{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T20:56:41Z","timestamp":1790369801597,"version":"4.1.0"},"reference-count":68,"publisher":"American Spinal Injury Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Spinal cord injury (SCI) disrupts the crucial \u201ccrosstalk\u201d between the spinal autonomic nervous system and supraspinal control centers. Therefore, SCI may result not only in motor paralysis but also in potentially life-threatening impairments of many autonomic functions including, but not limited to, blood pressure regulation. Despite the detrimental consequences of autonomic dysregulation, management and recovery of autonomic functions after SCI is greatly underexplored. Although impaired autonomic function may impact several organ systems, this overview will focus primarily on disruptions of cardiovascular and thermoregulation and will offer suggestions for management of these secondary effects of SCI.<\/jats:p>","DOI":"10.46292\/sci2602-123","type":"journal-article","created":{"date-parts":[[2020,10,2]],"date-time":"2020-10-02T09:42:56Z","timestamp":1601631776000},"page":"123-127","source":"Crossref","is-referenced-by-count":15,"title":["A Primary Care Provider\u2019s Guide to Autonomic Dysfunction Following Spinal Cord Injury"],"prefix":"10.46292","volume":"26","author":[{"given":"Andrei","family":"Krassioukov","sequence":"first","affiliation":[{"name":"ICORD, Blusson Spinal Cord Centre, University of British Columbia, GF Strong Rehabilitation Center, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Stillman","sequence":"additional","affiliation":[{"name":"Departments of Internal Medicine and Rehabilitation Medicine, Sydney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa A.","family":"Beck","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"25425","reference":[{"key":"i1082-0744-26-2-123-b1","series-title":"Prog Brain Res","first-page":"223","article-title":"The clinical problems in cardiovascular control following spinal cord injury: an overview","volume":"152","year":"2006","unstructured":"Krassioukov\n              AV\n            , ClaydonV.\n          The clinical problems in cardiovascular control following spinal cord injury: an overview. Prog Brain Res. 2006;152:223\u2013229."},{"key":"i1082-0744-26-2-123-b2","series-title":"J Neurotrauma","first-page":"1927","article-title":"Contemporary cardiovascular concerns after spinal cord injury: Mechanisms, maladaptations, and management","volume":"32","year":"2015","unstructured":"Phillips\n              AA\n            , KrassioukovAV.\n          Contemporary cardiovascular concerns after spinal cord injury: Mechanisms, maladaptations, and management. J Neurotrauma. 2015;32:1927\u20131942."},{"key":"i1082-0744-26-2-123-b3","series-title":"J Urol","first-page":"1038","article-title":"Neurogenic pulmonary edema associated with autonomic dysreflexia","volume":"128","year":"1982","unstructured":"Kiker\n              JD\n            , WoodsideJR, JelinekGE.\n          Neurogenic pulmonary edema associated with autonomic dysreflexia. J Urol. 1982;128:1038\u20131039."},{"key":"i1082-0744-26-2-123-b4","series-title":"Am J Obstet Gynecol","first-page":"223","article-title":"Management of autonomic hyperreflexia associated with a low thoracic spinal cord lesion","volume":"153","year":"1985","unstructured":"Gimovsky\n              ML\n            , OjedaA, OzakiR, ZerneS.\n          Management of autonomic hyperreflexia associated with a low thoracic spinal cord lesion. Am J Obstet Gynecol. 1985;153:223\u2013224."},{"key":"i1082-0744-26-2-123-b5","series-title":"J Spinal Cord Med","first-page":"170","article-title":"Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury","volume":"40","year":"2017","unstructured":"Koyuncu\n              E\n            , ErsozM.\n          Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury. J Spinal Cord Med. 2017;40:170\u2013174."},{"key":"i1082-0744-26-2-123-b6","series-title":"Arch Phys Med Rehabil","first-page":"682","article-title":"A systematic review of the management of autonomic dysreflexia after spinal cord injury","volume":"90","year":"2009","unstructured":"Krassioukov\n              A\n            , WarburtonDE, TeasellR, EngJJ.\n          A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009;90:682\u2013695."},{"key":"i1082-0744-26-2-123-b7","series-title":"Handbook of Clinical Neurology","first-page":"435","article-title":"The cardiovascular system in tetraplegia and paraplegia","year":"1992","unstructured":"Mathias\n              CJ\n            , FrankelHL.\n          The cardiovascular system in tetraplegia and paraplegia. In: FrankelHL, ed. Handbook of Clinical Neurology. 17th ed. 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Spinal Cord. 2014;52:494\u2013498."},{"key":"i1082-0744-26-2-123-b9","series-title":"Spinal Cord","first-page":"863","article-title":"Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury","volume":"51","year":"2013","unstructured":"Liu\n              N\n            , FougereR, ZhouMW, NigroMK, KrassioukovAV.\n          Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury. Spinal Cord. 2013;51:863\u2013867."},{"key":"i1082-0744-26-2-123-b10","series-title":"Top Spinal Cord Inj Rehabil","first-page":"282","article-title":"International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), First Edition 2012","volume":"18","year":"2012","unstructured":"Krassioukov\n              A\n            , Biering-SorensenCF, DonovanW\n          etal.International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), First Edition 2012. Top Spinal Cord Inj Rehabil. 2012;18:282\u2013296."},{"key":"i1082-0744-26-2-123-b11","series-title":"Arch Phys Med Rehabil","first-page":"1774","article-title":"Silent autonomic dysreflexia during a routine bowel program in persons with traumatic spinal cord injury: A preliminary study","volume":"83","year":"2002","unstructured":"Kirshblum\n              SC\n            , HouseJG, O\u2019ConnorKC.\n          Silent autonomic dysreflexia during a routine bowel program in persons with traumatic spinal cord injury: A preliminary study. Arch Phys Med Rehabil. 2002;83:1774\u20131776."},{"key":"i1082-0744-26-2-123-b12","series-title":"J Spinal Cord Med","first-page":"33","article-title":"Incidence of autonomic dysreflexia and silent autonomic dysreflexia in men with spinal cord injury undergoing sperm retrieval: Implications for clinical practice","volume":"31","year":"2008","unstructured":"Ekland\n              MB\n            , KrassioukovAV, McBrideKE, ElliottSL.\n          Incidence of autonomic dysreflexia and silent autonomic dysreflexia in men with spinal cord injury undergoing sperm retrieval: Implications for clinical practice. J Spinal Cord Med. 2008;31: 33\u201339."},{"key":"i1082-0744-26-2-123-b13","series-title":"J Spinal Cord Med","first-page":"2","article-title":"Life-threatening outcomes associated with autonomic dysreflexia: A clinical review","volume":"37","year":"2014","unstructured":"Wan\n              D\n            , KrassioukovAV.\n          Life-threatening outcomes associated with autonomic dysreflexia: A clinical review. J Spinal Cord Med. 2014;37:2\u201310."},{"key":"i1082-0744-26-2-123-b14","series-title":"Arch Phys Med Rehabil","first-page":"591","article-title":"Intracerebral hemorrhage secondary to autonomic dysreflexia in a young person with incomplete C8 tetraplegia: A case report","volume":"86","year":"2005","unstructured":"Pan\n              SL\n            , WangYH, LinHL, ChangCW, WuTY, HsiehET.\n          Intracerebral hemorrhage secondary to autonomic dysreflexia in a young person with incomplete C8 tetraplegia: A case report. 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J Spinal Cord Med. 2001;20:284\u2013308."},{"key":"i1082-0744-26-2-123-b16","series-title":"Arch Phys Med Rehabil","first-page":"876","article-title":"A systematic review of the management of orthostatic hypotension after spinal cord injury","volume":"90","year":"2009","unstructured":"Krassioukov\n              A\n            , EngJJ, WarburtonDE, TeasellR.\n          A systematic review of the management of orthostatic hypotension after spinal cord injury. Arch Phys Med Rehabil. 2009;90:876\u2013885."},{"key":"i1082-0744-26-2-123-b17","series-title":"J Neurotrauma","first-page":"1713","article-title":"Orthostatic hypotension and autonomic pathways after spinal cord injury","volume":"23","year":"2006","unstructured":"Claydon\n              VE\n            , KrassioukovAV.\n          Orthostatic hypotension and autonomic pathways after spinal cord injury. J Neurotrauma. 2006;23:1713\u20131725."},{"key":"i1082-0744-26-2-123-b18","series-title":"Neurology","first-page":"1470","article-title":"The Consensus Committee of the American Autonomic Society and the American Academy of Neurology 1. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy","volume":"46","year":"1996","unstructured":"The Consensus Committee of the American Autonomic Society and the American Academy of Neurology 1. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. 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Geriatrics. 2004;59:22\u201327."},{"key":"i1082-0744-26-2-123-b21","series-title":"Spinal Cord","first-page":"303","article-title":"Postural hypotension and abnormalities of salt and water metabolism in myelopathy patients","volume":"35","year":"1997","unstructured":"Frisbie\n              JH\n            , SteeleDJR.\n          Postural hypotension and abnormalities of salt and water metabolism in myelopathy patients. Spinal Cord. 1997;35:303\u2013307."},{"key":"i1082-0744-26-2-123-b22","series-title":"Neurology","first-page":"611","article-title":"Cognitive function after spinal cord injury: A systematic review","volume":"91","year":"2018","unstructured":"Sachdeva\n              R\n            , GaoF, ChanCCH, KrassioukovAV.\n          Cognitive function after spinal cord injury: A systematic review. Neurology. 2018;91:611\u2013621."},{"key":"i1082-0744-26-2-123-b23","series-title":"J Cereb Blood Flow Metab","first-page":"794","article-title":"Regional neurovascular coupling and cognitive performance in those with low blood pressure secondary to high-level spinal cord injury: Improved by alpha-1 agonist midodrine hydrochloride","volume":"34","year":"2014","unstructured":"Phillips\n              AA\n            , WarburtonDE, AinsliePN, KrassioukovAV.\n          Regional neurovascular coupling and cognitive performance in those with low blood pressure secondary to high-level spinal cord injury: Improved by alpha-1 agonist midodrine hydrochloride. J Cereb Blood Flow Metab. 2014;34:794\u2013801."},{"key":"i1082-0744-26-2-123-b24","series-title":"Am J Phys Med Rehabil","first-page":"114","article-title":"Occurrence of fever associated with thermoregulatory dysfunction after acute traumatic spinal-cord injury","volume":"74","year":"1995","unstructured":"Colachis\n              SC\n            , OtisSM.\n          Occurrence of fever associated with thermoregulatory dysfunction after acute traumatic spinal-cord injury. Am J Phys Med Rehabil. 1995;74:114\u2013119."},{"key":"i1082-0744-26-2-123-b25","series-title":"Spinal Cord","first-page":"705","article-title":"Environmentally responsive temperature instability in pediatric spinal cord injury","volume":"37","year":"1999","unstructured":"McLean\n              DE\n            , KearneyJ, CawleyMF.\n          Environmentally responsive temperature instability in pediatric spinal cord injury. 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Med Sci Sports Exerc. 2003;35:1100\u20131107."},{"key":"i1082-0744-26-2-123-b30","series-title":"J Spinal Cord Med","first-page":"27","article-title":"Hypothermia in patients with chronic spinal cord injury","volume":"30","year":"2007","unstructured":"Khan\n              S\n            , PlummerM, Martinez-ArizalaA, BanovacK.\n          Hypothermia in patients with chronic spinal cord injury. J Spinal Cord Med. 2007;30:27\u201330."},{"key":"i1082-0744-26-2-123-b31","series-title":"Arch Phys Med Rehabil","first-page":"435","article-title":"Reflex sweating in patients with spinal cord injury: A review","volume":"58","year":"1977","unstructured":"Fast\n              A.\n            \n          \n          Reflex sweating in patients with spinal cord injury: A review. 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Prog Brain Res. 2006;152:223\u2013229."},{"key":"i1082-0744-26-2-123-b2","series-title":"J Neurotrauma","first-page":"1927","article-title":"Contemporary cardiovascular concerns after spinal cord injury: Mechanisms, maladaptations, and management","volume":"32","year":"2015","unstructured":"Phillips\n              AA\n            , KrassioukovAV.\n          Contemporary cardiovascular concerns after spinal cord injury: Mechanisms, maladaptations, and management. J Neurotrauma. 2015;32:1927\u20131942."},{"key":"i1082-0744-26-2-123-b3","series-title":"J Urol","first-page":"1038","article-title":"Neurogenic pulmonary edema associated with autonomic dysreflexia","volume":"128","year":"1982","unstructured":"Kiker\n              JD\n            , WoodsideJR, JelinekGE.\n          Neurogenic pulmonary edema associated with autonomic dysreflexia. J Urol. 1982;128:1038\u20131039."},{"key":"i1082-0744-26-2-123-b4","series-title":"Am J Obstet Gynecol","first-page":"223","article-title":"Management of autonomic hyperreflexia associated with a low thoracic spinal cord lesion","volume":"153","year":"1985","unstructured":"Gimovsky\n              ML\n            , OjedaA, OzakiR, ZerneS.\n          Management of autonomic hyperreflexia associated with a low thoracic spinal cord lesion. Am J Obstet Gynecol. 1985;153:223\u2013224."},{"key":"i1082-0744-26-2-123-b5","series-title":"J Spinal Cord Med","first-page":"170","article-title":"Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury","volume":"40","year":"2017","unstructured":"Koyuncu\n              E\n            , ErsozM.\n          Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury. J Spinal Cord Med. 2017;40:170\u2013174."},{"key":"i1082-0744-26-2-123-b6","series-title":"Arch Phys Med Rehabil","first-page":"682","article-title":"A systematic review of the management of autonomic dysreflexia after spinal cord injury","volume":"90","year":"2009","unstructured":"Krassioukov\n              A\n            , WarburtonDE, TeasellR, EngJJ.\n          A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009;90:682\u2013695."},{"key":"i1082-0744-26-2-123-b7","series-title":"Handbook of Clinical Neurology","first-page":"435","article-title":"The cardiovascular system in tetraplegia and paraplegia","year":"1992","unstructured":"Mathias\n              CJ\n            , FrankelHL.\n          The cardiovascular system in tetraplegia and paraplegia. In: FrankelHL, ed. Handbook of Clinical Neurology. 17th ed. Elsevier Science Publishers; 1992;435\u2013456."},{"key":"i1082-0744-26-2-123-b8","series-title":"Spinal Cord","first-page":"494","article-title":"Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury","volume":"52","year":"2014","unstructured":"Faaborg\n              PM\n            , ChristensenP, KrassioukovA, LaurbergS, FrandsenE, KroghK.\n          Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury. Spinal Cord. 2014;52:494\u2013498."},{"key":"i1082-0744-26-2-123-b9","series-title":"Spinal Cord","first-page":"863","article-title":"Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury","volume":"51","year":"2013","unstructured":"Liu\n              N\n            , FougereR, ZhouMW, NigroMK, KrassioukovAV.\n          Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury. Spinal Cord. 2013;51:863\u2013867."},{"key":"i1082-0744-26-2-123-b10","series-title":"Top Spinal Cord Inj Rehabil","first-page":"282","article-title":"International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), First Edition 2012","volume":"18","year":"2012","unstructured":"Krassioukov\n              A\n            , Biering-SorensenCF, DonovanW\n          etal.International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), First Edition 2012. 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Arch Phys Med Rehabil. 2002;83:1774\u20131776."},{"key":"i1082-0744-26-2-123-b12","series-title":"J Spinal Cord Med","first-page":"33","article-title":"Incidence of autonomic dysreflexia and silent autonomic dysreflexia in men with spinal cord injury undergoing sperm retrieval: Implications for clinical practice","volume":"31","year":"2008","unstructured":"Ekland\n              MB\n            , KrassioukovAV, McBrideKE, ElliottSL.\n          Incidence of autonomic dysreflexia and silent autonomic dysreflexia in men with spinal cord injury undergoing sperm retrieval: Implications for clinical practice. J Spinal Cord Med. 2008;31: 33\u201339."},{"key":"i1082-0744-26-2-123-b13","series-title":"J Spinal Cord Med","first-page":"2","article-title":"Life-threatening outcomes associated with autonomic dysreflexia: A clinical review","volume":"37","year":"2014","unstructured":"Wan\n              D\n            , KrassioukovAV.\n          Life-threatening outcomes associated with autonomic dysreflexia: A clinical review. J Spinal Cord Med. 2014;37:2\u201310."},{"key":"i1082-0744-26-2-123-b14","series-title":"Arch Phys Med Rehabil","first-page":"591","article-title":"Intracerebral hemorrhage secondary to autonomic dysreflexia in a young person with incomplete C8 tetraplegia: A case report","volume":"86","year":"2005","unstructured":"Pan\n              SL\n            , WangYH, LinHL, ChangCW, WuTY, HsiehET.\n          Intracerebral hemorrhage secondary to autonomic dysreflexia in a young person with incomplete C8 tetraplegia: A case report. Arch Phys Med Rehabil. 2005;86:591\u2013593."},{"key":"i1082-0744-26-2-123-b15","series-title":"J Spinal Cord Med","first-page":"284","article-title":"Acute management of autonomic dysreflexia: Adults with spinal cord injury presenting to health-care facilities. Clinical practice guidelines. Consortium for Spinal Cord Medicine","volume":"20","year":"2001","unstructured":"Acute management of autonomic dysreflexia: Adults with spinal cord injury presenting to health-care facilities. Clinical practice guidelines. Consortium for Spinal Cord Medicine. J Spinal Cord Med. 2001;20:284\u2013308."},{"key":"i1082-0744-26-2-123-b16","series-title":"Arch Phys Med Rehabil","first-page":"876","article-title":"A systematic review of the management of orthostatic hypotension after spinal cord injury","volume":"90","year":"2009","unstructured":"Krassioukov\n              A\n            , EngJJ, WarburtonDE, TeasellR.\n          A systematic review of the management of orthostatic hypotension after spinal cord injury. Arch Phys Med Rehabil. 2009;90:876\u2013885."},{"key":"i1082-0744-26-2-123-b17","series-title":"J Neurotrauma","first-page":"1713","article-title":"Orthostatic hypotension and autonomic pathways after spinal cord injury","volume":"23","year":"2006","unstructured":"Claydon\n              VE\n            , KrassioukovAV.\n          Orthostatic hypotension and autonomic pathways after spinal cord injury. J Neurotrauma. 2006;23:1713\u20131725."},{"key":"i1082-0744-26-2-123-b18","series-title":"Neurology","first-page":"1470","article-title":"The Consensus Committee of the American Autonomic Society and the American Academy of Neurology 1. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy","volume":"46","year":"1996","unstructured":"The Consensus Committee of the American Autonomic Society and the American Academy of Neurology 1. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology. 1996;46:1470."},{"key":"i1082-0744-26-2-123-b19","series-title":"ANGIA","first-page":"855","article-title":"Effects of beta-adrenergic-receptor agonists and antagonists in diabetics with symptoms of postural hypotension \u2013 a double-blind, placebo-controlled study","volume":"37","year":"1986","unstructured":"Cleophas\n              TJM\n            , KauwFHW, BijlC, MeijersJ, StapperG.\n          Effects of beta-adrenergic-receptor agonists and antagonists in diabetics with symptoms of postural hypotension \u2013 a double-blind, placebo-controlled study. ANGIA. 1986;37:855\u2013862."},{"key":"i1082-0744-26-2-123-b20","series-title":"Geriatrics","first-page":"22","article-title":"Orthostatic hypotension \u2013 A primary care primer for assessment and treatment","volume":"59","year":"2004","unstructured":"Sclater\n              A\n            , AlagiakrishnanK.\n          Orthostatic hypotension \u2013 A primary care primer for assessment and treatment. Geriatrics. 2004;59:22\u201327."},{"key":"i1082-0744-26-2-123-b21","series-title":"Spinal Cord","first-page":"303","article-title":"Postural hypotension and abnormalities of salt and water metabolism in myelopathy patients","volume":"35","year":"1997","unstructured":"Frisbie\n              JH\n            , SteeleDJR.\n          Postural hypotension and abnormalities of salt and water metabolism in myelopathy patients. Spinal Cord. 1997;35:303\u2013307."},{"key":"i1082-0744-26-2-123-b22","series-title":"Neurology","first-page":"611","article-title":"Cognitive function after spinal cord injury: A systematic review","volume":"91","year":"2018","unstructured":"Sachdeva\n              R\n            , GaoF, ChanCCH, KrassioukovAV.\n          Cognitive function after spinal cord injury: A systematic review. Neurology. 2018;91:611\u2013621."},{"key":"i1082-0744-26-2-123-b23","series-title":"J Cereb Blood Flow Metab","first-page":"794","article-title":"Regional neurovascular coupling and cognitive performance in those with low blood pressure secondary to high-level spinal cord injury: Improved by alpha-1 agonist midodrine hydrochloride","volume":"34","year":"2014","unstructured":"Phillips\n              AA\n            , WarburtonDE, AinsliePN, KrassioukovAV.\n          Regional neurovascular coupling and cognitive performance in those with low blood pressure secondary to high-level spinal cord injury: Improved by alpha-1 agonist midodrine hydrochloride. 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