Physiotherapy Management of Spinal Cord Injuries and Autonomic Dysreflexia

Autonomic dysreflexia is a medical emergency as it is a life threatening situation. It is very critical that physiotherapists are informed about this condition especially when handling spinal cord injury patients.

Autonomic dysreflexia is an abnormal and excessive excitation of the sympathetic nervous system (involuntary) in response to stimuli.

Even though autonomic dysreflexia is commonly associated with SCI patients with lesions at T6 and above,  it can also present in non-traumatic causes like in patients with spinal cord tumour or those who have undergone neurosurgery at level T6 and above. It can also be seen in multiple sclerosis

Physical therapists should watch out for signs of Autonomic Dysreflexia when handling neurological cases especially SCI patients with lesions in T6 and above.

Common causes of autonomic dysreflexia are

  • a blocked catheter, 
  • constipation, 
  • pressure ulcers, 
  • tight clothing 
  • some physiotherapy manoeuvres like "stretching" and electrical stimulation.

Some common signs of Autonomic Dysreflexia are

  • a slow heart rate (bradycardia), 
  • increased blood pressure by 20-40mmHg, 
  • severe headache, 
  • Nasal congestion
  • shortness of breath, 
  • flushing of the skin and sweating above the injury

What should a Physiotherapist do if you suspect a patient you are treating is beginning to experience Autonomic Dysreflexia?

  • Your first action is to stop whatever you are doing that could have triggered it, 
  • sit the patient up or raise his head and lower his legs and check his BP. 
  • If it's high call for medical assistance immediately, as Autonomic dysreflexia is life threatening.


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