{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T21:02:11Z","timestamp":1793221331557,"version":"4.5.0"},"reference-count":70,"publisher":"American Spinal Injury Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"\n Background:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objectives:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n 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\n autonomic phenotype<\/jats:italic>\n , which serves as a snapshot of how normal or abnormal sympathetic inhibition and recruitment of activation may be after SCI.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.46292\/sci24-00071","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T11:41:24Z","timestamp":1750765284000},"page":"50-61","source":"Crossref","is-referenced-by-count":4,"title":["A Novel Testing Battery for Preserved Autonomic Regulation Following Spinal Cord Injury and New Translationally Focused Data Representation"],"prefix":"10.46292","volume":"31","author":[{"given":"Ryan","family":"Solinsky","sequence":"first","affiliation":[{"name":"Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"},{"name":"Spaulding Rehabilitation Hospital, Cambridge, Massachusetts"},{"name":"Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Burns","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Cambridge, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W.","family":"Hamner","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Cambridge, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel D.","family":"Veith","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Singer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Andrew","family":"Taylor","sequence":"additional","affiliation":[{"name":"Spaulding Rehabilitation Hospital, Cambridge, Massachusetts"},{"name":"Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"25425","reference":[{"issue":"4","key":"b1","series-title":"J Spinal Cord Med.","first-page":"405","article-title":"Exploring daily blood pressure fluctuations and cardiovascular risk among individuals with motor complete spinal cord injury: A pilot study","volume":"40","author":"Dance\n DL","year":"2017","unstructured":"Dance\n DL\n , ChopraA, CampbellK, DitorDS, HassounaM, CravenBC. Exploring daily blood pressure fluctuations and cardiovascular risk among individuals with motor complete spinal cord injury: A pilot study. J Spinal Cord Med.2017;40(4):405-414."},{"issue":"10","key":"b2","series-title":"J Neurotrauma.","first-page":"1371","article-title":"Targeting recovery: Priorities of the spinal cord-injured population","volume":"21","author":"Anderson\n KD","year":"2004","unstructured":"Anderson\n KD\n \n . Targeting recovery: Priorities of the spinal cord-injured population. J Neurotrauma.2004;21(10):1371-1383."},{"issue":"18","key":"b3","series-title":"J Neurotrauma.","first-page":"2624","article-title":"Multi-domain assessment of autonomic function in spinal cord injury using a modified autonomic reflex screen","volume":"34","author":"Berger\n MJ","year":"2017","unstructured":"Berger\n MJ\n , KimpinskiK, CurrieKD, NouraeiH, SadeghiM, KrassioukovAV. Multi-domain assessment of autonomic function in spinal cord injury using a modified autonomic reflex screen. J Neurotrauma.2017;34(18):2624-2633."},{"issue":"2","key":"b4","series-title":"Phys Med Rehabil Clin N Am.","first-page":"275","article-title":"Autonomic nervous system dysfunction after spinal cord injury","volume":"18","author":"Garstang\n SV","year":"2007","unstructured":"Garstang\n SV\n , Miller-SmithSA. Autonomic nervous system dysfunction after spinal cord injury. Phys Med Rehabil Clin N Am.2007;18(2):275-296."},{"issue":"6","key":"b5","series-title":"J Spinal Cord Med.","first-page":"713","article-title":"A retrospective review of safety using a nursing driven protocol for autonomic dysreflexia in patients with spinal cord injuries","volume":"39","author":"Solinsky\n R","year":"2016","unstructured":"Solinsky\n R\n , SvircevJN, JamesJJ, BurnsSP, BunnellAE. A retrospective review of safety using a nursing driven protocol for autonomic dysreflexia in patients with spinal cord injuries. J Spinal Cord Med.2016;39(6):713-719."},{"key":"b6","series-title":"Auton Neurosci.","first-page":"37","article-title":"Baroreflex autonomic control in human spinal cord injury: Physiology, measurement, and potential alterations","volume":"209","author":"Draghici\n AE","year":"2018","unstructured":"Draghici\n AE\n , TaylorJA. Baroreflex autonomic control in human spinal cord injury: Physiology, measurement, and potential alterations. Auton Neurosci.2018;209:37-42."},{"key":"b7","series-title":"Curr Phys Med Rehabil Rep.","first-page":"443","article-title":"Autonomic dysreflexia after spinal cord injury: Beyond the basics","volume":"8","author":"Linsenmeyer\n TA","year":"2020","unstructured":"Linsenmeyer\n TA\n , GibbsK, SolinskyR. Autonomic dysreflexia after spinal cord injury: Beyond the basics. Curr Phys Med Rehabil Rep.2020;8:443-451."},{"issue":"5","key":"b8","series-title":"J Spinal Cord Med.","first-page":"549","article-title":"Exploring detailed characteristics of autonomic dysreflexia","volume":"41","author":"Solinsky\n R","year":"2018","unstructured":"Solinsky\n R\n , KirshblumSC, BurnsSP. Exploring detailed characteristics of autonomic dysreflexia. J Spinal Cord Med.2018;41(5):549-555."},{"key":"b9","series-title":"J Spinal Cord Med.","first-page":"S54","article-title":"Prevalence and etiology of autonomic dysreflexia in children with spinal cord injuries","volume":"27","author":"Hickey\n KJ","year":"2004","unstructured":"Hickey\n KJ\n , VogelLC, WillisKM, AndersonCJ. Prevalence and etiology of autonomic dysreflexia in children with spinal cord injuries. J Spinal Cord Med.2004;27(suppl 1):S54-60."},{"issue":"2","key":"b10","series-title":"Top Spinal Cord Inj Rehabil.","first-page":"23","article-title":"International Standards to Document Autonomic Function Following SCI (ISAFSCI: second edition)","volume":"27","author":"Wecht\n JM","year":"2021","unstructured":"Wecht\n JM\n , KrassioukovAV, AlexanderM, et al. International Standards to Document Autonomic Function Following SCI (ISAFSCI: second edition). Top Spinal Cord Inj Rehabil.2021;27(2):23-49."},{"issue":"3","key":"b11","series-title":"PloS One.","article-title":"High-intensity, whole-body exercise improves blood pressure control in individuals with spinal cord injury: A prospective randomized controlled trial","volume":"16","author":"Solinsky\n R","year":"2021","unstructured":"Solinsky\n R\n , DraghiciA, HamnerJW, GoldsteinR, TaylorJA. High-intensity, whole-body exercise improves blood pressure control in individuals with spinal cord injury: A prospective randomized controlled trial. PloS One.2021;16(3):e0247576."},{"issue":"12","key":"b12","series-title":"J Neurotrauma.","first-page":"1122","article-title":"Increased central arterial stiffness explains baroreflex dysfunction in spinal cord injury","volume":"31","author":"Phillips\n AA","year":"2014","unstructured":"Phillips\n AA\n , KrassioukovAV, AinsliePN, CoteAT, WarburtonDE. Increased central arterial stiffness explains baroreflex dysfunction in spinal cord injury. J Neurotrauma.2014;31(12):1122-1128."},{"key":"b13","series-title":"Diabetologia","first-page":"180","article-title":"Which battery of cardiovascular autonomic function tests? Comment","volume":"33","author":"Ewing\n DJ","year":"1990","unstructured":"Ewing\n DJ\n \n . Which battery of cardiovascular autonomic function tests? Comment. 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Mayo Clin Proc. 2012;87(12):1196-1201."},{"issue":"12","key":"b18","series-title":"PM R.","first-page":"1483","article-title":"Methodologic implications for rehabilitation research: Differences in heart rate variability introduced by respiration","volume":"14","author":"Solinsky\n R","year":"2022","unstructured":"Solinsky\n R\n , SchleiferGD, DraghiciAE, HamnerJW, TaylorJA. Methodologic implications for rehabilitation research: Differences in heart rate variability introduced by respiration. PM R.2022;14(12):1483-1489."},{"key":"b19","series-title":"Circ Res.","first-page":"109121","article-title":"Reflex regulation of arterial pressure during sleep in man. A quantitative method of assessing baroreflex sensitivity","volume":"24","author":"Smyth\n HS","year":"1969","unstructured":"Smyth\n HS\n , SleightP, PickeringGW. Reflex regulation of arterial pressure during sleep in man. A quantitative method of assessing baroreflex sensitivity. Circ Res.1969;24:109121."},{"key":"b20","series-title":"Clin Auton Res.","first-page":"153","article-title":"The expanding role of the cold pressor test: A brief history","volume":"31","author":"Lamotte\n G","year":"2021","unstructured":"Lamotte\n G\n , BoesCJ, LowPA, CoonEA. The expanding role of the cold pressor test: A brief history. Clin Auton Res.2021;31:153-155."},{"issue":"5","key":"b21","series-title":"J Spinal Cord Med.","first-page":"557","article-title":"Intravesical lidocaine decreases autonomic dysreflexia when administered prior to catheter change","volume":"42","author":"Solinsky\n R","year":"2019","unstructured":"Solinsky\n R\n , LinsenmeyerTA. Intravesical lidocaine decreases autonomic dysreflexia when administered prior to catheter change. 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Neurourol Urodyn.2013;32(4):387-392."},{"issue":"1","key":"b24","series-title":"J Rehabil Res Dev.","article-title":"Assessment of autonomic dysfunction following spinal cord injury: Rationale for additions to International Standards for Neurological Assessment","volume":"44","author":"Krassioukov\n AV","year":"2007","unstructured":"Krassioukov\n AV\n , KarlssonAK, WechtJM, WuermserLA, MathiasCJ, MarinoRJ. Assessment of autonomic dysfunction following spinal cord injury: Rationale for additions to International Standards for Neurological Assessment. J Rehabil Res Dev.2007;44(1)."},{"issue":"4","key":"b25","series-title":"J Spinal Cord Med.","first-page":"201","article-title":"International standards to document remaining autonomic function after spinal cord injury","volume":"35","author":"Krassioukov\n A","year":"2012","unstructured":"Krassioukov\n A\n , Biering-S\u00f8rensenF, DonovanW, et al. International standards to document remaining autonomic function after spinal cord injury. J Spinal Cord Med.2012;35(4):201-210."},{"issue":"1","key":"b26","series-title":"Spinal Cord Ser Cases.","first-page":"17100","article-title":"Pulse article: Survey on the current usage of the International Standards for the Assessment of Autonomic Function after Spinal Cord Injury (ISAFSCI)","volume":"3","author":"Alexander\n M","year":"2017","unstructured":"Alexander\n M\n , WechtJ, KrassioukovA, International Autonomic Standards Committee. Pulse article: Survey on the current usage of the International Standards for the Assessment of Autonomic Function after Spinal Cord Injury (ISAFSCI). Spinal Cord Ser Cases.2017;3(1):17100."},{"key":"b27","article-title":"EAU Guidelines on Neuro-Urology","author":"Blok\n B","year":"2024","unstructured":"Blok\n B\n , Del PopoloG, GroenJ, et al. EAU Guidelines on Neuro-Urology. 2024. https:\/\/uroweb.org\/guidelines\/neurourology"},{"issue":"S6","key":"b28","series-title":"Neurourol Urodyn.","first-page":"S50","article-title":"Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations","volume":"37","author":"Drake\n MJ","year":"2018","unstructured":"Drake\n MJ\n , DoumouchtsisSK, HashimH, GammieA. Fundamentals of urodynamic practice, based on International Continence Society good urodynamic practices recommendations. Neurourol Urodyn.2018;37(S6):S50-S60."},{"issue":"3","key":"b29","series-title":"Urogynecology.","first-page":"170","article-title":"Comparison of urodynamic volume measurements using room and body temperature saline: A double-blinded randomized crossover study design","volume":"18","author":"Gehrich\n AP","year":"2012","unstructured":"Gehrich\n AP\n , HillMJ, McWilliamsGD, LarsenW, McCartinT. Comparison of urodynamic volume measurements using room and body temperature saline: A double-blinded randomized crossover study design. Urogynecology.2012;18(3:170-174."},{"issue":"2","key":"b30","series-title":"Am J Physiol Heart Circ.","first-page":"H668","article-title":"Clinical correlates of frequency analyses of cardiovascular control after spinal cord injury","volume":"294","author":"Claydon\n VE","year":"2008","unstructured":"Claydon\n VE\n , KrassioukovAV. Clinical correlates of frequency analyses of cardiovascular control after spinal cord injury. Am J Physiol Heart Circ.2008;294(2):H668-678."},{"issue":"2","key":"b31","series-title":"Am J Physiol Heart Circ.","first-page":"H835","article-title":"Sympathovagal balance of the heart in subjects with spinal cord injury","volume":"272","author":"Grimm\n DR","year":"1997","unstructured":"Grimm\n DR\n , De MeersmanRE, AlmenoffPL, SpungenAM, BaumanWA. Sympathovagal balance of the heart in subjects with spinal cord injury. 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J Neurotrauma.2004;21(10):1371-1383."},{"issue":"18","key":"b3","series-title":"J Neurotrauma.","first-page":"2624","article-title":"Multi-domain assessment of autonomic function in spinal cord injury using a modified autonomic reflex screen","volume":"34","author":"Berger\n MJ","year":"2017","unstructured":"Berger\n MJ\n , KimpinskiK, CurrieKD, NouraeiH, SadeghiM, KrassioukovAV. Multi-domain assessment of autonomic function in spinal cord injury using a modified autonomic reflex screen. J Neurotrauma.2017;34(18):2624-2633."},{"issue":"2","key":"b4","series-title":"Phys Med Rehabil Clin N Am.","first-page":"275","article-title":"Autonomic nervous system dysfunction after spinal cord injury","volume":"18","author":"Garstang\n SV","year":"2007","unstructured":"Garstang\n SV\n , Miller-SmithSA. Autonomic nervous system dysfunction after spinal cord injury. Phys Med Rehabil Clin N Am.2007;18(2):275-296."},{"issue":"6","key":"b5","series-title":"J Spinal Cord Med.","first-page":"713","article-title":"A retrospective review of safety using a nursing driven protocol for autonomic dysreflexia in patients with spinal cord injuries","volume":"39","author":"Solinsky\n R","year":"2016","unstructured":"Solinsky\n R\n , SvircevJN, JamesJJ, BurnsSP, BunnellAE. A retrospective review of safety using a nursing driven protocol for autonomic dysreflexia in patients with spinal cord injuries. J Spinal Cord Med.2016;39(6):713-719."},{"key":"b6","series-title":"Auton Neurosci.","first-page":"37","article-title":"Baroreflex autonomic control in human spinal cord injury: Physiology, measurement, and potential alterations","volume":"209","author":"Draghici\n AE","year":"2018","unstructured":"Draghici\n AE\n , TaylorJA. Baroreflex autonomic control in human spinal cord injury: Physiology, measurement, and potential alterations. Auton Neurosci.2018;209:37-42."},{"key":"b7","series-title":"Curr Phys Med Rehabil Rep.","first-page":"443","article-title":"Autonomic dysreflexia after spinal cord injury: Beyond the basics","volume":"8","author":"Linsenmeyer\n TA","year":"2020","unstructured":"Linsenmeyer\n TA\n , GibbsK, SolinskyR. Autonomic dysreflexia after spinal cord injury: Beyond the basics. Curr Phys Med Rehabil Rep.2020;8:443-451."},{"issue":"5","key":"b8","series-title":"J Spinal Cord Med.","first-page":"549","article-title":"Exploring detailed characteristics of autonomic dysreflexia","volume":"41","author":"Solinsky\n R","year":"2018","unstructured":"Solinsky\n R\n , KirshblumSC, BurnsSP. Exploring detailed characteristics of autonomic dysreflexia. 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Top Spinal Cord Inj Rehabil.2021;27(2):23-49."},{"issue":"3","key":"b11","series-title":"PloS One.","article-title":"High-intensity, whole-body exercise improves blood pressure control in individuals with spinal cord injury: A prospective randomized controlled trial","volume":"16","author":"Solinsky\n R","year":"2021","unstructured":"Solinsky\n R\n , DraghiciA, HamnerJW, GoldsteinR, TaylorJA. High-intensity, whole-body exercise improves blood pressure control in individuals with spinal cord injury: A prospective randomized controlled trial. PloS One.2021;16(3):e0247576."},{"issue":"12","key":"b12","series-title":"J Neurotrauma.","first-page":"1122","article-title":"Increased central arterial stiffness explains baroreflex dysfunction in spinal cord injury","volume":"31","author":"Phillips\n AA","year":"2014","unstructured":"Phillips\n AA\n , KrassioukovAV, AinsliePN, CoteAT, WarburtonDE. Increased central arterial stiffness explains baroreflex dysfunction in spinal cord injury. J Neurotrauma.2014;31(12):1122-1128."},{"key":"b13","series-title":"Diabetologia","first-page":"180","article-title":"Which battery of cardiovascular autonomic function tests? Comment","volume":"33","author":"Ewing\n DJ","year":"1990","unstructured":"Ewing\n DJ\n \n . Which battery of cardiovascular autonomic function tests? Comment. Diabetologia. 1990;33:180-181."},{"key":"b14","series-title":"Spinal Cord.","first-page":"815","article-title":"The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)\u2014What's new?","volume":"57","author":"Rupp\n R","year":"2019","unstructured":"Rupp\n R\n \n . The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)\u2014What's new?Spinal Cord.2019;57:815-817."},{"issue":"4","key":"b15","series-title":"Spinal Cord.","first-page":"308","article-title":"Evidence-based scientific exercise guidelines for adults with spinal cord injury: An update and a new guideline","volume":"56","author":"Martin Ginis\n KA","year":"2018","unstructured":"Martin Ginis\n KA\n , Van Der ScheerJW, Latimer-CheungAE, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: An update and a new guideline. Spinal Cord.2018;56(4):308-321."},{"issue":"2","key":"b16","series-title":"Am J Hypertens.","first-page":"173","article-title":"Refined assessment of blood pressure instability after spinal cord injury","volume":"28","author":"Hubli\n M","year":"2014","unstructured":"Hubli\n M\n , GeeCM, KrassioukovAV. Refined assessment of blood pressure instability after spinal cord injury. Am J Hypertens.2014;28(2):173-181."},{"issue":"12","key":"b17","series-title":"Mayo Clin Proc","first-page":"1196","article-title":"COMPASS 31: A refined and abbreviated Composite Autonomic Symptom Score","volume":"87","author":"Sletten\n DM","year":"2012","unstructured":"Sletten\n DM\n , SuarezGA, LowPA, MandrekarJ, SingerW. COMPASS 31: A refined and abbreviated Composite Autonomic Symptom Score. Mayo Clin Proc. 2012;87(12):1196-1201."},{"issue":"12","key":"b18","series-title":"PM R.","first-page":"1483","article-title":"Methodologic implications for rehabilitation research: Differences in heart rate variability introduced by respiration","volume":"14","author":"Solinsky\n R","year":"2022","unstructured":"Solinsky\n R\n , SchleiferGD, DraghiciAE, HamnerJW, TaylorJA. Methodologic implications for rehabilitation research: Differences in heart rate variability introduced by respiration. 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