-normal R–R intervals (SDNN) and square root of the mean of the squared differences between successive R–R intervals (RMSSD) (time domain); and high frequency power (HF), low-frequency power (LF), very low frequency power (VLF), ultra-low frequency power (ULF) and total power (TP) (frequency domain). Changes in the magnitude of HRV outcomes over the 24 h period were investigated using a novel multi-component cosinor model constrained to the form of a three-harmonic Fourier series. Results: Participants were grouped as lesion level T6 and above (n = 22) or below T6 (n = 36). Most of them were male (n = 40, 69%) and the median age (interquartile range) was 50.5 (28) years. Both groups exhibited similar diurnal patterns in most HRV metrics. The lowest values occurred in the late afternoon (4–6 pm) and gradually increased, peaking around midnight to early morning (1–6 am). Exceptions included RMSSD, which peaked before midnight, and ULF, which showed a double peak pattern that peaked from 11 am to 1 pm and 4–6 am in participants with lesion level at T6 and above. The HRV values in participants with lesion level T6 and above were generally lower than participants with lesion level below T6, except for peak values of RMSSD, HF and LF. Conclusion: This study demonstrated substantial diurnal variation of HRV in participants with SCI in both groups of participants. In clinical and research settings, diurnal variations in HRV must be taken into consideration. [ABSTRACT FROM AUTHOR]

This chapter will discuss the aetiology, anatomy and pathophysiology of spinal cord injury. It will provide a framework for classifying spinal cord injuries and examine the various syndromes that can occur. Furthermore, it will consider the initial management of patients with spinal cord injury and their long-term prognosis. [ABSTRACT FROM AUTHOR]

Autonomic dysreflexia (AD) is a common autonomic complication of spinal cord injury (SCI) characterized by a sudden increase is blood pressure triggered by peripheral stimulation, such as bladder distention. Iatrogenic AD events often occur during various medical procedures including urodynamic assessments (UDSs) used to evaluate lower urinary tract (LUT) function in individuals with SCI. To date, there are no established clinical practices that would allow early detection of the development of episodes of AD. Heart rate variability (HRV) is a reliable and non-invasive metric for evaluating autonomic regulation of the cardiovascular system, with demonstrated utility in people with SCI during UDSs. We aim to provide a comprehensive evaluation of cardiovascular function during UDS-induced AD using ultra-short-term HRV analysis and identify changes in cardiovascular dynamics to predict the onset of AD. We assessed cardiovascular data in a total of 24 participants with sensorimotor complete SCI above T6 (17 males, 7 females, median age = 43 [36–50] years) who experienced AD during UDS. We used continuous electrocardiographic recordings to evaluate HRV in 60 sec overlapping windows during filling cystometry. The mean of "normal-to-normal" heartbeats (meanNN), its standard deviation (SDNN), and the root mean square of successive differences (RMSSD) were calculated and used in all subsequent analyses. We found that SDNN and RMSSD diminished during the early phase of bladder filling and sharply increased during AD. Using the lowest point of statistical variability in heart rate (i.e., SDNN), we were able to predict AD events within 240 sec (percentile 25–percentile 75: 172–339 sec) before the first systolic blood pressure peak after AD onset (sensitivity = 0.667; specificity = 0.875). Our results indicated a temporary increase in sympathetic activity during the early phase of bladder filling, which is followed by an increase in parasympathetic outflow to the heart when AD occurs. These findings have significant clinical implications that extend beyond the context of UDS and demonstrate the importance of identifying early changes in HRV in order to accurately predict AD episodes in people living with SCI. [ABSTRACT FROM AUTHOR]

Abstract Dysregulation of the autonomic nervous system is an important long-term consequence of spinal cord injury (SCI). Yet, there is a scarcity of teaching resources about this topic for preclinical medical students. Given the association of SCI sequelae with emergency complications and mortality, it is imperative to equip medical students with the ability to recognize them. We designed a “Meet the Patient” (MTP) session with the primary goal to enhance student learning about SCI sequelae by interacting with patients and listening to real-life stories. The session primarily focused on recognizing triggers and symptoms of autonomic dysreflexia (AD) and discussing the loss of bowel and bladder control, while providing opportunities to learn more about living with SCI from patients’ real-life experiences. During the MTP session, patients living with SCI discussed their experience with AD, neurogenic bowel and bladder, and spasticity, among other SCI sequelae. We evaluated the outcomes of the MTP session by assessing numerical performance in questions related to the session (post-session quiz and final exam) and students’ satisfaction (post-session survey) in two subsequent academic years. The numerical performance in SCI-questions was high for both academic years (and higher than national average for the final exam question), indicating adequate acquisition of knowledge. Satisfaction with the session was high, with most students indicating that the session helped them consolidate their knowledge about the topic.

Felicia M Michael,1,2 Samir P Patel,1,2 Adam D Bachstetter,2,3 Alexander G Rabchevsky1,2 1Department of Physiology, University of Kentucky, Lexington, KY, 40536-0509, USA; 2Spinal Cord & Brain Injury Research Center (SCoBIRC); University of Kentucky, Lexington, KY, 40536-0509, USA; 3Department of Neuroscience, University of Kentucky, Lexington, KY, 40536-0509, USACorrespondence: Alexander G Rabchevsky, University of Kentucky, Department of Physiology, Spinal Cord & Brain Injury Research Center (SCoBIRC), B471, Biomedical & Biological Sciences Research Building, 741 South Limestone Street, Lexington, KY, 40536-0509, USA, Tel +1 859-323-0267, Fax +1 859-257-5737, Email agrab@uky.eduIntroduction: In addition to paralysis and loss of sensation, high-level spinal cord injury (SCI) causes sympathetic dysfunction that can lead to autonomic dysreflexia (AD) and chronic immune suppression involving splenic leukopenia. Evidence has shown that treatment with either gabapentin or blockade of TNFα mitigates maladaptive plasticity and the underlying hemodynamic dysfunction, spleen atrophy, and immune dysfunction associated with AD. Because significant improvements long term was noted following treatments only during acute stages of recovery, we sought to systematically examine changes in proinflammatory and immunomodulatory cytokines to ascertain the reason.Methods: Adult female Wistar rats underwent complete T4 spinal transection before euthanasia at systematic intervals from 3 days to 8 weeks after injury. Using qRT-PCR and meso scale discovery (MSD) assays, the gene and protein expression of TNFα and IFNγ in the spleen, upper thoracic (T4-9) and lumbosacral (L5-S6) spinal cords were analyzed.Results: We found that spleen atrophy occurs in a biphasic manner compared to naïve controls, with significant decreases in the spleen mass noted at 3 days and 8 weeks after injury. Splenic TNFα mRNA and protein levels did not change significantly over time, while IFNγ gene expression dipped acutely with trends for increased protein levels at more chronic time points. TNFα protein increased significantly only in thoracic spinal cord segments from 3 to 14 days post-injury. IFNγ mRNA and protein levels remained unelevated in injured spinal cords over time, with trends for increased protein levels at 2 and 8 weeks in the lumbosacral segments.Discussion: Novel temporal-spatial cytokine expression profiles reveal that TNFα protein levels are increased solely in upper thoracic segments after high thoracic SCI, while IFNγ remains unaltered. Splenic leukopenia and latent systemic immunosuppression are not associated with altered TNFα or IFNγ expression in the spleen or spinal cord.Keywords: autonomic dysreflexia, cytokine expression, spleen atrophy, inflammation

After spinal cord injury (SCI), normally innocuous visceral or somatic stimuli can trigger uncontrolled reflex activation of sympathetic circuitry, causing pathological dysautonomia. We show that remarkable structural remodeling and plasticity occur within spinal autonomic circuitry, creating abnormal sympathetic reflexes that promote dysautonomia. However, when mice are treated early after SCI with human-equivalent doses of the US Food and Drug Administration (FDA)-approved drug gabapentin (GBP), it is possible to block multi-segmental excitatory synaptogenesis and abolish sprouting of autonomic neurons that innervate immune organs and sensory afferents that trigger pain and autonomic dysreflexia (AD). This "prophylactic GBP" regimen decreases the frequency and severity of AD and protects against SCI-induced immune suppression. These benefits persist even 1 month after stopping treatment. GBP could be repurposed to prevent dysautonomia in at-risk individuals with high-level SCI.

Dysregulation of the autonomic nervous system is an important long-term consequence of spinal cord injury (SCI). Yet, there is a scarcity of teaching resources about this topic for preclinical medical students. Given the association of SCI sequelae with emergency complications and mortality, it is imperative to equip medical students with the ability to recognize them. We designed a "Meet the Patient" (MTP) session with the primary goal to enhance student learning about SCI sequelae by interacting with patients and listening to real-life stories. The session primarily focused on recognizing triggers and symptoms of autonomic dysreflexia (AD) and discussing the loss of bowel and bladder control, while providing opportunities to learn more about living with SCI from patients' real-life experiences. During the MTP session, patients living with SCI discussed their experience with AD, neurogenic bowel and bladder, and spasticity, among other SCI sequelae. We evaluated the outcomes of the MTP session by assessing numerical performance in questions related to the session (post-session quiz and final exam) and students' satisfaction (post-session survey) in two subsequent academic years. The numerical performance in SCI-questions was high for both academic years (and higher than national average for the final exam question), indicating adequate acquisition of knowledge. Satisfaction with the session was high, with most students indicating that the session helped them consolidate their knowledge about the topic. [ABSTRACT FROM AUTHOR]

• Blood pressure dysregulation is common but underdiagnosed in SCI. • Understanding the effect of blood pressure dysregulation on well-being is limited by poor measurement tools. • A new patient-reported outcome measure that captures problems with blood pressure was developed. To report on the development and calibration of the new Blood Pressure Dysregulation Measurement System (BPD-MS) item banks that assess the effect of BPD on health-related quality of life (HRQOL) and the daily activities of Veterans and non-Veterans with spinal cord injury (SCI). Cross-sectional survey study. Two Veteran Affairs medical centers and a SCI model system site. 454 respondents with SCI (n=262 American Veterans and n=192 non-Veterans; N=454). Not applicable The BPD-MS item banks. BPD item pools were developed and refined using literature reviews, qualitative data from focus groups, and cognitive debriefing of persons with SCI and professional caregivers. The item banks then underwent expert review, reading level assessment, and translatability review prior to field testing. The items pools consisted of 180 unique questions (items). Exploratory and confirmatory factor analyses, item response theory modeling, and differential item function investigations resulted in item banks that included a total of 150 items: 75 describing the effect of autonomic dysreflexia on HRQOL, 55 describing the effect of low blood pressure (LBP) on HRQOL, and 20 describing the effect of LBP on daily activities. In addition, 10-item short forms were constructed based on item response theory-derived item information values and the clinical relevance of item content. The new BPD-MS item banks and corresponding 10-item short forms were developed using established rigorous measurement development standards, which represents the first BPD-specific patient-reported outcomes measurement system unique for use in the SCI population. [ABSTRACT FROM AUTHOR]

This case study explores the benefits of transanal irrigation as a treatment for a patient with a spinal cord injury who was experiencing chronic constipation. In this case, the patient was having episodes of autonomic dysreflexia as a result of the constipation. This condition is unique to patients with spinal cord injury and presents a stroke risk. The article outlines the contraindications and cautions that need to be considered in assessing a patient's suitability for transanal irrigation, and the elements that form part of a holistic assessment by a specialist nurse. [ABSTRACT FROM AUTHOR]

Introduction: Autonomic dysreflexia (AD) is a condition developed secondary to a spinal cord injury, which manifests with the loss of coordinated autonomic responses and cardiovascular control. For the care of the person, the nurse has the nursing diagnosis of AD, which allows the precise interpretation of the human responses of each individual. However, it is necessary to strengthen and update the diagnosis to the new disciplinary knowledge that evolved with nursing practice. For this, proposing a situation-specific theory is essential to explain the phenomenon of interest and guide practice. Objective: To construct a situation-specific theory for the nursing diagnosis of AD derived from the adaptation model of Sor Callista Roy. Materials and methods: Theoretical study developed in five stages: defining the approach to construct the theory, defining key concepts, developing a pictorial diagram, building propositions, and establishing causal relationships and evidence for practice. Results: The situation-specific theory included defining key concepts, developing a pictorial diagram, building propositions, and establishing causal relationships and evidence for practice. We described the concepts and their relationships through seven propositions and identified 19 ineffective behaviors and 43 environmental stimuli. Of them, 39 are focal, and four are contextual stimuli. Conclusions: This situation-specific theory offers a substantiated and comprehensive explanation of the human response to AD for supporting nursing care. [ABSTRACT FROM AUTHOR]

Introduction: Autonomic dysreflexia (AD) affects about 70% of individuals with spinal cord injury (SCI) and can have severe consequences, including death if not promptly detected and managed. The current gold standard for AD detection involves continuous blood pressure monitoring, which can be inconvenient. Therefore, a non-invasive detection device would be valuable for rapid and continuous AD detection. Methods: Implanted rodent models were used to analyze autonomic dysreflexia after spinal cord injury. Skin nerve activity (SKNA) features were extracted from ECG signals recorded non-invasively, using ECG electrodes. At the same time, blood pressure and ECG data sampled was collected using an implanted telemetry device. Heart rate variability (HRV) features were extracted from these ECG signals. SKNA and HRV parameters were analyzed in both the time and frequency domain. Results: We found that SKNA features showed an increase approximately 18 seconds before the typical rise in systolic blood pressure, indicating the onset of AD in a rat model with upper thoracic SCI. Additionally, low-frequency components of SKNA in the frequency domain were dominant during AD, suggesting their potential inclusion in an AD detection system for improved accuracy. Discussion: Utilizing SKNA measurements could enable early alerts to individuals with SCI, allowing timely intervention and mitigation of the adverse effects of AD, thereby enhancing their overall well-being and safety. [ABSTRACT FROM AUTHOR]

A spinal cord injury (SCI) can be a devastating condition in children, with profound implications for their overall health and quality of life. In this review, we aim to provide a concise overview of the key aspects associated with SCIs in the pediatric population. Firstly, we discuss the etiology and epidemiology of SCIs in children, highlighting the diverse range of causes. We explore the unique anatomical and physiological characteristics of the developing spinal cord that contribute to the specific challenges faced by pediatric patients. Next, we delve into the clinical presentation and diagnostic methods, emphasizing the importance of prompt and accurate diagnosis to facilitate appropriate interventions. Furthermore, we approach the multidisciplinary management of pediatric SCIs, encompassing acute medical care, surgical interventions, and ongoing supportive therapies. Finally, we explore emerging research as well as innovative therapies in the field, and we emphasize the need for continued advancements in understanding and treating SCIs in children to improve their functional independence and overall quality of life. [ABSTRACT FROM AUTHOR]

Introduction. Autonomic dysreflexia (AD) is a life-threatening dangerous condition in patients with spinal cord injury (SCI) above the T6 segment level. It is characterized by a sudden rise in systolic blood pressure more than 20 mmHg, and unpredictable reactions from the autonomic nervous system. An episode of autonomic dysreflexia can lead to several cardiovascular catastrophes – heart attack and/or acute cerebrovascular accident up to a lethal outcome. Currently, there is no diagnostic algorithm and no way to determine risk factors for the occurrence of autonomic dysreflexia.Objective. To search for the most informative diagnostic criteria for autonomic dysreflexia in patients with spinal cord injury.Materials and methods. The study included 40 patients with SCI above the T6 segment. Depending on the SCI degree, two groups were distinguished. Group 1 (n = 14) included patients with complete spinal cord injury, advising category A on the ASIA scale. Group 2 (n = 26) included patients with incomplete spinal cord injury, classified as ASIA-B, C, D. For a preliminary assessment of the risk factors for the development of AD, an ADFSCI questionnaire was used, then a urodynamic study was conducted with simultaneous registration of systolic / diastolic blood pressure (SBP / DBP), and heart rate, which confirmed or denied the presence of AD in patients.Results. According to the ADFSCI questionnaire, most patients showed a high degree of severity of autonomic disorders, suggesting the presence of AD. Subsequently, this assumption was confirmed by the results of a urodynamic testing with simultaneous monitoring of SBP / DBP and heart rate. When comparing the groups, statistically significant differences were found in the parameters of the ADFSCI questionnaire, as well as in the indicators of SBP / DBP (at the points of maximum detrusor pressure and when the cystometric capacity is reached).Conclusion. The obtained results allow us to draw conclusions about the high incidence of AD in patients with SCI above the T6 segment and the need for a preliminary assessment of the risks of developing this condition based on the ADFSCI questionnaire before conducting a urodynamic study. Considering the possible complications of AD, the urodynamic testing should be accompanied by continuous monitoring of the indicators of the cardiovascular system.

The complex task of intermittent urinary catheterization requires a team approach to optimize patient outcomes, independence, and quality of life. Occupational therapists make unique contributions to intermittent urinary catheterization training and education throughout a patient's lifespan. This article will describe how occupational therapists and nursing professionals may collaborate to optimize intermittent urinary catheterization programs for patients and their caregivers. [ABSTRACT FROM AUTHOR]

Background: Neurogenic bowel dysfunction (NBD) is a common problem among people with spinal injury; management of bowel dysfunction and related problems are considered significant factors in daily life after injury. But despite the critical relevance of bowel dysfunction in the daily life of SCI survivors, there have been few published studies on the management of NBD. So, this study aimed to describe the bowel programmers utilized by people with SCI in China and the impact of bowel dysfunction on the quality of life (QoL). Design: A cross-sectional online survey. Setting: Rehabilitation Medicine Department of Wuhan's Tongji Hospital. Participants: SCI patients who had been diagnosed with neurogenic bowel dysfunction and who were receiving regular medical monitoring at the rehabilitation medicine department were invited to participate in our study. Outcome measures: A neurogenic bowel dysfunction (NBD) score is a questionnaire developed to evaluate the severity of neurogenic bowel dysfunction. A Short Form-12 (SF-12) was designed to measure the quality of life in people with SCI. Demographic and medical status information was extracted from their medical records. Results: The two questionnaires were sent to 413 SCI patients. Two hundred ninety-four subjects (43.1 ± 14.5 years of age; men, 71.8%) responded. Most of the respondents performed their bowel movement daily 153 (52.0%), a defecation time was 31–60 min among 70 (23.8%) of them, 149 (50.7%) used medication (drops or liquid) to treat constipation, and 169 (57.5%) used digital stimulation more than once per week to boost the bowel evacuation. This study found a significant association between the QoL score and the time used for each defecation, autonomic dysreflexia (AD) symptoms, taking medication to treat fecal incontinence, using digital stimulation, having uncontrollable flatus and perianal skin problems. Conclusion: Management of bowel dysfunction is complex and associated with QoL in people with SCI. Items of the NBD questionnaire that greatly deteriorated the QoL were time in one defecation > 60 min, symptoms of AD during or before defecation, taking medication (drops or liquid), and using digital stimulation. Dealing with those problems can improve the life quality of spinal cord injury survivors. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) produces damage to the somatic and autonomic pathways that regulate lower urinary tract, sexual, and bowel function, and increases the risk of autonomic dysreflexia. The recovery of these functions has a high impact on health, functioning, and quality of life and is set as the utmost priority by patients. The application of reliable models to predict lower urinary tract, sexual, and bowel function, and autonomic dysreflexia is important for guiding counseling, rehabilitation, and social reintegration. Moreover, a reliable prediction is essential for designing future clinical trials to optimize patients' allocation to different treatment groups. To date, reliable and simple algorithms are available to predict lower urinary tract and bowel outcomes after traumatic and ischemic SCI. Previous studies identified a few risk factors to develop autonomic dysreflexia, albeit a model for prediction still lacks. On the other hand, there is an urgent need for a model to predict the evolution of sexual function. The aim of this review is to examine the available knowledge and models for the prediction of lower urinary tract, sexual, and bowel function, and autonomic dysreflexia after SCI, and critically discuss the research priorities in these fields. [ABSTRACT FROM AUTHOR]

Autonomic dysreflexia (AD) is one of the most common, yet most life-threatening, complication to occur following a spinal cord injury (SCI), at or above thoracic level six (T6). The main symptom of AD is a sudden and severe rise in blood pressure, which could cause death if untreated. Healthcare providers should be informed and familiar with the diagnosis and treatment of AD. It is important to note that most SCI patients, once discharged from rehabilitation hospitals, are managed at their own homes or a community rehabilitation setting, such as care, residential or nursing homes. Often, owing to the rapid onset and severity of the symptoms of AD, people with a SCI who develop AD are often admitted to the nearest local health facility, which may be staffed by healthcare professionals who have little or no knowledge or experience in managing AD. This article will offer very clear information regarding the causes, pathophysiology, symptoms and management of AD. [ABSTRACT FROM AUTHOR]