title: Silent autonomic dysreflexia during a routine bowel program in persons with traumatic spinal cord injury: a preliminary study.
abstract: OBJECTIVE
  To determine the existence and frequency of silent autonomic dysreflexia in subjects with a complete spinal cord injury (SCI) above the neurologic level of T6.
  
  
  METHODS
  Prospective design.
  
  
  METHODS
  Blood pressure monitoring of subjects during a routine bowel program.
  
  
  METHODS
  Ten subjects with chronic (>1 y), complete (American Spinal Injury Association Impairment Scale class A) SCI with a neurologic level of injury above T6.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  An increase in systolic blood pressure (SBP) of greater than 20 to 40 mmHg above baseline or an SBP greater than 150 mmHg.
  
  
  RESULTS
  The mean resting blood pressure for the subject group was 104/65 mmHg. During the bowel program, no subject reported experiencing any of the classic symptoms of autonomic dysreflexia. The mean maximum blood pressure recorded during the bowel program was 160/90 mmHg. All of the patients had an increase in SBP greater than 20 mmHg above baseline, and 70% had an increase in SBP greater than 40 mmHg above baseline. Sixty percent of subjects had an increase in SBP greater than 150 mmHg, with 40% of subjects reaching an SBP greater than 170 mmHg at least once during their bowel program.
  
  
  CONCLUSIONS
  Silent autonomic dysreflexia occurs frequently in SCI during bowel programs. Further study is recommended to determine whether preventative measures or treatment is needed.
authors.affiliation: Spinal Cord Injury and Ventilator Dependent Program, Kessler Institute for Rehabilitation, West Orange, NJ 07052, USA. skirshblum@kessler-rehab.com
authors.forename: Steven C
authors.initials: SC
authors.lastname: Kirshblum
authors.forename: Jamie G
authors.initials: JG
authors.lastname: House
authors.forename: Kevin C
authors.initials: KC
authors.lastname: O'connor
mesh_terms: D000328:Adult; D000368:Aged; D020211:Autonomic Dysreflexia / Q000209:etiology* / Q000503:physiopathology; D001794:Blood Pressure; D003672:Defecation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology / Q000534:rehabilitation