NEURAL CONTROL OF CARDIOVASCULAR FUNCTION FOLLOWING SPINAL CORD INJURY IN HUMANS

Maintenance of stable arterial blood pressure during orthostatic challenges is a major problem after spinal cord injury (SCI). Since early participation in rehabilitation is critically important in reducing long term morbidity, recovering the ability to regulate blood pressure during therapy is essential for individuals with SCI. The objective of our study was to investigate short term cardiovascular function of able-bodied (AB), paraplegic (PARA) and tetraplegic (TETRA) subjects in response to head up tilt (HUT) as an early indicator of autonomic damage that might forewarn of future orthostatic regulatory problems. We acquired cardiovascular variables from able-bodied (AB; n=11), paraplegic (PARA; n=5) and tetraplegic (TETRA; n=5) subjects in response to HUT. The SCI patients in both groups were in their first two months post injury. Data were recorded at rest and during 7 min each at 20??, 40??, 60?? and 80?? HUT. Techniques used to estimate regulatory capability and reflex activity included: Mean values and spectral power of heart rate (HR) and arterial blood pressure (BP), baroreflex sequence measurements and cross correlation between HR and systolic blood pressure (SBP). An index of baroreflex sensitivity (BRS), baroreflex effectiveness index (BEI), and the percentage occurrence of systolic blood pressure (BP) ramps and baroreflex sequences were calculated from baroreflex sequence measurements. The spectral power of HR and BP, the cross correlation of systolic BP and heart rate (HR) were examined in low frequency (LF: 0.04-0.15 Hz) and high frequency (HF: 0.15-0.4 Hz) ranges. The BRS index was significantly (p andlt; 0.05) decreased from supine to 80o HUT in AB and TETRA. This index in PARA was the lowest at each tilt position in the three groups, and decreased with tilt. The percentage of heart beats involved in systolic BP ramps and in baroreflex sequences significantly (pandlt;0.05) rose from supine to 80o HUT in AB, was relatively unchanged in PARA and declined in TETRA. Both of these indexes were significantly (pandlt;0.05) lowerin the SCI than in the AB group at each tilt level. The BEI values were greatest in AB, and declined with tilt in all groups. Spinal cord injured patients had less power of BP and HR fluctuations than AB in both LF and HF regions. The LF spectral power of BP and HR increased with tilt in AB, remained unchanged in PARA and decreased in TETRA. The HF spectral power of HR decreased in all three groups. The peak HR / BP cross correlation in the LF region was greatest in AB, and significantly (pandlt;0.05) increased during HUT in AB, remained fairly constant in PARA, and declined in TETRA. The peak cross correlation in the HF region significantly (pandlt;0.05) decreased with tilt in all groups, and the SCI group had lower values than AB at each tilt level. We conclude that both PARA and TETRA had a smaller percentage of SBP ramps, BRS, and lower BEI than AB, likely indicating decreased stimulation of arterial baroreceptors, and less engagement of feedback control. The mixed sympathetic, parasympathetic innervations of paraplegics, or their elevated HR, may contribute to their significantly lower BRS. Our data indicate that the pathways utilized to evoke baroreflex regulation of HR are compromised by SCI and this loss may be a major contributor to the decrease in orthostatic tolerance following injury